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Pak J Med Sci May – 2020 Vol. 36 No. COVID19-S4 www.pjms.org.pk COVID19-S37INTRODUCTION End of 2019 brought the global community to be aware of an emerging health crisis which originated in WUHAN CHINA. Most of the world was not prepared for a situation in which their whole lives will change so in spite of warning messages, the response by global health community and policy makers was slow. In January 2020 the World Health Organization (WHO) declared the outbreak of a new coronavirus disease, COVID-19, to be a Public Health Emergency of International Concern.1 WHO stated that there is a high risk of COVID-19 spreading to other countries around the Correspondence:Dr. Uzma Urooj, MBBS, FCPS.Assistant Professor, Department of Gynae/Obs,Army Medical College, NUMS, MH Rawalpindi, Pakistan.Res: Flat G, Block 4, Range Road,Opposite CMH Rawalpindi, Pakistan.Email: druzmaurooj@yahoo.com * Received for Publication: April 7, 2020 * 1st Revision Received: April 14, 2020 * 2nd Revision Received: April 23, 2020 * Final Revision Accepted: April 25, 2020Original ArticleExpectations, Fears and Perceptions of doctors during Covid-19 PandemicUzma Urooj1, Asma Ansari2, Asifa Siraj3, Sumaira Khan4, Humaira Tariq5ABSTRACTObjectives: The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic.Methods:This is a mixed method exploratory survey. A questionnaireexploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group.Results:The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fearincluded, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations.Conclusion:It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers.KEYWORDS: Covid-19, Fears, Mental stress, Pandemic, Expectations.doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643How to cite this:Urooj U, Ansari A, Siraj A, Khan S, Tariq H. Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S37-S42. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2643This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uzma Urooj et al.Pak J Med Sci May – 2020 Vol. 36 No. COVID19-S4 www.pjms.org.pk COVID19-S38world. In March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic. So, after an initial mundane response suddenly a mass hysteria and panic were created. There was unfiltered non-scientific information bombardment2which affected the health care professionals who are directly exposed to a new virus creating havoc. Reason being that they are not aware what they are fighting with no foreseeable cure and large number of their peers being affected or dying. Some health workers were facing stigmatization and even their families wanted to be disassociated due to a constant stream of negative news.3 Only recently the media has started giving statistics of recovered people too otherwise the news was filled with just people dying everywhere4 invariably contributing to stress and restlessness amongst doctors. This outbreak is a unique and unprecedented scenario for most of the health workers and their families too. This is a long-term fight and requires sustained response.5 Staff needs to be protected from chronic stress and poor mental health during this response. This means they will have a better capacity to fulfil their roles. They need a regular up-to-date information and communication in order to avoid confusion and further stresses. The administrators are also facing the same stresses so there should be mutual trust, constant reassurance, availability of PPE, standard guidelines and flexible duty hours.6 Doctors are amongst the people most at risk of getting the disease. It is causing undue stress and restlessness when colleagues are sick or on ventilator in ICU due to coming in contact with Covid-19.7 Most of the doctors have no one else to take care of their children or families during times of self-isolation or quarantine. As every time a doctor falls ill the already strained health system gets a blow. The biggest concern is bringing the virus home to their families. There is also a fear that if they fall ill they will be betraying the health system and their patients as they will not be able to contribute.8 As new information about the disease is upgraded daily the concerns also rise. The doctor realizes that being young will not be protective or the virus is airborne so from today the protection requirement is different.9 These challenging times are as hard for the patients, communities as well as the health care staff. There is a need to assess the fears, expectations and perceptions of health care workers in our context as it is a topic which is hardly given any attention. Doctors are there to treat but their views should be considered and addressed. This study was conducted to assess the perceptions, expectations and fears of doctors during the Covid-19 pandemic and identify the areas which need to be addressed.METHODS A cross-sectional web-based survey was carried out by using google forms. A new questionnaire was developed, after validation from five experts, who were working as medical educationist as well as senior consultants with experience of more than 15 years. it was pilot tested. The final survey consist-ed of total 12 questions; 8 of which were close-end-ed and 4 were open-ended. Participants included the Pakistani as well as few UK 22.2% (n=10), USA 22.2% (n=10) clinicians, who were actively involved in clinical practice and duties during Covid-19 pan-demic. Sample size was calculated by using open Epi calculator. These clinicians included anesthe-tist, surgeons, physicians, radiologists, pathologists, pediatricians, gynecologists, postgraduate trainees, medical officers & house officers working in various healthcare institutes. The diversity of the group al-lowed for generalization of results to all specialties to assess the clinicians. Opinions from all the an-gles. After ethical approval ER-A/28, and informed consent, 250 participants, selected through purpo-sive sampling, were contacted through E-mails and WhatsApp group’s anonymity and confidential-ity was assured. Later, reminders were also sent via e-mails and WhatsApp. 222 participants filled questionnaire and returned forms. Data was saved in Excel sheets directly from the Google forms. For close-ended questions frequencies and percentages were calculated. For open-ended questions induc-tive coding was done in excel. After initial coding, line-by-line coding was done for each response by primary researcher (UU) and the similar codes were grouped together to make themes. Frequencies were calculated for each theme. The coding process and themes were cross-checked by four reviewers separately (AA, AS, SK, RI) for validation.RESULTSThe study included 150(67.5%) Female and 72(32.4%) Male participants. The mean age was 33.58±4.21 years. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. Covid-19 patients were not present in hospitals of 134(60.3%) doctors and 88(39.3%) doctors had Covid-19 patients in their hospitals. Fears of doctors are shown in Table-I.

Pak J Med Sci May – 2020 Vol. 36 No. COVID19-S4 www.pjms.org.pk COVID19-S39 Covid-19 patients were not present in hospitals of 60.36% (n=134) doctors who responded and 39.3% (n=88) doctors had Covid-19 patients in their hospitals. 83.3% (n=185) doctors were aware of the SOPs and policies related to Covid-19, whereas 15.8% (n=35) were not aware and 0.9% (n=2) responded “may be”. Donning and doffing awareness was there in 76.1% (n=169), no awareness in 5.8% (n=13) and “may be” was answer of 18.1% (n=40). Following themes were generated from the open-ended questions.Fears of doctors: Fears of doctors included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. Some of the statements of participants were;-“Facing a situation where I am helpless against the state of the patient” (P 2)-“To get infected” (P 13)-“We are working without PPE….may be infected with corona virus” (P 23)-“To have the severe complications of the disease in the patients n in ourselves” (P 30)-“…..Disease can spread rapidly” (P 35)-“Fearful for the family back home” (P 40)-“Treating a patient normally who turns out to be covid19 positive later on” (P 41)-“I have to perform my duty because I am doctor…no fear…” (P 44)-“I have faith in Allah” (P 45)-“Exposing my family to infection as well” (P 49)-“Catching the infection and unknowingly becoming a spreader rather than the care giver.” (P 178)-“Asymptomatic carriers and transmission are worrisome” (P 180)-“Panic among the paramedics and junior staff” (P 185)-“As we work without PPE……fear of getting corona virus” (P=196)Feelings of doctors during duties: Doctors expressed different feelings while working during Covid-19 pandemic. Some of these feelings were; Uncertainty and fear 12.1% (n=27), sense of duty 27.9% (n=62), depressing circumstances 58% (n=129), anxiety 86% (n=191), worried 28.8% (n=64), motivated 33.3% (n=74), hopeful 56.7% (n=126), cautious 31% (n=69), ambitious 15.3% (n=34), apprehensive and confused 4% (n=9). Some of the statements were;-“We feel proud of being the frontline fighters against this illness” (P 136) -“As a doctor, I’m at high risk and I’m feeling proud while performing high risk duties during this pandemic” (P 153)-“Praying to be out of this pandemic as early as possible” (P 169)-“Feel grateful to be given a chance to help the affected” (P 176) -“Fearful but ambitious” (P 181)-“Uncertainty about the entire situation and fears of contacting infection” (P 188)-“Worried because of not having proper PPE”-“Feelings of empathy for people who are quarantined and for patients who have contracted covid-19” (P 193)-“We have to work through thick and thin and protect our families as well” (P 197)-“Working with full energy along with faith in Allah Almighty” (P 201)-“Serving humanity and mankind” (P213)-“I feel obliged that I am fulfilling my duties…” (P 220)-“Situation is same everywhere. Protective kits, PPE is available to only the administration who will never directly see the patient, the real healthcare teams are given scanty sources”Thoughts going through the mind of doctors on way to duty: Responses of doctors on question regarding their thoughts while they are on way to hospital were mixed. Some of these thoughts are documented in their words as follows;-“May ALLAH protect us all and give speedy recovery Fears & Perceptions of doctors during Covid-19 PandemicTable-I: Fears of doctors.Fear FrequencyInfecting family members 177(79.7%)Rapid spread of disease 140(63%)Complications of disease 134(60.3%)Becoming a carrier 64(28.8%)Missing the diagnosis 62(27.9%)Fig.1: Family as center of concern.