INTRODUCTION

Coronavirus disease 2019 (COVID-19), which originated in Hubei Province in China in December 2019, has spread rapidly worldwide. Approximately three months later, on March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. Three years and four months later, the WHO lifted the international public-health emergency protocols for COVID-19. Similar to other countries, Korea was afflicted by the pandemic as well. In particular, the issue of human rights violations occurred during COVID-19 in Korea and various countries worldwide. The Korean government’s administrative actions, enforced as preventive measures against COVID-19, resulted in restrictions to freedom [1].

Moreover, human rights violations in patients with COVID-19 and medical personnel deployed under unsatisfactory conditions have been reported. A study reported that public-health doctors deployed in 2020 to prevent the spread of COVID-19 experienced significant workloads (average of 12.22 hr/day). Additionally, they complained of working in vulnerable environments, such as performing screenings in a container or tent that was unsafe from infection and devoid of air conditioning and personal protective equipment [2].

In psychiatry, providing treatment to infected patients increases vulnerabilities such as increased stress and the risk of infection among healthcare workers. This is caused by factors such as the absence of cooperation and unfamiliarity with infection control measures, although they are necessary for infection control [3]. Moreover, patients with psychiatric disorders are a high-risk group with low compliance with infection-control measures, and some cluster infections occur in psychiatric wards [4]. In Korea, cluster infections occurred in vulnerable facilities such as long-term care hospitals and nursing homes, including mental health facilities, during the early stages of the outbreak.

Psychiatric Hospital D in Cheongdo-gun in Korea is a representative case of cluster infection in a facility vulnerable to infection among patients with mental disorders. At that time, infection-control medical personnel were formed urgently, mostly voluntarily, and dispatched upon request from the local governments and hospitals where the infection occurred. Additionally, research on patients with mental disorders and medical personnel with new infectious diseases is limited. This study focuses on the experiences of medical personnel dispatched to mental-health institutions in response to COVID-19. Our aim is to investigate the experiences of medical personnel dispatched to Hospital D in Cheongdo-gun, which the first psychiatric facility in Korea to be isolated, during the initial spread of COVID-19 in February 2020. It was a tragic event, with 98% of all 103 hospitalized patients diagnosed with COVID-19 and eight deaths within a month of the outbreak [5]. Additionally, we aim to provide foundational data for establishing guidelines and standards related to human rights protection measures for patients and medical personnel in similar situations.

METHODS

This qualitative study analyzed a report titled “Interview Results of Healthcare Staff Dispatched to an Isolated Mental Health Institution” funded by the National Human Rights Commission of Korea [6]. This report includes interviews regarding the human rights violations of the psychiatric patient of the hospital and medical personnel who were dispatched to Hospital D in Cheongdo-gun county. Based on this report, we devised a strategy to analyze human rights violations and the lack of administrative support for medical staff assigned to hospitals. Using the raw data, we conducted a content analysis on the issues surrounding the response following the closure of psychiatric hospitals in the early days of COVID-19 and on how to prepare for emerging infectious diseases in the future.Three of the authors of this study participated the interviews. This study analyzed not only the report but also all original interview data. The key research questions are whether the preparedness and on-the-ground response to the outbreak was adequate by the governments and province that recruited volunteers to support mental health institutions that were struggling during the COVID-19 outbreak, and what should be the human rights protection standards for supporting mental health institutions that need to be isolated during a novel infectious disease pandemic.

Nine participants as an interviewee, including five medical professionals from the National Center for Mental Health (NCMH), one infectious disease specialist, and three on-site specialists who were dispatched to Hospital D in Cheongdo-gun county during the COVID-19 outbreak in February 2020 and provided patient care and transport services, were recruited using a purposive sampling method (Table 1).

Interviews with medical personnel dispatched to Hospital D, which a cohort-quarantined psychiatric institution, were conducted from August 4-6, 2020. A 2-hour group interview with medical professionals from the NCMH and an infectious-disease specialist was conducted with three participants each, and 1-hour individual interviews were conducted with three on-site specialists. Data from the National Human Rights Commission’s “Results of interviews on medical personnel dispatched to a cohort quarantined psychiatric institution” and the transcripts of the interviews were analyzed [6]. Where necessary, some of the contents were reviewed by relevant personnel. The researchers read the interview transcripts and extracted meaningful phrases and sentences related to the experiences of the medical personnel dispatched to the quarantined psychiatric institution of Hospital D. The themes and related quotes were derived and comprehensively described (Table 2).

The original transcript of the report and interview data was used for data analysis in this study, following the three-step qualitative content analysis process proposed by Elo and Kyngäs [7]. First, in the preparation stage, the original report and interview data were reviewed holistically, with a focus on the major research questions, to grasp the overall context. The data were then repeatedly examined, key statements were extracted from the original interview data, meaningful analytical units were identified, and open coding was conducted to create a list. Second, in the organization stage, the open codes were categorized and structured based on the subject of the report and the research questions. Third, in the reporting stage, the abstracted subcategories were integrated based on similarities and differences in meaning and characteristics, and the main subject was ultimately derived by synthesizing them into a higher-level category.

Ethics Statement

This study was approved by the Institutional Review Board of U1 University (IRB No. U1IRB 2023-01) and was performed in accordance with the principles of the Declaration of Helsinki.

RESULTS

The following key themes emerged from the qualitative analysis of the interviews. The first is problems in preparing the government and province to respond to mental health organizations experiencing COVID-19 outbreaks. The second is on-site and follow-up response situations and problems. The final theme is problems in protecting human rights of patients and medical personnel and matters requiring improvement.

Preparedness, On-Site Situation, and Response

Recruiting participation

On February 19, 2020, the day after the outbreak of the cluster infection at Hospital D in Cheongdo-gun county, the NCMH began recruiting volunteers. The specialists participated at the request of the head of the NCMH Medical Department. Infection-control specialists participated voluntarily after learning about the NCMH advertisements.

“Suddenly, I received a call at night saying that some medical staff were required to be there, whereas others could not. Thus, I was asked if I could be there immediately. As I was not aware of the situation, I impulsively said that I would be there.” (NCMH, Medical Professional 5)

Pre-information level

At the time of dispatch, polymerase-chain-reaction tests of patients at Hospital D were still being conducted. Moreover, the volatile situation and the size and condition of the patients after arriving at the site could not be ascertained accurately owing to absence of an on-site situation control tower in the early stages of the outbreak. Additionally, the dispatched medical and assistive personnel were not trained in basic epidemic prevention rules, onsite rules, or safety management. Some dispatched medical personnel, who had never experienced an infectious disease, learned how to safely manage them through individual and informal channels.

“I think I had inadequate information. All I received was verbal information over a phone call. A public health physician was there beforehand; therefore, I obtained the doctor’s contact information and called him as I was leaving. I did not even have any information about where I would go yet; therefore, I met with him and went in without knowing the internal structure. Everyone was so busy with their work that I could not sit back and be briefed on the situation. However, as soon as I went, I was confused about what to do.” (On-site Specialist 2)

“I went to work on a Saturday morning and rode a group bus to the hospital. On the way, I learned how to wear a Level D on YouTube.” (Infectious-Disease Specialist)

Initial on-site situation and response

The initial response tasks of the dispatched medical personnel included identifying and triaging the patient’s condition, communicating with the medical personnel at Hospital D, establishing and communicating with the patient’s transport plan, and preparing the patient’s report. Owing to the shortage of medical personnel in hospitals, the dispatched medical personnel could not easily interact directly with the patients or monitor their condition. The most significant issue was the difficulty in retrieving the patients’ medical records. Moreover, the patients could not be treated owing to the insufficient facilities or workforce for treating severely ill patients onsite. Considering 103 confirmed cases of COVID-19 and seven deaths, transfer to other hospitals became a key goal. In general, the dispatched medical personnel experienced difficulty in triaging severely ill patients and making transport decisions owing to their inadequate experience during the initial response. Additionally, coordination and cooperation were challenging because the necessary manuals or control towers were not available.

“I went into the psychiatric ward, and the most difficult thing was the absence of no local personnel.” (NCMH, Medical Professional 1)

“I identified the patient but no one was available to perform the next steps due to quarantine restrictions. Decisions regarding whether and where to send them changed frequently. This is my understanding of the situation.” (On-site Specialist 1)

On-site Follow-up Response and Problems

Quarantine from the outside

The dispatched medical personnel discovered that the quarantine of Hospital D was not intended for treating or protecting patients in the hospital but to prevent external transmission. After the quarantine period, side effects such as infection and death occurred, which caused harm to the patients of Hospital D. The participants mentioned that strict restrictions on the movement of patients and medical personnel at Hospital D, particularly during quarantine, were problematic even though they were temporary measures to prevent external transmission. Although the term “cohort quarantine” was used, the participants insisted that it did not reflect the original meaning and that a different term was necessitated for the hospital’s closure caused by internal-management limitations.

“We should not use the term cohort quarantine. Instead, we should say temporary lockdown or stay. “Stay still for now; we don’t know which of you has been infected.” There is a need to stay still and classify non-contacts through epidemiological investigation, classify contacts and non-contacts among medical staff, and create a new word to express the condition before self-isolating those people.” (NCMH, Medical Professional 1)

“I think the most unfortunate thing is that we should have checked whether or not we had a facility that could quarantine the cohort and then let the inpatients stay.” (Infectious-Disease Specialist)

Lack of on-site response control towers and manuals

After the initial turmoil and trial and error, a government-wide task force was formed at the C province office on February 22, 2020, and normal support and control began the following day. As a stable control, emergency transfers were provided to severely ill patients based on patient-condition monitoring. Patients were transferred to the general ward on the second floor instead of the psychiatric ward such that those requiring medical monitoring could be treated more effectively. Patient transfer was performed in stages and all patients were transferred on February 28, 2020. Although the follow-up response was relatively stable, the dispatched medical personnel agreed that they could not respond in the best manner owing to the unavailability of a specific manual for quarantine, a unified control tower, and an initial infection expert.

“On Saturday morning, a government-wide task force was established at the C province office......When they received a request from me, they instructed the relevant ministries to arrange the necessary resources, and since the 23rd, they could be integrated. I think the situation became slightly smoother after that.” (NCMH, Medical Professional 2)

Problems in medical responses and issues to be improved

Among the major problems and issues requiring improvement based on medical responses provided by medical personnel, “the absence of infection specialists at the beginning” and “the absence of manuals and control towers” were the most important. Even after the dispatch of medical personnel, no infectious-disease specialists were available to identify and manage the infection situation, which rendered it difficult for the initial response to occur, thus resulting in a delay in follow-up measures. Moreover, the characteristics of patients with mental illness and communication could not be identified accurately owing to the absence of cooperation or support from the internal staff of Hospital D. Furthermore, the unavailability of essential equipment and operating personnel for emergency treatment during cohort isolation, as well as the shortage of nursing staff, were major problems that must be addressed.

“The staff there did not cooperate very well......They said that they would not do it anymore. At that time, everyone was panicking. I wished that I could leave the place soon. I was afraid. It was confusing because all of their colleagues had already been confirmed positive and sent elsewhere.” (NCMH, Medical Professional 2)

“It was very hard to work in Level D; therefore, we had to take more shifts. We had to take three to four times more shifts than usual. That was very difficult and when we talked about it. I think there was a miscommunication, where somebody mentioned that we did not need to perform those shifts anymore. Therefore, the dispatch request that we had worked very hard to arrange was canceled.” (On-site Specialist 3)

Problems related to hospital environment and issues to be improved

The dispatched medical personnel assessed that the cluster infection that occurred in Hospital D was likely to spread due to the typical vulnerable psychiatric-ward environment, such as crowded and closed living spaces and communal-living arrangements for patients. In addition to structural problems in the wards, some cases occurred in which patients with psychiatric disorders could not appropriately implement epidemic control rules, or unexpected situations occurred in which the patients posed a threat to the health and safety of the dispatched medical personnel. Additionally, owing to the isolation or departure of medical and assistive staff at Hospital D, basic cleaning and hygiene management was insufficient. Initially, supplying lunchboxes to external companies was challenging.

“The environment was terrible. There was no food, no cleaning, no care for the patients, and I felt like I was living in a garbage can for two or three days. They neither had much space nor lived separately from each other. There were about ten people in one room, and they were sleeping in a small space about the size of a bed.” (NCMH, Medical Professional 3)

“There was neither the division of contaminated areas nor the concept of that...... If patients pulled, it tore; in fact, everyone who went there said they were not confident that they would not get infected. We managed to stop some patients from eating leftover food from the day before. I think we were exposed to infections during that process.” (Infectious-Disease Specialist1)

Problems in protection of human rights of patients and medical personnel and issues to be improved

Regarding the protection of patients’ human rights, the study participants mentioned the following issues: “insufficient medical protection or measures due to insufficient communication,” “decision-making for transfer made without regard to the patient’s (guardian’s) wishes,” and “insufficient basic preparations or patient protection during transportation.” Although cohort isolation was urgent and temporary at the time, the dispatched medical personnel agreed that basic protection and support measures were insufficient owing to the characteristics and perceptions of patients with psychiatric disorders. Additionally, the participants mentioned that if the patient had been regular, more specific explanations and support would have been provided.

The most significant problem was the limited prior training or guidance on protecting the human rights of medical staff. Additionally, control or support for the protection of medical staff in the field was inadequate. Moreover, they mentioned issues such as insufficient workforce for shifts, inadequate livelihood support, unreasonable compensation, and low morale due to false media reports and social perceptions. Therefore, a manual related to the protection of medical staff and experts in their management of medical staff is necessitated.

“Patients stand in line to take their medicine. When a patient was in line, I went to take the patient’s temperature. The temperature was over 39 degrees. I think that he would not have been standing there if he had told us about his health. He did not even know that he was sick and was standing there. I felt so sad about it.” (Infectious-Disease Specialist1)

“(When transferring to another hospital) I told them to wear diapers because the bus could not stop at a rest area during the drive to Seoul. This would not have been instructed to regular people but was instructed to psychiatric patients.” (Infectious-Disease Specialist1)

“We worked every day for 12 days, almost without a day off. For the first week, I did not finish until 11 p.m. As an epidemiological investigator, I wrote a report to the government, briefed the staff at the Ministry of Health and Welfare about the patients’ situation, and sent them the documents. I did not know that I was tense at the time. But now that I think about it, the situation was really difficult.” (On-site Medical Specialist 3)

“I think social attention is very important. There should be appropriate compensation.” (NCMH, Medical Professional 5)

DISCUSSION

This study investigated the motivation for participation, preinformation level, initial on-site situation and response, attitudes toward cohort isolation, problems related to medical response and environmental support, and human rights protection among medical personnel dispatched to a cohort-quarantined psychiatric hospital where the first cluster of infections occurred in Korea. The participants were voluntarily dispatched in response to requests from the Korea Disease Control and Prevention Agency and Korean Medical Association. However, they were unprepared during the deployment. This is analogous to nurses who were instructed to volunteer when they applied for volunteer work in a previous study [8], and is similar to reports of people entering the field without knowledge, skills, and training related to emerging infectious diseases [9]. In the early days of the COVID-19 pandemic, Korea was relatively successful in containing the spread of the disease, but the outbreak in Daegu, Gyeongbuk province, centered on Shincheonji religious group, became a major crisis. The COVID-19 outbreak in psychiatric institutions posed another challenge for the government. It was difficult enough to stop the spread of the epidemic, but an outbreak in psychiatric institution, which had been practicing isolation treatment due to a lack of community treatment facilities, posed a dilemma for the government. There were no hospitals to transfer patients to, and psychiatric medical staff with no experience in dealing with infectious diseases were avoiding treatment for fear of contracting the disease. The government, which would be criticized for ignoring human rights if it left Hospital D unattended, urgently needed the voluntary support of dedicated medical professionals in psychiatry and infectious diseases. However, there was little pre-information sharing or organized preparation with volunteer medical personnel.

Isolating psychiatric hospitals from the outside world was initiated at the beginning of the COVID-19 pandemic in Korea. Other countries have experienced similar challenges during lockdowns, with psychiatric hospitals being no exception, facing restrictions on outside contact. However, psychiatrists have provided online psychological support during the COVID-19 outbreak [4,10,11]. Outside personnel have been brought in to see psychiatric patients diagnosed with COVID-19 or transferred to outside hospitals. However, Korea’s unique psychiatric care environment, where psychiatric patients spend the longest time in the world [12], has a much more closed psychiatric care environment, which has created greater challenges in outside contact and coordinating with outside care.

The inability of dispatched medical personnel to use the medical information system owing to the absence of staff from Hospital D was a source of stress. Addition, insufficient support, such as accommodation and workforce for shifting, was problematic. This is consistent with the reports of previous studies, in which medical staff complained of excessive workload and hours, inadequate personal protective equipment, overzealous media news, and feelings of inadequate support [13-16]. Moreover, healthcare personnel responding to emerging infectious diseases mentioned having psychological experiences such as fear of infection, concern for family health, trust and support from the organization, information about risks, and concerns regarding stigma [17-19]. Patients with mental illnesses face heightened treatment demands as they require simultaneous care for infectious diseases, such as COVID-19, and management of psychiatric symptoms. This aligns with research describing the vulnerability of psychiatric ward environments to infectious diseases and the challenges of nursing psychiatric patients [12]. Factors such as multi-bed room structures, shared bathroom use, communal dining and group activities, and sealed windows for patient safety contribute to poor ventilation, placing these settings at higher risk for infections [20,21]. In addition to these physical treatment environments, individuals with mental illnesses often struggle with self-care and lack sufficient knowledge, making it challenging for them to engage in infection prevention behaviors [21]. This can be understood as a unique characteristic of mental illness that complicates infection prevention efforts.

Regarding the study participants’ opinions on isolating medical institutions from the external world, they consistently highlighted that it is a type of isolation different from “cohort isolation.” When a new infectious disease emerges and a medical institution must be isolated, clear standards should be established regarding when a medical institution should be isolated and which patients should be sent first when transferring patients. Patient protection was the primary objective of this study. In the on-site follow-up response process, we discovered that a better response was not possible owing to the absence of a specific response manual, a unified control tower, the initial introduction of infection experts, and a sufficient workforce. Moreover, active government intervention is necessary to isolate medical institutions.

Patients with mental illness who are infected with COVID-19 are at increased risk of spreading the infection and having difficulty getting appropriate healthcare compared to the general patients [19]. At the beginning of the pandemic, there was a severe shortage of beds and personnel for proper treatment. In addition, Hospital D was not a suitable environment for psychiatric patients with COVID-19. Therefore, these patients had to be transferred to the National Psychiatric Hospital or other national psychiatric hospitals for proper treatment.

The participants recognized that the key to protecting human rights in the isolation of mental health institution was to establish an environment and system for providing appropriate medical care. More specifically, creating an environment and system to enable faster and more appropriate responses is necessary. This can be accomplished by securing facilities for safe and sufficient medical care, strengthening national and local government governance in response to isolation, and promoting the early participation of experts in the government’s immediate response team. Additionally, the support and cooperation between national and local governments to provide appropriate medical care, safety, and protection to dispatched medical staff, sufficient work authority, and post-incident compensation should be strengthened. The COVID-19 outbreak and its sequelae in psychiatric institutions such as Hospital D have been linked to the limitations of social policies on mental health. This issue has been criticized for disproportionately impacting socially vulnerable populations during the COVID-19 pandemic due to inequitable infectious disease response policies and the usual social system environment [22].

Finally, the human rights of people with mental disabilities should be protected by building community-centered mental health systems that understand the special situation of people with mental disabilities and shift the mental healthcare system away from closed wards and isolation. Studies have shown that community-centered mental health systems have been effective in improving COVID-19 infections and complications among psychiatric patients. In particular, the central government should legislate and provide financial support, and local governments should operate community mental health systems that are appropriate to reality. In addition, it is necessary to reiterate the lesson that the involvement of families of mental health patients in community mental health system and collaboration with various community resources should be routine to reduce the isolation of people with mental illness during emergencies such as COVID-19 and to ensure that people with mental illness can overcome the crisis with continuous care [20].

The study’s shortcomings include the fact that it is based on the subjective statements of healthcare workers who were involved in the COVID-19 response, rather than objective data, which limits its generalizability. However, the strength of this paper is that it contains the first-hand accounts of medical staff who risked their lives and actively responded to the early COVID-19 outbreak in psychiatric hospitals, and it has important academic value for how to respond to an outbreak of a new infectious disease in such hospitals.

A comprehensive examination of the experiences of medical personnel dispatched to a psychiatric hospital that urgently implemented cohort isolation due to large-scale infection during the initial spread of COVID-19 revealed that medical personnel were dispatched without basic training and guidance. They established a response system by identifying the situation and decision-making process for transporting patients. The participants emphasized considering the composition of response personnel and establishing medical-staff response manuals at ordinary times, as well as supplementing and strengthening basic support and human rights protection for patients and medical staff.

To provide safe and active treatment even in the situation of new infectious diseases to mentally ill patients, community-centered treatment and care systems must be organized. This requires active government policy-making and budgeting. It also requires systematic support from local governments. Finally, a policy to strengthen communication and cooperation with the human rights of patients and medical staff caring for them should be prepared from time to time.

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Acknowledgements

None.

Author Contributions

Conceptualization: Kim Y, Na B. Data curation: Kim Y. Formal analysis: Kim Y, Na B. Funding acquisition: None. Methodology: Kim Y. Project administration: Kim Y, Hyun JH, Lee J, Nam Y, Yim E, Lee K, Na B. Visualization: Kim Y. Writing – original draft: Kim Y, Hyun JH, Lee J, Nam Y, Yim E, Lee K, Na B. Writing – review & editing: Kim Y, Hyun JH, Lee J, Nam Y, Yim E, Lee K, Na B.

REFERENCES

• 1. Seo C. Integrated understanding of human rights required in COVID-19 crisis and related legal and policy challenge. Public Interest Hum Rights 2021;21: 249-280. (Korean)
• 2. Hong S. Novel coronavirus (COVID-19) pandemic and human rights of health professionals: focused on public health doctors. Health Policy Manag 2022;32(3):330-333. (Korean). https://doi.org/10.4332/KJHPA.2022.32.3.330Article
• 3. Rovers JJ, van de Linde LS, Kenters N, Bisseling EM, Nieuwenhuijse DF, Oude Munnink BB, et al. Why psychiatry is different - challenges and difficulties in managing a nosocomial outbreak of coronavirus disease (COVID-19) in hospital care. Antimicrob Resist Infect Control 2020;9(1):190. https://doi.org/10.1186/s13756-020-00853-zArticlePubMedPMC
• 4. Williams R, Tweed J, Rebolledo L, Khalid O, Agyeman J, Pinto da Costa M. Patient adherence with infection control measures on a novel ‘COVID-19 triage’ psychiatric in-patient ward. BJPsych Open 2021;7(4):e131. https://doi.org/10.1192/bjo.2021.968ArticlePubMedPMC
• 5. Jeon H. How did the Cheongdo Daenam Hospital become a deserted place. SiSA In; 2020 May 20 [cited 2024 Sep 30]. Available from: https://www.sisain.co.kr/news/articleView.html?idxno=41985
• 6. Kim M. Report on interview survey results for healthcare workers in C institution. Seoul: Consens; 2020. (Korean)
• 7. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.xArticlePubMed
• 8. Ha JH, Kim KR. A nurse’s volunteering experience in Daegu during the COVID-19 pandemic: a qualitative case study. Nurs Health Issues 2021;26(1):18-28. (Korean). https://doi.org/10.33527/nhi2021.26.1.18Article
• 9. Jin D, Lee G. Experiences of nurses at a general hospital in Seoul which is temporarily closed due to COVID-19. J Korean Acad Soc Nurs Educ 2020;26(4):412-422. (Korean). https://doi.org/10.5977/jkasne.2020.26.4.412Article
• 10. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 2020;7(4):300-302. https://doi.org/10.1016/S2215-0366(20)30073-0ArticlePubMedPMC
• 11. Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020;7(4):e17-e18. https://doi.org/10.1016/S2215-0366(20)30077-8ArticlePubMedPMC
• 12. Kim AM. Why do psychiatric patients in Korea stay longer in hospital? Int J Ment Health Syst 2017;11: 2. https://doi.org/10.1186/s13033-016-0110-6ArticlePubMedPMC
• 13. Vindrola-Padros C, Andrews L, Dowrick A, Djellouli N, Fillmore H, Bautista Gonzalez E, et al. Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK. BMJ Open 2020;10(11):e040503. https://doi.org/10.1136/bmjopen-2020-040503ArticlePubMedPMC
• 14. Cai J, Sun W, Huang J, Gamber M, Wu J, He G. Indirect virus transmission in cluster of COVID-19 cases, Wenzhou, China, 2020. Emerg Infect Dis 2020;26(6):1343-1345. https://doi.org/10.3201/eid2606.200412ArticlePubMedPMC
• 15. Styra R, Hawryluck L, Robinson S, Kasapinovic S, Fones C, Gold WL. Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak. J Psychosom Res 2008;64(2):177-183. https://doi.org/10.1016/j.jpsychores.2007.07.015ArticlePubMedPMC
• 16. The Lancet. COVID-19: protecting health-care workers. Lancet 2020;395(10228):922. https://doi.org/10.1016/S0140-6736(20)30644-9Article
• 17. Imai H, Matsuishi K, Ito A, Mouri K, Kitamura N, Akimoto K, et al. Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009. BMC Public Health 2010;10: 672. https://doi.org/10.1186/1471-2458-10-672ArticlePubMedPMC
• 18. Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare workers’ attitudes to working during pandemic influenza: a qualitative study. BMC Public Health 2009;9: 56. https://doi.org/10.1186/1471-2458-9-56ArticlePubMedPMC
• 19. Koh Y, Hegney DG, Drury V. Comprehensive systematic review of healthcare workers’ perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. Int J Evid Based Healthc 2011;9(4):403-419. https://doi.org/10.1111/j.1744-1609.2011.00242.xArticlePubMed
• 20. Lasalvia A, Bodini L, D’Astore C, Gomez F, Pesarin A, Imperadore G. The impact of COVID-19 pandemic on psychiatric rehabilitation in residential facilities: perspectives of staff and residents. J Psychosoc Rehabil Ment Health 2023;1-15. https://doi.org/10.1007/s40737-023-00343-6Article
• 21. Amerio A, Vai E, Bruno E, Costanza A, Escelsior A, Odone A, et al. COVID-19 impact on the Italian community-based system of mental health care: reflections and lessons learned for the future. Clin Psychopharmacol Neurosci 2023;21(1):2-9. https://doi.org/10.9758/cpn.2023.21.1.2ArticlePubMedPMC
• 22. Choi H, Kim SY, Kim JW, Park Y, Kim MH; Working Group for the People’s Report on COVID-19 in Korea. Mainstreaming of health equity in infectious disease control policy during the COVID-19 pandemic era. J Prev Med Public Health 2021;54(1):1-7. https://doi.org/10.3961/jpmph.20.593ArticlePubMedPMC

Figure & Data

References

Citations

Citations to this article as recorded by