Mental Health Sequelae in Health Professionals in Spain during the COVID Pandemic

The COVID-19 pandemic has raised several concerns regarding its mental health effect on patients and professionals. In the beginning, the absence of knowledge about the disease transmission or effective therapies, the quick spread among the population collapsing hospitals in combination with the lack of protection measures put healthcare professionals working in the frontline in a high stressful situation. The professionals had to face several unprecedented challenges: improvised hospitals, living in hotels to avoid infecting the family, deciding, as in wartime, which patients could be intubated and which could not, doubling shifts, and above all, the uncertainty about the disease, the high severity and the contagiousness that isolated the patients from their family, leaving the health professional with the responsibility of being a caregiver in the broad sense of the word. With this picture several studies have reported a high prevalence of mental disorders. A survey of 9138 Spanish professionals conducted during the first wave of the pandemic showed that 45.7% had a mental disorder (depression, generalized anxiety disorder, panic attacks, post-traumatic stress disorder and SUD), 14.5% had any disabling current mental disorder and 8.4% had suicidal thoughts. In Spain, managed by the Galatea Foundation, there is a special programme of confidential care for doctors with a mental illness or addiction. During the pandemic, a 30% increase of requests for help were registered, 70% of which came from primary health care professionals. The presentation provides also qualitative data with testimonies of professionals and antistress protection measures implemented by some health institutions.

The Impact of the COVID-19 Pandemic on Physicians' Working Hours and Earnings in São Paulo and Maranhão States, Brazil.

Evidence exists on the health impacts of the current COVID-19 pandemic on health workers, but less is known about its impact on their work dynamics and livelihoods. This matters, as health workers-and physicians in particular-are a scarce and expensive resource in low- and middle-income countries (LMICs). Our cross-sectional survey set out to explore changes in working hours and earnings during the second year of the pandemic in a representative sample of 1183 physicians in Brazil's São Paulo (SP) and Maranhão (MA) states. Descriptive analysis and inferential statistics were employed to explore differences in working hours and earnings among public and private sector physicians across the two locations. The workloads and earnings of doctors working exclusively in the public sector increased the most in the second year of the epidemic, particularly in MA. Conversely, the largest proportion of private-only doctors in our sample saw a decrease in their working hours (48.4%, 95% CI 41.8-55.0), whereas the largest proportion of public-only doctors in MA saw an increase in their working hours (44.4%, 95% CI 38.0-50.8). Although earnings remained broadly stable in the public sector, a third of public sector-only physicians in MA saw an increase in their earnings (95% CI 24.4-36.2). More than half of private-only doctors across both states saw a decrease in their earnings (52.2%, 95% CI 45.6-58.8). The largest proportion of dual practitioners (the majority in Brazil and in our sample) maintained their pre-pandemic levels of income (38.8%, 95% CI 35.3-42.3). As public-sector doctors have been key in the fight against the pandemic, it is critical to invest in these cadres in order to develop epidemic preparedness in LMICs, and to find new ways to harness for-profit actors to deliver social benefits.

The importance of physical examination in primary health care provided by NPHW is being threatened in COVID19 times.

Physical examination has been one of the three pillars of diagnostic evaluation of illnesses. It has a larger role in the armamentarium of non-physician health workers. Due to prescriptions for social distancing in preventing COVID19, physical examination is being performed lesser than before. This poses a serious threat to the abilities of NPHW as well as to their relationship with the community.