**3.1 Stress among patient population**

The increasing number of confirmed cases, a lack of knowledge of COVID-19, the rapid transmission rate, infection fears, lockdown conditions, difficulties in routine medical treatments, shortages of human resources in hospitals, insufficient psychological preparation, separation from loved ones, financial loss, stigma, loss of freedom, and uncertainty over illness status act as significant stressors for patients. These patients often display features of distress such as feeling nervous, worried in certain situations of panic, tendency to overreact, inability to control things in life, inability to overcome difficulties in daily life, and coping with things. The early months of pandemic had the higher reported prevalence of stress with a significant proportion of individuals reporting being upset due to things happening unexpectedly, inability to overcome difficulties in daily life, and anger at things being outside their control. Among suspected patients, those with history of travel to areas with ongoing community transmission were found to display greater stress [15]. Patients who are kept in isolation and quarantine experience significant levels stress as well [2]. It is expected that individuals may resort to social media during corona-led social distancing for stress relief and with the aim of accessing entertaining content, such as movies, comedies, and communication with family and friends, but frequent media exposure may itself be a source of psychological stress for these patients [16, 17]. Distress and panic during pandemics can propagate and promote misinformation in various ways along with increased digital screen time and unhealthy use of technology. Amid this, there has been a hidden epidemic of "information" that makes COVID-19 stand out as a "digital infodemic" from the earlier outbreaks. Misinformation and fake news are invariable accompaniments to this "information pollution" which can add to existent superior stress levels in the population [18]. Unfortunately, even immunocompromised and chronic disease patients are under tremendous psychological and physical stress in the face of this large-scale infectious public health crisis due to lack of proper healthcare infrastructure and treatment [19–21].

### **3.2 Stress among HCW population**

Amid the ongoing unforeseen situation of coronavirus disease 2019 (COVID-19) pandemic, health care workers of multiple disciplines have been predisposed to a considerable amount of stress. A statistically significant association was found between perceived stress and female sex, designation

*Mental Impact of COVID-19 – Fear, Stress, Anxiety, Depression and Sequels DOI: http://dx.doi.org/10.5772/intechopen.102754*

(postgraduate trainees), work hours ≥6 hours/day, COVID-19 positive ward duties and staying with family due to potential risk of transmission to family members [22]. Disturbed sleep time and schedules due to rotational duties exhaust these HCWs both physically and mentally. The physical discomfort and occupational dermatoses associated with the use of PPE have also been shown to be related to greater levels of stress symptoms [23]. Practicing new methods of a discipline different than what he/she has mastered over the years, long hours of working in extreme conditions under PPE kit discomfort, long duty hours with no food/water/urination allowed during the time of duty with PPE, and irritation and physical strain in PPE during the summer season have been constant precipitators of stress among the doctors of all the disciplines working as frontline warriors [22]. With a scarcity of resources and an ever increasing number of patients, life-saving decisions have to be made. Making such decisions amid intense work pressure leads to added stress within emergency departments as well as during after-duty hours [24]. All doctors are susceptible to developing higher stress irrespective of their discipline during the COVID-19 pandemic, and this is further precipitated by their quarantined living conditions [22, 25]. Older HCWs demonstrate a high level of psychological distress, possibly as a result of increased complications of COVID-19 with increasing age and also because older people may have health issues making them more prone to infection with its complications [26]. In conclusion, HCWs are exposed to a protracted source of distress which may exceed their individual coping skills and lead to further chronic psychological problems.
