The present study was to assess perception and attitude of hospital-based HCWs, with regard to Covid-19 crisis. An overall average concern score of 48.5±12.8 out of a maximum possible score of 96 points was observed, with a negative range of attitude, indicating a moderate level of concern. In comparison with the results of a previous survey in the same settings using the same data collection tool, to assess the concern of HCWs about MERS outbreak in Saudi Arabia,16 HCWs reported significantly higher mean concern scores about Covid-19 pandemic. These were observed for; overall concern, self-satisfaction-related concern, social status-related concern and government-related concern. These findings reflect the higher concern about Covid-19 than MERS-CoV among HCWs in the same setting with a previous MERS-Cov outbreak.16 This may reflect the impact and role of mass media and social media marketing on the way we perceive our world and our everyday lives on individual, social and societal levels, during these critical times. Even with the help of the media, this pandemic has had worldwide repercussions and is not yet controlled in some countries. However, the finding of a significantly lower mean score reported for infection control-related concern about Covid-19 infection may be attributed to the previous experiences of HCWs, and the institutions they work for, with MERS-outbreak of how to deal with such outbreaks. A study was carried out on 582 HCWs at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, showed that the majority of HCWs had mild anxiety from Covid-19.13 However; the survey was conducted before registering any case of Covid-19 in Saudi Arabia.
An important finding in the present study was that a high level of concern about Covid-19 pandemic was prevalent across the different concern domains. The highest level of concern was observed in the HCWs’ responses to questions regarding fears of infection of a family member, fears of being in public places that may result in infection, the closure of schools and workplaces in the event of an epidemic and risks associated with dealing with a febrile patient, obligation of care provision for patients infected with Covid-19 and government’s action to implement the curfew and the movement restriction periods. It was interesting that in the present study, 85% agreed that school and shopping markets need to be closed, while only 19% during the previous MERS outbreak.16 This finding may reflect the perception of HCWs in our study of the magnitude of Covid-19 pandemic. However, it is important to note that this perception of fear might differ from country to another. For example in Japan with the absence for an epidemic during the SARS-COV outbreak, more than 50% reported having a high level of fear and an anxiety of infection,19 while in Thai study, nearly all HCWs reported acceptance to take the risk of caring for H5N1 patients. 20
In line with the WHO recommendations for institutional preparedness to reduce the impact of potential outbreaks, MNG-HA has developed a comprehensive plan of medical and public health response for Covid-19 epidemic.21 This plan aimed at the protection of HCWs through the implementation of strict infection control measures and personal protection practices. Despite these efforts, HCWs in our study did not feel safe at the workplace and felt at risk of contracting the infection. This finding is similar to a study in the UK in which 66% of the HCWs did not feel confident in the healthcare system’s ability to cope with bird flu epidemic.22. The exact reasons of such high concern among HCWs, despite the existence of a preparedness plan, cannot be determined from the current study and further studies are needed.
Our study shows that HCWs who were in direct contact with patients had significantly higher concern scores than those who were not in direct contact. This finding was in agreement with the results of a study in China23 to compare the average values of fear, anxiety and depression due to Covid-19 pandemic between medical and admin staff, where medical staﬀ reported greater fear, anxiety and depression than administrative staﬀ. This finding is not surprising given the higher perceived risk by those HCW due to the condition of the work environment. However it is important to pay special attention to those HCWs to manage their perception of risk by ensuring that they have access to proper personal protective equipment (PPE) and safe patients’ handling procedures.24
Saudi HCWs, in the present study, reported higher concern to Covid-19 pandemic as compared to non-Saudis. This can be explained by the culture norms and the difference in living conditions between Saudis and non Saudi HCW. The majority of non saudi HCW are expats who are likely to live alone with their family memebrs living in their home countries. Therfore expats are less likely to worry about the risk of infecting their family members and loved one compared to Saudi HCW who live with their families and tend to have a very active social life.25. The present study also showed that living with others was an independent predictor of high level of concern about Covid-19 infection, most likely due to their fear of transmitting the infection to others if they get infected.
An interesting but a little counterintuitive finding of our study is the fact that older HCWs were less concerned about covid-19 than the younger ones. This is especially true given that risk factors for severe disease and death in Covid-19 include older age among many other factors.26 However, this finding could be attributed to the fact that oldest HCW's could not be working in direct contact to patients, due to the higher risk of severe disease. Further, there was a significant association between higher concern score and lower education level. In a survey on the undergraduate medical students in 3 medical institutes of Karachi, the majority of students found worrisome of getting infected with Covid-19 during medical rotations, dreaded insufficient care and inappropriate treatment if they acquire infection and thought their institute-associated hospital won’t be able to handle the situation in case of an uncontrolled outbreak.27 One possible explanation can be inferred from the theory of reasoned action of a causal relationship between knowledge and experience and the subsequent positive perception and intention to change behavior.28attitudes and behavioral intent.
In the current study HCWs of western region had significantly higher concern score compared to other regions. This was different than the study during MERS where the HCWs of central region had higher concern than other regions.16 We believe that these differences are likely due to the perception of HCWs of the magnitude of the pandemic in the different regions. During Covid-19, the western region had shown much rapid increase of confirmed cases compared to the other regions.6 Additionally, the government has implemented complete lockdown of the western region prior to other regions. However during MERS, the largest outbreak has taken place in the central region. The large magnitude of the epidemic the western region compared to other regions in the country could have contributed to the observed level of concern of HCWs in this region.
Our study is not without limitation. Our survey was based on self-reported information which might suffer from a recall bias. Moreover, all study participants were HCWs in tertiary hospitals, and therefore could limit the generalizability of the findings to other settings. Finally, all identified predictors of concerns cannot be interpreted beyond general association. Despite these limitations, our study addresses a major problem faced by HCWs in many countries around the world during this pandemic.