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To the Editor—The outbreak of the 2019 novel coronavirus disease (COVID-19) infection in Wuhan has rapidly and widely spread nationwide and to other countries, which has caused an exponential increase in patients with infection. As of 23 March 2020, the number of confirmed cases of COVID-19 infection increased to 81 171 in the Chinese mainland, including 3277 deaths and 1573 patients in critical condition [1]. With the national fight to combat the COVID-19 for about 60 days after Wuhan was sealed off, the number of confirmed cases in China, including in Hubei province, has continued to decline and suspected cases nationwide have also dropped sharply. However, the number of cases of infection in other countries is still rising, with a rapid increase in Europe, especially in Italy, and other parts of the world. A total of 302 704 patients with confirmed disease and 28 342 deaths have been reported in countries outside of China so far. Frontline medical workers and scientists have played a leading role in fighting against the COVID-19 outbreak. China has sent many medical staff from across the country to Hubei province in the virus fight. Almost all medical workers in Hubei province have worked on the frontline to participate in the emergency response. According to preliminary estimates, there were more than 80 000 medical workers in 131 COVID-19–designated hospitals, and more than 170 000 medical workers in Hubei province fighting against COVID-19. In additon, a total of 6097 medical workers from different provinces in China were in Hubei province to assist in the response to COVID-19 by 30 January 2020 [2]. More medical teams were then sent out to the hardest-hit areas in Hubei province, including rescue and medical teams from different provinces, the army medical teams, specialized doctors’ and nurses’ teams, and emergency medical teams from different hospitals. For example, the emergency medical team from the Second Xiangya Hospital was able to set up field hospitals and ambulances to help and serve the victims. These medical staff are in the forefront of the battle to combat COVID-19, providing medical services to the most affected areas. The updates of confirmed case numbers of medical staff infection have alarmed the pandemic status and severity of COVID-19. As of 11 February, statistical data show that the outbreak has caused 1716 confirmed cases of medical staff infection, with 1502 (87.5% of the total medical staff infections) in Hubei province, and a grievous loss of 6 lives. The majority of these cases came from Wuhan, where 1102 medical staff were infected with COVID-19 in the outbreak [3]. On 24 February, the World Health Organization–China Joint Mission on COVID-19 held a press conference in Beijing and announced that over 3000 medical personnel were infected with COVID-19. On 23 March, there were 4824 medical staff who had been infected with COVID-19 in Italy [4]. Mental health care for the frontline medical workers around the word is urgently needed [5]. The frontline medical professionals have worked under great psychological stress and faced many challenges and losses [6]. The large number of patients with COVID-19, suspected cases, hospitalizations, and patients in critical condition has made the medical work incredibly hard. The transmission of COVID-19 from humans to humans and the increasing number of deaths could elicit their unease and fear about getting infected. The bad outcomes of some critical patients and the suffering of patients and their relatives could lead to worsening anxiety and mental distress. The lack of medical supplies, the uncertain information from various resources, the loneliness, and concerns for their loved ones may increase the mental pressure. These factors will increase medical staffs’ anxiety and lead them to be reluctant to work [7]. Although the National Health Commission of China has released the notification of basic principles for emergency psychological crisis interventions for the patients with COVID-19 pneumonia [8], the psychological condition of healthcare workers has often been neglected [6, 9]. To this, a recent notice issued by the State Council announced that the governments should provide a guarantee for the frontline medical workers and their families [10]. In addition to basic goods and supplies, security, and work subsidies, the notice emphasized the importance of timely mental health care for medical staff. First, to provide health and life support to prevent them from being vulnerable to potential physical and mental health problems, including COVID-19. Second, to find and help with the negative psychological status and sleep disorders of healthcare staff to promote the prevention and intervention of mental diseases. Third, to build and encourage the communication of healthcare staff and their families, relieve their psychological stress, and strengthen the confidence and courage to defeat the disease. The State Council on 11 February issued a new notice concerning the physical and mental health of frontline medical staff, which was jointly drawn up by several ministries including the National Health Commission [11]. There are 4 national mental psychological illness clinical medicine research centers in China. Led by the 4 national mental centers, all mental health and psychological centers across the country responded quickly to offer psychological counseling and support. An increasing number of psychiatric hospitals, psychology departments, and psychologists have gradually developed psychology measurement systems and provided strategies and counseling services for healthcare professionals to deal with psychological problems. For example, the Mental Health Institute of the Second Xiangya Hospital set up a psychological serving platform on 12 February to provide telephone counseling, online counseling, and video-consulting services for frontline medical staff. An online screening inventory was also developed to help frontline medical staff identify their possible mental problem and get timely psychological support through strategies to reduce psychological stress, the Psychic Hotline, and online diagnosis by professional psychiatrists [12]. Systematic psychological training for the frontline medical staff and back-up staff was provided through instructor-led online training, onsite training, and group training. The health committee of Sichuan has developed a series of mental health services for medical staff. In addition to online and telephone counseling, they adopted innovative psychological interventions through short videos and online games [13]. Different organizations have posted self-rated mental health scales for medical staff and provided suggestions based on their results. Mental health handbooks were also developed to help people deal with stress and other psychological problems. Moreover, mental health centers were required to start on-site psychological assistance by sending experienced psychologists to the most affected areas of the COVID-19 outbreak. Based on the limited medical resources, most psychological experts have been and will be dispatched to Hubei province to support mental health services. With the increasing spread of the virus worldwide, the COVID-19 outbreak is now considered a pandemic. While there are many challenges and struggles with COVID-19, we know that we are engaged and prepared for the fight. With the huge efforts to offer mental health care for medical professionals, patients, and others affected by the outbreak, we hope this can bring courage, confidence, and willpower to these fighters, and the end of the outbreak comes soon. Financial support. The study is supported by the National Nature Science Foundation of China (grant number 81901401); Key R&D Program Projects, National Science Foundation of China (grant number 2016YFC1306900); and the National Nature Science Foundation of China (grant number 81622018). Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
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