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

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
IN HANOI IN 2020

Specialization : Preventive Medicine
Code
: D720302

THESIS OF GRADUATION MEDICAL DOCTOR
Course 2015-2021

Mentor.
Ass. ProLLe Thi Thanh Xuan

Hanoi-2021
ACKNOWLEDGEMENT
I am indebted to my mentor. Assoc.Prof.Le Thi Thanh Xuan from The
Department of Occupational Health. School of Preventive Medicine and Public
Health for her exemplary guidance, monitoring and constant encouragement
throughout the course of this-■c -ÍM
thesis.
Qỉ ugc V HlI also wish to take this opportunity to
express a deep sense of gratitude to the Board of Directors, Training Department

of School of Preventive Medicine and Public Health for their cordial support,
valuable information and guidance which helped me in completing this task
through various stages. I 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 provided by them ill 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 part 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 Hoang

r-u -ÍM CỊỈ ugc V Hl


SOCIALIST REPUBLIC OF VIETNAM
Independence-Freedom - Happiness
CONFIRMATION
To:

Management Board of Hanoi Medical University.
-

Department of Undergraduate Training Management and Department of
Student Affairs. Hanoi Medical University.

-

School of Preventive Medicine and Public 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. 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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ABBRE MATION
HCWs
PPE

: Healthcare worker

: Personal protective equipment

CDC

: Control diseases center

ILO
EFA

: International Labour
Organization
: Exploratory factor analysis

WHO

: World Health Organization
TABLE OF CONTENTS

ACKNOWLEDGE*IE NT
CONFIRMATION
ABBREVIATION
ABSTRACT

REFERENCES
APPENDIX 1

LLST OF TABLES


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: and
indirect contact with contaminated surfaces.................................6

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


Abstract
- Reason for writing: Healthcare workers are front-line responders facing a
disproportionate increase in occupational responsibilities during the
COVID-19 pandemic. Added work-related stress among healthcare
personnel may lead to personal and work-related repercussions, such as
burn-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 some
factors associated with the impacts of Covid-19 on work of research
subjects.
- Methods: A cross-sectional web-based study was earned 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 the
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 was appreciated by society”. Being female (coef. = -0.069.
95% CI= -0.12 to -0.018) had a negative correlation with "good working
relationship of study participants", comparing to those being male while

people with more ages were more increased W'ork 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 study
finally characte rizes targeted demographics that may benefit from
appreciation by employers and society during a national pandemic.

Key word: COMD-19. workload, healthcare worker

-ÍM Qỉ ugc V Hl


7

INTRODUCTION

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 cunrent COVID-19
virus, officially known as SARS-CoV-2. was placed by lhe International
Commission on Virus Classification (ICTV). SARS-CoV-2 is a new strain of the
Corona 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 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 virus
causing acute respiratory infections Covid-19. USA. India and Braàl are the 3
countries 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. Da
Nang. 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
asuffering
significant
impact
on
public
health
and
poses
frontline
a challenge
HCWs
in
for
direct
health
contact
workers
with
(HCWs).
patients
especially
with
COVID19.
pandemic

Studies
could
around
affect
the
world
health
sho-w
status
that
of
health
COVID-19
workers
by
increasing
increasing
the
the
rate
rate
ofthe
of
insomnia,
COVID-19
fatigue,
infection
anxiety,
and
depression

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

r-u -ÍM Qỉ ugc V Hl

2 health-related effects of the pandemic
revealed significantly increased incidence of anxiety and stress among this
workforce [4-7], Regarding working challenges. Schwartz et al. indicated that in
China, the fear of being infected and work-related pressure were the key
motivations for several healthcare workers to find other jobs [8]. Additionally,
the healthcare workers expected that their families would sympathize their
working environment and not be obsessed with the probability of being infected
by them. However, healthcare staff admitted that they felt insecure due to the
shortage of personal protective equipment (PPE) and feeling helpless when
Keating severe patients with poor prognosis [9.10].
These
workers'
mental
attention,
health
issues
but
also
not
understanding
only
affect
tile
and
decisionhealth
making
2019.
In

ability.
addition,
This
could
COVID-19
hinder
pandemic
fight
also
against
lias
longCOVTDterm
life
effects
and
work
on
overall
of
the
health
as
worker
well
[11].
as
on
For
the
instance,

quality
in
comprehensive
Vietnam
particularly.
general
hospital
Bach
Mai
in
Hospital,
the
North
a
of
leading
Vietnam
was
an
further
epicenter
spread
of
in
a
COVID-19
the
community.
outbreak,
The

contributing
whole
hospital
to
was
then
limited
quarantined
financial
from
and
Marell
human
resources
28
to
April
for
12
health
[12].
care,
Given
alongside
Vietnam
besides
the
underdeveloped
higher
infected

health
risks
infrastructure
compare
to
the
in
general
face
with
population.
adversities
Vietnamese
including
healthcare
the
shortage
workers
of
PPE.
might
increasing
During
the
workload
nationwide
and
partial
added
responsibilities

lockdown,
healthcare
[13.14].
workers
spent
of
contact
more
time
with
at
their
the
fami
hospitals,
lies,
isolation,
which
might
burn-out.
cause
a
lack
frustration,
and
discrimination
[11.14.15].

r-u -ÍM QỈ ugc V Hl

9

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 rhe disease [16][17]. the genomic characteristics of the virus [18].
and challenges for global health governance [19]. However, limited research has
been 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 the

healthcare workers and some associated factors in Hanoi in 2020" with two
following specific objectives:
1. To describe die impacts of Covid-19 on work of the healthcare worker in
Hanoi, year 2020.

To analyze
associated
with the impacts of
Cơvid-19
onsome
workfactors
of above
research subjects.

Chapter 1

LITERATURE REVIEW
1.1 Concepts
1.1.1.

The Healthcare Worker

According to WHO (2006), healthcare workers are people whose job it is
toprotect and improve the health of their communities [20]
1.12. Workload
According to ILO. workload is regularly assess time requirements and
assign reasonable deadlines ensure that working hours are predictable and
reasonable [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 a
broad range of topics 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 workplace[22].
1.2 Characteristics of pathology and prevention, treatment of COVID-19
1.2.1

Definition and origin ofCovi(l~19

1.2.1.1

Origin of c OVID-19

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1
0

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). SAR.S initially emerged in Guangdong. China and then spread rapidly
around the globe with more than sooo infected persons and "76 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 MERScoronavirus infected more titan 2428 individuals and S38 deaths [25]. MERSCoV is a member beta-coronavirus subgroup and phylogeneticallv diverse from
other human-CoV. The infection of MERS-CoV initiates from a mild upper
respirator.' injury' while progression leads to severe respirators' disease. Similar
to SARS-coronavirus. patients infected with MERS-coronavirus suffer
pneumonia, followed by ARDS and renal failure [26]
Al 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 are 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 coronavirus that killed more 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 |i
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

r-u -ÍM Qỉ ugc V Hl

1
1

as COVỈD- 19 [28].[29].[30], SARS-CoV-2 is the third known coronavirus after
SARS and Middle East respiratory' syndrome (MERS). SARS - CoV and MERS
CoV are also in the coronavirus group [31 ].
Ỉ.2.L2 Definition ofCOVJD-19

COVID-19
is
an
acute
respiratory
disease
caused
by2012.
an
emerging
family
have
type
of
coronavirus.
identified,
including
Other
members
SARS-CoV
of in

this
in
2003.
virus
Most
HCoV
NL63
of
these
inbeen
2004.
have
HK.U1
caused
in
pandemics
2005,
and
of
MERS-CoV
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 (ICTV). This newly
discovered coronavirus lias a genome similar to the virus that caused the 2003
SARS epidemic (SARS-CoV) by more than 70ỸÓ. The SARS-CoV-2 virus
spread more rapidly than its two ancestors. SARS-CoV and MERS-CoV, but had
a lower mortality rate [1].
1.2.2

Transmission characteristics and diagnosis

1.2.1.1

Transmission characteristics

A thorough understanding of the routes of SARS CoV-2 ưansmission is
essential for prevention and biosafety’. The 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 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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1
2

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 diameter

That can travel in the air through a short distance (usually <1 meter). Airborne
transmission (droplet nuclei <5 pm in diam- eter and traveling >1 meter) is
currently not evident but may play a role if certain aerosol-generating
procedures are conducted.’"' The fecal-oral route is not a significant driver of
COVID-19 transmission, but it warrants further investigation's].
1.2.1.2

Diagnos isand prognosis

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 common
symptoms were diarrhea (4%) and vomiting (5%). 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 / 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 without
initial symptoms will progress to clinical symptoms [36].
Groups most frequently reported to have severe illness and higher
mortality include people over the age of 60. men. people with underlying
medical conditions such as hypertension, diabetes, cardiovascular di sease. and
respiratory' illness, chronic autoclaving and cancer [39]. 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 2.3%.
China.2.8%.
Italyand
and
0.5%.
South
Korea,
respectively
the mortality'
[42].
Therates
were

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

r-u -ÍM Qỉ ugc V Hl


1
3

among those over 80 years old (14.8%. 8.2% and 3.7%. respectively). Current
estimates suggest an average incubation period of five to six days for COVTD19. 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. Treat men t a nd preven tion
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 Covid-19 infection is mainly
symptomatic treatment. Huang et al's study repons that tile 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 antibiotics, 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].
1.23.2.

Prevention method

Tire World Health Organization (WHO) recommends that in order to
protect yourself from COVID-19. tire following preventive measures should be
well done [46]:
- Wash your hands regularly and thoroughly, wash your hands with an
alcohol-based quick antiseptic solution or wash your hands with soap and
water. Washing your hands with soap and water or using an alcohol-based

r-u -ÍM Qỉ ugc V Hl

1
4

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 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 COVID- 19 virus, if the cough is sick.
- Avoid touching eyes, nose and mouth: Hands touch many surfaces and
can be infected. Once contaminated, hands can transmit the virus to the
eyes, nose or mouth. Front there, the virus can enter the body and cause
illness.
- Practicing respiratory- hygiene: Make sure you and those around you
adhere ro good respiratory' hygiene. This means covering your mouth and
nose with your elbow or a tissue when you cough or sneeze. Then throw
away used paper immediately. Viruses spread by droplets. By adhering to
good respiratory hygiene protects those around you from viruses like
colds, flu and COVID-19.
- If you have a fever, cough attd have trouble breathing, see your doctor
early. Stay home if you feel unwell. If you have a fever, cough and have
traible breathing, see your doctor and call first. Follow the instructions of
your local health authority. The national and local governments will have
the most up-to-date information on the situation in the region. Calling
ahead will allow the healthcare provider 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 your
healthcare proũder. national and local public health authorities, or be
proactive 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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1
5

information on whether COVID-19 has spread in the region.
1.2.3.3.

Recommendation for people who have been or visited recently

(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 as
headache and mild runny nose, until you recover. Avoiding contact with
others and visiting health facilities will allow them to operate more
efficiently and help protect yourself and others from COVID-19 and other
viruses.
- If you have a fever, cough and have trouble breathing, seek medical
advice promptly as Illis could be due to a respiratory infection or other
serious condition. Call in advance and report on any recent travel. Calling
ahead 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.
1.2.3.4.

Regulations and policies for responding to pandemic COVID19

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 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]:
- 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 of
global spread.
- Early identification, isolation and care, including optimal care for infected

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1
6

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 misinformation;
- Minimize social and economic impacts through multidisciplinary
partnerships.
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 and
treatment; natural disasters, fires....
- Work at state agencies, units, aimed forces, diplomatic missions and
authorized establishments.

In case
of
leaving
theBasically,
house,
they
must
wear
aDo
mask,
wash
their
gather
hands
more
with
than
soap
2
people
or

antiseptic
inand
public
solution:
places,
outside
notof
offices,
distance
schools,
of
2
meters.
hospitals
must
stop
keep
the
a minimum
public
passenger
transport,
except
for

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

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1
7

The Ministry of Health has officially announced a message featuring 5K
[52] (in Vietnamese) Khau trang (facemask)- (Khu khuan) disinfection- (Khoang
each) distance- (Khong tu tap) no crowded (Khai bao y te) health declaration to
help citizens get used to living safely with the COVID-19 pandemic in ‘new
normal’ state.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
ĩ 0E0 KHẨU TRANG VẢI )
1 thrtngxurt'tyMi U.

iitkhoịnUy

c*BDEO KHẨU TRANG Y TẺ

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caỡ vt SINH, LAU RỬA
úđếnhícứ. tMng thoiitg

Clử KHOẢNG CA CH

khlUếprtcvtintaHkMc

THONGiĐIẸ
P'

KHỒNC TẬP
TRUNG

infection.
1.2.3.5.

Prevention in medical facilities

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

0Cểi nt MC *.

KNrttUaMiSÓT, HO, KHỚ THỞ pl <4y
THựCHÈ
trHApp NCOYI

x

BLUEỈOME tậlAMcM

DƯƠNG DÁY HỔNG CỦA BỘ Y TÍ: 1900 9095

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hole Dutnc diy aAac cù Bệ«h 0987.4917«?

óí được cinb Ma agvyto c«

ứ làữ< bdhg dií a khim H«h M tầo

Uy Bhiỉm CỮVIO-19

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

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1
8

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 the screening, separation, isolating and testing all

suspicious cases. Absolutely do not let people at risk of COVID-19 infection
entering the hospital. Renew 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 patient's family.
- For the Department of Health
-r Direct affiliated hospitals to re-evaluate the hospital criteria set for safety
against COVID-19 epidemics and acute respirator}’ infections in accordance
with Decision No. 3088 I QD-BYT dated July 16. 2020.

* Continue
to
strengthen
inspection
and
supervision
affi
safety
liates
criteria.
and
units
Strictly
in the
comply
area
with
according
the
entry

to
two
of full
setsof
of
the
test
results
on
the
online
software
using
tire
account

r-u -ÍM Qỉ ugc V Hl


19

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 the 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 Oil case
management software cdc.kcb.ML
1.3.

The epidemiological situation ofCOVTD-19

As infections
of
May
9.
2021.
tire
COVID-19
situation
had
many
complicated
developments.
territories,
The
reporting
pandemic
158.302.232
has
spread
cases
to
274
and
3.295.975
respiratory
deaths
infections
due

toNational
Covid-19.
the
SARS-CoV-2
USA.
India
virus
and
causing
Brazil
acute
are
the
Vietnam
3the
countlies
as
of
May
with
9.
the
2021,
highest
there
number
were
3412
of
cases

[2].
of
COVIDIn
19;
countries
35
deaths
and
and
territories
2659
recover)'
with
cases
cases,
in
ranking
the
world.
163/274
Hai
Duong.
with
Hanoi.
highest
Da
Nang.
number
Ho
of

Chi
COVID-19
Minh
City
cases
are
in
the
Vietnam
provinces
[2].
Hanoi
19
is
the
city
in
Vietnam[3]
with
the
third
and
is
highest
also
home
number
to
of
frontline

COVIDhospitals
COVTD-19
in
treating
Vietnam,
COVID-19.
from
April
During
27
to
the
May
4th
10.
outbreak
2021.
Hanoi
of
was
141
the
cases
city
[3].
having
especially
the
most
the

infections
cluster
of
in
cases
Vietnam
in
two
with
Diseases
central
hospitals
2
and
K
hospital[3]
were
Hospital
of
Tropical

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20

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21

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ló

1.4.

Impacts of COVID-19 on work of healthcare workers

1.4.1. In the world
During fighting against the COVID-19 pandemic, health workers in
Wuhan have faced great pressure, including high risk of infection and
insufficient personal protective equipment, oxerwork, frustration. Not only that,
health workers are discriminated against, isolated, patients have negative
emotions, lack of contact with their families. and burnout [11]. Serious
conditions are causing mental health problems such as stress, anxiety, symptoms
of depression, insomnia, rejection, anger and fear. These mental health issues not
only affect a healthcare provider's attention, understanding, and decision-making
ability', can hinder the fight against 2019-nCoV, but can also have long-term
effects to their overall health. Therefore, protecting the mental health of healthcare workers (HCWs) is critical for disease control and their own long-term
health [55].
Impacts of COVID-19 to the work of HCXVs were investigated in some
studies including workload, fear of SARS-CoV2 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 SARSCoV2 infection and then trasmitted to others (colleagues, family members,
community members...). Thus, the HCWs often had high pressure during
COVID-19 epidemic.

Somework
researches
show

that
COVID-19
epidemic
has
affected
people
coming
the
work
for
and
medical
life
examination
ofThis
the
HCWs.
and
The
treatment
number
of
at
many
during
health
the
period
facilities
of

COVID-19.
hasthe
decreased
On has
the
sharply
one
hand,
from
this
30%
can
-50%
have
when
a
selfmedicating
negative
impact
at
on
home.
health
of
a
the
direct
sick
impact
person

on
the
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 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 ill Italy have increased workload (p <0.05) [59]. The survey of
nurses and midwives in the UK highlighted that 52% of respondents had to work
overtime 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 non-emergent operations, nonemergency neurosurgical treatment was delated because the medical system
required care and treatment of patients with COVID-19. Jean's study showed that
A total of 226 respondents (46.1%) repotted that their operative volume had
dropped more than 50%. For the countries most affected by COVID-19. this
proportion was 54.7% [61]. 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].
1.42. lit Vietnam
Xuan LTT et all conducted a cross-sectional study on the effects of
COVID-19 on life and work of healthcare worker through hospital-based survey.
The data was collected during 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 HCWs was affected, including working spirit reduced, workload 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 at work."
Only 3.2% of respondents agreed that “their work was appreciated by society".
Moreover, being female lias a positive association with "Negative attitude
towards working conditions" domain (Coef. = 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 (Coef. = 0.36; 95% CI = 0.09 to 0.63) had positive
association with "Increased work pressure due to COVID-19" domain.
However, prior studies almost focused on assessing epidemiological
prevalence, clinical characteristics of confirmed COVID-19 cases, and
challenges for managing health sequelae. Limited research lias been available on
the impacts of COVID-19 on work of healthcare workers in Vietnam,
particularly in Hanoi city where number of COVID-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 proúde useful insights for informing future
health policies aiming to tailor support for healthcare workers to fight against
this unpredictable pandemic.

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1.5.

Associated factors of COVTD-19 impacts on work of healthcare

workers

1.5J. Workplace Factors
Various researches illustrated that department, work time and working
relationship were factors related to negative impacts of CƠVÌD-19 on work of
healthcare workers.

In aworked
study
byindicated
Lucchini
etpatients
al.
in
Italia
in staff,
2020.
ato
33%
increase
who
was
with
COVID-19
in
the
nursing
in
intensive
workload
among
care

Unit
those
(ICƯ).
make
an
The
effort
authors
to
increase
suggested
the
their
ICU
colleagues
nursing
worldwide
start
to
basic
training
ICU
registered
procedures,
nurses
and
to
from
general
wards

to
perform

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25

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 was
shown that healthcare workers are at a higher risk of exposure, so the application
ofpeisonal protective equipment (PPE) is necessary. Accordingly, the mandatory
use of PPE dramatically elevates both nursing workload and fatigue[64].
In addition. Iloonakkcr Ct al.’s 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 h cycle time had a lower mental workload in
comparison with a 12-h shift time [65]. So. shortening work shifts and adjusting
shifts to psychophysiological 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). Therefore, it is important that
sufficient 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 the
degree of exhaustion that the health worker has experienced. Some studies have
found female physidans 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 depersonalization, which can further

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