Our study showed a higher response from female doctors. A greater number of responses was obtained from hospital-based doctors and those with at least 21-35 years of professional experience. With respect to the most significant impact caused by the COVID-19 pandemic, around 44.75% of all doctors (53 females, 28 males) had a combination of health, financial and economic as well as professional development and educational issues. Around 54% of all had financial issues. Owners of private practices had suffered more personal losses due to costs for maintenance, provision of personal protective equipment and so on. They did not receive adequate support. Similar findings were seen in certain studies [4, 5].
About 70 doctors were concerned only about their health. A study done in China amongst 1357 health professionals reported more than 85% feared of self-infection , however this accounts for a larger study group than just doctors.
Amongst 128 participants who reported moderate to unbearable psychological impact that was related to COVID-19, 67% were females. And with those with less than 21 years of professional experience, the disease had severe psychological impact on 15 doctors (66.7% females) and had unbearable psychological impact on 5 doctors (60% females).
Certain studies had similar findings of women, young age, married and frontline workers being susceptible to severe mental health problems [6, 7, 8]. Even though we had a higher number of female respondents, the pattern is similar.
Whilst evaluating additional personal problems in our study, 64.2-81.3% doctors reported at least one issue, either singly or in combination. Mental fatigue was the most commonly reported problem, followed by burnout syndrome and physical tiredness. Amongst all doctors, 22% selected other problems too. An evaluation of 3599 Northern Italian dentists found fatigue as one of the most common symptoms suffered . A multinational, multicentre study amongst 906 HCWs in Singapore and India found at least 66.7% experiencing 1 symptom, physical or psychological. 19.4% had anxiety and at least 13.6% had depression . Another systemic review and meta-analysis evaluated 13 studies with a combined total of 33,062 HCWs with a pooled prevalence of 23.1% with anxiety in 12 studies, 22.8% with depression in 10 studies and 34.32% with insomnia in 5 studies . These findings were also corroborated by a study amongst Chinese surgical staff .
Only 15% of our study group reported access to medical and financial support if an employee contracts COVID-19, most were unaware of any services. This is a dire finding, because there is a real risk of reduction in physicians due to the disease or the fear of contracting it. The study done amongst medical practices in USA has shown a real healthcare workforce shortage of 22% layoffs and 48% furloughs in April 2020 with an increased prediction of 36% and 60% respectively in May 2020 . It could be accordingly worse in low income countries, as was seen during the Ebola virus epidemic in West Africa .
In terms of support that should be provided to all ENT doctors, 58 on health services and 48 with financial support, 92 agreed on all services including psychological counselling.
In order to help healthcare systems, USA has signed the Coronavirus Aid, Relief and Economic Security (CARES) Act providing 100 billion dollars to the Department of Health and Human Services to reimburse eligible health care providers for healthcare related expenses or lost revenues attributed to COVID-19 . Europe has decided to provide incentives for surge capacity like Germany pays hospitals 50,000 Euros for each new intensive care unit bed, Netherlands receives 10 Euros for each registered patients and so on. Supplementary payments have been promised to several European countries. Ireland has made agreement with private hospitals to draw on their space, supplies and staff, so that these premises are accessible to the whole population . Maintenance and efficient functioning of health care systems are the key elements in every society worldwide and always need a strong backbone of support, without which, the consequences would be irreparable and disastrous. Furthermore, a large part of maintaining good physical and mental health amongst HCWs, more so amongst specialties with high risk such as Otorhinolaryngology should be made a priority. Mandatory health checks and evaluation of the psychological status of a healthcare professional should be made, if necessary with the help of questionnaires .