Many world leaders have likened the coronavirus pandemic to a ‘war’. If that is the case, it’s one of the most grueling there is since you’re fighting an invisible enemy. This is not a war fought with tanks and fighter jets; the battlefield is in the intensive care ward of hospitals, with healthcare workers on the front lines.

Facing medical supply shortages, interminable shifts, and the risk of a life-threatening illness for themselves and their families, doctors and medical staff are under immense mental strain.

According to China’s National Health Commission, more than 3,300 health-care workers have been infected as of early March and, by the end of February, at least 22 had died. In Italy, 20% of responding healthcare workers were infected, and some have died.

Their reports are harrowing, describing extreme physical and mental exhaustion, tormenting triage decisions that often require sacrificing those with lower chances of surviving in order to save those with better odds, and the pain of losing patients and colleagues — all on top of the hovering stress of becoming infected.

These circumstances are bound to cause symptoms of depression, anxiety, insomnia, and distress. A recent study confirms these suspicions, finding that among “Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.”

The study, which was recently published in the journal JAMA Network Open, involved 1,257 Chinese healthcare workers in 34 hospitals that received COVID-19 patients.

The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale–Revised, respectively.  Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians.

Half of the participants reported symptoms of depression, 44.6% had anxiety, 34% had insomnia, and 71.5% suffered from distress.

“Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers,” the authors of the new study wrote.

Similar adverse psychological reactions were reported during the 2003 SARS outbreak, with studies finding that healthcare workers had very high levels of stress, anxiety, and depression symptoms. These effects might have long-term psychological implications.

If it wasn’t obvious already, frontline healthcare workers deserve and require special attention. This means governments need to provide all the medical supplies that they need, as well as enabling clear protocols that protect both their physical and mental health.

We need to take care of healthcare workers so they, in turn, can properly take care of us when our time comes to ask for help.