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

41 Table 3.10 Correlation between living withand avoidance of health care worker’s work due to COVID-19.... Correlation between age group and avoidance of health care worker s work due t

Public Health for her exemplary guidance, monitoring and constant encouragement throughout the course of this thesis I also wish to take this opportunity to express a deep sense of gratitude to the Board of Directors, Training Department of School of Piex entire Medicine and Public Health for their cordial support valuable information and guidance which helped me in completing this task through various stages 1 would like to express my deepest thanks to the Managing Board Department of Training Hanoi Medical University who had created 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 their valuable information pres ided by them in their respective fields and allow me to use 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 my loving family, relatives and friends for their constant encouragement without them this thesis would not be possible

The result of my thesis is pan of the data from the survey which was implemented from April 2020 to December 2020 by the Department of Occupational 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-19 pandemic on health worker and some associated factors in Hanoi.2020 The data of this project has not been publicly available anywhere

Student

Nguyen Huy Hoaug

Management Board of Hanoi Medical University

- Department of Undergraduate Training Management and Department

of Student Affairs, Hanoi Medical University

- School of Preventive Medicine and Pdblic Health Hanoi Medical University

- Department of Occupational Health School of Preventive Medicine and Public Health

Examination Committee for Graduation Thesis 2020-2021

I hereby declare that this research was originally done by myself Tire data handling and analysis were objectively completed with honesty The results of this stud)' have not been published in any document

Hanoi May 2O2Ỉ

StudentNguyen Hu) Hoang

PPE : Personal protective equipmentCDC : Control diseases center

ILO : International Labour OrganizationEFA : Exploratory factor analysis

WHO ; World Health Organization

1.2 Characteristics of pathology and prevention treatment of COXTD

12.1 Definition and origin of Covid-19

122 Transmission characteristics and diagnosis -

4

19 44

123 Treatment and pre ention • III ritiirtII!I till Ifiifii Ifiiiim ItiMt II«|||«IIIIHIII

13 The epidemiological situation of COVID-19

1.4 Impacts ofCOVTD-19 on work of healthcare workers

1.4.1 In die world

1616

CHAPTER 2: RESEARCH SUBJECTS AND METHODOLOGY

2.33 Variables and indicators 22

2.4 Data collection tool and technique 252-4.1 Technique for data collection

2.4.2 Tool for data collection

252.5 Potential Errors and Solutions • •• •• • •••••• as r.272.6 Data management and analysts

3.1 Characteristics of research subjects 29

OVID-19

3.2 Impacts on respondents’ work due to (

33 Some associated factors with perception on work impacts

34due toCOVID-19

CHAPTER 4 DISCUSION™.

4 1 Impacts on healthcare worker' work due to COVID-19

4.2 Some associated factors to impacts on work of HCWs

70

™71

Table 2.1 Variables and indicators 22

Table 3.1 Demographic characteristics of study participants 29

Table 3.2 Occupational characteristics of study participants 30

Table 3.3 Working department of study participants 31

Tabic 3.4 The construct validity of the questionnaire with respect to the impacts of COVID* 19 work of hospital staff .37

Table 3.5 Correlation between level of hospitals and avoidance of healthcare workers work due to COM D-19 39

Table 3.6 Correlation between genderand avoidance of healthcare worker’s work due to COVID-19 39

Table 3.7 Correlation between job title and avoidance of healthcare worker’s work due to COMD-19 40

Table 3.8 Conelation between risk of exposure and avoidance of healthcare workers work due to COMD-19 41

Table 3.9 Corrđation between marital status and avoidance of health care worker s work due to COX1D-19 41

Table 3.10 Correlation between living withand avoidance of health care worker’s work due to COVID-19 42

Table 3.11 Correlation between educationand avoidance of health care worker's work due to COVID-19 42

Table 3.12 Correlation between age group and avoidance of health care worker s work due to COVID* 19 43

Table 3.13 Correlation between occupational age occupational age group and avoidance of health care worker’s work due to COVID-19 44

study participants 45Table 3.16 Correlation between job title and good working relationship of

Table 3.17 Correlation between risk of exposure to coxid-19 and good

working relationship of study partkipants 46Table 3.18 Correlation between marital status and good working relationship

of study participants 4'Table 3.19 Correlation between status living with and good working

relationship of study participants 47Table 3.20 Correlation bemwn education and good working relationship of

study participants ~ 43Table 3.21 Correlation between group ages and good working relationship of

study participants iiriMMin timtf Iifiiif I mint Mil tun IIIMI ti 43Table 3.21 Correlation between working year group and good working

relationship of study participantsTable 3.22 Correlation between le\-el of hospitals and increased work

pressure due to COVID-19 50Table 3.23 Conelation between gender and increased "Ork pressure due to

COVID-19 tniMimivittm timimiimmmmiimmmiiMi mmtiiiimit

Table 3.24 Correlation between job title and increased work pressure due to

COVID-19 51Table 3.25 Correlation between risk of exposure and increased woik pressure

due to COVID-19

to COVID-19Table 3.28 Correlation between education and increased work pressure due to

COVID-19

Table 3.29 Correlation between age group and increased work pressure due

to COVID-19 • Me ••••••••••••••••••••••••••••••••• «•«•••••••••••••• •■••••• 53Table 3.30 Correlation between working year group and increased work

pressure due to COVID-19 54Table 3.31 Multivariate regression for identifying factors associated with

avoidance of heahh care worker's work due to COVID-19 55Table 3.32 Multivariate regression for identifying factors associated with

good working relationship of study participants 57Table 3.33 Multivariate regression for identifying factors associated with

increased work pressure due to COVID 19 - 60

infection consist of short-range, large-droplet transmission (>5 pm in diameter, traveling <1 meter): close, unprotected, direct contact; and indirect contact withcontaminated surfaces •••.■••• ••••••*■ •••■>■•6Figure 1.2: 5K messages recommended by tile Ministry of Health 12Figure 13 Map of COVID-19 cases in Vietnam from April 27 to May 10,

2021 15Figure 3.1 Risk of exposure to COVID-19 of subjects 32Figure 3.2 Provided with necessan goods duiing COVID-19 32Figure 3.3 Pro'ided with personal protective equipment during COVID-19 33 Figure 3.4 Organize advocacy activities 33Figure 3.5 Avoidance of healthcare worker's work due to COVID-19 34Figure 3.6 Good working relationship of study partidpaits 35Figure 3.7 Increased work pressure due to COVID-19 of study participants 36

facing a disproportionate increase in occupational responsibilities during the covn>19 pandemic Added work-related stress anKMLg healthcare personnel may lead to personal and work-related repercussions, such as burn-out or decreased quality of care for patients

- Problem: Tire aim of ths study was to describe the impacts of Covid-

19 on work of tire healthcare worker in Hanoi in 2020 and analyze some factors associated with the impacts of Covid-19 on work of research subjects

- Methods: A cro6S-sectional web-based study was carried out to collect respondents' demographic data and job impacts in Hanoi in 2020 Snowball sampling technique was applied to recruit 1621 healthcare worker The exploratory factor analysis (EFA) was used to examine tire validity’ of the instrument

Results: Of the 1621 respondents, 13.5% agreed that "working spirit was maintained well.” followed by 11% of respondents reported that there were “enough employees at work " Only 4.9% of respondents agreed that

“their work w as appreciated by society” Being female (coef = -0.069, 95% CI= -0.12 to -0.018) had a negative correlation with ’good working relationship of studs’ participants", comparing to those bemg male while people with more ages were more increased work pressure due to COVID-19 (Coef - 0.02; 95% CI - 0.006 to 0.034)

- Conclusion: Our findings revealed marginal impacts of the COVID* 19 pandemic on the work and life of hospital staff in Vietnam This studs’ finally characterizes targeted demographics that may benefit from appreciation by employers and society during a national pandemic

Key word: COMD-19 workload, healthcare worker

Despite the remarkable achievements in the 20th century infectious diseases still have negative effects around the world On March 11, 2020 the World Health Organization (WHO) officially declared COVID-19 a pandemic and it was the first pandemic caused by coronavirus The current COVID-19 virus, officially known as SARS-CoV-2, was placed by rhe International Comnnssien on Virus Classification (ICTV) SARS-CoV-2 is a new strain of the Corona virus lire COVID* 19 virus 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 COVID-19 situation had many complicated developments 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

X HUS causing acute respiratory infections Coxid-19 USA India and Braãl are tire 3 countries With tile highest number of cases (2| In Vietnam as of May 9

2021 there were 3412 cases of COVID-19; 35 deaths and 2659 recovery eases, ranking 163/274 countries and territories with cases in the world Hai Duong Da Nang Ha Not and Ho Chi Minh City are the provinces with the highest number ofCOVID-19 cases in Vietnam [3]

COVID-19 has a significant impact on public health and poses a challenge for health workeis iHCWs) especially frontline HCWs in direct contact with patients with COVTD-19 Studies wound the world show that the COVID-19 pandemic could affect the health status of health workers by increasing the rate of COVID-19 infection and increasing tlie rate of insomnia fatigue, anxiety depression or suffering for the liealtli worker To date, the impacts of the COVID-19 pandemic on the health, life and work of healthcare workers have been investigated Prexious studies evaluating

infected and work-related pressure were tile key motivations for several healthcare workers to find other jobs [8] Additionally, the healthcare woikers expected That their families would sympathize their woTtang environment and not be Obsessed with the probability of being infected by’ them However, healthcare staff admitted that they fell insecure due to the shortage of personal protective equipment (PPE) and feeling lielpless when treating severe patients with poor prognosis [9.10].

These mental health issues not only affect the health workers' attention, bin also understanding and decision-making ability This could hinder the fight against COVĨD-2019 In addition, the COVID-19 pandemic also lias long-term effects on overall health as well as on tile quality of life aikl work

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 c OVID-19 outbreak, contributing to further spread in the community The whole hospital was then quarantined from March 28 to April 12 [12] Given 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 woikets spent more lime al tire hospitals, wliich might cause a lack of contact with their families isolation burn-out, frustration, and discrimination [11.14.15]

To the best of my knowledge most of the research related to this outbreak have focused on the epidemiological identification and clinical characteristics of patients with the disease [16][17] the genomic characteristics of the virus [IS], and challenges for glcbal health governance [ 19] However limited research has been available on the impacts of CO\1D-

19 on work of the healthcare workers in Vietnam So I do the research natred

"Impacts of Covld-19 on work or the healthcare workers and some associated factors in Hanoi In 2020" with two following spedfic objectives:

1 To describe the unpacts of Covid-19 on work of the healthcare worker

in Hanoi, year 2020

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

Chapter 1

LITERATI RE REVIEW

1.1 Concepts

l.JJ rhe Healthcare Worker

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

J J J WprWood

According to 11.0 woildoad is regularly assess time requirements and assign reasonable deadlines ensure that working hours are predictable and reasonable (21 J

Ỉ.U Working conditions

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

employment relationships Generally speaking, working conditions cover a broad range of tojtics and issues, from working time (hours of work, rest periods, and work schedules) to remuneration as well as the physical conditions and mental demands that exist in the woricplace(22]

1.2 Characteristics or pathology and prevention, treatment 0ÍCOMD-19

Ỉ.2.I Definition and origin of cOlid-19

J.2J.1 Origin of COVJD-J 9

In 2003 the Chinese population was infected with a virus causing Severe Acute Respiratory Syndrome (SARS) in Guangdong province The virus was confirmed as a member of the Beta-coronavirus subgroup and was named SARS-CoV (23], [24], The infected patients exhibited pneumonia symptoms with a diffused alveolar injury which lead to acute respiratory distress syndrome (ARDS) SARS initially emerged in Guangdong China and then spread rapidly around the globe with more than sooo infected persons and 776 deceases A decade later in 2012 a couple of Saudi Arabian nationals were diagnosed to be infected with another coronavirus- The detected virus was confirmed as a member of coronaviruses and named as the Middle East Respiratory Syndrome

Coronavirus (MERS-CoV) The World health organization reported that MERS- coronavirus infected more than 2428 individuals and $38 deaths [25] MERS- CoV is a member beta-coronavirus subgroup and phylogcncticalty diverse from other human-CoV The infection of MERS-CoV initiates from a mild upper respiratory- injury' while progression leads to severe respiratojy disease Similar

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

At the end of 2019 WHO was notified by the Chinese government of several cases of pneumonia with an unfamiliar cause The outbreak started

at the Hunan seafood market in China s Wuhan city and quickly infected more than 50 people Live animals axe commonly sold at the Hunan seafood market such as bats, frogs, snakes, birds, marmots and rabbits [27]

On January 12 2020 the Chinese 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 corona virus that killed mote than eighteen hundred and infected over seventy thousand individuals within the first fifty days of the epidemic This virus was reported to be a member of the ft group of coronaviruses The novel virus was named as 2019 novel coronavirus (2019-nCov) by the Chinese researchers The International Committee on Taxonomy of Viruses (ICTV) named the virus as SARS-CoV-2 and the disease as COVID-

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

J.2.J.2 Definition ofCOVID-i 9

COVID-19 is an acute respiratory disease caused by an emerging type

of corona\irus other members of this virus family have been identified, including SARS-CoV in 2003 HCoV NL63 in 2004 HKLT 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 the International Commission on Virus Classification ỢCTV) This newly discovered coronavirus has a genome similar to the virus that caused the 2003 SARS epidemic (SARS-CoV) by more than 701® The SARS-CoV-2 virus spread more rapidly than its two ancestors SARS-CoV and MERS-CoV but had a lower mortality rate (I]

1.2.2 Trans mission characteristics and diagnosis

1.2.1.1 Transmission characteristics

A thorough understanding of the routes of SARS CoV-2 transmission is essential for prevention and biosafety Tile major routes of transmission of SARS-CoV-2 are believed to be person-to-person transmission through respiratory droplets, close unprotected contact with an infectious individual, and touching items that hove been contaninated(Flg ].l)[32-34]

COVIIM9 tranNntaloa min; dropke* direct cvntaci aiMl indirect conlnct

Figure 1.1 Drivers of transmission of cơronavừus (COI 'ID-19)

infection consist of short-range, large-droplet transmission c>s ftm

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

and indirect contact wừh contaminated surfaces.

Droplet transmission is spread by small droplet nuclei >5 urn in diameter

that can Travel in the air through a short distance (usually <1 meter) Ait home transmission (dioplet nuclei <5 tun in diam- eter and trawling >1 meter) is currently not evident but may play a role if certain aerosol-generating procedures are conducted.5 s The fecal-oral route is not a significant driver of COVID-19 transmission but it warrants further investigation[351-

J.2J.2 Diagnosuand prognosis

Commonly reported clinical symptoms in infected cases were fever (88%), dry cough (68%) fatigue (38%) sputum (33%), dyspnea (19%), sore throat (14%), headache (14%) and myalgia or joint pain (15%) [36] Less common symptoms were dĩanbea (4%) and vomiting (5%x About 80% of reported cases in China had mild to moderate illness (including cases without pneumonia and with pneumonia) 13.8% were seriously ill and 6.1% were

very critically ill (respiratory failure, septic shock and Ỉ or multiple organ

dysfunction / failure) [37] Cases of asymptomatic viral infection have also been reported [38Ị Based on data horn China, the WHO report indicates that

up to 75% of cases without initial symptoms will progress to clinical symptoms [36]

Groups most frequently reported to have severe illness and higher mortality* include people over die age of 60 men people with underly ing medical conditions such as hypertension, diabetes, cardiovasculai disease, and respiratory illness, chronic autoclaving and cancer [39J There is no evidence

of a negative outcome in a newborn with COVID-19 pneumonia from the mother and this virus was not found in breast milk [40] Available information indicates that children are as likely to be infected as adults and experienced mainly mild clinical 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 rale increases with a^ in all countries, with the highest mortality among those over 80 years old (14-S^ft 8.2% and 3.7% respectively) Current estimates suggest an average uicubation period of five to six days for COVID-

19 with a range of 1 to 14 days The majority (97.5%) of people with clinical manifestation of COVID-19 will develop symptoms within 11.5 days (95CI%

■ 8 2 to 15.6 days) RNA viruses have been identified in the respiratory specimens, feces, whole blood, serum, saliva, and urine of patients with symptoms {36} Patients infected with COVID-19 with conjunctivitis have detected RNA viruses in tears and conjunctival secretions [41]

1.23 Jreafment and prevention

1.23.1 Treatment

Currently, there is currently no specific treatment for COVID-19 disease Scientists around the world are working to find and develop treatments for COVID-19(43] The treatment of patients with Co\id-]9 infection is mainly symptomatic treatment Huang et afs study reports that the most common complications in patients with 2019-nCoV infection are acute respiratory' distress syndrome, followed by anemia, acute heart injury, and secondary infection [44], Therefore, empirical anibiotics antiviral therapy (oseltamivir) and systemic corticosteroids are often used for treatment Patients with•untreated hypoxaemia receive invasive mechanical ventilation Holshue et al used remdesivir in the treatment of patients infected with Covid-19 and achieved good results [45 J

1.23.2 Prevention method

The World Health Organization (WHO) recommends that in order to protect yourself from COVID-19 the following preventive measures should

be well done [46J:

- Wash your hands regularly and thoroughly wash your hands with an alcohol-based quick antiseptic solution 01 wash your hands with soap and water Washing your hands with soap and water or using an alcohol-based hand tub will kill Vituses 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 or sneezes, they spray droplets of liquid from their nose or mouth that can contain the virus If you are too close, you can inhale water droplets, including CƠVID-

19 virus, if the cough is ack

- Avoid touching ey es, nose and mouth: Hands touch many surfaces and can be infected Once contaminated, hands can transmit the vims to the eyes, nose or mouth From there, the ũrus can enter the body and cause illness

- Practicing respiratory hygiene: Make sure you and those ar-ound you adhere to good respiratory hygiene This means covering your mouth and nose with your elbow or a tissue wlren you cough or sneeze Then throw away- used papei immediately Viruses spread by droplets By adiering to good respiratory hygiene protects those around you from viruses Like colds, flu and COVID-19

- If you have a fever, cough and have trouble breathing, see your doctor early Stay home if you feel unwell If you have a fever, cough and have trouble breathing, see your doctor and call first Follow the instructions of your local Irealth authority The national and local governments will have the most up-to-date information on the situation in tire region Calling aliead will allow the healthcare proc ider TO get the health care provider quickly and to the right facility This will also protect and help prevent the spread of viruses and other infections

- Regularly update your medical situation and follow advice given by

J OUT healthcare provider, national and local public health authorities, or be proactive about bow to protect yourself and others from COVID-19 National and local governments will have the most up-to-date information on whether covn> 19 has spread in the region

I 2J.3 Recommendation for people who have been or visited recently (last

Ỉ 4 days) tn areas where COVID-I9ts spreading

- Follow thei nstructions outlined above

- Stay home if you begrn to feel unwell, even with mild symptoms such

as headache and mild ninny nose, until you recover Avoiding contact with others and visiting health facilities will allow them to operne more efficiently and help protect yourself and others from COXTD-19 and other viruses

- If you have a fever, cough and have trouble breathing, seek medical advice promptly as this could be due to a respiratory infection or other serious condition Call in advance and report on any recent travel- Calling aliead will allow your health department to quickly get to the correct facility This will also help prevent the spread of COVID-19 and other viruses

J 23.4 Regulations and policies for responding to pandemic COVID-19

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 the new epidemic as quickly as possible While scientists are working hard to develop new vaccines and treatments for this emerging disease [47- 49], effective preventive measures for affected countries like Vietnam are needed

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

- Intermptions of person-ro-person transmission include reduction of secondary infection between close contacts and medical personnel, prevention

of transmission amplification events, and further prevention of global spread

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

- Identify’ and reduce transmission from animal sources;

- Address key unknowns related to clinical severity degree of transmission and infection, and accelerate the development of diagnosis, therapy and vaccines;

- Communicate risk and event important information to all communities and combat ntisinfonnation;

- Minimize social and economic impacts through multidisciplinary partnerships

In Vietnam, in April 2O2Ũ the Vietnamese government issued Directive No 16/CT-TTg[5l|, implementing social gap keeping distance between people in order to minimize the risk of community 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 and treatment: natural disasters fires

- Work at state agencies, units anned forces, diplomatic missions and authorized establishments

- hl 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 passenger transport, except for

eases of public senice reasons, workers transport vehicles, experts, isolators, vehicles transporting production materials goods Minimize die operation of personal vehicles.

The Ministry of Health has officially announced a message featuring 5K [52] (in Vietnamese) Khau trang (facemask)- (Khu khuan) disinfection- (Kboang each) distance- (Không ni tap) no crowded (Khar bao y te) health declaration IO help citizens get used to lúi ng safely with lhe COVID-19 pandemic in ‘new normal’ state

Figure L2ĩ 5K messages recommended by the Ministry of Health

Under tike message, the Ministry of Health encourages people to regularly wear face masks at public places and crowded areas, wear medical masks at medical facilities and quarantine areas People are recommended to regularly wash hands with soap or hand sanitizers: clean surfaces and

frequently contacting objects (doorknobs, mobile phones tablets, tables, and chairs) People are also asked to keep safe distance with each other and avoid mass gatherings They are called on to conduct health declaration on NCOVI app install BlueZone which will help detect the risk of COVID-19 infection

1.23.5 Prevention in medical/aciĩưíes

On December 2, 2020 the Ministry of Health issued official Letter No

6649 / BYT-KCB to units on strengthening COVID-19 epidemic prevention

at medical examination and treatment establishments (53]

- For the hospital

Review and re-evaluate all measures to prevent and control epidemics

at medical examination and treatment establishments according to documents, directives, directions, and hospital safety criteria set of the National Steering Committee for Disease Control COVID-19, the Ministry of Health and the Administration of Examination and Treatment issued

Strictly implementing file screening, separation, isolating and testing all suspicious cases Absolutely do not let people at risk of COVID-19 infection entering the hospital Review departments with high-risk patients such as intensive care, elderly treatment, hemodialysis cardiovascular, respiratory

Tightly control people in and out not allow or limit maximum care for the potient's family

• For the Department of Heal th

+ Direct affiliated hospitals to re-evaluate the hospital criteria set for safety against COVID-19 epidemics and acute respiratory infections in accordance with Decision No 30S8 / QD-BYT dated July 16.2020

+ Continue to strengthen the inspection and supervision of affiliates and units in the area according to two sets of safety criteria Strictly comply with the entry of full test results on the online software using the account of the

Department of Health for the Ministry of Health to monitor, inspect and supervise To suspend the operations of collectives and individuals and units that do not comply with die set of criteria for hospitals and safety clinics.+ Directing facilities that treat positive COVID-19 cases to focus on treating patients, not to let serious progression and death: make daily case reports on specific test results, clinical developments, and treatment prognosis

on case management software cdc.kcb.vn

1.3 The epidemiological situation of COVID-19

As of May 9 2021 the COVID-19 Situation bad many complicated developments The pandemic has spread to 274 countries and terntories reporting 158302.232 cases and 3.295.975 deaths due TO the SARS-CoV-2 virus causing acme respiratory infections Covid-19 USA India and Brazil are tlie 3 countries with the liighesi number of cases [2] In Vietnam as of May 9

2021 there were 3412 cases of COVTD-19; 35 deaths and 2659 recovery eases, ranking 163/274 countries and territories with cases in the world Hai Duong Hanoi Da Nang Ho Chi Minh City are the provinces with the highest number of COVID-19 cases in Vietnam [2] Hanoi is the city with the third highest number of COVID-19 infections in Vietnamp] and is also home to frontline hospitals treating COVĨD-19 During the 4th outbreak of COVID-19

in Vietnam, from April 27 to May 10 2021 Hanoi was the city haring tile 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]

lây ntitícn vong cộng đAoọ

1.4 Impact* orCOVID-19 on work of healthcare workers

Ỉ.4J ỉn ill e world

During fighting against die COVID* 19 pandemic, health workers in Wuhan have faced great pressure, including high nsk of infection and insufficient personal protective equipment overwork frustration Not only that, health workers are discriminated against, isolated, patients have negative emotions, lack of contact with tlieii families, and burnout [ 11] Serious conditions are causing mental health problems such as stress anxiety, symptoms of depression, insomma, rejection, anger and fear Ihese mental heal di issues not only affect a healthcare provider's attention, understanding, and decision-making ability, can hinder the tight against 2019-nCoV, but can also have long-term effects to their overall health Therefore, protecting the mental health of health-care workers (HCWs) is critical for disease control and their own long-term health (55]

Impacts of COX’ID-19 TO the work of HCWs were investigated in some studies including workload, fear of SARS-CoV'2 infection, more stressful The impacts included decrease of number of patients sharply but the HCWs must work 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 during COMD-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 al many health facilities lias decreased sharply from -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 self* medicating 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 liandle patient and relationship management in this stressful situation [57], [58].

Some studies have shown that health workers increase the workload, in contrast, reducing the number of professional jobs leading to reduced income Health workers in Italy have inn eased workload (p <0.05) [59] The survey

of tuirees and midwives in the UK highlighted that 52% of respondents had to

w ork overtime and that two thirds were not paid for overtime [60]

In a Jean wc survey in the US on the impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations, non­emergency neurosurgical treatment was delayed because rhe medical system required care and treatment of patients with COVID-19 Jean’s study showed tliat A total of 226 respondents (46.1%) reported that their operative volume had dropped more than 50% For the countries most affected by COVID-19 tins proportion w as 54.7% (61 J Another study in China also showed that fear

of infection and work pressure was the reason why many health workers want

to find other jobs [62]

I.-4 J In I let n am

Xuan LTT et all conducted a cross-sectional study on tlie effects of COVID-19 on life and work of healthcare worker tlưough hospital-based Slavey The data was collected dining one week of nationwide partial lockdown from April 7 to 14 2020 in Vietnam The study found that due to COVID-19, the work of HCSVs was affected, including working spirit reduced, woikload and less appreciated by society Female HCWs in admin and infectious depts have more negative impacts on work due to COVID-19 than others Of the 742 respondents 21.2% agreed that “working spirit was

maintained well." followed by 16.1% of respondents reported that there were

“enough employees al work." Only 3.2% of respondents agreed that "their work was appreciated by society" Moreover, being female has a positive association with “Negative altitude towards working conditions" domain (Ccef = 0.19 CI: 0.09 to 0.3) Healthcare workers working in administrative offices (Coef - 0.20; 95% CI - 0.05 to 0.36) and infectious departments (Corf = 0.36; 95% CI = 0.09 to 0.63) had positive association with

“Inneased work pressure due to COMD-19" domain

However, prior studies almost focused on assessing epidemiological prevalence, clinical characteristics of confirnKd COVID-19 cases, and challenges for managing health sequelae Limited research has been available

on the impacts of COV1D-19 on work of healthcare workers in Vietnam particularly tn Hanoi city where number of COV1D-19 cases was high in the country Thus, this study aims to examine how COVID-19 impacts on work

of healthcare worker The findings may provide useful insights for informing future health policies aiming to tailor support for healthcare workers to fight against tins unpiedictable pandemic

1.5 Associated factors of COVID-19 impacts on work of healthcare workers

LSJ Workplace Factors

Various researches illustrated that department work lime and working relationship were factors related to negative impacts of COVID-19 on work of healthcane workers

In a study by Lucchini el al in Italia in 2020 a 33% increase was indicated in the nursing workload among those who worked with C0V1D-19 patients in intensive care Unit (ICIẠ The autliots suggested their colleagues worldwide to make an effort to increase the ICU nursing staff, to start training registered nurses from general wards to perform basic ICU procedures, and to

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

to be prepared to face tlie epidemic [63] During the COVID-19 pandemic, it was shown that healthcare workers 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[64Ị

In addition Iloonakkcr ct al « study showed that workload and shift working had a significant association with each other and night shift had higher workload scores compared to rotational and morning shifts They found that night shifts had a higher workload compared to the morning shift Also, their study showed that shifts with an 8 hcycle time had a lower mental workload in comparison with a 12-h shift time [65] So shortening work shifts and adjusting shifts to psvchophysiological characteristics workers can improve worker performance to manage crisis [66.67]

Furthermore, in the study of Sadia Malik at el they found that fear of COVID-19 was a significant predictor of workplace panic anxiety and workplace avoidance behavior among doctors Fear of COVID-19 accounted for 38% variance in workplace panic anxiety and 29.6% in workplace avoidance behavior among doctors This indicates that the fear of COVID-19 has the potential of negatively affecting doctors work by specifically triggering phobic reactions (i.e panic anxiety or avoidance behavior) Tlierefore it is important dial sufficient resources and enabling working conditions are provided for tile doctors to allay their feais of COVID-19 infectwn[68]

J.3-2 Personal Characteristics

Manifold research showed that age gender are factors related to the degree of exhaustion that the health worker lias experienced Some studies have found female physicians to have 20% 60% increased odds of fatigue

compared to men [69.70.71], Females are more likely to experience burnout because of the strong influence of emotional exhaustion on depeisonalization which can further lead to reduced personal accomplishment [72], A Norwegian study in year 2010 reporting the risk factors for physician bumout found higher exhaustion levels among women resulted from work home conflicts, whereas for men fatigue was strongly predicted by work load [73],

Ỉ.Ỉ3 Organizational Factors

Organizational factors such as negative leadership behaviors, work load expectations, insufficient rewards, limited interpersonal collaboration, and limited opportunities for advancement and social support for physicians may also influence burnout (74] Some studies have shown that organizations and leaders that provide physicians with increased control over the workplace issues, and are more “physician friendly" and ‘ family friendly", arc more likely to employ physicians with higher career satisfaction and lower reported stress [75],

During the COVID-19 pandemic, it was shown that healthcare workers are at a higher risk of exposure, so the application of peisonal 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 this infection epidemic not only needs

a sufficient number of health care providers, but also maximizes the ability of each clinician in eating for a high volume of patients [77], Cao el 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 during the COMD-19 epidemic Additionally, they approved that each hospital should establish a specific contingency plan according to its condition [78]

Chapter 2RESEARCH SUBJECTS AND METHODOLOGY

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

- Subject agr eed to participate in the study

❖ Exclusion criteria:

- Healthcare worker was absent during the research period

- Healthcare worker was a paiient infected with COVID-19

2.2 Study lime and study sites

• Study rime: 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 control centers of districts in Hanoi

2.3 Methodology

2.3J Study design

A cross • sectional study was used

23.2 Sampling

2.32.J Sampling

The entire sample was selected to recnite study participants A list of all healthcare worker including doctor and nurse working at hospital in Hanoi was made Tire online survey questionnaire was sent by a core group of the School of Preventive Medicine and Public Health - Hanoi Medical University to medical staff working at medical facilities in Hanoi through application sites such as Gmail Facebook andZalo

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

1, 2020 to October 2020

233 I'ariables and indicators

rabfe 2.1 I aridities and indicators

Variables

Indicators classificationr

Definition

Tools

Dem ograph ic ch aracleristia

- Working department • Name of faculty working - Questionnaire

Objective J: To Describe the Impacts of Covid-t 9 on work of the

healthcare worker

-Not be appreciated

by the unit leader

- The percentage of people responding “Totally agree”

which never been

Do not dare 10 tell

your family about

•

- Questionnaire

2.4 Data collection tool and technique

• Using questionnaires that have been built, edited and supplemented to create a survey questionnaire via internet (survey online) to interview the subjects

-e Said questionnaires according to the designed online link available to all departments of the hospital and health facilities

- Select eligible subjects for selection and exclusion for interview

2.4J rool fir data collection

A self-reported questionnaire consisting of 24 questions in forms of single-choice multiple-choicr and open-ended questions pertaining to the effects of the COVID-19 pandemic on personal life and work of healthcare staff was sent to the respondents The questionnaire was developed according

to the one used for assessing life and job impacts due to SAKS pandemic [61]

Demographic characteristics: W't included questions to measure sociodemographic characteristics including age gender (male, female) marital status (single separated'windowed.’married) educational level

Occupational characteristics: Participants were asked about their current title (doctors/ nurses'others) and current work status including years of experiences, working places and level of the hospitals they were working

information regarding rhe impact of COVID19 on work of healthcare

workers: identify’ the impacts of COVID-19 on hospital start's work, the research asked them to report their experiences related to COVID-19 using 1-1 multiple-choices questions including 11 “ I have to do work that I normally

do noi do": 2) "I have additional workload": 3) "I have lư work overtime": 41

■•] feel more stressful at work": 5) "there is conflict among colleagues" 6}

"my working spirit is well maintained”; 7) "there arc insufficient employees

at my workplace to handle the different demands": 81 "I feel appreciated by the hospital/ clinic/ my employer": 9) "1 do not feel appreciated by the society"; 10) "Being avoided because of work"; II)." do not dare to tell your family about your risk"; 12) "relatives being avoided 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 (I "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 other necessities PPE) and the sources of support (family, friends andrelativeS'Colleagues'workplace.’ Government' Organizations and other philanthropists) that they would like to reveive

2.5 Potential Error* And Solution*

- Finalized the tools after the pilot stage so that they became relatively fit

in the teal Reviewing all the tools before implementing the data collection and reviewing all the completed forms before sending to research subjects

- Double data entering for cross checking, any mistake identified would

be checked directly with information written in the questionnaire and being collected

2.6 Data management and analysis

- Data was entered into the data base of the Epidata version 3.1 by two distinct people, then cleaned and analyzed using Softs are Stata version 15.0

• STATA 15.0 (StitaCorp LP College Station, TX) was used to analyze the data Descriptive statistics was adopted to examine characteristic data which cover frequency, percentage, mean, standard deviation We applied the exploratory factor analysis (EFA) to assess the construct of the measurement and define interpretable underlying sub-domains of perceived impacts of

covn>19 on the work of healthcare workers Principle component analysis was used to extract those domains An eigenvalue of I 5 '*11$ selected as a threshold which was defined by' the screen test We used Orthogonal Varimax rotation with Kaisers* normalization to reorganize items in scales, which aimed to increase the interpretability’ of these factors A cut-off point for faơor loading was equal to 0.5.1 also perfornrd a cross-loading in one item

and then assigned it to the appropriate domain based on both the nature of the question and the overarching dimension Cronbach’s alpha described the internal consistency reliability of each domain There we three sub-domains identified by EFA including 1) Avoidance of health care worker’s work due

to COVID-19 (4 questions); 2) Good working relationship of study panti Cl pants (4 questions); 3) Increased work pressure due to COVID 19 (4 questions) A multivariable regression model was applied to identify factors associated with each domain of the EFA To obtain reduced models stepwise forward selection sUategies were utilized with a log-LikeLihood ratio test was set at a p-value of 0.2 Statistical significance was defined at a p-value of less than 0.05

2.7 Ethical consideration

- Tlie study was approved by the Research Committee at School of Preventive Medicine and Public Health Hanoi Medical University dated 27 March 2020

• Study subjects were online informed consent to participate voluntarily

in the stud)’ after understanding The study purposes and objectives

• Stud)' results were used to improve life quality and work of heathcare workers, not for private purpose and all individual data are kept in computer confidentiality

- Interviewees had right to refuse or stop answering at any questions that they want to do

Chapter 3 RESULTS

3.1 Characteristics of study participants

Table 3 J Demographic characteristics of study participants

Variables (D =1621) Frequencies (d) Percentage (®0)

(.Min-SD

The table 3.1 shows lire demographic characteristics of the respondents Among 1621 respondents who completed the survey there were