COVID-19 and Healthcare Security: Challenges and Opportunities for Building Enduring Systems of Safety

ABSTRACT

COVID-19 has impacted health security throughout the pandemic and into the future in a variety of ways. Our response to the pandemic has highlighted existing challenges in health security, created new vulnerabilities and provided opportunities to build resilience against future threats. Exacerbating a long-term trend, violent incidents in healthcare continued to rise after the start of the pandemic. Workplace violence involving patients and visitors increased significantly in traditional and non-traditional healthcare settings. As alternate clinical care and storage sites popped up, malicious actors ramped up attacks on healthcare infrastructure and supply chains. These threats demanded that healthcare organizations become more agile and flexible in their security response (He et al., 2021). Beyond these attacks, shortages of critical supplies made it clear that medical supply chains have fundamental weaknesses in our twenty-first century landscape (U.S. Food and Drug Administration, n.d.). Supply chain experts assert that to avoid repeating these mistakes, we must build more robust and intelligence-driven medical supply chains, on both domestic and international levels. At facilities within health systems, more collaboration between departments produced positive results overall for security and safety. Where it makes sense, this enhanced collaboration should be continued as regular practice. These kinds of efforts also created more security consciousness among all stakeholders, a development we must seize to prepare for the challenges that lay ahead.

GLOBAL TRENDS FOR VIOLENCE IN HEALTHCARE SETTINGS

Exacerbating a long-term trend, violent incidents in healthcare continued to rise after the start of the pandemic. Workplace violence involving patients and visitors increased significantly in traditional and non-traditional healthcare settings. In a large mixed methods study, healthcare workers were about 50% more likely than others to have been harassed, bullied, or hurt due to COVID-19 (Dye et al., 2020). In the United States, physical attacks on healthcare workers were increasing well before the pandemic hit. Injuries caused by workplace violence in healthcare settings increased by 67% between 2011 and 2018 (U.S. Bureau of Labor Statistics, 2020). Healthcare and social service workers in the private sector also had five times the risk of suffering from workplace violence than all other private sector workers (U.S. Bureau of Labor Statistics, 2020). Mirroring global statistics, the pandemic amplified this trend in the United States. (Devi, 2020; Larkin, 2021; Wieffering & Housing, 2021). Between Feb 11, 2020, and July 31, 2020, the International Committee of the Red Cross found 611 attacks related to the pandemic in healthcare settings across 33 countries. This number is likely a massive undercount, as healthcare workplace violence has been consistently underestimated, even before the pandemic (Devi, 2020; Joint Commission on Accreditation of Healthcare Organizations, 2018; Arnetz et al., 2015). Multiple studies show that 60% of incidents go unreported (Larkin, 2021). A strong body of evidence reveals that personnel are least likely to report events that are non-physical in nature or do not result in serious injury (Arnetz et al., 2015). Incidents which cause no, or minimal, bodily harm can serve as a leading indicator for the occurrence of more serious incidents (Arnetz det al., 2015).

Another under-the-surface hazard healthcare workers have faced is the burden of trauma or extreme stress. People who may not have had the resources they needed to manage this stress sometimes turned to unhealthy coping mechanisms (Prasad et al., 2021). Despite these struggles, many people continued to show up to work every day. However, this resilience has taken a toll on individuals and organizations that ripples into the future. Unresolved tension between healthcare workers exacerbated what was already a chaotic environment. Failure to address these trends threatens the health and productivity of workers as well as the environment of care (Gates et al., 2011; Centers for Disease Control and Prevention [CDC], 2002; Lanctot & Guay, 2014).