The three studies evaluated the psychological impact of COVID-19 on healthcare workers. Study 1 found increased stress, anxiety and depression scores in physician trainees with more exposure to COVID-19 patients over time. Study 2 found higher odds of depression and anxiety in healthcare workers with direct exposure to COVID-19 patients. Study 3 observed 34.3% of healthcare workers reported psychological stress symptoms, with the highest levels of depression and anxiety in frontline workers. However, the studies had limitations like potential bias from questionnaires, short observation periods, and non-representative sampling. Future research on epidemiological determinants like climatic, environmental and societal factors is recommended.

1. Student’s Name
Professor’s Name
Course Number
Date

2. No study till date on COVID-19 Epidemiology
• Most nations are combating COVID-19 in the dark, without understanding its epidemiology,
since they believe it is better to cure than to comprehend it now.
• However, the disease's control will only be an impossible goal without an epidemiological
knowledge of it.
• The information on COVID-19 is not epidemiological; rather, it consists only of the number
of cases, fatalities, focused testing, or the virus's ability to survive in various environments
and temperatures.
• As I believe that it is less a disease but more a ‘political disaster’ or a ‘Disease of Diagnosis’
or just a ‘Political disorder’ it is fought with political weapons than the strategic disease
control techniques.

3. Epidemiological determinants of the COVID-19
• Though several studies have been published or under publication, none of the study
qualifies for the classification as epidemiological, most of the studies are either
ecological (not fully ecological too) or clinico-pathological (even without proper
understanding of pathology).
• Some studies claim to determine several modulators of the disease as, median age of
population, BCG vaccination status, several co-morbidities but conflicting reports
just proved that it is just a game to play with non-epidemiological data in leisure time
under lockdown.

4. Content Background/Incidence of Outcome
• The fast spread of coronavirus disease 2019 (COVID-19)
has put a significant burden on the physical and emotional
wellbeing of healthcare personnel worldwide.
• The consequences have been severe for physician trainees,
a unique group that functions as both learners and
caregivers with restricted autonomy.
• The exposure of the disease is mainly affecting the health
workers.

5. Incidence of Exposure
• Healthcare professionals are on the front lines of the COVID-19 struggle, thus
they will be the most vulnerable to the SARS-COV-2 virus.
• If the pandemic affects a large number of healthcare personnel, the healthcare
system will confront a serious manpower shortage to deal with it.
• As a result, when engaging with each patient and delivering service, all healthcare
staff must follow conventional infection control procedures.
• Health workers are experiencing mental health and stress to deal with patients with
this severe disease.

6. Biological Mechanism of Covid-19
• Given the high load, there is a rising demand
for and attention on safeguarding HCWs
across the world, including:
1. The supply of personal safety equipment
(PPE), training,
2. Treating fatigue, and
3. Mitigating psychosocial repercussions.

7. Review of Study 1
• One study to discuss on is, “Effects of Persistent Exposure to COVID-19 on
Mental Health Outcomes Among Trainees: a Longitudinal Survey Study (Goss, et
al. 1204).”
• This study was conducted by Charles W. Goss PhD and his colleagues.
• The research study was presented to the Division of Biostatistics in Washington
University.
• The objective was to investigate the longitudinal effects of physician trainee
exposure to patients being tested for COVID-19 on stress, anxiety, depression, and
burnout using three surveys conducted during the early phase of the pandemic.

8. Continuation
• The study design of this study is Longitudinal survey study.
• Study population and recruitment strategy is physician trainees (N = 1375) at an academic medical
center.
• Reported exposures was not significant (P = 0.223).
• The exposure assessment is 22% per additional exposure (95% CI: + 2 to + 46%; P = 0.026).
• The stress exposure was strongest for the third survey, where mean depression scores increased by
33% per additional exposure (95% CI: + 18 to + 50%; P < 0.001) (Goss, et al. 1207).
• The outcome definition in case 1 shows that healthcare workers were affected by COVID-19.
• The outcome assessment in survey interaction effect had a P value less than 0.10 (P = 0.058.
• The investigators reported an OR.

9. Review of Study 2
• Study two research topic is, “COVID-19 Outbreak and Its Association with
Healthcare Workers' Emotional Stress: a Cross-Sectional Study (Park, et al. 1).”
• This study was conducted by Chulyong Park and his colleagues.
• The research was presented to the Department of Occupational and Environment
Medicine, Yeungnam University Hospital.
• The objective of this study aims to assess the immediate correlates of emotional
stress and to identify which specific jobs, departments, and exposure types are risk
factors for emotional stress in healthcare workers.

10. Continuation
• The study design used was a questionnaire administered to the university hospital workers and also included the
patient health questionnaire.
• The study population was 1,003 participants.
• The exposure to random or unspecified patients was also associated with depression.
• The exposure definition is r depression and anxiety were 3.62 (95% CI, 2.24–5.83) and 2.41 (95% CI, 1.31–4.42).
• The exposure of the health workers results are, of the 1003 people, (OR, 1.85; 95% CI, 1.35–2.54) (Park, et al. 2).
• The outcome definition of the investigator is statistically significantly higher ORs for depression than those who
had not.
• The outcome assessment of the results is depression (OR, 3.05; 95% CI, 2.30–4.03) and anxiety (OR, 2.96; 95%
CI, 2.01–4.35)
• The investigator reported the crude odds ratios (ORs).

11. Review of Study 3
• Study three research topic is, “Psychological
Stress Risk Factors, Concerns and Mental
Health Support Among Health Care Workers in
Vietnam During the Coronavirus Disease 2019
(COVID-19) Outbreak (Nguyen, et al. 1).”
• This study was conducted by Phuong Thi Lan
Nguyen and her colleagues.
• The study design used is a cross-sectional study
design with convenience sampling.
Phuong Thi Lan Nguyen
Phuong Thi Lan Nguyen

12. Continuation
• The study population was n=774 enrolled participants.
• The exposure definition of the workers analysed is 761 (98.3%) subjects were eligible.
• The exposure frontline HCWs [OR =1.77 (95% CI: 1.17–2.67).
• The outcome definition is found that 34.3% HCWs had psychological stress symptoms.
• The outcome assessment in highest percentages of depression and anxiety—45.9% and 21.6%, respectively.
• The highest percentages of depression and anxiety—45.9% and 21.6%, respectively
• Adjustable variables are depression total score ranges from 0 to 27, anxiety range 0–21, and e (VAS) from 0
to 10.
• The investigator reported odds ratios (OR) with 95% confidence interval (CI). A p-value ≤0.05 was
considered statistically significant.

13. Conclusion of Studies
• In the three studies there was a selection bias of the methodology used to collect the data.
• There was a huge difference on how to determine the exposure or outcome between all
studies.
• The epidemiologic evidence presented is not conclusively concluded due to short comings
that is associated to the methodology used for the study design used.
• I recommend that the number of study population to limited to a group of individuals
who will meet the objective of the study.
• The exposure should be uniformly defined as the study research.
• The overall conclusion of the three studies states that COVID-19 has caused
psychological torture to healthcare workers.

14. Evaluation of Studies
• Limitation 1: using of questionnaire is
limited to the research.
• Limitation 2: use of Longitudinal survey as
a study design.
• Limitation 3: Use of sampling is another
limited factor.

15. Limitation 1
• Dishonest answers were offered in the questionnaires which affect the results.
• In study 3 the results were not statistically correct due to unanswered questions in
the questionnaires.
• In online questionnaires in study 3, the it was hard to convey feelings and emotions.
• In using the questionnaires the respondents may have a hidden agenda.
• The results may not be discreet due to questionnaire or survey fatigue.

16. Limitation 2
• The cross-sectional study in Study 2 was only completed for 8 days, and this
procedure takes a long time.
• Because of the short observation duration, the researcher risks collecting data that
is not completely reliable.
• This approach necessitates a large sample size. Because the population number
was modest, this strategy proved useless.
• The data in Study 2 is incorrect, hence the results are incorrect. For instance, the
exposure assessment was incorrect.

17. Limitation 3
• In study 3 the researcher used clustered sampling method. It caused some
shortcomings like:
1. Chances of bias
2. Difficulties in selecting truly a representative sample
3. Need for subject specific knowledge
4. changeability of sampling units
5. impossibility of sampling.

18. Conclusions
• In the three studies, healthcare workers are affected directly by COVID-19
outbreak.
• All the studies attributes:
1. Training programs should adapted.
2. Psychological interventions are highly recommended.
3. Health authorities should be responsible in protecting the psychological well-
being.

19. Recommendations
• The SARS-CoV-2 coronavirus and its related COVID-19 have generated a
worldwide emergency that necessitates an active, integrated, interdisciplinary, and
quick response from the scientific community.
• This disease needs future epidemiological research. Recommendations includes:
1. Study design on Climatic and environmental factors
2. Study design on Societal factors
3. Study design on Public health

20. Climatic and Environmental Factors
• This research will help the public health community respond to the present crisis and
develop efforts to prevent the COVID-19 pandemic's recurrence and subsequent
disasters.
• I recommend further research on climatic conditions and environmental factors in
order to learn more about how it is associated to the pandemic.
• This research will help the public health community respond to the present crisis and
develop efforts to prevent the COVID-19 pandemic's recurrence and subsequent
disasters.

21. Research on Societal factors
• The use of suitable geographical and temporal
resolution and time frames, as well as behavioral,
social, and community interventions and control
measures, socioeconomic variables and the impacts
of population mixing, numerous environmental
determinants, and the use of appropriate spatial and
temporal resolution and time frames, must all be
thoroughly explored.

22. Research on Public health
• Environmental research will give public health
to do more research on the pandemic.
• As a result, we must use this opportunity for the
scientific community to do research that best
informs policymaking in the interests of:
1. A healthy and
2. Sustainable future at the local, regional, and
global levels.

23. Works Cited
Goss, Charles W., et al. "Effects of Persistent Exposure to COVID-19 on Mental Health and
Burnout Outcomes Among Trainees: A Longitudinal Study (Preprint)." 2021.
Nguyen, Phuong T., et al. "Psychological Stress Risk Factors, Concerns and Mental Health
Support Among Health Care Workers in Vietnam During the Coronavirus Disease 2019
(COVID-19) Outbreak." Frontiers in Public Health, vol. 9, 2021.
Park, Chulyong, et al. "COVID-19 Outbreak and Its Association with Healthcare Workers'
Emotional Stress: a Cross-Sectional Study." Journal of Korean Medical Science, vol. 35,
no. 41, 2020.