Objective: The COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained a secondary consideration in many hospitals pandemic response. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce this impact. Additionally, it aims to provide a framework for future evidence-based programs that support the wellbeing of frontline HCWs throughout the ongoing pandemic and into the future, helping to prepare for Disease X. Methods: A systematic review was completed using MEDLINE, CINHAL and Cochrane databases with bibliographic and grey literature searches. Results: 17 publications were included. Symptoms of psychological distress were reported in up to 70% of frontline HCWs, with as many as 50% suffering depression, 62% reporting anxiety and 45% of those requiring quarantine experiencing insomnia. Mindfulness training, safe rest areas, mental health practitioners and pandemic rostering are responses that have been implemented across health services during the pandemic, but their efficacy in reducing psychological burden has not been fully assessed. Conclusions: The impact of COVID-19 has been enormous; however, its final toll remains unknown. High rates of psychological distress amongst frontline HCWs means the impact will extend far beyond the virus itself. Health services must implement evidence-based resilience strategies to ensure the safety of their frontline staff now and into the future.

The authors have declared no competing interest.

This research received no specific grant or funding from any funding agency in the public, commercial or not-for-profit sectors.

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All data produced in the present study are available upon reasonable request to the authors