Dear Editor
The outbreak of COVID-19 has severely affected the healthcare sector worldwide and has created many challenges. One of the important challenges is the increasing need for healthcare workers, especially nurses [1]. As most nursing activities require direct contact with patients, nurses are more vulnerable to Infection with COVID-19. In the severe acute respiratory syndrome (SARS) epidemic, about 50% of the deaths consisted of healthcare workers who had close contact with the patients [2]. According to the International Nursing Council’s analysis of the data collected from 30 countries, about 6% of COVID-19 cases were among healthcare workers (ranging from 0% to 18%) [3].
Survivors of emerging diseases experience many physical, mental, psychological, and social problems. Complaints of psychological problems and chronic fatigue have been common among survivors of SARS and the Middle East respiratory syndrome (MERS) related coronavirus. In one study, the prevalence of chronic fatigue syndrome was reported to be more than 32% among survivors, 18 months after the onset of MERS [4]. Other studies on SARS and MERS survivors have shown that more than 40% and 50% of survivors experience chronic fatigue syndrome, respectively [5, 6]. Fatigue is a mental feeling of weakness, lack of energy, and exhaustion. This type of fatigue usually lasts more than 6 months and does not decrease with rest. It is accompanied by complex symptoms, periods of weakness, sleep disorders, cognitive impairment, autonomic dysfunction, and muscle and joint pain [7]. Thus, presumably in nurse survivors with this disease, such disorders can decrease productivity, increase absence from work, quit the job, be dismissed by employers because of the unwillingness to care for patients with COVID-19, and ultimately reduce the quality of care and patient satisfaction [8]. For many emerging infectious diseases, no standard treatment exists and most of the care provided to patients is supportive nursing care.
The results of studies have shown that one of the most important reasons for the shortage of nurses has been the increase in the prevalence of emerging diseases. During the outbreak of these diseases, the increase in demand on the one hand and the decrease in the labor force following the possible illness or leaving the job, on the other hand, along with the prolongation of the pandemic outbreak process make the shortage of nurses more critical.
Therefore, in the first stage, to maintain the safety of the existing nursing staff, special protocols should be considered to reduce the risk of infection of nurses in contact with COVID-19 patients. Some of these effective protocols can be special training and practice for nurses, creating a logical and scientific work plan, maximizing the use of infection control systems, providing psychological counseling, and avoiding unnecessary contact of staff with possible causes of disease transmission. In the next stage, given the prevalence of chronic fatigue syndrome in past emerging diseases, more research should be done to identify its cause and mechanisms along with its possible effects on the quality of personal and professional lives of nurses.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declare no conflict of interest.


References

1. Lippi G, Sanchis-Gomar F, Henry BM. Coronavirus disease 2019 (COVID-19): The portrait of a perfect storm. Annals of Translational Medicine. 2020; 8(7):497. [DOI:10.21037/atm.2020.03.157] [PMID] [PMCID]
2. Wenzel RP, Bearman G, Edmond MB. Lessons from severe acute respiratory syndrome (SARS): Implications for infection control. Archives of Medical Research. 2005; 36:610-6. [DOI:10.1016/j.arcmed.2005.03.040] [PMID] [PMCID]
3. International Council of Nursing (ICN). ICN calls for data on healthcare worker infection rates and deaths. 2020 [cited 6 May 2020]. [Link]
4. Lee SH, Shin H-S, Park HY, Kim JL, Lee JJ, Lee H, et al. Depression as a mediator of chronic fatigue and post-traumatic stress symptoms in middle east respiratory syndrome survivors. Psychiatry Investigation. 2019; 16:59. [DOI:10.30773/pi.2018.10.22.3] [PMID] [PMCID]
5. Van der Velden PG, Grievink L, Kleber RJ, Drogendijk AN, Roskam A-JR, Marcelissen FG, et al. Post-disaster mental health problems and the utilization of mental health services: A four-year longitudinal comparative study. Administration and Policy in Mental Health and Mental Health Services Research. 2006; 33:279-88. [DOI:10.1007/s10488-005-0027-x] [PMID]
6. Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: A systematic review. Psychological medicine. 2008; 38:467. [DOI:10.1017/S0033291707001353] [PMID] [PMCID]
7. Larun L, Odgaard-Jensen J, Brurberg KG, Chalder T, Dybwad M, Moss-Morris RE, et al. Exercise therapy for chronic fatigue syndrome (individual patient data). Cochrane Database of Systematic Reviews 2018; 12:CD011040. [DOI:10.1002/14651858.CD011040.pub2] [PMCID]
8. Ren S-Y, Gao R-D, Chen Y-L. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the coronavirus disease 2019 epidemic. World Journal of Clinical Cases. 2020; 8(4):652-7. [DOI:10.12998/wjcc.v8.i4.652] [PMID] [PMCID]