**1. Introduction**

The expansion in March 2020 of the epidemic of the SARS-CoV-2 coronavirus, COVID-19, has meant an unknown scenario for the world's population where panic and fear of contagion has spread rapidly to all continents as a reaction to globalization, taking over almost completely the information transmitted by the media and social networks [1–4]. The disease that began in Wuhan (China) in December 2019, initially associated with pneumonia, quickly became a global epidemic [5]. It became a major global problem, in such a way that on 30 January 2020 the World Health Organization

designated the COVID-2019 outbreak as a "public health emergency of international concern" (PHEIC) because of its rapid spread [6].

This pandemic has changed the lives and behaviors of all people (habits, customs, ways of relating, confinement in the digital age, etc.) [7,8] and professionals (health protocols, health alerts, isolation measures, individual and community prevention measures) [9,10]. A single cause has provoked the same collective thinking at a global level and is based on two main lines of action; first, the need to protect ourselves from the virus, and second, to resist the social and economic crisis caused by it.

The actions aimed at surviving the COVID-19 disease also involved managing personal skills and resources to combat the secondary effects that this pandemic may have produced. As many authors have already pointed out, the pandemic has had psychological effects on the general population, but especially on health professionals [11–14]. This group has been exposed for a long period of time to the constant threat of infection with the virus, which is often described as fatal, and which causes a sense of danger and uncertainty in their daily activities among health workers and also in society as a whole [15].

According to the Report on the situation of COVID-19 in health care personnel in Spain, as of 21 May 2020, 40,921 had been infected and 53 deaths had been reported through the SiViES platform of the Centro Nacional de Epidemiología (National Center for Epidemiology) [16]. Considering that the total number of people infected in Spain on that same date was 269,863 [17], the number of health professionals infected exceeds 15%, a sign of the risk to which they have been exposed in their professional work. However, these data should be considered with caution since the number of figures has constantly changed. Updated data from May 29 of the same report shows 40,961 positive cases in health professionals and 52 deaths, fewer than previous counts.

This official report does not include the characteristics related to the professional category of health professionals or other considerations related to professional practice. On 9 May 2020, the Asociación de Médicos Unidos por sus Derechos (Physicians United for their Rights of Association) presented the report "Condiciones de los médicos españoles en la práctica clínica durante la crisis de COVID-19" (conditions of Spanish physicians in clinical practice during the COVID-19 crisis), which included higher figures than those provided by the Ministry, with 48,320 health professionals infected and 76 dead [18]. In addition, this report includes elements that show how health professionals have dealt with the pandemic and under what conditions.

The most relevant data shows that 12% of the physicians had suffered from the disease (data without taking into account those who were asymptomatic); 23% of the physicians suffering from COVID-19 had returned to work without having performed PCR (polymerase chain reaction), that is, without checking through the corresponding diagnostic tests if they were free of the virus or if they had developed antibodies, which would help prevent the virus from spreading in hospitals. Those measures would have help them to prevent the virus from spreading in hospitals; 66.5% had attended patients with COVID-19, 49% considered that they lacked sufficient protective material, highlighting the fact that 1/3 did not have Fpp2 or Fpp3 masks, and one in four physicians had reused their mask for more than a week. Finally, 86.8% of physicians considered that they could have been a vector of the disease because they lacked adequate protective material [18].

This amount of numbers causes uncertainty in the population, especially among health professionals. Altogether, with the lack of personal protective equipment (PPE) and the contradictory information, due to the lack of knowledge of the virus by official sources, are elements that keep the level of professional anxiety very high, and may cause other disorders that would not benefit professional practice at all.

In this scenario, health professionals have carried out a titanic task, with personal unprecedent, work, and social pressure within a context of insufficient PPE to fight this disease. Recent studies [19–22] show how working under pressure from COVID-19 have a significant impact on health professionals, especially those who work in a more precarious context, working long hours, without adequate PPE, etc. In addition, Lai et al. point out that in Wuhan "a considerable proportion of health workers reported experiencing symptoms of depression, anxiety, insomnia and distress, especially women, nurses and frontline health care workers directly involved in the diagnosis, treatment or nursing care of patients with suspected or confirmed COVID-19" [23]. Due to the fact that during the stages prior to the health crisis, in previous studies carried out in Spain, medium-high values of burnout were found [24–28] we asked whether during this phase of increased active cases and overflow of health care facilities caused by the SARS-CoV-2 pandemic, professionals might exhibit evidence of the three components of the Maslach burnout scale [29], emotional exhaustion, depersonalization, and changes in self-fulfilment, as these are the ones that other studies have indicated are most at risk of developing health problems from COVID-19 [23,30]. At the same time, the perception of stress among professionals is closely related to burnout, reporting a higher level of emotional exhaustion and depersonalization [31]. While it is true that burnout is a process that develops over time [32], during the months of March and April the volume, workload and deaths of patients admitted were much higher than in previous months [33], which makes us wonder if this context could have aggravated the situation as occurred in other countries [34,35] in the three subscales of the Maslach burnout inventory.
