Article Review: Impact of COVID-19 on the Health Care System

Name:

Department

Course

Instructor

Date
Introduction

Heavily shaken by the coronavirus pandemic, many people are thinking about how we

could have arrested the COVID-19 crisis more efficiently. The crisis not only challenges

disease control and management but could also have far-reaching and long-term effects on

states, societies, and international cooperation. Nurses have always been at the front lines of

this battle against an army of billions of microscopic viruses, and they were not spared since

many of them ended up as casualties and most survivors must have been traumatized.

However, despite all odds, nurses kept fighting against the disease all over the world until

humanity emerged victorious with the invention of working vaccines. COVID is still here

with us, and there is a greater need for research on how to arm ourselves in case of another

pandemic. An attempt is made in this essay to review two quantitative articles that shed much

light on how the battle against coronavirus affected health systems and frontline nurses in all

corners of the world.

Article 1

"Quantitative Research on the Impact of COVID-19 on Frontline Nursing Staff at a

Military Hospital In Saudi Arabia” is an article published in the Nursing Open Journal by

Loujain Sharif, Khalid Almutairi, and others. The authors aimed to study the relationship

between stress, psychological symptoms, and Job satisfaction among frontline Nursing staff

at the military hospital in Saudi Arabia during the COVID-19 pandemic. The second article,

"Quantitative Analysis of the Impact of COVID-19 On the Emergency Medical Services

Systems (EMS) in Tokyo," is published in the Acute Medicine and Surgery Journal by

Yutaka Igarashi, Mio Yabuki, and others. The aim is to investigate how the global pandemic

imposed a heavy burden on the Emergency Medical Services systems.

Data was gathered for the study in Saudi Arabia using an online survey. Contact was

made with a population of 1,225 registered nurses who worked at a military hospital between
February and April 2021. Data were evaluated using descriptive and multivariate analysis, the

student's t-test for independent samples, one-way ANOVA, and Tukey's multiple comparison

tests after 625 (51%) respondents provided their responses. The eight components of

demographic data were age, gender, marital status, nationality, level of education, experience,

and department. The scales utilized to determine the causes and frequency of stress and

anxiety among nurses as well as the degrees of job satisfaction were the Expanded Nursing

Stress Scale (ENSS), the Depression, Anxiety, and Stress Scales (DASS), and Job

Satisfaction Survey (JSS).

The analysis of data was conducted using the SPSS 26.0 Windows version statistical

software. Descriptive statistics were used to describe the quantitative and categorical

variables. For the multivariate analysis, a stepwise multiple linear regression was carried out

to observe independent relationships of variables of categorical study variables with the three

quantitative variables namely DASS, ENSS, and JSS score. Dummy variables were created to

facilitate the inclusion of the study variables due to their categorical nature. The proportion of

variability R2 was used to mark the change in the outcome variable explained by the

significant independent variables in the model. Regression coefficients were also used to

report the observed statistical significance of the estimated outputs.

Of the 624 nurses who completed the survey (response rate: 51%), 91.3% were

women, approximately two-thirds (66.8%) were aged between 25–35 years, and more than

50% were unmarried. The majority were Filipino (75.8%), and only 5.6% were Saudi.

Approximately 90% of the sample had a bachelor's degree, and 48.4% had 1–5 years of

experience; 6.3% had more than 15 years of experience. The sample was distributed among

the following departments and units: emergency departments (14.6%), intensive care units

(22.6%), inpatient units (39.1%), and outpatient units (9.6%); the remaining 14.1% were from

other departments. A quarter of the sample (n = 156) had tested positive for COVID-19.
 This investigation revealed a relationship between stress, psychological symptoms,

and job satisfaction. The main concerns were workload, work department, supervision,

collegial relationships, and high mortality rates in patients. More research is needed to

identify what types of support are required, along with mechanisms to tailor such support to

the different variables identified by the nursing participants. Based on the findings of this

study, we recommend focusing efforts on raising awareness among hospital managers

regarding nurses' psychological symptoms and possible support measures, which may include

flexible working hours, clear communication, and training in palliative and end-of-life care.

Finally, qualitative investigation is highly recommended to explore in-depth further context

for the identified sources of stress, and psychological and emotional experiences among

nurses as frontline workers facing COVID-19. A co-design approach may be particularly

beneficial, as this will not only lead to strategies that draw from the knowledge and

experience of the nursing staff but also potentially offer these nurses the opportunity to take

back some control in a time of immense instability.

Article 2

Publicly accessible data, such as the daily number of newly diagnosed COVID

patients, the weekly number of transportation challenges, and the field activity time, from

March 2, 2020, to January 25, 2021, were used to conduct the study in Tokyo. As controls,

data from the same time the year before were used. On January 24, 2020, Tokyo received

official confirmation of the first COVID-19 case. In January, there were three confirmed

COVID-19 cases, followed by 34 cases in February, and 489 cases in March 2020. The

instances from January and February were disregarded (considered outliers) because the

numbers began to increase in March. The data from the TFD included the field activity time

and the number of transport difficulties from March 4, 2019, to January 26, 2020, and from

March 2, 2020, to January 24, 2021.

distribution of patients, the percentage of severe cases, and the survival rate within a month

following out-of-hospital cardiac arrest (OHCA) were also taken into consideration.

Additionally, we made use of TMG data about the daily count of newly diagnosed COVID-

19 patients in Tokyo. The Pearson correlation coefficient was used to determine whether

there was a linear association between two sets of data, and a t-test was performed to

compare the means of continuous variables between the two groups. Statistical significance

was defined as a P value of 0.05. R version 4.0.4 (The R Foundation for Statistical

Computing, Vienna, Austria) was used to analyze all of the data.

When compared to 2019, the overall number of EMS calls dropped by 12.7%

(720,965 versus 825,929) in 2020. The percentage of patients with mild disease reduced the

most, by 16.9%, followed by moderate disease by 12.5%, and severe disease by 8.7%. The

number of sports, job, and automobile injuries declined by 44.5%, 16.1%, and 15.0%,

respectively, depending on the type of emergency call, however, the number of self-harm

injuries grew by 7.2% from 2019 to 2020. There were fewer emergency calls, particularly for

children and teenagers. The survival rate was significantly lower in cases where OHCA was

witnessed (12.9% versus 17.8% in cases where bystander cardiopulmonary resuscitation

(CPR) was administered; P 0.001; and 3.5% versus 5.7% in cases where bystander CPR was

not administered; P 0.001). The overall survival rate at 1 month after OHCA was also

significantly lower in 2020 than in 2019 (4.7% versus 6.3%; P 0.001). Cardiogenic OHCA

and witnessed OHCA with bystander CPR, however, did not alter significantly between 2020

and 2019 (30.9% and 33.4%, respectively; P = 0.24; Fig. 1C). The rate of cardiogenic OHCA

defibrillation did not differ significantly between 2020 and 2019 (41.5% versus 42.0%; P =

0.78).
 According to this study, the Tokyo EMS system was adversely impacted by the rise in

new COVID-19 patients. The frequency of transport difficulties rose by 86.4 per day and the

field activity duration increased by 3.48 minutes for every 1,000 additional patients with

COVID-19 per day. Patients with OHCA may experience a higher mortality risk as a result of

COVID-19.

Conclusion

A review of these two articles shows that although the Pandemic is already behind us,

it has left scars in the health sector. The situation in Saudi Arabia shows that the Pandemic

might have taken away the joy of nurses and other health workers at large. The case of Tokyo

shows that major health systems might have been hard hit by the pandemic. However, these

scars could be used for good, and since many weaknesses in the healthcare systems have been

revealed, it is time for healthcare organizations to recover and enhance the human resource

army of nurses through education and training along with motivation.

References
Igarashi, Y., Yabuki, M., Norii, T., Yokobori, S., & Yokota, H. (2021). Quantitative Analysis

of the Impact of Covid-19 on The Emergency Medical Services System in Tokyo.

Acute Medicine and Surgery, 8(1). doi:https://doi.org/10.1002/ams2.709

Sharif, L., Almutairi, K., Sharif, K., Mahsoon, A., Banakhar, M., Albeladi, S., . . . Wrught, R.

(2023, January). Quantitative Research on The Impact of Covid-19 on Frontline

Nursing Staff at a Military Hospital In Saudi Arabia. Nursing Open, 10(1), 217-229.

doi:https://doi.org/10.1002/nop2.1297