**6.5 Health Care Workers**

It appears that disaster management workforce was itself not immune to the psychological consequences of the pandemic. While others were under strict vigil of lockdown and quarantine, the local hospitals continued to receive suddenly thousands of critically ill COVID-19 patients and were forced to implement their emergency protocols [15]. With overwhelming hospitals and a rapidly increasing demand along with supply shortage, frontline HCW were put to immense stress. Previous studies on the infectious outbreaks of SARS, MERS and Ebola have revealed the severity of emotional distress among medical practitioners and law enforcing agents who faced PTSD, depression, anxiety, exhaustion and burnout at the onset, during and even after the outbreak of such epidemics [11]. A study conducted on 1563 health professionals found roughly half of them to suffer from depression, whereas 44.7% and 36.1% from anxiety and sleep disturbances. Higher depression, anxiety and acute overall psychological burden was reported particularly in those directly diagnosing and treating COVID cases [34]. Spoorthy et al. suggested that 68.7%–85.5% of medical staff comprises of females and were likely to be affected in the COVID-19 pandemic by elevated degrees of anxiety, distress and depression [39]. Psychological symptoms were frankly correlated with increased duty hours, lack of shift rotations, societal stigma, inadequate medical protective equipment, increased witness to death and dying, increased risk of exposure and self-blame, as well as the guilt and fear of spreading the infection to the family members [39, 40]. They suffered the worst sleep quality and sleep time. The discrimination, isolation, negative emotions of patients and lack of contact with own families for long led to frustration and hopelessness. Some studies have even depicted burnout of young nurses and found them to be more anxious and depressed when compared to doctors, which could be accounted due to low nurse to patient density (**Figure 2**) [39].

#### **Figure 2.**

*The text in the inner circle depicts the probable causes of mental health disorders while that in the boxes depict how those circumstances were created and got aggravated due to COVID-19.*
