Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic

PLOS ONE RESEARCH ARTICLE Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic Espen Saxhaug Kristoffersen ID1,2*, Bendik Slagsvold Winsvold ID3,4, Else Charlotte Sandset4,5, Anette Margrethe Storstein6, Kashif Waqar Faiz1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Neurology, Akershus University Hospital, Lørenskog, Norway, 2 Department of General Practice, University of Oslo, Oslo, Norway, 3 Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway, 4 Department of Neurology, Oslo University Hospital, Oslo, Norway, 5 The Norwegian Air Ambulance Foundation, Oslo, Norway, 6 Department of Neurology, Haukeland University Hospital, Bergen, Norway * Abstract OPEN ACCESS Citation: Kristoffersen ES, Winsvold BS, Sandset EC, Storstein AM, Faiz KW (2021) Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic. PLoS ONE 16(2): e0246567. https://doi.org/10.1371/journal. pone.0246567 Background The ongoing COVID-19 pandemic has caused rapid changes in the healthcare system. Workforce reorganization, reduced standard of care and a lack of personal protection equipment (PPE) for health care workers were among the concerns raised in the first wave of the pandemic. Our aim was to explore the experiences, distress and burden among Norwegian neurologists during the first weeks of the pandemic. Editor: Emanuele Bartolini, Nuovo Ospedale Prato (NOP) Santo Stefano, USL Toscana Centro, ITALY Received: December 23, 2020 Methods Accepted: January 21, 2021 Hospital-based neurologists in Norway (n = 400) were invited to a web-based survey in April 2020. The study focused on patient management, organizational changes and personal stress during the first weeks of the pandemic lockdown. Work-home interface stress was assessed by the Cooper Job Stress Questionnaire. Published: February 4, 2021 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0246567 Copyright: © 2021 Kristoffersen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting information files. Results In total, 135 neurologists participated. Seventy-three% experienced a change in their personal work situation, and 67% examined patients with suspected COVID-19 infection and neurological disease. Changed access to resources, and the perception that medical followup was unsatisfactory, were associated with a high degree of burden and stress. Neurologists were also worried about the potential lack of PPE and the fear of spreading SARS CoV-2 to close family members. The mean score of work-home interface stress was 2.8 with no significant differences between gender or specialist status. Reduced standard of care was reported for all neurological conditions, and in particular for non-emergency treatments. PLOS ONE | https://doi.org/10.1371/journal.pone.0246567 February 4, 2021 1 / 14 PLOS ONE Funding: The author(s) received no specific funding for this work. Competing interests: BWS has received speaking fees from Novartis, unrelated to the present work. ECS has received speaking fees from Bayer and Novartis, unrelated to the present work. AMS,ESK, KWF and SHJ report no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Neurology during the COVID-19 pandemic Conclusion The vast majority of neurologists in Norway experienced a change in their personal work situation during the first phase of the pandemic. The fear of becoming infected and ill was not a major contributor to burden and stress. Introduction The coronavirus disease of 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020 and led to challenges in the delivery of medical care worldwide [1, 2]. Initially, there was much uncertainty, and different countries and regions chose different approaches. The major common goal was to reduce cross-infection with Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) and thus to protect patients and hospital staff in order to avoid critically overloading the healthcare system [3]. Workforce reorganization, changing and increased shift load and downscaling of usual care were among the initial efforts made [3]. In many countries this led to a reduced availability of in-hospital appointments and delayed treatment for chronic diseases [2]. A rapid shift in favor of telemedicine provided continuous access to care despite infection control measures for some patients, but for others this resulted in suboptimal consultations without the possibility of a proper clinical examination and treatment [4, 5]. While efforts were made on all levels of the healthcare system, physiciansincluding neurologists—remained on the frontline. Early reports of lack of personal protective equipment (PPE) and deaths among exposed physicians contributed to uncertainty and fear [6, 7]. During these first hectic weeks of the pandemic, it was reported that a proportion of COVID-19 patients presented with neurological symptoms [8, 9]. No consensus statements were in place for the management of neurological disorders in the very beginning of the pandemic. Thus, neurologists needed to handle uncertainty, potential risk of infection, and balancing the risk of being infected with the need to protect patients with chronic neurological disorders that were at increased risk if infected by COVID-19. In addition, workforce reorganization, long shifts, increased workload, physical exhaustion, social isolation, quarantine, inadequate PPE, uncertainty about virus transmission routes, and the need to make treatment decisions with reduced standard of care may have affected both physical and mental health [10]. The work-home interface stress may have increased as a consequence of work-related changes, but also out of fear to bring infection home to the family. The effect of this additional stress is of interest, in particular in light of the high rates of burnout among neurologists compared to other physicians and the general population [11, 12]. Such stressors may increase the risk of medical errors and reduced patient safety, which themselves are a risk factor for physician burnouts [12]. The objectives of this “Neurology during a pandemic” (NeuroPan) study were two-fold: i) to investigate the initial experiences of management of neurological patients, and ii) to investig (...truncated)