COVID-19 and experiences of moral injury in front-line key workers

April, 2020

This article looks at the experiences of front line workers during the COVID-19 pandemic. It pays particular attention to experiences that could be potentially morally injurious events. The article discusses the difficulties in diagnosing and treating moral injury. Concluding by making several practical recommendations to limit, inform and support staff exposed to potentially morally injurious events.


The COVID-19 virus outbreak was declared a pandemic by the WHO on 12 March 2020. Whilst the infection mortality rate is not fully understood, it appears to be considerably higher than that of other recent pandemics (e.g. H1N1 pandemic, mortality rate 0.02%) [1]. Furthermore, several groups of people, such as the elderly and those with some pre-existing medical conditions, appear to be particularly vulnerable to the disease. International evidence, and the public health messaging put forward by Public Health England, suggests that COVID-19 may place a substantial demand on an overstretched National Health Service (NHS). A lack of specific resources—such as a lack of beds in Intensive Care Units, essential medicines and ventilators—and increased demand on the NHS may mean that front-line workers, such as clinicians, paramedics and other care staff, may be unable to provide adequate treatment to all patients, as seen in Italy. Additionally, current guidance recommends that anyone who is showing signs of a potential COVID-19 infection (e.g. new persistent cough, fever), or who lives in a house with someone who shows such signs, must self-quarantine at home meaning that some clinicians will be unable to return to their ‘front-line’ responsibilities at a time when their colleagues are working exceptionally hard. As a result of these exceptional challenges, lives will inevitably be lost that could, in other circumstances, have been saved. Non-clinical professionals in other essential roles, such as the justice system, media workers, social workers, etc., may also feel the profound effects of being required to perform already highly challenging duties in a more constrained manner which may lead to risks being more difficult to manage. How such events will impact front-line, key worker teams remains unclear, but it is likely that many will experience a degree of moral distress and some moral injuries

Full Reference

Williamson V, Murphy D, Greenberg N. COVID-19 and experiences of moral injury in front-line key workers. Occup Med (Lond). 2020 Jul 17;70(5):317-319. doi: 10.1093/occmed/kqaa052. PMID: 32239155; PMCID: PMC7184422.

Report a problem with this article