Impacts of COVID19 on work of healthcare workers and some associated factors in Hanoi in 2020

MINISTRY OF EDUC ATION MINISTRY OF HEALTHAND TRAINING HANOI MEDICAL UNB ERSITY NGUYEN HUY HOANG IMPACTS OF COVID-19 ON WORK OF THE HEALTHCARE WORKERS AND SOME ASSOCIATED FACTORS I am ind

MINISTRY OF EDUC ATION MINISTRY OF HEALTH

AND TRAINING

HANOI MEDICAL UNB ERSITY

NGUYEN HUY HOANG

IMPACTS OF COVID-19 ON WORK OF THE HEALTHCARE WORKERS AND SOME ASSOCIATED FACTORS

I am indebted to my mentor Assoc.Prof.Le Thi Thanh Xuan from TheDepartment of Occupational Health School of Preventive Medicine and PublicHealth for her exemplary guidance, monitoring and constant encouragementthroughout the course of this thesis I also wish to take this opportunity toexpress a deep sense of gratitude to the Board of Directors, Training Department

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of School of Preventive Medicine and Public Health for their cordial support,valuable information and guidance which helped me in completing this taskthrough various stages I would like to express my deepest thanks to theManaging Board, Department of Training Hanoi Medical University who hadcreated a favorable and wonderful environment in the school for the past 6 years.

I wish to thank all the teachers in the Department of Occupational Health, School

of Preventive Medicine and Public Health Hanoi Medical University for theirvaluable information provided by them ill their respective fields and allow me touse data for my dissertation I am grateful for their cooperation during the period

of my assignment Lastly I would like to express my deepest thanks to myloving family, relatives and friends for their constant encouragement withoutthem this thesis would not be possible

The result of my thesis is part of the data from the survey which wasimplemented from April 2020 to December 2020 by the Department ofOccupational Health The data extraction has been approved by project members

My main role in this project was support in cleaning data and data analysis.Through this role I would like to describe the occupational burden of Covid-19pandemic on health worker and some associated factors in Hanoi,2020 The data

of this project has not been publicly available anywhere

Student Nguyen Huy Hoang

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SOCIALIST REPUBLIC OF VIETNAMIndependence-Freedom - Happiness

CONFIRMATIONTo:

Management Board of Hanoi Medical University

- Department of Undergraduate Training Management and Department ofStudent Affairs Hanoi Medical University

- School of Preventive Medicine and Public Health Hanoi MedicalUniversity

Department of Occupational Health School of Preventive Medicine andPublic Health

- Examination Committee for Graduation Thesis 2020-2021

I hereby declare that this research was originally done by myself The data

handling and analysis were objectively completed with honesty The results of this study have not been published in any document

Hanoi May 2021

Student

Nguyen Huy Hoang

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WHO : World Health Organization

LIST OF FIGURES

Figure 1.1 Drivers of ưansmission of coronavirus (COX7!D-19) infection consist

of short-range, large-droplet transmission (>5 pm in diameter,traveling <1 meter); close, unprotected, direct contact: andindirect contact with contaminated surfaces 6

Figure 3.7 Increased work pressure due to COVID-19 of study participants 36

- Reason for writing: Healthcare workers are front-line responders facing adisproportionate increase in occupational responsibilities during theCOVID-19 pandemic Added work-related stress among healthcarepersonnel may lead to personal and work-related repercussions, such asburn-out or decreased quality of care for patients

- Problem: The aim of this study was to describe the impacts of Covid- 19

on work of the healthcare worker in Hanoi in 2020 and analyze somefactors associated with the impacts of Covid-19 on work of researchsubjects

- Methods: A cross-sectional web-based study was earned out to collectrespondents’ demographic data and job impacts in Hanoi in 2020.Snowball sampling technique was applied to recruit 1621 healthcareworker The exploratory factor analysis (EFA) was used to examine thevalidity of the instrument

- Results: Of the 1621 respondents 13.5% agreed that "working spirit wasmaintained well." followed by 11% of respondents reported that therewere “enough employees at work." Only 4.9% of respondents agreed that

“their work was appreciated by society” Being female (coef = -0.069.95% CI= -0.12 to -0.018) had a negative correlation with "good workingrelationship of study participants", comparing to those being male whilepeople with more ages were more increased W'ork pressure due toCOVID-19 (Coef = 0.02; 95% CI = 0.006 to 0.034)

- Conclusion: Our findings revealed marginal impacts of the COVID-19pandemic on the work and life of hospital staff in Vietnam This studyfinally characte rizes targeted demographics that may benefit fromappreciation by employers and society during a national pandemic

Key word: COMD-19 workload, healthcare worker

Despite the remarkable achievements in the 20th century, infectiousdiseases still have negative effects around the world On March 11 2020 theWorld Health Organization (WHO) officially declared COVID-19 a pandemicand it was the first pandemic caused by coronavirus The cunrent COVID-19virus, officially known as SARS-CoV-2 was placed by lhe InternationalCommission on Virus Classification (ICTV) SARS-CoV-2 is a new strain of theCorona virus The COVID-19 vims spread more rapidly than its two ancestors.SARS-CoV and MERS-CoV but had a lower mortality rate [1]

As of May 9 2021 the COXTD-19 situation had many complicateddevelopments The pandemic has spread to 274 countries and territories,reporting 158.302.232 cases and 3.295.975 deaths due to the SARS-CoV-2 viruscausing acute respiratory infections Covid-19 USA India and Braàl are the 3countries with die highest number of cases [2] In Vietnam as of May 9 2021.there were 3412 cases of COVID-19: 35 deaths and 2659 recovery' cases,ranking 163/274 countries and territories with cases in the world Hai Duong DaNang Ha Noi and Ho Chi Minh City are the provinces with the highest number

of co VID-19 cases ill Vietnam [3]

COVID-19 has a significant impact on public health and poses a challenge for health workers (HCWs) especially frontline HCWs in direct contact with patients with COVID-

19 Studies around the world sho-w that the COVID-19

pandemic could affect the health status of health workers

by increasing the rate of COVID-19 infection and

increasing the rate of insomnia, fatigue, anxiety,

depression or suffering for the health worker To date, the impacts of the COVID-19 pandemic on the health, life and work of healthcare workers have been investigated Previous studies evaluating

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2 health-related effects of the pandemicrevealed significantly increased incidence of anxiety and stress among thisworkforce [4-7], Regarding working challenges Schwartz et al indicated that inChina, the fear of being infected and work-related pressure were the keymotivations for several healthcare workers to find other jobs [8] Additionally,the healthcare workers expected that their families would sympathize theirworking environment and not be obsessed with the probability of being infected

by them However, healthcare staff admitted that they felt insecure due to theshortage of personal protective equipment (PPE) and feeling helpless whenKeating severe patients with poor prognosis [9.10]

These mental health issues not only affect tile health workers' attention, but also understanding and decision-making ability This could hinder the fight against COVTD-

2019 In addition, the COVID-19 pandemic also lias term effects on overall health as well as on the quality

long-of life and work long-of the health worker [11] For instance,

in Vietnam particularly Bach Mai Hospital, a leading comprehensive general hospital in the North of Vietnam was

an epicenter of a COVID-19 outbreak, contributing to

further spread in the community The whole hospital was limited financial and human resources for health care, alongside the underdeveloped health infrastructure in Vietnam besides higher infected risks compare to the

general population Vietnamese healthcare workers might face with adversities including the shortage of PPE

increasing workload and added responsibilities [13.14] During the nationwide partial lockdown, healthcare workers

of contact with their fami lies, isolation, burn-out frustration, and discrimination [11.14.15]

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To the best of my knowledge most of the research related to this outbreakhave focused on the epidemiological identification and clinical characteristics ofpatients with rhe disease [16][17] the genomic characteristics of the virus [18].and challenges for global health governance [19] However, limited research hasbeen available on the impacts of COVID- 19 on work of the healthcare workers

in Vietnam So I do the research named "Impacts of Covld-19 on work of thehealthcare workers and some associated factors in Hanoi in 2020" with twofollowing specific objectives:

1 To describe die impacts of Covid-19 on work of the healthcare worker inHanoi, year 2020

To analyze some factors associated with the impacts of Cơvid-19 on work of above research subjects

Chapter 1LITERATURE REVIEW1.1 Concepts

According to WHO (2006), healthcare workers are people whose job it istoprotect and improve the health of their communities [20]

1.12 Workload

According to ILO workload is regularly assess time requirements andassign reasonable deadlines ensure that working hours are predictable andreasonable [21]

1.13 Working conditions

According to ILO working conditions are at the core of paid work and

employment relationships Generally speaking, working conditions cover abroad range of topics and issues, from working time (hours of work, restperiods, and work schedules) to remuneration, as well as the physical conditionsand mental demands that exist in the workplace[22]

1.2 Characteristics of pathology and prevention, treatment of COVID-19

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In 2003 the Chinese population was infected with a virus causing SevereAcute Respiratory Syndrome (SARS) in Guangdong province The virus wasconfirmed as a member of the Beta-coronavirus subgroup and was namedSARS-CoV [23] [24] The infected patients exhibited pneumonia symptomswith a diffused alveolar injury which lead to acute respiratory distress syndrome(ARDS) SAR.S initially emerged in Guangdong China and then spread rapidlyaround the globe with more than sooo infected persons and "76 deceases Adecade later in 2012 a couple of Saudi Arabian nationals were diagnosed to beinfected with another coronavirus The detected virus was confirmed as amember of coronaviruses and named as the Middle East Respiratory SyndromeCoronavirus (MERS-CoV) The World health organization reported that MERS-coronavirus infected more titan 2428 individuals and S38 deaths [25] MERS-CoV is a member beta-coronavirus subgroup and phylogeneticallv diverse fromother human-CoV The infection of MERS-CoV initiates from a mild upperrespirator.' injury' while progression leads to severe respirators' disease Similar

to SARS-coronavirus patients infected with MERS-coronavirus sufferpneumonia, followed by ARDS and renal failure [26]

Al the end of 2019 WHO was notified by the Chinese government ofseveral cases of pneumonia with an unfamiliar cause The outbreak started at theHunan seafood market in China's Wuhan city and quickly infected more than 50people Live animals are commonly sold at the Hunan seafood market such asbats, frogs, snakes, birds, marmots and rabbits [27], On January 12 2020 theChinese National Health Commission released more details on the epidemic,proposing viral pneumonia [27], At that time Wuhan an emerging business hub

of China experienced an outbreak of a novel coronavirus that killed more thaneighteen hundred and infected over seventy thousand individuals within the firstfifty days of the epidemic This virus was reported to be a member of the |igroup of coronaviruses The novel virus was named as 2019 novel coronavirus(2019-nCov) by the Chinese researchers The International Committee onTaxonomy of Viruses (ICTV) named the virus as SARS-CoV-2 and the disease

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as COVỈD- 19 [28].[29].[30], SARS-CoV-2 is the third known coronavirus afterSARS and Middle East respiratory' syndrome (MERS) SARS - CoV and MERSCoV are also in the coronavirus group [31 ].

Ỉ.2.L2 Definition ofCOVJD-19

COVID-19 is an acute respiratory disease caused by an emerging type of coronavirus Other members of this virus family have been identified, including SARS-CoV in 2003 HCoV NL63 in 2004 HK.U1 in 2005, and MERS-CoV in 2012 Most of these have caused pandemics of respiratory

infections The case was severe, typically the 2003 SARS pandemic COVID- 19

is now officially known as SARS-CoV-2 and has been established by theInternational Commission on Virus Classification (ICTV) This newlydiscovered coronavirus lias a genome similar to the virus that caused the 2003SARS epidemic (SARS-CoV) by more than 70ỸÓ The SARS-CoV-2 virusspread more rapidly than its two ancestors SARS-CoV and MERS-CoV, but had

a lower mortality rate [1]

A thorough understanding of the routes of SARS CoV-2 ưansmission isessential for prevention and biosafety’ The major routes of transmission ofSARS CoV-2 are believed to be person-to-person transmission throughrespiratory droplets, close unprotected contact with an infectious individual andtouching items that have been contaminated (Fig l.l)[32-34]

COVI P-19 transmission routes; droplets, direct contact, and indirect contact

Daect contact

Indued contact

Figure 1.1 Drivers of transmission of coronavirus (COV1D-19)

infection consist of short-range, large-droplet transmission (>$ urn

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in diameter, traveling <1 meter); close, unprotected, direct contact;

and indirect contact with contaminated surfaces.

Droplet transmission is spread by small droplet nuclei >5 um in diameterThat can travel in the air through a short distance (usually <1 meter) Airbornetransmission (droplet nuclei <5 pm in diam- eter and traveling >1 meter) iscurrently not evident but may play a role if certain aerosol-generatingprocedures are conducted.’"' The fecal-oral route is not a significant driver ofCOVID-19 transmission, but it warrants further investigation's]

Commonly reported clinical symptoms in infected cases were fever (88%).dry7 cough (68%) fatigue (38%) sputum (33%) dyspnea (19%) sore throat.(14%) headache (14%) and myalgia or joint pain (15%) [36] Less commonsymptoms were diarrhea (4%) and vomiting (5%) About 80% of reported cases

in China had mild to moderate illness (including cases without pneumonia andwith pneumonia) 13.8% were seriously ill and 6.1% were very' critically ill(respiratory' failure, septic shock and / or multiple organ dysfunction / failure)[37] Cases of asy mptomatic viral infection have also been reported [38] Based

on data from China, the WHO report indicates that up to 75% of cases withoutinitial symptoms will progress to clinical symptoms [36]

Groups most frequently reported to have severe illness and highermortality include people over the age of 60 men people with underlyingmedical conditions such as hypertension, diabetes, cardiovascular di sease andrespiratory' illness, chronic autoclaving and cancer [39] There is no evidence of

a negative outcome in a newborn with COVID-19 pneumonia from the motherand this virus was not found in breast milk [40] Available information indicatesthat children are as likely to be infected as adults and experienced mainly mildclinical manifestations [40]

In data on COVID-19 diagnosed cases in China Italy and South Korea, the mortality' rates were 2.3% 2.8% and 0.5% respectively [42] The

mortality rate increases with age in all countries, with the highest mortality

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among those over 80 years old (14.8% 8.2% and 3.7% respectively) Currentestimates suggest an average incubation period of five to six days for COVTD-

19 with a range of 1 to 14 days The majority (97.5%) of people with clinicalmanifestation of COVID-19 will develop symptoms within 11.5 days (95CI% =8.2 to 15.6 days) RNA viruses have been identified in the respiratoryspecimens, feces, whole blood, serum saliva, and urine of patients withsymptoms [36] Patients infected with COVID-19 with conjunctivitis havedetected RNA viruses in tears and conjunctival secretions [41]

1.23 Treat men t a nd preven tion

Currently, there is currently no specific treatment for COVID-19 disease.Scientists around the world are working to find and develop treatments forCOVID-19(43] The treatment of patients with Covid-19 infection is mainlysymptomatic treatment Huang et al's study repons that tile most commoncomplications in patients with 2019-nCoV infection are acute respiratory'distress syndrome, followed by anemia, acute heart injury', and secondary’infection [44] Therefore, empirical antibiotics, antiviral therapy (oseltamivir)and systemic corticosteroids are often used for treatment Patients with untreatedhypoxaemia receive invasive mechanical ventilation Holshue et al usedremdesivir in the treatment of patients infected with Covid-19 and achievedgood results [45]

Tire World Health Organization (WHO) recommends that in order toprotect yourself from COVID-19 tire following preventive measures should bewell done [46]:

- Wash your hands regularly and thoroughly, wash your hands with analcohol-based quick antiseptic solution or wash your hands with soap andwater Washing your hands with soap and water or using an alcohol-based

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hand mb will kill viruses that may be on your hands.

- Maintain social distance: Maintain a distance of at least 1 meter (3 feet)from anyone who is coughing or sneezing When someone coughs orsneezes, they spray droplets of liquid from their nose or mouth that cancontain the virus If you are too close, you can inhale water droplets,including COVID- 19 virus, if the cough is sick

- Avoid touching eyes, nose and mouth: Hands touch many surfaces andcan be infected Once contaminated, hands can transmit the virus to theeyes, nose or mouth Front there, the virus can enter the body and causeillness

- Practicing respiratory- hygiene: Make sure you and those around youadhere ro good respiratory' hygiene This means covering your mouth andnose with your elbow or a tissue when you cough or sneeze Then throwaway used paper immediately Viruses spread by droplets By adhering togood respiratory hygiene protects those around you from viruses likecolds, flu and COVID-19

- If you have a fever, cough attd have trouble breathing, see your doctorearly Stay home if you feel unwell If you have a fever, cough and havetraible breathing, see your doctor and call first Follow the instructions ofyour local health authority The national and local governments will havethe most up-to-date information on the situation in the region Callingahead will allow the healthcare provider to get the health care providerquickly and to the right facility This will also protect and help preventthe spread of viruses and other infections

- Regularly update your medical situation and follow advice given by yourhealthcare proũder national and local public health authorities, or beproactive about how to protect yourself and others from COVID-19.National and local governments will have the most up-to-date

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information on whether COVID-19 has spread in the region.

(last 14 days) in areas where COVID-19 is spreading

- Follow the instructions outlined above

- Stay home if you begin to feel unwell, even with mild symptoms such asheadache and mild runny nose, until you recover Avoiding contact withothers and visiting health facilities will allow them to operate moreefficiently and help protect yourself and others from COVID-19 and otherviruses

- If you have a fever, cough and have trouble breathing, seek medicaladvice promptly as Illis could be due to a respiratory infection or otherserious condition Call in advance and report on any recent travel Callingahead will allow your health department to quickly get to the correctfacility This will also help prevent the spread of COVID-19 and otherviruses

The COVID-19 epidemic is an important issue in global health security[18] and it also creates an urgent need for national and provincial preparedness

in Vietnam for disease prevention and coordinated responses to quell tire newepidemic as quickly as possible While scientists are working hard to developnew vaccines and treatments for this emerging disease [47- 49] effectivepreventive measures for affected countries like Vietnam are needed

The WHO's strategic objective for the response to COVID-19 is [50]:

- Interruptions of person-to-person transmission include reduction of

secondary infection between close contacts and medical personnel,

prevention of transmission amplification events, and further prevention ofglobal spread

- Early identification, isolation and care, including optimal care for infected

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- Communicate risk and event important information to all communitiesand combat misinformation;

- Minimize social and economic impacts through multidisciplinarypartnerships

In Vietnam in April 2020 the Vietnamese government issued Directive

No 16CT-TTg[51], implementing social gap keeping distance between people

in order to minimize the risk of conununity infection, ask people to stay at home,minimize going out except in necessary cases:

- Purchase of food food, medicine and other essential goods and services;

- In urgent cases such as: emergency care, medical examination andtreatment; natural disasters, fires

- Work at state agencies, units, aimed forces, diplomatic missions andauthorized establishments

In case of leaving the house, they must wear a mask, wash their hands with soap or antiseptic solution: Do not

gather more than 2 people in public places, outside of offices, schools, hospitals and must keep a minimum

distance of 2 meters Basically, stop the public passengertransport, except for

cases of public sen ice reasons, workers transport vehicles, experts, isolators,vehicles transporting production materials goods Minimize the operation ofpersonal vehicles

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The Ministry of Health has officially announced a message featuring 5K[52] (in Vietnamese) Khau trang (facemask)- (Khu khuan) disinfection- (Khoangeach) distance- (Khong tu tap) no crowded (Khai bao y te) health declaration tohelp citizens get used to living safely with the COVID-19 pandemic in ‘newnormal’ state.frequently contacting objects (doorknobs, mobile phones, tablets,tables, and chairs) People are also asked to keep safe distance with each otherand avoid mass gatherings They are called on to conduct health declaration onNCOVI app install BlueZone which will help detect the risk of COVID-19

infection

On December 2 2020 the Ministry of Health issued Official Letter No

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Figure 1.2: 5K messages recommended by the Ministry of Health

Under tire message, the Ministry of Health encourages people to regularlywear face masks at public places and crowded areas, wear medical masks atmedical facilities and quarantine areas People are recommended to regularlywash hands with soap or hand sanitizers; clean surfaces and

6649 / BYT-KCB to units on strengthening COVID-19 epidemic prevention atmedical examination and treatment establishments [53].

- For the hospital

Review and re-evaluate all measures to prevent and control epidemics atmedical examination and treatment establishments according to documents,directives, directions, and hospital safety criteria set of the National SteeringCommittee for Disease Control COVID-19 the Ministry of Health and theAdministration of Examination and Treatment issued

Strictly implementing the screening, separation, isolating and testing allsuspicious cases Absolutely do not let people at risk of COVID-19 infectionentering the hospital Renew departments with high-risk patients such asintensive care, elderly treatment, hemodialysis, cardiovascular, respiratory

Tightly control people in and out not allow or limit maximum care forthe patient's family

- For the Department of Health

-r Direct affiliated hospitals to re-evaluate the hospital criteria set for safetyagainst COVID-19 epidemics and acute respirator}’ infections in accordance

with Decision No 3088 I QD-BYT dated July 16 2020.

* Continue to strengthen the inspection and supervision ofsafety criteria Strictly comply with the entry of full test results on the online software using tire account of the

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Department of Health for the Ministry of Health to monitor, inspect andsupervise To suspend the operations of collectives and individuals and units that

do not comply with the set of criteria for hospitals and safety clinics

“ Directing facilities that treat positive COVID-19 cases to focus on treatingpatients, not to let serious progression and death: make daily case reports onspecific test results, clinical developments, and treatment prognosis Oil casemanagement software cdc.kcb.ML

1.3 The epidemiological situation ofCOVTD-19

As of May 9 2021 tire COVID-19 situation had many

complicated developments The pandemic has spread to 274 countries and territories, reporting 158.302.232 cases andthe 3 countlies with the highest number of cases [2] In Vietnam as of May 9 2021, there were 3412 cases of COVID-19; 35 deaths and 2659 recover)' cases, ranking 163/274 countries and territories with cases in the world Hai Duong Hanoi Da Nang Ho Chi Minh City are the provinces Hanoi is the city with the third highest number of COVID-

19 infections in Vietnam[3] and is also home to frontline hospitals treating COVID-19 During the 4th outbreak of COVTD-19 in Vietnam, from April 27 to May 10 2021 Hanoi was the city having the most infections in Vietnam with

141 cases [3] especially the cluster of cases in two

central hospitals were National Hospital of Tropical

Diseases 2 and K hospital[3]

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of depression, insomnia, rejection, anger and fear These mental health issues notonly affect a healthcare provider's attention, understanding, and decision-makingability', can hinder the fight against 2019-nCoV, but can also have long-termeffects to their overall health Therefore, protecting the mental health of health-care workers (HCWs) is critical for disease control and their own long-termhealth [55].

Impacts of COVID-19 to the work of HCXVs were investigated in somestudies including workload, fear of SARS-CoV2 infection more stressful Theimpacts included decrease of number of patients sharply but the HCWs mustwork more time However, their income reduced They also might fear of SARS-CoV2 infection and then trasmitted to others (colleagues, family members,community members ) Thus, the HCWs often had high pressure duringCOVID-19 epidemic

Some researches show that the COVID-19 epidemic has

affected the work and life of the HCWs The number of

people coming for medical examination and treatment at many health facilities has decreased sharply from 30% -50%during the period of COVID-19 On the one hand, this can have a negative impact on the health of the sick person when selfmedicating at home This has a direct impact on the work of health workers

[56] Health-care workers face great challenges when working in an outbreak,exhausted by heavy workload and lack of Personal Protection Equipment (PPE).find it difficult to handle patient and relationship management in this stressfulsituation [57] [58]

Some studies have shown that health workers increase the workload, incontrast, reducing the number of professional jobs leading to reduced income.Health workers ill Italy have increased workload (p <0.05) [59] The survey ofnurses and midwives in the UK highlighted that 52% of respondents had to workovertime and tliat two thirds were not paid for overtime [60]

In a Jean wc survey in the US on the impact of COVID-19 on

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neurosurgeons and the strategy for triaging emergent operations, emergency neurosurgical treatment was delated because the medical systemrequired care and treatment of patients with COVID-19 Jean's study showed that

non-A total of 226 respondents (46.1%) repotted that their operative volume haddropped more than 50% For the countries most affected by COVID-19 thisproportion was 54.7% [61] Another study in China also showed that fear ofinfection and work pressure was the reason why many health workers want tofind other jobs [62]

1.42 lit Vietnam

Xuan LTT et all conducted a cross-sectional study on the effects ofCOVID-19 on life and work of healthcare worker through hospital-based survey.The data was collected during one week of nationwide partial lockdown fromApril 7 to 14 2020 in Vietnam The study found that due to COVID-19 thework of HCWs was affected, including working spirit reduced, workload andless appreciated by society Female HCWs in admin and infectious depts havemore negative impacts on work due to COVID-19 than others Of the 742respondents 21.2% agreed that “working spirit was maintained well." followed

by 16.1% of respondents reported that there were "enough employees at work."Only 3.2% of respondents agreed that “their work was appreciated by society".Moreover, being female lias a positive association with "Negative attitudetowards working conditions" domain (Coef = 0.19 CI: 0.09 to 0.3) Healthcareworkers working in administrative offices (Coef = 0.20; 95% CI = 0.05 to 0.36)and infectious departments (Coef = 0.36; 95% CI = 0.09 to 0.63) had positiveassociation with "Increased work pressure due to COVID-19" domain

However, prior studies almost focused on assessing epidemiologicalprevalence, clinical characteristics of confirmed COVID-19 cases, andchallenges for managing health sequelae Limited research lias been available onthe impacts of COVID-19 on work of healthcare workers in Vietnam,particularly in Hanoi city where number of COVID-19 cases was high in thecountry Thus, this study aims to examine how COVID-19 impacts on work ofhealthcare worker The findings may proúde useful insights for informing futurehealth policies aiming to tailor support for healthcare workers to fight againstthis unpredictable pandemic

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1.5 Associated factors of COVTD-19 impacts on work of healthcareworkers

1.5J Workplace Factors

Various researches illustrated that department, work time and workingrelationship were factors related to negative impacts of CƠVÌD-19 on work ofhealthcare workers

In a study by Lucchini et al in Italia in 2020 a 33% increase was indicated in the nursing workload among thosewho worked with COVID-19 patients in intensive care Unit (ICƯ) The authors suggested their colleagues worldwide totraining registered nurses from general wards to perform basic ICU procedures, and to

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dedicate intensive care nurses to manage more complex procedures, in order to

be prepared to face the epidemic [63] During the COVID-19 pandemic, it wasshown that healthcare workers are at a higher risk of exposure, so the applicationofpeisonal protective equipment (PPE) is necessary Accordingly, the mandatoryuse of PPE dramatically elevates both nursing workload and fatigue[64]

In addition Iloonakkcr Ct al.’s study showed that workload and shiftworking had a significant association with each other, and night shift had higherworkload scores compared to rotational and morning shifts They found thatnight shifts had a higher workload compared to the morning shift Also, theirstudy showed that shifts with an 8 h cycle time had a lower mental workload incomparison with a 12-h shift time [65] So shortening work shifts and adjustingshifts to psychophysiological characteristics workers can improve workerperformance to manage crisis [66 67],

Furthermore, in the study of Sadia Malik at el they found that fear ofCOVID-19 was a significant predictor of workplace panic anxiety and workplaceavoidance behavior among doctors Fear of COVID-19 accounted for 38%variance in workplace panic anxiety and 29.6% in workplace avoidance behavioramong doctors This indicates that the fear of COVID-19 has the potential ofnegatively affecting doctors work by specifically triggering phobic reactions(i.e panic anxiety’ or avoidance behavior) Therefore, it is important thatsufficient resources and enabling working conditions are provided for the doctors

to allay their fears of COVID-19 infect ion [68]

1.52 Personal Characteristics

Manifold research showed that age gender are factors related to thedegree of exhaustion that the health worker has experienced Some studies havefound female physidans to have 20% 60% increased odds of fatigue compared tomen [69,70,71] Females are more likely to experience burnout because of thestrong influence of emotional exhaustion on depersonalization, which can further

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lead to reduced personal accomplishment [72] A Norwegian study in year 2010reporting the risk factors for physician bumout found higher exhaustion levelsamong women resulted from work home conflicts, whereas for men fatigue wasstrongly predicted by work load [73].

1.53 Organizational Factors

Organizational factors such as negative leadership behaviors, work loadexpectations, insufficient rewards, limited interpersonal collaboration, andlimited opportunities for advancement and social support for physicians may alsoinfluence burnout [74] Some studies have shown that organizations and leadersthat provide physicians with increased control over the workplace issues, and aremore “physician friendly” and “family friendly”, arc more likely to employphysicians with higher career satisfaction and lower reported stress [75]

During the COVID-19 pandemic, it was shown that healthcareworkers are at a higher risk of exposure, so the

application of personal protective equipment (PPE) is

necessary Accordingly, the mandatory use of PPE

dramatically elevates both nursing workload and fatigue [76] Achieving a sufficient health care workforce during tills infection epidemic not only needs a sufficient

number of health care providers, but also maximizes the ability of each clinician in caring for a high volume of patients [77], Cao et al in their study concluded that the hospital emergency management plan of West China

Hospital could reduce the emergency department workload protect healthcare staff, and control the cross-infection plan according to its condition [78]

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Chapter 2RESEARCH SUBJECTS AND METHODOLOGY

- Has e worked for at least 6 months or more at the study time

- Subject agreed to participate in the study

❖ Exclusion criteria:

- Healthcare worker was absent during tire research period

- Healthcare worker was a patient infected with COVID-19

2.2 Study time and study sites

- Study time: The study was carried out from April 2020 to April 2021

- Study sites: The study was conducted at health facilities and treating patients with COVID-19 (positive or suspected) and disease conưol centers of districts in Hanoi

2.3.2 Sampling

2.3.2 J Sampling

The entire sample was selected to recruite study participants A list of allhealthcare worker including doctor and nurse working at hospital in Hanoi wasmade The online survey questionnaire was sent by a core group of the School ofPreventive Medicine and Public Health - Hanoi Medical University to medicalstaff working at medical facilities in Hanoi through application sites such asGmail Facebook and Zalo

In the process of sampling 1621 health workers were selected fromparticipating hospitals during the 14-day data collection period from April 1

2020 to October 2020

2.33 Variables and indicators

Table 2.1 Variables and indicators

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- Living with - Family/friends: Alone -Questionnaire

- Working department - Name of faculty' working -Questionnaire

Objective 1: To Describe the impacts of Covid 19 on work of the healthcare

worker

- Not be appreciated

by the unit leader

The percentage of peopleresponding “Totally agree" QuestionnaireNot be appreciated by

society

The percentage of peopleresponding “Totally agree” -Ques tionnaireSpirit works not

maintain well

The percentage of peopleresponding “Totally agree” -QuestionnaireThere are not enough

employees at work

The percentage of peopleresponding “Totally agree" -Ques tionnaireThere is conflict

between colleagues

The percentage of peopleresponding "Totally agree” -QuestionnaireMore stressful at work The percentage of people

responding “Totally agree" -Ques tionnaire

Increased workload The percentage of peopleresponding “Totally agree” -Questionnaire

overtime

The percentage of peopleresponding “Totally agree" -QuestionnaireHase to do work The percentage of people -Questionnaire

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which never been

Do not dare to tell

your family about

your risk

- The percentage of peopleresponding "Totally agree" QuestionnaireRelatives being

Objective 2: To analyze some associated factor with the life and work

due to COVID-19 among research subjects

Perception of the support provided during the COVID-19 pandemic

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- Questionnaire

2.4 Data collection tool and technique

2.4.1 Technique for data collection

- Using questionnaires that have been built, edited and supplemented tocreate a survey questionnaire xia internet (survey online) to interview thesubjects

’ Send questionnaires according to the designed online link available to alldepartments of the hospital and health facilities

- Select eligible subjects for selection and exclusion for interview 2.42 Tool

for data collection

A self-reported questionnaire consisting of 24 questions in forms of choice, multiple-choice, and open-ended questions pertaining to the effects of theCOVID-19 pandemic on personal life and work of healthcare staff was sent tothe respondents Tile questionnaire was developed according to the one used forassessing life and job impacts due to SARS pandemic (61]

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sociodemographic characteristics including age gender (male/female) maritalstatus (single/separated/windowed/married) educational level

Occupational characteristics: Participants were asked about their current

title (doctors/ nuises/others) and current work status including years ofexperiences, working places and level of the hospitals they were working

Information regarding the impact of COVID-19 on work of healthcare workers:

identify the impacts of COVID-19 on hospital staff's work, the research askedthem to report their experiences related to COVID-19 using 14 multiple-choicesquestions including I)" I have to do work that I normally do not do"; 2) "I haveadditional workload"; 3) ”1 have to work overtime"; 4) “I feel more stressful atwork"; 5) "there is conflict among colleagues" 6) "my working spirit is wellmaintained"; 7) “there are insufficient employees at my workplace to handle thedifferent demands"; 8) "I feel appreciated by the hospital/ clinic/ my employer";9) "I do not feel appreciated by the society": 10) "Being avoided because ofwork"; II)." do not dare to tell your family about your risk"; 12) "relatives beingavoided because of work"; 13) "avoid sharing information about own job"; 14)

"Worry' about homemate is colleagues exposuring with COVID-19 patients".Each question had 5 options to respond (1 ‘Totally disagree” 2 “ Disagree" 3

"Neutral sentiment" 4 " Agree" and 5 "Totally agree")

Finally, the participants were asked to report their

perceptions on the necessity of means of support (food and Ollier necessities PPE) and the sources of support

- Finalized the tools after the pilot stage so that they became relatively fit inthe real Reviewing all the tools before implementing the data collectionand renewing all the completed forms before sending to research subjects

- Double data entering for cross checking, any mistake identified would bechecked directly with information written in the questionnaữe and beingcorrected

2 Ổ Data management and analysis

• Data was entered into the data base of the Epidata version 3.1 by twodistinct people, then cleaned and analyzed using Software Stata version 15.0

- STATA 15.0 (StataCorp LP College Station TX) was used to analyze thedata Descriptive statistics was adopted to examine characteristic datawhich cover frequency, percentage, meat! standard deviation We appliedthe exploratory factor analysis (EFA) to assess the construct of themeasurement and define interpretable underlying sub-domains ofperceived impacts of COVID-19 on the work of healthcare workers.Principle component analysis was used to extract those domains Aneigenvalue of 1.5 was selected as a threshold which was defined by thescreen test We used Orthogonal Varimax rotation with Kaisers’normalization to reorganize items in scales, which aimed to increase theinterpretability of these factors A cut-off point for factor loading wasequal to 0.5.1 also performed a cross-loading in one item and thenassigned it to the appropriate domain based on both the nature of thequestion and the overarching dimension Cron bach’s alpha described theinternal consistency reliability of each domain There were three sub-domains identified by EFA including 1) Avoidance of health care worker'swork due to COVID-19 (4 questions); 2) Good working relationship ofstudy panticipants (4 questions); 3) Increased work pressure due toCOVID 19 (4 questions) A multivariable regression model was applied to

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identify- factors associated with each domain of the EFA To obtainreduced models, stepwise forward selection strategies were utilized with alog-likelihood ratio test was set at a p-value of 0.2 Statistical significancewas defined at a p-value of less than 0.05.

* Interviewees had right to refuse or stop answering at anyquestions that they want to do

Chapter 3RESULTS3.1 Characteristics of study participants

Table 3.1 Demographic characteristics of study participants

Variables (n=1621) Frequencies (n) Percentage (°'o)

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Table 3.2 Occupational characteristics of study participants

Percentage(<%)

Level of hospital

District health

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The occupational characteristics of the respondents are presented in Table3.2 The majorin- of respondents reported that approximately two third ofrespondents (61.1%) were nurse, followed by doctor (38.9%) Health staffserving at provincial hospitals and central hospitals accounted for 7.6% and24.6% of the respondents, while the figures for district health center and lowerlevel were the highest, account for 67.7% Their accumulated working years were11.39 (SD = 8.34 years) on average and the proponion of occupational age group0-5 years were the highest, account for 28.44% by contrast, the lowestpercentage was group of working year 16-20 (12.15%)

Table 3.3 f forking department of study participants

Imaging Diagnosis-Scientific laboratory 39 2.4

The table 33 illustrates the workplace of the respondents

at the emergency-intensive department, internal medicine, surgery-obstetrics-pediatrics were similar, respectively such as pharmacy and rehabilitation

r-u

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• lv«rtU<v • Soơ»IKfw> • AJmou no

Figure 3.1 Risk of exposure to COỈ1D-19 of healthcare worker

Figure 3.1 presents the risk of exposure to COVID-19 by self-reportingfrom study participants More than half of respondents reported they wereoccasionnally exposed (56.4%) One third of them were risk of daily exposure tothe disease Only 7.0% participants were almost not exposed to the

Figure 3.2 Provided with necessary goods during CO11D-Ỉ9

The figure 3.2 displays the perception of HCWs provided with necessaryduring the pandemic The majority of respondents totally agreed that theirfamily, workplace and the Government were the primary sources of pres idingthem with necessary goods (7.5% 6.7% and 7.8% respectively)

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Figure 3.3 Provided with personal protective equipment during COỈ 7D-19

Figure 3.3 depicts the perception of provided with personal protective equipment.Regarding PPE support 14.7% 12.2% 6.7% of respondents totally agreed that it should

be provided by the workplace, the Government, and other organizations, respectively

Figure 3.4 Organize advocacy activities