To the Editor:
The COVID-19 pandemic is a global health threat with some experts arguing it is the most serious respiratory virus threat to public health since the 1918 influenza outbreak.1 As of May 10, 2020, there have been 4,097,158 confirmed cases and 282,495 deaths worldwide.2 COVID-19 has challenged our daily living, economic stability, and behaviors.
Health workers are the cornerstone of every health system. Health workers are at the front line of COVID-19 and are exposed to hazards that put their lives at risk. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, and occupational burnout.3 Health workers experience stress and concern about transmitting the disease to family members and experience a constant sense of intense fear, stigmatization, and ostracism when treating patients with COVID-19.3 There is an urgent need to care for the wellbeing of health workers to prevent serious consequences for patients and a possible collapse in our health systems.
In contrast with other countries, health workers in Mexico are not always praised, and some experience discrimination, threats, and attacks.4 As of May 10, 2020, there have been 33,460 confirmed cases of COVID-19 in Mexico and 3353 reported deaths.2 The growing number of COVID-19 cases in Mexico has brought with it a wave of violence against health workers who have wrongly been accused of spreading the disease.4 Some patients have been observed to purposely cough or spit on health care workers. Health workers, hospital administration, and government must exercise “zero tolerance” concerning violence against health workers.
Violence against health workers is a complex problem5–7 and there is a lack of rigorous research to address it.8,9 The current climate in Mexico and clear gaps in the literature strongly support the need for studies to understand, prevent, and address violence against health workers, especially in the context of infectious disease outbreaks.
Rosibel Rodríguez-Bolaños, PhD*
Francisco Cartujano-Barrera, MD†
Brenda Cartujano, MD‡
Yvonne N. Flores, PhD§∥
Ana Paula Cupertino, PhD¶
Katia Gallegos-Carrillo, ScD§
*Department of Tobacco Research, National Institute of Public Health Cuernavaca, Morelos, Mexico
†Department of Cancer Prevention and Control, Hackensack University Medical Center, Hackensack, NJ
‡Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY
§Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico
∥UCLA Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA
¶James P. Wilmot Cancer Institute University of Rochester Medical Center Rochester, NY
1. Ferguson NM, Laydon D, Nedjati-Gilani G, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team. 2020. https://doi.org/10.25561/77482
2. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;S1473-3099:30120–30121.
3. Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;S0889-1591:30523–30527.
4. United Nations News: La ONU en México condena las agresiones contra los profesionales de la salud que lucha contra el coronavirus. Available at: https://news.un.org/es/story/2020/04/1473372
. Accessed April 26, 2020.
5. Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;374:1661–1669.
6. Singh M. Intolerance and violence against doctors. Indian J Pediatr. 2017;84:768–773.
7. Luna-García JE, Urrego-Mendoza Z, Gutiérrez-Robayo M, et al. Violencia en el trabajo del sector público de la salud: una visión desde las personas trabajadoras. Bogotá, Colombia, 2011-2012 [Violence at work in the public health sector: a view from the working people. Bogotá Colombia, 2011-2012]. Rev Fac Med. 2015;63:407–417.
8. Runyan CW, Zakocs RC, Zwerling C. Administrative and behavioral interventions for workplace violence prevention. Am J Prev Med. 2000;18(suppl):116–127.
9. Heckemann B, Zeller A, Hahn S, et al. The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting. A narrative review of current literature. Nurse Educ Today. 2015;35:212–219.