When the World Health Organization declared Covid-19 a global pandemic in March 2020, the Western Cape soon experienced rapid growth in the number of cases, establishing it as the epicentre of the disease in the country. Now, a new study shows that healthcare workers in the province experienced high levels of uncertainty, restriction, fear, anxiety, and exhaustion.

The beginning of the Covid-19 pandemic brought about feelings of disbelief and confusion, and changes in clinical guidelines and protocols at work. Preparations for the unknown started immediately and involved gathering information, learning about the disease, adopting new protocols, and making physical preparations in emergency centres.

Elzarie Theron, a research fellow in the Division of Emergency Medicine at the University of Cape Town and lead author of the paper published in the African Journal of Emergency Medicine, says: “Experiences around the unfamiliarity with Covid-19 included discussions about the authenticity of information and the integration of new information into practice. As more information became available, protocols were adjusted accordingly, leading to an environment characterised by constant change.”

The study explored the healthcare workers’ lived experiences and perceptions of the disease. The researchers collected data over four months using one-on-one interviews, and healthcare workers recorded voice recordings.

Healthcare workers experienced frequent adaptations in their work environment whilst at the same time dealing with multiple challenges such as a lack of resources, long work hours, and tired staff.

“The pandemic exacerbated the scarcity of critical care resources resulting in implicit and explicit rationing based on the odds of prognosis,” says Theron. “Doing the best for the most was considered a constitutional imperative yet at odds with healthcare worker training and beliefs, which likely contributed to stress levels and possibly moral injury.”

“Although not a formal mental health condition, moral injury does predispose to negative thoughts about self and others and can predispose to mental health conditions including suicidal ideation. The long-term consequences of the pandemic then, is yet to be seen.”

Commenting on the study’s findings, Theron says: “Prolonged exposure to these burdens resulted in what some participants referred to as “Covid-burnout” – a sense of exhaustion affecting work and personal lives and resulting in reduced work satisfaction and difficulty in performing work tasks. Rapidly changing guidelines could have led to an information overload that in itself may lead to information anxiety which, in turn, could lead to anxiety overload.”

Despite the difficulties, the study found that healthcare workers demonstrated resilience and commitment to caring for patients. The results indicated that change, over time, resulted in adaptation to a new way of practicing and keeping safe in and outside of work.

Previous studies have indicated that resilience training can reduce anxiety, stress, burnout, and depression in healthcare workers, says Theron. “We believe resilience training should be embedded in everyday healthcare work training and not only be initiated when the healthcare system may be under strain from shocks such as pandemics or disasters.”

The study found that healthcare workers perceived themselves to be high-risk members of the community due to their proximity to the virus, which led to an increased level of restriction, guilt, and in some cases healthcare worker stigma.

“Healthcare workers were perceived to be carriers of the virus and have been stigmatised and discriminated against in many parts of the world. Unlike other pandemics our planet has encountered, the unprecedented (social) media coverage has exacerbated Covid-19-related panic and despair in the general population and amongst healthcare workers. False information circulated on social media also contributed to the formulation of misconceptions, othering and stigmatising responses to healthcare workers,” said Theron.

In the study, healthcare workers shared their experiences of support and connection that helped them cope with the pandemic, as well as their expectations of support that were not met. They also shared stories of putting in extra effort to provide emotional support to sick patients and their families and of encouragement and camaraderie between colleagues in the workplace.

Theron says: “The work-related support identified in our study included managerial and mental health support to frontline workers. Both are supported by previous studies, with mental health support being a concern in low- to middle-income countries, and of special importance to younger healthcare workers.”