Healthcare worker fatigue during COVID-19, SARS, and MERS: a meta-analysis

The physical and psychological impact of caring for patients during a coronavirus public health emergency had adverse effects on healthcare workers (HCW), including fatigue.

To examine the prevalence of fatigue among HCW during severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) or Coronavirus disease 19 (COVID-19) and identify associated risk and protective factors.

Systematic searches of Embase, PsycINFO, Ovid-MEDLINE, CINAHL, HMIC and the Cochrane Library were conducted to July 2024. Inclusion criteria were English-language quantitative reports of fatigue in HCW during COVID-19, SARS and MERS. Random-effects meta-analyses were used to estimate pooled prevalence. Subgroup analyses examined fatigue by role, frontline status and personal protective equipment (PPE).

Eighty-eight articles (n = 74 914) met our inclusion criteria; 32 were eligible for meta-analysis. The pooled prevalence of fatigue was 55% (95% CI 46-65%, k = 32). Mental fatigue was reported by 58% (95% CI 17-90%, k = 4), while 53% (95% CI 38-67%, k = 11) experienced fatigue related to PPE use. No significant differences were observed between doctors and nurses (P = 0.327) or frontline and non-frontline staff (P = 0.103). Risk factors included stress, anxiety, depressive symptoms, workload and extended working hours, while resilience, self-efficacy and sufficient rest were protective. Substantial heterogeneity (I2 ∼99%) and reliance on cross-sectional designs limited causal inference.

Our study indicated that over half of HCW reported fatigue and highlighted its multifactorial nature. Organizational-level interventions, such as optimized shift patterns, mandated rest breaks and psychological support are essential to mitigate fatigue, safeguard wellbeing and ensure safe healthcare provision.