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Survey of Health Workers at Well-Resourced U.S. Facilities Reveals Protective Equipment Shortages, Workplace Retaliation, Lack of Guidelines During Early Months of COVID-19 Pandemic

PHR calls on governments to set and enforce emergency standards for health worker protections and on employers to abide by obligations to protect the health, rights, and speech of employees

A survey of 901 health workers, largely people who worked at well-resourced health facilities in the United States, about their experiences during the early months of the COVID-19 emergency highlights the dire lack of preparation, supplies, and guidance for professionals on the front lines of the pandemic response. Conducted by Physicians for Human Rights (PHR) and the University of California, Berkeley, “Silenced and Endangered: Clinicians’ Human Rights and Health Concerns about Their Facilities’ COVID-19 Response” provides a snapshot of experiences and voices from the first wave of the pandemic, illuminating how even well-resourced health care facilities at top national institutions struggled to protect health workers from the virus and from reprisals for speaking out about their safety concerns.

Sixty-three percent of health care workers who responded to the survey reported personal protective equipment (PPE) shortages at their place of work, while 25 percent said they had to ration disinfectants and other cleaning supplies. More than half of respondents (54 percent) stated that they had not received sufficient training or preparation from their employers in how to allocate scarce resources to patients during the COVID-19 pandemic. Meanwhile, fear of reprisals and punishment for voicing concerns was rampant, with only 37 percent of respondents saying that they would feel confident speaking publicly about safety issues without facing retaliation from their institution.

In the light of the continued PPE shortages, retaliation for speaking about, and lack of governmental and institutional support for health workers that have extended into 2021, PHR is calling on the Biden administration and the Occupational Safety and Health Administration (OSHA) to immediately enact strengthened workplace safety standards for health and other frontline workers. OSHA should also prioritize whistleblower protection enforcement actions by ensuring that all complaints are fully investigated and resolved (including the backlog of complaints from throughout 2020).

From May to June 2020, PHR and Berkeley researchers sent an online survey to PHR’s global network of clinicians and to nurse and physician membership organizations. The survey asked about clinicians’ experiences with 1) access to adequate resources such as PPE and materials for patient care; 2) retaliation from employers or government officials for speaking out in defense of the safety and rights of patients and health care workers; and 3) provision of clear, transparent guidelines and training around resource allocation. Almost all of the 901 health care workers who completed the survey were physicians and nurses practicing at U.S. academic medical centers and private health systems in urban and semi-urban areas, primarily in California, Massachusetts, and New York.

As a cross-sectional survey administered over one month in the early phase of the pandemic, this data provides a snapshot at a single point in time of experiences of health care workers during the COVID-19 pandemic. The ever-changing nature of the COVID-19 global health crisis and the variations between regions and facilities limits the survey’s generalizability. However, while respondents disproportionately worked for highly resourced health facilities in a highly resourced country, the severe threats to the health and human rights they reported underscore the urgency for governments and employers to improve working conditions and protections for health workers everywhere.

“Many government officials and employers have applauded health workers and declared them heroes, while at the same time silencing their voices and denying them basic, life-saving protections,” said Michele Heisler, MD, MPA, medical director at PHR, professor of public health and internal medicine at the University of Michigan, and one of the report co-authors. “At precisely the moment when we needed to listen to medical professionals, our survey shows that governments and employers failed health workers, exposing them to severe health and human rights threats. This also created stress and moral injury among these clinicians as they were prevented from fulfilling their professional duties in the way that they believed was right. Our survey provides a cautionary tale for how not to respond to a pandemic, relevant for the ongoing fight against COVID-19 and for future public health emergencies. Many of the system failures these clinicians described months ago still have not been adequately resolved. We have to do better.”

PHR’s report highlights a range of survey responses that provide insight into the profound challenges endured by health workers in the early months of the pandemic, such as:

Lack of PPE and training:

  • 63 percent of health care workers reported PPE shortages at their place of work.
    • Of respondents who worked in health facilities that faced PPE shortages, 76 percent were worried about their personal health; 63 percent of those who did not report PPE shortages also expressed concerns for their own health.
    • In interviews of a sample of survey respondents, clinicians reported being prevented from using PPE that they themselves had purchased.
  • 67 percent said they would agree to complete medical tasks outside of their own formal training to care for patients with COVID-19.

Inability to voice concerns:

  • 20 percent of respondents reported that they did not feel comfortable discussing safety issues internally with their health facility administration.
  • Only 37 percent said that they would feel confident speaking publicly about safety concerns without facing retaliation from their institution.

Rationing of essential supplies:

  • 37 percent of respondents reported that their workplace was actively limiting or rationing PPE.
  • 25 percent reported the rationing of disinfectants, sanitizers, and other cleaning supplies in their workplace.
  • 23 percent of respondents experienced active rationing and limiting of COVID-19 diagnostic tests in their workplace.

Lack of guidance on scare resource allocation:

  • 54 percent of respondents stated that they had not received sufficient training or preparation in how to allocate scarce resources to patients during the COVID-19 pandemic.
  • 46 percent of respondents felt that their health care facility had not given them clear information about how scarce resources would be allocated, if necessary, in order to prevent the burden of making decisions from falling on the bedside team.
  • 34 percent of respondents were worried about personally making resource allocation decisions.
  • More than half of health care worker respondents were concerned that their belief in what is right would conflict with institutional constraints or procedures when allocating limited resources.

While reliable data is scarce and extensive variation between facilities and regions persists, a lack of PPE, diagnostic testing, and institutional support continue to be major concerns for many health workers around the United States and globally into the winter of 2021. And while medical professionals in the United States now have access to COVID-19 vaccines, PHR is appalled that frontline health workers in many low- and middle-income countries lack access to vaccines while wealthy countries hoard supplies and inoculate far less vulnerable individuals. PHR, Oxfam, and a coalition of health and human rights groups call for a People’s Vaccine and demand that COVID-19 vaccines be free, fair, and accessible to everyone, everywhere. 

“While our report offers insights to guide the current and future phases of the COVID-19 response, it also contributes to the historical record and understanding of what health workers endured in the midst of an unparalleled global health crisis,” said Rohini Haar, MD, MPH, PHR medical advisor, adjunct professor of epidemiology at the School of Public Health, University of California, Berkeley, and a report co-author. “Unfortunately, continuing shortages make it clear that early, heroic efforts by health workers and advocates to sound the alarm about shortcomings in the pandemic response still have not been adequately addressed. Health workers continue to die preventable deaths and face unconscionable health and human rights risks. The Biden administration’s early actions to mobilize resources and coordinate a centralized COVID-19 response are welcomed first steps, notably a January Executive Order on Protecting Worker Health and Safety and revised COVID-19 guidance from the Occupational Safety and Health Administration (OSHA). However, the administration must also implement emergency temporary standards for worker protections in health settings that address personal protective equipment, hand washing and sanitation, and transparency of information, among other issues. Such emergency standards should be further codified into a permanent, mandatory safety and health standard in the United States.”

“We, of course, owe the world’s health workers our gratitude and appreciation for saving countless lives during the pandemic – but we also owe them safety standards, workplace protections, and adequate resources,” said Dr. Haar.

“Silenced and Endangered: Clinicians’ Human Rights and Health Concerns about Their Facilities’ COVID-19 Response” issues recommendations to local, state, and national governments, as well as to health facilities, employers, and systems. While the survey reports on conditions in the early phase of the pandemic, the concrete steps governments and employers must take remain salient and urgent:

  • Governments worldwide need to set and enforce emergency standards for worker protections, workplace safety standards, transparency, accurate reporting, and accountability. National, state/provincial, and local governments also must implement clearly defined and universally enforceable workplace safety standards for health care settings.
  • National, state/provincial, and local governments must coordinate and work together to ensure an adequate supply of PPE and other critical resources to maintain the safety of health care workers and patients. If necessary, legislation providing emergency powers must be passed or strategically deployed, such as the Defense Production Act in the United States, to increase supplies for the current response to COVID-19 and to restore stockpiles for future epidemics.
  • Employers, state/provincial and local governments, and all other relevant actors must be required to develop and communicate clear training and explicit guidance for scarce resource allocation. They must also refrain from taking retaliatory actions or engaging in any form of harassment against health care workers, including those speaking out publicly about workplace safety concerns.
  • Whistleblower protections must be strengthened to safeguard health workers’ ability to raise the alarm about dangerous conditions without fear of discrimination or retribution.

PHR is mobilizing an advocacy campaign for health professionals and advocates to call on OSHA to implement necessary, enforceable workplace protections for workers in health care settings, and to take urgent action to adjudicate the thousands of COVID-19-related whistleblower complaints.

Since the earliest days of the pandemic, PHR has spotlighted the challenges experienced by workers on the front lines and advocated for science-based, human rights-driven pandemic policies at all levels of government. PHR’s worldwide network of health professionals and human rights advocates continues to demand that officials let science lead in order to safeguard the health and wellbeing of health workers and the global public alike. 

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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