Initially, the discussion group identified the most vulnerable group of HCWs to professional overload: HCWs at the frontline of COVID-19 who are in direct contact with patients with possible or confirmed infections and support staff of health care departments or units, such as the emergency department, primary health care, home hospitalization, critical care, reanimation unit, internal medicine, pneumology, and infectious diseases departments.

Taking into consideration the literature review on the SARS-CoV-2 pandemic and the opinions of the discussion group participants and their own experiences, the most common pressing situations for HCWs were identified and classified into five categories (see Textbox 1).

Regarding the design of interventions to prevent and handle the identified problems or pressing situations, the literature review on the experiences in Wuhan and Hunan (China) hospitals was considered. Besides, we reviewed other methods for the recovery of the second victim, which were applied in different conditions but can also be applied in this context. Finally, considering the aforementioned situations (Textbox 1), the discussion group proposed possible strategies and actions to approach the most severe demands and needs. Multimedia Appendix 1 shows the detected needs and resources to face each problem situation of HCWs during the COVID-19 outbreak. For each need, many recommendations were offered and 19 support resources were created as intervention proposals. Infographics were designed to complement some of these resources (see Multimedia Appendix 2) [16]. It is noteworthy that the nineth resource, named “self-report,” differs from the rest, and it consists of a COVID-19 acute stress scale for the HCWs. This is an ad hoc 10-question test to assess whether the HCWs were overwhelmed by the situation they were experiencing [17].

A digital platform was developed including the aforementioned content and support resources. The name of this platform is Be + against COVID, and it is composed of a website in three languages (Spanish, English, and Brazilian Portuguese) and a mobile app (for Android and iOS). The site is freely accessible to anyone with an internet connection, and the app is freely available to download from the official stores.

The Be + against COVID platform was made known to the HCWs directly through the members of the research group (see Multimedia Appendix 3), their organizations, and through the main social networks of the members and organizations involved (mainly through Facebook and Twitter). The platform’s twitter account (@second_victims) was used to further disseminate the contents of the web and the various updates and publications of the app.

No general diffusion means were used to ensure that the web and app only reached our target audience. Therefore, except for residual cases, the majority of web visits and app downloads, which will be detailed in the next sections, came from health care professionals.

This paper shows the development and the start-up of a project that arose from the urgent need to prevent and address the pressing situation that HCWs were and are facing in the world. Since Spain has been one of the first and most affected countries by the COVID-19 outbreak worldwide, this project can serve as an experience for others. The Be + against COVID platform (website and mobile app) was developed in three language versions to guide on possible actions that can be put into practice in health care centers to help confront the emotional impact on frontline HCWs caused by the current pandemic. Since there was no background about similar initiatives, the experience of China, previously published initiatives to facilitate the recovery of the second victim, and the interventions already implemented in some hospitals in Spain were considered to plan prevention and approach actions. During the first 2 months from the launch of the Spanish language version of the website, users from different countries accessed the website, but visitors were mostly from Spain. The most interesting and useful part of the website for HCWs was the resources section composed by intervention proposals that aim to provide a solution for the detected needs, and the “self-report” was the most visited resource. Currently, the Spanish language version of the website is being updated with content related to the recovery phase (postcrisis).

These resources were designed to help address the emotional consequences of caring for patients with COVID-19 in the context of the outbreak. This situation was characterized by a lack of foresight, demand for an immediate response from health professionals, and a shortage of resources. The focus was on providing resources through this platform for individual use.

Professionals from different disciplines (psychologists, psychiatrists, occupational health professionals, clinicians, and nurses) were involved in the design and redesign of these resources to support frontline health professionals in the care of patients with COVID-19, gathering experience in many hospitals and health care centers. They have assessed the adequacy of resources to the needs experienced by the professionals and have suggested improvements. In addition, Latin American professionals have been involved in the transcultural and linguistic adaptation of the resources and the self-report scale. Given that the expansion of the outbreak has been different according to each territory, the proposal of resources to face acute stress must be wide, varied, and flexible. The data confirm that acute stress increases in those territories with the greatest number of cases and highest mortality. In this case, the acceptability of the proposal is greatest [22]. In other countries, some hospitals provide psychological assistance hotlines to HCWs and carry out prevention programs. To offer a pool of recommendations and support resources through a free website is a different and original initiative. To the best of our knowledge, there is no similar experience in Europe or Latin America. We consider that this paper may be useful to develop a web-based tool with a similar objective or in a similar context. The Brazilian research group Enfermagem da Escola Paulista de Enfermagem da Universidade Federal de São Paulo (EPE-UNIFESP) translated our resources into Portuguese, and they were incorporated into its institutional website [23].

Given the current situation, conditions may differ across time and context, and therefore, our proposal of interventions is limited to the time and context of this study. These proposed actions can change due to the urgency and demand of the situation. Additionally, the response of HCWs to the COVID-19 crisis might be different between countries, and therefore, the problem situations and resources may be applicable in health care systems of countries with similar sociocultural characteristics. The urgency of the situation did not allow us to analyze the effectiveness of the proposed interventions. Future research should investigate it.

Psychological assistance has been provided through telephone-, internet-, and application-based interventions to the health care community by some local or national institutions in response to the COVID-19 outbreak [9]. Several international organizations such as the WHO, the United Nations, and the International Red Cross Society have published recommendations that team leaders can consider to reduce stress and the psychological distress of frontline HCWs. Social support, clear communication, flexible working hours, and psychological help are some of these recommendations [24]. The State Council of China developed a psychological intervention plan, which consists of setting up nationwide psychological assistance hotlines to help during the outbreak [11,25]. However, some workers did not recognize any problems and refused any psychological help [11]. The Canadian Medical Association also offers some resources for supporting HCWs that focus on psychological assistance provided by volunteer psychologists [26]. On the other hand, Blake et al [27] developed and evaluated a digital learning package that includes evidence-based guidance, support, and signposting regarding psychological well-being for frontline HCWs from the United Kingdom. This online support package is free and comprised of 88 slides, and its content is similar to that of the digital platform developed by our team. Similar to our digital platform, this electronic package describes the actions that team leaders can take to support HCWs during the COVID-19 outbreak and offers some support resources (infographic and video formats) to protect psychological well-being [27]. The evaluation showed that it is useful and appropriate for any UK health care professional. In contrast to our website, which was published in three different language versions, Blake et al [27] seemed to be focused on workers from the United Kingdom to develop this package. Moreover, nowadays, a mobile app can be more practical for some users. Nevertheless, the fidelity, engagement, usability, and practicality of our digital platform should be evaluated in future research.

Although there are differences between the health systems of the different countries and it is evident that the spread of the SARS-CoV-2 pandemic is different in each continent and country, most of the problems identified, and for which these resources have been devised, are repeated in the literature [9,28-30], and it is verified in the experience described by health professionals in Brazil, Peru, Argentina, Colombia, Mexico, Ecuador, Italy, Portugal, and Central Europe.

The extrapolation of resources to mitigate acute stress among frontline health professionals in the care of patients with COVID-19, therefore, could be carried out in both public and private centers.

The development and redefinition of resources to support the health care workforce and address new outbreaks must take into account differences in organizational culture [31-33], psychological safety [34], and availability of financial and skilled human resources among countries.

Although similarities have been observed in the sources and acute stress responses of these professionals, there is a need to adapt resources to the context as, for example, has been done in Brazil, adapting the resources originally designed for the Spanish National Healthcare System. Future research studies may consider these differences when assessing the applicability of the resources designed.

Preparing for a spike in new COVID-19 cases from health care organizations and professionals, particularly on the frontline of care for patients with COVID-19, should be prioritized by health planners and managers, academics, and health care professionals. Systems have more resources and better organization and information to reduce clinical uncertainty, but templates need to be recovered physically and emotionally. The new developments of this platform are incorporating proposals to strengthen the resilience of organizations and professionals.

A digital platform (website and app) was developed and launched to provide support resources that might prevent and approach the emotional impact of HCWs and other support staff due to the current COVID-19 outbreak.