Healthcare providers as patients: COVID-19 experience

Abbas Al Mutair; Alexander Woodman; Amal I. Al Hassawi; Zainab Ambani; Mohammed I. Al Bazroun; Fatimah S. Alahmed; Mary A. Defensor; Chandni Saha; Faiza Aljarameez

doi:10.1371/journal.pone.0289131

Peer Review History

Original SubmissionDecember 19, 2022
25 Jun 2023 Decision Letter - Taofiki Ajao Sunmonu, Editor PONE-D-22-34667Healthcare Providers as COVID-19 Patients: Long-Term Psychological Consequences of Short-Term Physiological ExperiencePLOS ONE Dear Dr. Al Mutair, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 09 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Additional Editor Comments: The authors have tried to explore the physiological and psychological impact s of Covid 19 on the healthcare workers. This is an important clinical and occupational issues which would throw more lights on the well being of health care providers during the Covid 19 pandemics. tHE Authors need to address the concerns of the eminent reviewers on this article to improve its quality [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The premise of the research is the fact that, in spite of an abundance of research on the clinical (or ‘physiologic’) aspects of COVID-19, the authors feel there is paucity of information on the psychological aspects of COVID-19, especially as viewed through the lens of the experiences of the participants, which are health care workers (HCWs). However, the inclusion criteria is unclear. It seems that the authors intended to interview HCWs that had COVID-19 and recovered. Additionally, it is unclear if and how these infections were confirmed. Furthermore, the sample size is made of 10 participants (8 nurses & 2 food servers), and as such is hardly representative of HCWs. It is also unclear why the authors chose to use snowball sampling, considering that the sample size was small, and the population of interest was hardly inaccessible. Reviewer #2: The authors have evaluated the long-time psychological effect of the COVID pandemic on health care workers. This is a pertinent article using the lenses of the lived experiences of healthcare workers to evaluate the impact of the pandemic on their psychological state. I have a few comments. 1. I advise that the authors revise the title of the manuscript. The COVID-19 experience is both physiologic and psychological and some might argue there is a spiritual ramification to it. It’s best to leave it as COVID-19 experience rather than defining it as a physiological one. 2. The list of thematic categorizations should be removed from the body of the manuscript. This could be made into a table. 3. In figure one, please provide the legends to delineate the major themes and subthemes. I seem to have found only 5 themes instead of seven. Please clarify. 4. The limitation of the study should be discussed. The qualitative method of the study precluded determining patients’ allostatic loads which could influence their perception of the experiences. Data on the support system are hereby inferred and not quantified. The sampling method also did not allow for complete blinding of the participants. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0289131.r001
Revision 1
11 Jul 2023 Author Response 30 June 2023 Dear Editor, Re: Revised Manuscript ID PONE-D-22-34667 Please find attached our revised manuscript: “Healthcare Providers as COVID-19 Patients: Long-Term Psychological Consequences of Short-Term Physiological Experience. We would like to thank the reviewer for their thoughtful consideration of our manuscript. Comments Authors’ Response Comments to the authors The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Yes Thank you for this feedback. Conclusions of the paper were refined. 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes Thank you for this comment. The analysis of data was edited to allow reproducibility by future researchers. Have the authors made all data underlying the findings in their manuscript fully available? Reviewer #1: Yes Reviewer #2: Yes Thank you Is the manuscript presented in an intelligible fashion and written in standard English? Reviewer #1: Yes Reviewer #2: Yes Thank you Reviewer 1 The premise of the research is the fact that, in spite of an abundance of research on the clinical (or ‘physiologic’) aspects of COVID-19, the authors feel there is paucity of information on the psychological aspects of COVID-19, especially as viewed through the lens of the experiences of the participants, which are health care workers (HCWs). However, the inclusion criteria is unclear. It seems that the authors intended to interview HCWs that had COVID-19 and recovered. Additionally, it is unclear if and how these infections were confirmed. Furthermore, the sample size is made of 10 participants (8 nurses & 2 food servers), and as such is hardly representative of HCWs. Done 1. Our qualitative study aimed to understand and describe the life experiences, and particularly the psychological consequences, of healthcare providers who have survived COVID-19 as patients. Although we intended to focus on the psychological aspect of COVID-19 survivors, our inclusion criteria did not specify the survivors who had psychological effects, because that would minimize the sample size, as we understood from previous experiences that some HCWs don't see themselves, or don't like to present themselves as having psychological issues. Their self-image, self-presentation and their desire to return to their normal level of productivity at work could hinder their willingness to participate in this study and speak freely and transparently. For that, we made our inclusion criteria more general; however, before the interview, we ensure that all participants are aware of the aim of the study and during the interviews, we were conscious about how to concentrate more on the psychological influences and how the participants felt at those difficult moments and whether they continue to experience any kind of psychological issues. Our questions encouraged participants to talk naturally and give details about their experiences and for some participants, the interviews helped them to ventilate and recognize some stressors that irritated them such as how they felt being isolated and stigmatized as a source of fear and harm to others. This actually gave us a chance to capture every nuance of pain, and psychological impact they had or still have at the moment. 2. All infected cases for HCWs in Saudi Arabia were must to be confirmed by official COVID-19 test at hospital, and to be reported to Ministry of Health. Therefore, confirmation was granted from the beginning. 3. Yes, as in qualitative studies, we stopped recruiting participants once we reached the saturation, which was achieved with the 10th participant. In qualitative studies, the sample are not expected to be representative of the whole population especially if the participants belong to similar environments, and leadership systems that would shape their experiences. It is also unclear why the authors chose to use snowball sampling, considering that the sample size was small, and the population of interest was hardly inaccessible. We mainly used purposive sampling to recruit participants. However, in some hospitals we asked participants to refer others who fit with our inclusion criteria. We revised this statement in the manuscript and modified it to be "Purposive sampling" only since that is the main sampling technique we used. Reviewer 2 The authors have evaluated the long-time psychological effect of the COVID pandemic on health care workers. This is a pertinent article using the lenses of the lived experiences of healthcare workers to evaluate the impact of the pandemic on their psychological state. I have a few comments. 1. I advise that the authors revise the title of the manuscript. The COVID-19 experience is both physiologic and psychological and some might argue there is a spiritual ramification to it. It’s best to leave it as COVID-19 experience rather than defining it as a physiological one. Thank you for this comment. The title was revised into “Healthcare Providers as Patients: COVID-19 Experience” 2. The list of thematic categorizations should be removed from the body of the manuscript. This could be made into a table. Done 3. In figure one, please provide the legends to delineate the major themes and sub-themes. I seem to have found only 5 themes instead of seven. Please clarify. That is right. The analysis resulted in five themes and four sub-themes only not seven. We corrected this sentence in the result section of the manuscript. 4. The limitation of the study should be discussed. The qualitative method of the study precluded determining patients’ allostatic loads which could influence their perception of the experiences. Data on the support system are hereby inferred and not quantified. The sampling method also did not allow for complete blinding of the participants Thank you for this comment. Limitations section was added to the manuscript. Thank you once again for the feedback received, and I hope that this information fulfills all of your requirements. Should you have any queries or require further information please do not hesitate to contact me for clarification. Attachments Attachment Submitted filename: Rebuttal letter.docx https://doi.org/10.1371/journal.pone.0289131.r002
12 Jul 2023 Decision Letter - Taofiki Ajao Sunmonu, Editor Healthcare Providers as Patients: COVID-19 Experience PONE-D-22-34667R1 Dear Dr. Al Mutair, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Taofiki Ajao Sunmonu Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0289131.r003
Formally Accepted
15 Aug 2023 Acceptance Letter - Taofiki Ajao Sunmonu, Editor PONE-D-22-34667R1 Healthcare Providers as Patients: COVID-19 Experience Dear Dr. Al Mutair: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Taofiki Ajao Sunmonu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289131.r004

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