**7. Healthcare workers**

Health care workers (HCW) are at high-risk for not only contracting the coronavirus, but also for the adverse psychosocial effects of the pandemic. However, the infection incident rate among healthcare workers is difficult to ascertain since there is no routine covid testing at health care facilities or accessible centralized repository for HCW prevalence data. Nevertheless, there are some recent studies that examine prevalence of infection among HCWs [61–63]. For example, Mahajan et al. [63] found 11% prevalence among the HCWs in their Mumbai study. Another study

of healthcare workers in Kolkata suggests that routine COVID screening for HCWs is essential since they found 31% of their study participants who tested positive were asymptomatic; thereby increasing the risk of infection transmission unknowingly [63].

Dubey et al.'s [20] comprehensive literature review identified several factors that further compromise HCW well-being beyond the risk of infection exposure. Of particular relevance, they found that "burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substancedependence, and PTSD" added to HCW's already concerns due to their high risk for contracting the virus. A cross sectional study of both HCWs and non-HCWs presented similar results with prevalent conditions such as depression, insomnia and anxiety as the significant psychological impacts of the pandemic [64]. Chew et al.'s [65] multinational study of HCWs reported that 79% of HCWs experienced moderate to very severe depression. Further, 2.2% reported feeling moderate to extremely severe stress, while 3.8% reported experiencing moderate to severe levels of psychological distress. These psychological impacts seemed to manifest in psychosomatic symptoms such as headaches, throat pain, anxiety, lethargy and insomnia.

The issue of stigmatization further adds to the stress and anxiety level of healthcare workers. Medical personnel, ward attenders and COVID-19 patient caregivers have all been targets of public outrage (including assaults) since they are perceived as high-risk infection transmitters [66, 67]. The following case vignette lucidly highlights the impact on a revered medical provider.

#### **COVID-19 Warriors**

An announcement was uploaded on Twitter as "It causes us immense pain to inform you that our dear Dr KK Aggarwal passed away at 11.30 pm on May 17, 2021, in New Delhi, after a lengthy battle with Covid-19...,". India's most prominent face of Medical Fraternity is no more. The 62-year cardiologist Dr. K K Agarwal, Padma Shri awardee and former national president of Indian Medical Association, was critical and he had been on ventilator support for the past few days but later succumbed to COVID-19 in All India Institute of Medical Sciences. His family put out a statement "KK Agarwal wanted his life to be celebrated not mourned." Ironically during the pandemic, Dr. Agarwal made relentless efforts to educate the common people and was able to reach out to 100 million people through several videos and education programmes and also saved innumerable lives. According to the report of the Indian Medical Association (IMA), 270 physicians have died in India's recent COVID-19 surge since early April and so far, more than 1,000 have died since the beginning of the pandemic. IMA also reported state-wise data on doctors' death, with the maximum figures in Bihar (78), Uttar Pradesh (37), and Delhi (28). The death toll is likely far higher since the association tracks only 350,000 registered members, but India has about 1.2 million doctors. A large number of them are survived by their families and children who need help for sustenance, education and rearing. The IMA very generously initiated the COVID Martyrs Fund by appealing for a minimum one-day income donation from members and citizenry [68].
