Healthcare Workers' Perceptions and Medically Approved COVID-19 Infection Risk: Understanding the Mental Health Dimension of the Pandemic. A German Hospital Case Study

Abstract

IntroductionThis study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organizational measures. The aim is to explore “blind spots” of pandemic protection and make mental health needs of HCWs visible.MethodsWe have chosen an “optimal-case” scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organizational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n = 1,163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care.ResultsThe results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed “some” to “very strong” fear of acquiring infection at the workplace. Individual protective behavior and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived “no” or “little” protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behavior, but nursing was correlated with higher levels of personal risk estimations and fear of infection.ConclusionsA strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information, training/education and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

“…It is interesting to note, that we found statistical evidence for higher workplace risks for migrant HCWs in our research, but none of the items that measured individual perceptions, including protection by the employer, and health status did reflect differences, except higher sickness leaves in the group of non-EU foreign-born HCWs. A comparably low infection risk of HCWs at Hannover Medical School together with appropriate access to PPE and high vaccination coverage might explain this mismatch ( 31 , 71 ).…”

“…Theoretically, the research is informed by a health system approach ( 30 ), an intersectional perspective on social inequalities exacerbated by the COVID-19 pandemic, and a focus on actor-centred data ( 31 ). The connectedness of epidemiological and social conditions of the COVID-19 pandemic has been described in different ways.…”

“…The German hospital sector is generally well-equipped and additional measures were taken to ramp up infection control and protection of HCWs and, to a lesser degree, the psycho-social support of HCWs ( 41 – 43 ). As described elsewhere, “in 2020, when the CoCo Study was initiated, routine capacities of hospital beds accounted for 1,520 beds and 7,500 employees, including 3,100 HCWs (head counts)” ( 31 , 44 ).…”

“…Against this backdrop, we seek to close a gap and explore the situation of migrant HCWs through an intersectional lens in a health system with more effective pandemic measures. The German healthcare system and the organisational setting of Hannover Medical School, characterised by a comparably low infection risk of HCWs ( 31 ) serve our analysis as an optimal-case scenario. Our study aims to contribute new knowledge to HCWF policy and to reveal how health system conditions may exacerbate existing inequalities during a global public health crisis.…”

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID‐19

“…We applied an explorative qualitative approach based on semi‐structured interviews and informed by an intersectional research framework that places individual migrant HCWs in the context of health systems, organisations, and professions 40 . We set the focus on EU mobility and actor‐centred perceptions of the COVID‐19 situation.…”