Researchers at the University of Limerick’s RISE Lab and University of Gloucestershire’s HERA Lab have explored the experiences of frontline workers in the pandemic, as part of their CV19 Heroes project, uncovering new evidence for broader social influence in determining workers’ welfare. Dr. Elaine Kinsella and Dr. Rachel Sumner set up the CV19 Heroes project in March 2020 to track the welfare of all sectors of frontline workers in Ireland and the UK during the pandemic. The project has collected survey data and interview data from frontline keyworkers across all sectors (healthcare workers, but also supermarket workers, teachers, postal workers, police officers and Gardaí, delivery drivers, social workers, and many more) to understand more about their experiences, and what the consequences of their critical work will be.
Over the summer of 2020, the research team conducted 38 interviews with frontline workers across sectors, and in both countries (9 male, 29 female; 21 from Ireland, 17 from the UK), and their findings from this work have been published open access in Psychology and Health. The interviews were established to explore the psychological impact of working through COVID-19, and what key events or factors were important to the workers in determining their experiences of the pandemic. The project was established with a specific view to understand differences between the two nations due to their very different pandemic strategies (with the UK leading with a “herd immunity” strategy, and Ireland adopting a suppression approach), although for this phase the focus was more on understanding their experiences as a whole. The findings from this study have provided new information into our understanding of frontline working: firstly, that these workers have many shared experiences despite their diverse roles and sectors; and secondly, that their welfare is being impacted upon by very broad social factors beyond those in the workplace, including the media, the actions of the government, and the actions of the public.
Of key importance across the sample of participants was the influence of wider social contexts and rhetoric on their sense of health and wellbeing. For instance, they cited the impact of the media, slow government decisions and public adherence to public health advice on their health and wellbeing. Many participants described how they needed to cut back on their interactions with the media, social media, and government briefings over time as a means of preserving their mental health. Many participants based in the UK questioned the speed of the UK government response with some describing the move into lockdown as an “afterthought”, echoing the group’s recent findings in their first quantitative study from the project. Another key driver of negative perceptions of UK government response was inconsistency in messaging, whereas, for the most part, frontline workers in Ireland after the first surge were reasonably happy with the (then) caretaker government response to move the country into the initial lockdown —most felt the government and public health response was clear and timely. In stark contrast, the Irish government were actually commended for “listening to health experts rather than economic experts.” However, this was not always the case, as many participants identified major problems with the Irish government response in their lack of protection of vulnerable elderly in nursing homes and lack of provision of childcare. This suggests that while the Irish government response was commended in many ways, there was a failure to prioritise the needs of vulnerable and marginalised members of society.
Frontline workers have all reported increased psychological stress, exhaustion, and emotional toll from their particular roles in the pandemic. The illness and death observed by health and care workers was on a different scale to previous health crises. Many frontline workers expressed their deep sense of trauma, not only in seeing so much sickness and death, but also, in seeing individuals and families isolated in their grief and illness. The psychological and emotional toll was expressed across all sectors with workers outside of healthcare settings also describing their overwhelm and exhaustion through working long hours, covering for staff shortages, separation from family, fear of spreading the virus, and not being able to switch off from work. Increasing sick rates and suicide rates were reported across different sectors. Many participants reported as sense of duty to their work in the moment, but felt a sense of pride and strength through their important contribution. A few participants did note positive changes to work practices (e.g., different shift patterns, greater flexibility) had come about since the start of the outbreak, and others noted that it had not affected them in a particularly negative way. However, many others were concerned about the long-term psychological impact of working on the frontline with one participant likening the long-term health impact on frontline workers as a “time bomb”. Those in leadership positions outlined their concerns about asking staff to continuing working in difficult circumstances and faced their own moral dilemma in doing so, often with limited support. A number of those interviewed felt strong emotions, including frustration and anger, with people in their local community who were seen to blatantly disobey the public health rules including physical distancing and social restrictions: one frontline worker described this behaviour as “a kick in the teeth”.
Of interest were the participants’ perceptions of society’s injustices and hierarchies, and how these have become more apparent during the pandemic, and consequently weighing heavily on them. One participant eloquently described how the pandemic had brought the “shadows of society into light” and saw this as opportunity to do better in the future. A number of participants viewed the crisis as an opportunity to bring about positive changes in our own lives and communities. Many frontline workers also felt a sense of injustice with how the ‘hero’ label was being used over time. With some people categorised as heroes, while others were not, and many were called heroes but yet were not receiving appropriate compensation or supports. Whilst they are often not comfortable with internalising the hero label, many point to other sectors of frontline workers as being the “real heroes”. This particular concept was also highlighted by the researchers in a recent response to an article on the hero label in the pandemic published in the BMJ Journal of Medical Ethics.
In some more positive news, many participants felt that the pandemic had offered some unexpected benefits in their work and home lives, and in the wider community. A major positive was the sense of appreciation generated by others: some occupations which were previously seen as having a lower perceived value and status became more highly valued and better understood during the pandemic. Other benefits described by participants included closer working relationships with colleagues and finding new ways to connect and communicate with loved ones (often using technology). Others reported enhanced relationships with family and having more time to spend with family members. Some participants reported a shift in personal values and priorities, and rekindling their religiosity. Many people developed a deep sense of gratitude and appreciation for their own lives, often because of comparing themselves to others who were less well off (i.e., had lost their job, or did not have a garden, or lived in small houses or apartments). Some participants felt gratitude for their loved ones, nature, and day-to-day activities like sharing a meal together, and gratitude for their own resilience in dealing with pandemic-related challenges. Others expressed abstract and profound sentiments about how the world would be better because of this great upheaval. The prevailing sentiment was hope that at least some of the positive changes would remain.
Speaking on the work, Dr. Elaine Kinsella said: “Overall, this study has highlighted some new and really important context-specific factors that provide meaning for participants in understanding their roles in the pandemic in the UK and Ireland, as well as some factors that appear to be shared regardless of the geographic or situational context. Importantly, we see here that all frontline workers (not limited to healthcare roles) regardless of their role experience similar joys and sorrows”. The study has found that frontline workers have experienced great hardships, but often offset their own difficulties by comparing themselves to others who were worse off and looking for ‘silver linings’ in their own lives. Moreover, the researchers have been able to provide context to their previous findings of the importance of government response in welfare outcomes for these workers.
Dr. Rachel Sumner adds: “Decisive, clear, and strong action by central government resonates through the workforce, providing confidence in being supported to do their job. But crucially, meaningful action should also support these words, as it appears the incongruence has been particularly injurious for those on the frontline”. The study adds weight to existing literature that has covered the unfolding of the pandemic, highlighting the harm caused when governments fail to protect the vulnerable during the darkest moments in history not only for those vulnerable individuals themselves, but also for the employees who are tasked with caring for the vulnerable without proper resourcing or supports, and for the concerned onlookers. The present work provides important lessons for all actors in the pandemic – from the individual to the community, to the organisations, and the legislature.
