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Table 1 Themes and sub-themes emerging from the data

From: Documenting response to COVID-individual and systems successes and challenges: a longitudinal qualitative study

Themes

Sub-Themes

Evolution of perceptions over time

Individual-level Challenges

Fear of getting infected

The fear of getting infected by COVID was very high in the peak months, and for most of the participants, the fear reduced with time as the COVID cases started to decrease and the HCWs adapted to the new normal

Feeling demotivated and unappreciated

The HCWs felt emotionally taxed in the initial days of COVID. There was a feeling of sadness as the hospitals could not provide care to all the patients. In addition, they felt demotivated as the patients and the attendants treated them rudely when they could not get beds in the hospital

However, with time these negative interactions decreased

Disappointment due to people’s lack of compliance with COVID-19 protocols

The participants felt disheartened when they saw that the people were taking COVID lightly and were not following COVID-19 precautionary measures (wearing masks and physical distancing). This concern was there even when the number of cases went down in the later months

Physical Impacts due to heavy PPE use

Almost all the patients found it very difficult to wear the full PPEs. They felt tired, exhausted, and suffocated from wearing PPEs. Some even reported a lack of PPEs initially

Over time, the participants still felt it challenging to wear PPEs however they were now used to it. In addition, the participants reported satisfaction with the PPE's availability

Health System Challenges

Infrastructure, logistics, management, and communications response of the hospital

The healthcare workers felt difficulties in the initial months due to smaller, congested areas with reduced space to accommodate increasing cases, limited bed capacity, reduced bipAps/ventilator capacity, difficulty in communication due to heavy PPEs, shortages in the workforce, poor management skills of the workforce for critical patients as the disease was unknown, not trained how to use the PPEs properly

The FHCWs expressed relief and appreciation as the hospitals adapted over time by increasing the space and capacity of designated COVID-19 zones, the number of beds, the human resource, provided training in donning and donning of PPEs, improved management skills of critical patients, knowledge of the disease, and timely communication

Financial stressors

Initially, the participants were apprehensive about how will they make their ends meet if their salaries were reduced

The participants expressed much relief in the later months when the salaries were not reduced however there was a disappointment as the overtime salaries were discontinued

Hope for future

Improved disease knowledge and vaccine development trials

In the latter half of the study, the participants felt optimistic about the future and had high hopes for a COVID-free world as there was improved disease knowledge and ongoing trials for vaccine development