Surge in the demand for healthcare services during COVID | RMHP


Introduction

Viral diseases continue to emerge as a serious threat to public health. During the timeline of twenty years, there has been an emergence of several viral epidemics, including the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, H1N1 influenza (H1N1pdm09) in 2009, and the Severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 to 2003.1 Yet, a consistent feature of these public health crises is that the surge in the demand for healthcare services exceeds the availability.2 This shortfall compounded by the absenteeism of Healthcare workers (HCWs) during a pandemic poses an even greater threat to the healthcare sector.3

It is often assumed that HCW’s have a professional obligation to report to duty despite any probable risks to their safety and data from previous pandemics has supported this assumption.4 However, there exist several reports of non-illness-related absenteeism during various disease outbreaks in the past. During the 2003 SARS epidemic HCWs evaded examining infected patients and in some cases completely declined from performing their duties.4 Another study reported that 12% of the study participants would consider early retirement or resignation in response to a pandemic.5 Studies also show that when the risk of infectivity and virulence is high, non-illness absenteeism rates are also high.5 A survey evaluating the willingness and ability of HCWs to work during a calamitous disaster observed that greater than 80% of the study participants were willing to report to work during a natural calamity, while only 48.4% to 61.1% were willing to report to work during a SARS or smallpox outbreak, respectively.6 Therefore, non-illness-related absenteeism accompanied by illness-related absenteeism leads to a drastic scarcity of human resources.

Consequently, determining the factors that influence the willingness of HCWs to work during a pandemic is imperative, in order to effectively plan, prepare, and ensure the continued delivery of essential health services during a pandemic. In turn, these determinants can also assist hospitals in remodelling and refining their pandemic preparedness. In Pakistan, there is a dearth of literature regarding the attitudes and willingness of healthcare providers to work during a pandemic. For this reason, we set out to assess the willingness of doctors and medical students in Karachi, Pakistan to provide health services during the COVID-19 pandemic and to highlight the motivators and barriers that encourage and/or limit doctors from providing essential health services and medical students from volunteering during a pandemic.

Materials and Methods

Study Setting and Population

A cross-sectional, web-based survey was distributed in the months of June and July 2020 in Karachi, Pakistan to assess the risk perception and willingness to work among doctors and medical students during the COVID-19 pandemic. The sample size was calculated using “OpenEpi: Open Source Epidemiologic Statistics for Public Health”, using an anticipated frequency of 50% (p value = 0.5), confidence limits ± 5% and a confidence level of 95%. The sample size following the above calculation was 384. To account for non-response rate, the sample size was inflated by 10%. The final sample size was 423. Given the social distancing, restricted movement and lockdown being observed all over the country as a result of the COVID-19 pandemic, a web-based survey was chosen on the grounds of time, cost, and accessibility. The study participants included doctors and medical students residing in Karachi. Healthcare professionals and students practicing or training in the fields of nursing, pharmacy, dentistry, physiotherapy, laboratory technology, allied health sciences or homeopathy and doctors that have retired were excluded from the study.

Study Tool

A structured, self-administered questionnaire was adapted from a study by Rosychuk et al.2 The questionnaire was pretested and verified (validated) on a group of 50 participants. In the pilot survey, reliability of the study questionnaire was computed by Cronbach’s alpha and a value of 0.67 was acquired. The questionnaire comprising of 25 questions for doctors and 23 questions for medical students was launched via Google forms on June 21, 2020 and distributed to the public via social media platforms, such as WhatsApp, Twitter, Instagram and Facebook. Additionally, we requested the participants to further circulate the survey link among their colleagues. Prior to the commencement of the survey, online informed consent was taken from all participants. Absolute anonymity was maintained ensuring that all the information provided by the respondents cannot be linked back to them in any manner or form, as names or any other identifying information was not collected. The survey took approximately 10 minutes to complete and utilized skip logic. The questionnaire for doctors consisted of 25 questions (24 + 10 sub-questions): 8 requested socio-demographic information, 1 dealt with source of COVID-19 information, 4 focused on risk perception of COVID-19, 12 related to willingness to work during the pandemic and the consequences of not working. The questionnaire for medical students consisted of 23 questions (22 + 10 sub-questions): 7 requested socio-demographic information, 1 dealt with source of COVID-19 information, 4 focused on risk perception of COVID-19, 11 related to willingness to volunteer during the pandemic and the consequences of not volunteering. Responses were mostly either Yes, No or I do not know or a 5-point Likert scale ie on a continuum from strongly disagree to strongly agree.

Statistical Analysis

Data was entered and analyzed using Statistical Package for the Social Sciences software (SPSS) version 24.0. Mean ± Standard Deviation (SD) and Median (Inter Quartile Range, IQR) were computed for all quantitative variables. All the categorical variables were presented as frequencies and percentages. Chi-square test was applied between various categorical variables, to find possible statistical correlations. P-value <0.05 was considered statistically significant.

Results

Out of the 491 respondents surveyed, 104 responses were discarded as they were incomplete, giving us a response rate of 78.8%. From the final sample size of 387 respondents, 187 were doctors and 200 were medical students.

Socio-Demographics

The mean age of the doctors was 27.5 years (SD 4.2) and gender was predominantly female (64.2%). Resident doctors formed the bulk of our respondents (31.0%). Good health status was reported by 57.8% doctors and 52.9% disclosed that they refer to official sources such as WHO, CDC, medical journals, and physicians for COVID-19 information.

The mean age of medical students was 21.5 years (SD 1.4) and gender was predominantly female (71.0%). Medical students in their third clinical years formed the majority of the respondents (37.0%). Good health status was reported by 60.0% of the medical students and 44.5% disclosed that they refer to unofficial sources such as WhatsApp, Facebook, Instagram, television, newspaper, and friends and family for COVID-19 information. Tables S1 and S2 display the socio-demographic characteristics of doctors and medical students, respectively. Moreover, the academic year of study of medical students was significantly associated with the information sources referred to for COVID-19 (p = 0.01), wherein fourth year medical students referred to unofficial sources and second year medical students referred to both official and unofficial sources (Table S3).

Willingness to Work or Volunteer

Out of 187 doctors, 74.3% were working during the COVID-19 pandemic, of which 58.3% were willing to work, 10.7% were not willing to work and 5.3% said “I don’t know”, while 25.7% were not working during the pandemic, of which 16.6% were willing to work, 4.8% were not willing to work and 4.3% said “I don’t know”. Doctors were mostly willing to report for their usual shift (71.1%) during the…



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