Aggression, mini-aggression, and abuse against health care workers during the COVID-19 pandemic
Authors: Garcia-Zamora S , Pulido L , Antoniolli M , Garcia D , Perez G , Priotti M , Zaidel E , Lopez-Santi R , Vazquez G , Chango-Azanza D X , Nunez-Mendez R , Cabral L T , Sosa-Liprandi A , Miranda-Arboleda A F , Baranchuk A 
Published: December 2022

Abstract

Introduction
COVID-19 pandemic brought multiple negative consequences that go beyond the direct damage caused by the disease and that affect health systems as well. Complaints of attacks against health care workers became frequent and concerning. The objective of this survey was to characterize the frequency and type of violent behavior against front-line professionals in Latin America.

Material and methods
A cross-sectional electronic survey was carried out between January 11th to February 28th, 2022. Different health care workers from Latin America who have been delivering care at least from March 2020, regardless of whether they assist or not patients with COVID-19 were included. A non-probabilistic snowball sampling was performed, and the survey was

Results
The survey was responded by 3,544 participants from 19 countries (Figure 1); 58.5% were women, and the mean age was 41.9±11 years. The 70.8% were doctors, 16% nurses, 3.4% physiotherapists, and the remaining 9.8% had other functions within the health team. About 85.1% of physicians were specialists: 33.9% were cardiologists, 14.4% were intensivists or emergency physicians, 10.9% had some surgical specialty, 7.7% were pediatricians or related subspecialties, and the remaining 33.1% had other specialties. The 36.3% and 28.8% worked in public and private practice respectively, the remaining worked in both. Direct and regular care to COVID-19 patients was provided by 74.7% of all contestants.
Among the participants, 54.8% reported acts of violence: 95.6% suffered verbal violence, 11.1% physical violence, and 19.9% other types. 39.5% of respondents experienced it at least once a week. The acts of violence involved patients' relatives (32%), or patients together with their relatives (35.1%). The victims rated the stress level of these events with an average of 8.2±1.8 points (scale from 1 to 10). Approximately half of the health personnel who suffered an assault experienced psychosomatic symptoms after the traumatic event (Figure 2). Among the victims of violence, 56.2% considered changing their care tasks, and 33.6% abandoning their profession. However, only 23% of the health personnel attacked stated that they had made some type of legal action regarding these acts.
In a logistic regression model, doctors (OR 1.95, p&lt;0.01), nurses (OR 1.77, p=0.001), and administrative staff (OR 3.20, p&lt;0.01) suffered more violence than other health workers. Women more frequently suffered violence (OR 1.56, p&lt;0.01), as well as those who worked with patients with COVID-19 (OR 3.59, p&lt;0.01). Conversely, a lower probability of violence was observed at older ages (OR 0.96, p&lt;0.01).

Conclusion
We detected a high prevalence of violence against health personnel in Latin America during the current pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be more vulnerable. It is imperative to develop strategies to mitigate these acts and their repercussions on the health team.

Funding Acknowledgement
Type of funding sources: None.