This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
The importance of health professionals has been recognized in COVID-19 pandemic–affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers’ perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support.
The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health.
This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact.
We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of
In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination—conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future.
In December 2019, Chinese authorities notified the World Health Organization (WHO) of several cases of pneumonia of unknown etiology in the city of Wuhan [
The first case of COVID-19 in South America was described in Brazil in February 2020. It was a man returning from a trip to Italy, where a significant outbreak was ongoing [
Based on the report of the first 425 confirmed cases in Wuhan, the common symptoms detected included fever, dry cough, myalgia and fatigue, headache, hemoptysis, abdominal pain, and diarrhea [
In the affected countries, including Brazil, a rapid increase in the demand for health services occurred, mainly for hospital beds in intensive care units [
Recently, researchers have described the afflictions experienced by people during the pandemic period [
During the pandemic, the world has faced shutdown, slowdown, or lockdown, and individuals have been encouraged to use masks and practice social distancing. Meanwhile, health professionals had to go in the opposite direction. These workers were directly involved in offering diagnosis and treatment care for SARS-CoV-2-infected patients with almost uninterrupted work in a life-threatening, and sometimes, frustrating perspective. Lately, besides the feasible SARS-CoV-2 contamination risk, these professionals are also at a high risk of developing psychological distress and other mental health symptoms [
This study was a cross-sectional web-based survey conducted in Brazil. We prepared a 32-items questionnaire using the Google Forms electronic assessment. A combination of structured (yes/no), multiple-choice selections with 1 final open question was used. All questions were mandatory and divided into 2 blocks with different proposals: (1) personal profile (eg, age, gender, ethnicity, household income, schooling level, and professional characteristics) and (2) COVID-19 pandemic impact. Our objective in most questions was to reflect on the perceptions of health professionals about COVID-19 and allow the analysis based on the respondent’s declarations during the pandemic. It is important to note that any diagnosis pointed by the participants was not debated with them nor were they requested for any documents to assure the pathological situation or diagnosis. The questionnaire underwent an internal validation by both an expert panel of 5 and in a respondent set of 10 health professionals from a huge national health institution (Fiocruz). Experts critically reviewed the instrument and offered important feedback such as addition, deletion, and reformulation of questions and answers, and errors in the form systems used to create the questionnaire. The first approach of the survey asked for informed consent and for the autodeclaration status of “health professionals,” considering all the workers in any type of unit of the National Brazilian Health System (Sistema Único de Saúde).
The invitation to answer the questionnaire was distributed nationally to health professionals in different health institutions through emails, WhatsApp groups, and social media (Facebook). This study was designed to capture spontaneous perceptions from health professionals and had no epidemiological purpose. Their motivation to access and answer the forms relied on the altruistic feeling of the participant to collaborate with the research. Although the survey was not designed to follow strict representative numbers of health professionals in all Brazilian regions, a study of the last available census of Brazilian health professionals [
Data exploration, analysis, and cleaning were performed using the Python programming language (version 3.6) with the Jupyter interface. During the analysis, the percentage of participants who selected each response was computed, and the Pandas and NumPy libraries were used together with Matplotlib library for the table generation. Chi-square analysis was performed whenever necessary to statistically confirm differences between any specific group of interest. The participants indicated using a 5-point scale how much COVID-19 affected their lives (1=not affected and 5=very affected) and since the beginning of the pandemic, how much they thought about COVID-19 (1=not at all and 5=very much). The level of anxiety was measured by averaging the participants’ scores (ranging from 1 to 5) so that the higher the average, the greater the anxiety of the individual was expected regarding COVID-19. Word clouds were prepared in the WordArt program. This approach was previously validated by other studies [
The ethical approval for this research was obtained from the Research Ethics Committee of the Oswaldo Cruz Institute-CEP FIOCRUZ/IOC under the number CAAE: 34985420.0.0000.5248. All respondents gave informed consent before their entry into the study.
After the web-based questionnaire distribution, 1376 answers came from all 5 Brazilian regions in a regional percentage distribution, following the same trends observed in the data from the last census of the health care professionals available at the Brazilian Health Ministry. The analysis of the demographic part of the questionnaire section showed that most of the respondents were females (1159/1376, 84.2%) in the age range of 31-50 years (830/1376, 60.3%) (
Profile of the Brazilian health professionals enrolled in this study (N=1376).
Demographic characteristics | Values, n (%) | ||
|
|||
|
Southeast | 929 (67.5) | |
|
South | 149 (10.8) | |
|
Central West | 140 (10.2) | |
|
Northeast | 92 (6.7) | |
|
North | 66 (4.8) | |
|
|||
|
Female | 1159 (84.2) | |
|
Male | 215 (15.6) | |
|
Nonidentified | 2 (0.1) | |
|
|||
|
18-30 | 287 (20.9) | |
|
31-40 | 467 (33.9) | |
|
41-50 | 363 (26.4) | |
|
51-60 | 201 (14.6) | |
|
>60 | 58 (4.2) | |
|
|||
|
European-derived | 724 (53.6) | |
|
African-derived | 601 (43.7) | |
|
Asiatic | 23 (0.0) | |
|
Indigenous | 2 (0.0) | |
|
Nonidentified | 26 (0.0) | |
|
|||
|
University grade/postgraduate | 903 (65.6) | |
|
Complete technical/high school level | 438 (31.8) | |
|
Incomplete university grade | 30 (2.2) | |
|
Incomplete technical/high school level | 5 (0.4) | |
|
|||
|
<52 USD | 10 (0.7) | |
|
>52-260 USD | 33 (2.4) | |
|
>260-500 USD | 403 (29.3) | |
|
>500-1500 USD | 598 (43.5) | |
|
≥1500 USD | 332 (24.1) | |
|
|||
|
No | 44 (3.2) | |
|
1-3 persons | 1033 (75.1) | |
|
≥4 persons | 299 (21.7) |
More than 50% of the respondents declared themselves as European-derived people (724/1376, 53.6%), with African-derived people constituting 43.7% (601/1376) of the participants (
When asked about being infected by SARS-CoV-2, almost 22.9% (315/1376) reported positiveness (
Critically, 61.3% (193/315) answered that they were infected with SARS-CoV-2 while working at a health facility, whereas 15.2% (48/315) did not know where they were infected, and 13.3% (42/315) assumed that they got infected from their own family members that had COVID-19. An important result is that 48.3% (152/315) of those health professionals who acquired COVID-19 reported that family members or friends living in the same house also got infected, and 27.0% (85/315) think that they probably were the source of their infection (
We also asked that the participants that had COVID-19 to report their feelings during the pandemic period by using not only closed options but also allowing an additional open choice.
Labor characteristics of the working places and personal protection equipment and COVID-19 information acquired by health professionals who participated in the national survey (N=1376).
Labor information | Respondents, n (%) | ||
|
|||
|
Not working (unemployed) | 164 (11.9) | |
|
Working on the front line of COVID-19 | 546 (39.7) | |
|
Working, not on the front line of COVID-19 | 566 (41.1) | |
|
Retired/temporarily away owing to comorbidities | 100 (7.3) | |
|
|||
|
Public sector | 636 (46.2) | |
|
Private sector/philanthropy hospitals | 323 (23.5) | |
|
Both public and private sectors | 127 (9.2) | |
|
Family residences | 71 (5.2) | |
|
Health education institute | 18 (1.3) | |
|
Web-based surveillance | 11 (0.8) | |
|
Not working (retired/unemployed, others) | 164 (11.9) | |
|
|||
|
Yes | 996 (72.4) | |
|
No | 360 (26.2) | |
|
Did not answer | 20 (1.5) | |
|
|||
|
Yes | 1057 (76.8) | |
|
No | 319 (23.2) | |
|
|||
|
No | 882 (64.1) | |
|
Yes | 494 (35.9) | |
|
|||
|
Yes | 970 (70.5) | |
|
No | 406 (29.5) | |
|
|||
|
Ministry of Health/World Health Organization websites | 551 (40.0) | |
|
Television | 368 (26.7) | |
|
Internet sites/Facebook/Instagram | 254 (18.5) | |
|
Newspapers and journals | 109 (7.9) | |
|
At work | 10 (0.7) | |
|
Radio | 12 (0,9) | |
|
Refuse to get more information | 6 (0.4) | |
|
Friends and family members | 20 (1.5) | |
|
Science journals | 23 (1.7) | |
|
Other media/all the sources | 23 (1.7) |
COVID-19 pandemic impact on Brazilian health professionals who participated in the national survey.
COVID-19 self-reported information | Respondents, n (%) | |
|
||
|
Survey participants | 1376 (100.0) |
|
Got infected | 315 (22.9) |
|
Did not get infected/do not know | 1061 (77.1) |
|
||
|
One or two symptoms | 33 (10.5) |
|
Three or more symptoms | 263 (83.5) |
|
Headache | 274 (87.0) |
|
Body pain | 231 (73.3) |
|
Tiredness | 228 (72.4) |
|
Loss of taste and smell | 208 (66.0) |
|
Dry cough | 171 (54.3) |
|
Fever | 152 (48.3) |
|
Diarrhea | 144 (45.7) |
|
Breath difficulty | 128 (40.6) |
|
Minor symptoms (chest pressure, skin eruptions, conjunctivitis, vomiting) | 149 (47.3) |
|
Asymptomatic | 17 (5.4) |
|
||
|
No worsening | 287 (91.1) |
|
Hospitalized in the infirmary | 19 (6.0) |
|
Hospitalized in the intensive care unit without intubation | 8 (2.5) |
|
Hospitalized in the intensive care unit with intubation | 1 (0.3) |
|
||
|
Positive history of COVID-19 | 315 (100.0) |
|
Working in a health facility | 193 (61.3) |
|
Do not know | 48 (15.2) |
|
From family or friends | 42 (13.3) |
|
Public transportation | 16 (5.1) |
|
Supermarket/others | 16 (5.1) |
|
||
|
Yes | 152 (48.3) |
|
No | 134 (42.5) |
|
Do not know | 29 (9.2) |
|
||
|
Yes | 91 (8.6) |
|
No | 816 (76.9) |
|
Do not know | 154 (14.5) |
|
||
|
Yes | 85 (27.0) |
|
No | 181 (57.5) |
|
Do not know | 49 (15.6) |
Word cloud images showing the qualitative frequencies of positive (A) and negative (B) feelings reported by health professionals in the COVID-19 perception survey conducted in Brazil (September-October 2020).
Feelings reported by the health professionals in the survey, showing frequencies of answers in the group reporting experience of acquiring COVID-19 (black bars) in comparison with those that did not acquire COVID-19 (white bars). Asterisks indicate significant differences (
Effect of the COVID-19 pandemic on mental health/stress situations of Brazilian health professionals who participated in the survey (N=1376).
Answers concerning stress at work | Respondents, n (%) | |
|
||
|
I had an anxiety due to COVID-19 | 604 (43.9) |
|
I experienced difficulties falling asleep | 593 (43.1) |
|
I had difficulty concentrating | 453 (32.9) |
|
I lost interest in activities I used to do | 447 (32.5) |
|
I experienced traumatic situations at work | 385 (28.0) |
|
I do not feel safe leaving home | 372 (27.2) |
|
I did not go through these issues | 274 (19.9) |
|
I had the need to seek psychological help | 182 (13.2) |
|
||
|
Yes | 662 (48.1) |
|
No | 714 (51.9) |
|
||
|
No | 612 (44.5) |
|
Yes, general anxiety | 463 (33.6) |
|
Yes, depression | 217 (15.8) |
|
Yes, panic | 113 (8.2) |
|
||
|
Yes, from friends/family/religion/social networking | 918 (66.7) |
|
Yes, from professional support | 119 (8.6) |
|
No | 339 (24.6) |
|
||
|
Excellent | 202 (14.7) |
|
Good | 387 (28.1) |
|
Regular | 306 (22.2) |
|
Bad | 269 (29.5) |
|
Do not have bosses | 212 (15.4) |
The survey ended with 2 questions asking for a general opinion based on a 5-point scale and related to the general impact of COVID-19 in their lives (
Scores attributed by the health professionals participating in the survey to 2 questions regarding general perception of the impact of the COVID-19 pandemic in their life. Score 1 represents none/few and score 5 represents very much/very often/a lot. The questions were “Has COVID-19 affected your life?” (answers in black bars) and “How often, since the beginning of the pandemic, do you think about COVID-19?” (answers in white bars).
At the end of 2019, COVID-19 was described as a disease that could be easily transmitted and rapidly spread by the SARS-CoV-2 virus [
Our purpose in this study was to identify the impact of the COVID-19 pandemic on the life and work routine of Brazilian health professionals through the analysis of their perceptions and feelings during this period. Most health professionals who responded to the survey were females, European-derived, aged 31-40 years, and located in the southeast of Brazil, the most populous region. The data from our research showed a higher percentage of female health professionals’ participation in relation to males (our data: 1159/1376, 84.2% women and 215/1376, 15.6% men) confirming the literature, which shows that a greater number of health professionals in Brazil are females [
According to our survey, despite the highly stressful scenario, these female health workers did not respond differently from men in this pandemic situation, especially in terms of their feelings. They also felt the fear of COVID-19, sadness, hope, empathy, and insecurity while they cared for their family’s demands and social and economic problems. Literature shows that women are dealing with these health and stressful issues and social and economic problems totally by themselves, thus highlighting the need for creating gender-specific programs to help these women in the near future [
During the pandemic, the problems in the health care environment included the use of PPE that was intended for other individuals (eg, size for bigger men used by women or smaller persons) and even the absence of these materials as well as life support to use with the patients (eg, respiratory equipment). As the pandemic spread across the globe, the adequate provision of PPE for health professionals was a constant concern [
Based on the fact that the recent vaccines developed against coronavirus are still not available for everyone in all countries, including Brazil [
From the beginning of the SARS-CoV-2 outbreak, concerns have been raised about its effect on mental health [
The literature also described a systematic review that evaluated 29 studies, with a total sample size of around 22,000 health professionals. Similarly to our survey in which several health professionals experienced anxiety due to COVID-19 (N=9680, 44%), depression (N=7480, 34%), and insomnia (N=7260, 33%), the review showed that 21 papers described the prevalence of depression, 23 reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress [
Our study has some limitations, which need to be considered. The findings are not generalizable to all categories of health care professionals, as it is a compilation of all respondents’ impressions. Another important piece of information that should be deemed is the total period of the COVID-19 pandemic. We evaluated the perceptions and feelings of these professionals in a specific time frame. Therefore, longitudinal studies are recommended in Brazil. Despite the self-report questionnaire being one of the most widely used assessments, its use rather than a clinical assessment reduced the power of our findings. Another limitation of this study was that most of the respondents were those who used or operated the internet, which only constitutes a partial section of the society. However, this study could suggest a general overview of the perceptions and feelings present in the health professionals in Brazil.
In every country, during the COVID-19 pandemic, health care professionals had to work under pressure with risks of affecting their physical and mental health, by being on the front line and assisting to save lives. Our data showed that the COVID-19 pandemic affected overall 70% of the Brazilian health professionals, according to their answers to our survey. However, most of the feelings did not change when comparing those who did get infected to those who did not, men or women, suggesting that to be exposed to this work environment and the pandemic situation are enough to develop negative feelings, such as fear of COVID-19, sadness, and insecurity, despite keeping “alive” their hope. These negative feelings are probably maintained by knowing situations such as (1) absence of Brazilian strategies at the national level for mass testing of the population, (2) absence of effective public policies that reduce the cases of COVID-19, and (3) absence of sanitary measures carried out in a centralized manner by states and municipalities (not only guaranteed by calling the judiciary), especially in states where the epidemic is most severe. Altogether, these feelings and perceptions reported in this work are alarming and must be well addressed with interventions that enhance the quality of life of the health professionals. There is an urgent need for regular monitoring of potential stress disorders, aiming to reduce the associated side effects in the longer run. Therefore, health policymakers should plan actions to control and prevent mental disorders in this category of professionals as soon as possible. One of the actions that should be implemented in each hospital, clinic, and asylum is the creation of multidisciplinary groups that may attend and monitor the medical staff, including all involved, not only for training but also to dialogue and identify burnout situations before they deeply and irreversibly affect this group that is so stressed out in this pandemic. This also includes the assurance of vaccination (2 doses taken) for all of them.
personal protective equipment
World Health Organization
We thank Coordenação de Aperfeiçoamento de Pessoal de Nível Superio (CAPES), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) (E-26/210.844/2019; 201.983/2020), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (311361/2015-3) for the fellowships and financial support.
None declared.