Highlights
Healthcare workers are at high risk of mental health problems during viral epidemic outbreaks
This review of 117 studies offers pooled estimations of prevalence of acute stress disorder (40%), followed by anxiety (30%), burnout (28%), depression (24%), and post-traumatic stress disorder (13%).
It identifies a number of factors (sociodemographic, occupational and social) associated with mental health problems.
Interventional high-quality research is urgently needed to inform evidence-based policies for viral pandemics.
Objectives:To examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers´(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact.Design: Systematic rapid review and meta-analysis.Data sources: MEDLINE, Embase, and PsycINFO, searched up to 23 March 2020.
Method:We selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems.
Results:We included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%; 6 studies, 3,373 participants), followed by
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Introduction
The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID‐19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS‐TS). Recognising the distinct needs of this population, the National COVID‐19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID‐19 and COVID‐19 complications. Living guidelines mean that these evidence‐based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care.
Main recommendations
To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID‐19 and for the management of PIMS‐TS.
Changes in management as a result of the guidelines
The Taskforce currently recommends corticosteroids as first line treatment for acute COVID‐19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non‐invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS‐TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS‐TS.
The latest updates and full recommendations are available at http://www.covid19evidence.net.au.
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