Does previous SARS experience help healthcare workers cope with COVID-19?

Previous work during the 2003 SARS outbreak has no overall impact on the psychological distress seen in healthcare workers during the COVID-19 pandemic, although it was associated with lower scores of PTSD and depression, according to a new study published this week in the open-access journal PLOS ONE by Rima Styra of University Health Network, Toronto, Canada, and colleagues.

Surveys of physicians and nurses conducted during the current COVID-19 pandemic have found significant levels of depression, anxiety, insomnia and post-traumatic distress, similar to those seen during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks. Experience working during a prior infectious disease could either heighten or attenuate a person’s psychological response to an emerging infectious disease.

In the new study, Styra and colleagues conducted an online survey of 3,852 healthcare workers in the greater Toronto area, including 1256 nurses (34.1%), 1243 non-clinical staff (28.3%), 1034 allied health staff (28.1%) and 345 physicians (9.4%). 29.1% of respondents had also worked during the 2003 SARS outbreak. Mental health outcomes of healthcare workers were measured using three distinct scales.

More than half (50.2%) of all healthcare workers surveyed had moderate or severe scores for symptoms of post-traumatic stress disorder (PTSD), while rates of anxiety (24.6%) and depression (31.5%) were also high. Non-clinical healthcare workers were found to be at higher risk of anxiety (OR, 1.68; 95% CI, 1.19–2.15, P = .01) and depression (OR 2.03, 95% CI, 1.34–3.07, P < .001), while healthcare workers using sedatives (OR, 2.55; 95% CI, 1.61–4.03, P < .001), those who cared for only 2-5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06–2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96–1.93, P = .05) had a higher risk of PTSD. There was no statistically significant effect of previous SARS work experience on clinical or non-clinical healthcare workers’ overall psychological distress. While those who worked during the SARS outbreak experienced lower scores of PTSD (p=0.002) and depression (p<0.001), these differences disappeared after correcting for other factors such as age and career experience. The authors suggest that the data is important in guiding healthcare systems to provide appropriate, targeted and timely support to healthcare workers. 

The authors add: “Our study highlights the universal emotional distress experienced by healthcare workers, both clinical and non-clinical during the COVID-19 pandemic. It identifies that there are risk and protective factors of which we should be mindful given the wide reaching implications for staff wellness and  staff retention.”