According to the Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory disease caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) (1). As of 12 February 2022, according to Johns Hopkins University, the number of global cases reached 408,553,932 and the number of deaths was 5,802,661 (2). The viruses constantly change through mutation and new variants of a virus are expected to occur. Some variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. An increase in the number of cases will put more strain on healthcare resources, lead to more hospitalizations, and potentially more deaths (3).

For health and Health Care Workers (HCWs) around the world, the pandemic caused a heightened risk of occupational exposure to a new fast spreading disease and created the need to adapt roles and responsibilities for a wide range of tasks and professional settings. HCWs are not only at a high risk of infection, but they may also contribute to their spread from hospital to community environments and vice versa (4). This pandemic resulted in many infections and deaths among HCWs and their households (5). The health care sector is one of the most severely hit by the pandemic as the HCWs face multiple hazards that affect their physical, mental and social well-being (6). Lack of preparedness, the pandemic-related changes in working conditions, and access to and utilization of healthcare seemed to interact and create social tension among HCWs (7).

Hand hygiene has been one of the most important factors of infection control in a healthcare setting, according to a cross-sectional survey in Saudi Arabia. The hand hygiene knowledge and perception of the HCWs showed that the majority had moderate knowledge (57.8%) with perception (73.4%) of hand hygiene (8). The HCWs who were trained on hand hygiene were more likely to have good/ moderate perceptions than those without training. Another study in Bangladesh among dentists showed those with higher qualification levels had more knowledge and better practice toward COVID-19 than lower level qualifications, which indicated the more training for HCWs on infectious diseases the better knowledge and practice toward the pandemic (9).

According to the study, frontline COVID-19 healthcare workers were 52.0% more likely to have depression, 57.0% more likely to have anxiety, and 60.0% more likely to experience distress than non-frontline healthcare workers (10). The study on subjective burden and perspectives of German HCWs during the COVID-19 pandemic shows that there is a high increase of mental stress among the HCWs as worrying about their future regarding the well-being of their family and HCWs revealed that there is less time for personal life, and reduced in sleeping quality (11).

The COVID-19 pandemic has made psychological stress on HCWs in high-demand settings for long hours of work while they are separated from their families and facing social stigma (12). A review of health workers in China and Singapore found that one in four reported depression and anxiety, and one in three suffered from insomnia during COVID-19. The WHO also recently highlighted an alarming rise in reports of health workers being targets of verbal harassment, discrimination, and physical violence during this pandemic. In Fiji, the first case of COVID-19 was reported on the 19th of March 2020, followed by the second wave of Delta variant reported on the 26th of April 2021. While the international border has opened and the third wave of the outbreak began in December 2021 and currently the Omicron variant is being recorded in Fiji (13). Fiji has received the majority of the funds and medical equipment to assist in preventing and controlling COVID-19 for frontline HCWs as they play a vital role in stopping the virus in its tracks. On 28 August 2020, Fiji received Personal Protective Equipment (PPE) and other medical supplies from the Asian Development Bank and the Government of Japan which were procured by the United Nations Children's Fund (UNICEF), so that the frontline HCWs are well equipped, as well as protected from potential infections and enable the undisrupted delivery of essential services to the communities being served (14).

Most of the study shows that some of the attitudes among HCWs toward COVID-19 are that they are afraid of being infected and some are in fear of transmitting the disease to their families due to the unavailability of (PPEs). The study aimed to explore the barriers faced by frontline HCWs in managing COVID-19 in Fiji using a qualitative study.

While managing the COVID-19 situation, the HCWs adjusted the workload, as they worked as a team, with a trustful, friendly, and supportive environment. Some of the HCWs felt tired, frustrated, got rude to patients, found it difficult to handle situations, were affected mentally and physically, and were stressed. Few of the HCWs did not have experience working long hours. A study shows due to inadequate quantities of PPEs, developed anxiety and apprehension of the fear of infection among the HCWs (21). It also showed that long working hours for HCWs during the COVID-19 outbreak had contributed as a risk factor to COVID-19 infection among HCWs. A survey in Italy showed that the HCWs' perception of the risk of being infected was significantly higher in the workplace than in the outside environment (22).

Moreover, in terms of poor communication, the HCWs mentioned that there was a need for consultation on guidelines and more awareness in different languages while managing the COVID-19 situation. The HCWs also highlighted that there was poor communication within the HCWs while managing the COVID-19 situation. Some of the HCWs mentioned that the COVID-19 protocols were very strict, this was in terms of the COVID-19 restrictions and curfews, making it hard to contact the patient's families. A study in Nepal shows that 61% of health workers had poor knowledge about COVID-19 transmission (23). Additionally, a study shows almost 50% of respondents were unsure or did not know to whom and to where COVID-19 cases should be reported. Similarly, the majority of HCWs did not participate in educational activities and emergency planning for COVID-19 (24).

Furthermore, in terms of the lack of resources, the HCWs mentioned that there were poor management, poor isolation rooms, conditions, and spacing in health facilities. They also felt that there was a lack of human resources and other lack of medical resources available while managing the COVID-19 situation. The HCWs mentioned that there were miscommunication, political issues, and language barriers while managing COVID-19. A study in Australia shows that the HCWs were more concerned about their job security and many reported lost work hours (25). Another study in Oman reveals that the challenges are linked to the insufficient infectious disease and public health expertise at the field level and the intensive workload that drained HCWs physically and emotionally (26).

Moreover, a study shows that the most common barrier was the lack of awareness among the general population about COVID-19 preventive measures (89.1%). Other common perceived barriers included poor healthcare infrastructure (85.2%), an insufficient supply of PPE (86%), lack of affordable hand sanitizers and facemasks for the public (83.9%), and inadequate financial resources for COVID-19 prevention and control (82.7%). Half of the participants perceived the weak performance of the local media in spreading awareness of COVID-19 as a barrier. The lack of training on infectious disease outbreaks and the absence of emergency response protocols were also perceived as barriers by 67.7 and 72.2% of respondents, respectively (24).

The HCWs had mentioned that all the COVID-19 precautionary measures were practiced at the health facility when the patients or visitors visited the health facility, while the HCWs also practiced all the precautionary measures while managing the patients. Virtual communications were also practiced for any form of training and meetings as a COVID-19 precautionary measure. In terms of the COVID-19 precautionary measures outside the health facility, such as masks, hand hygiene, social distancing, and isolation, the HCWs practiced all these, however, sometimes they forget especially the mask-wearing. All the training was practiced virtually due to the COVID-19 precautionary measures and HCWs do not have any issues with this.

In conclusion, the HCWs had knowledge on COVID-19 and they practiced all the COVID-19 restrictions while managing the cases in Fiji. This had been attributed to the presence of many barriers, such as workload, tiredness, frustration, and sometimes difficult-to-handle situations, getting the HCWs affected mentally and physically. The HCWs highlighted the lack of awareness on COVID-19 preventive measures to the general public, as awareness programs would help in the reduction of the cases and helps the HCWs in managing the COVID-19 cases well.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by College Health Research Ethics Committee (CHREC) of Fiji National University. The patients/participants provided their written informed consent to participate in this study.

AD: conceived and designed the experiments, performed the experiments, analyzed and interpreted the data, contributed reagents, materials, analysis tools or data, and wrote the paper. MM: conceived and designed the experiments, analyzed and interpreted the data, contributed reagents, materials, analysis tools or data, and wrote the paper. Both authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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