Individual sources of burn-out and embitterment and illustrative quotes
| Subthemes | Illustrative quotes |
| Mistrust of patients with COVID-19 | ‘I became cynical and mistrustful of people. No matter what patients, close contacts, or others may say, I don’t trust them unless there is objective evidence… I eventually look up GPS and credit card transactions because I don’t trust them.’ – FHW4, male ‘When they say they are Christian, then I think ‘This person will lie to me.’ ‘This person is so eloquent so (s)he must be lying.’… Christians are skillful and sneaky. I have strong preconceptions about them now.’ – FHW2, female ‘When patients say ‘I didn’t go there’ without showing me any evidence, I get angry and yell at them. When I reflected on my behavior later, I was shocked at myself treating them as criminals.’ – FHW1, female |
| Moral dilemmas | ‘I used to be proud of myself doing such an important work serving our country and the public. The more I work, however, the more I feel like this job is about restricting personal freedom. After I classify people, I tell them, ‘Stay inside. Stay inside for 14 days. Go get testing.’ Suppressing citizen’s freedom like this, I can’t say that I feel worth doing this.’ – FHW7, male ‘We are looking at CCTV, GPS, and credit card records. In fact, even I get scared. What if one day I have COVID-19 symptoms, I know what kind of personal information would be disclosed.’ – FHW1, female ‘Many patients from Cluster X* refused to be interviewed. Their sexual identity can be exposed during the interviews, so it is understandable that they are lying to me. [During interviews] I asked myself, ‘Is it even right to keep interrogating them like this?’’ – FHW20, male ‘Some local authorities are eager to disclose every patient information to the public, and I always feel angry about it. I really don’t understand them. They just want to show people that they are doing something and reassure citizens.’ – FHW16, male |
| Anxiety about the impact of decisions | ‘If I don’t look into this case, will I miss contacts leading to the spread of the disease? Anxiety about such things is always present, and it is a major source of my stress… I’m currently relying on medication because of stress resulting from anxiety and guilt.’ – FHW1, female ‘I got into a huge car accident because I was so preoccupied with thoughts about my work. I classified one person as a close contact [to be in quarantine], but what’s the likelihood that this person actually has COVID-19? And what’s the possibility that people whom I missed turn out to be patients?’ – FHW11, male ‘The [sexual minority] patient was very cooperative. But after the interview, I constantly searched news, worrying if this case would be disclosed by the media because then (s)he would be forcibly outed.’ – FHW9, female |
*Cluster X occurred at a gay nightclub in May 2020. Confirmed and suspected cases of the cluster hid their whereabouts due to a fear of disclosing their sexual identity.
CCTV, closed-circuit television; GPS, global positioning system.