In late December of 2019, reports began circulating that a pneumonia-like virus was making people sick in Wuhan, China. On January 11, 2020, the first known death resulting from an illness caused by the “2019 novel coronavirus” was reported by the Chinese media. Over the following days, the first cases outside of mainland China began to crop up. Confirmed cases occurred in Japan, South Korea, Thailand, and the U.S. On January 31 of 2020, the Trump administration declared the coronavirus outbreak a public health emergency in the U.S. and set quarantines for Americans who had recently traveled to certain parts of China. By March 13 of 2020, President Trump declared a national emergency in the U.S. and, soon after, it was reported that the U.S. had more than 10,000 cases. By March 26 of 2020, the U.S. had the highest number of COVID-19 cases in the world, with at least 81,321 infections and over 100 deaths.
Massive efforts within the U.S. to “flatten the curve” and keep hospitals from being overrun were already well underway with key attention on expanding testing and vaccine research. “Non-essential” businesses closed and office workers set up shop at home. Education went online. Sports seasons were cancelled. Churches were closed. Every aspect of life changed drastically…and it happened shockingly fast.
At the beginning of the pandemic, doctors, nurses, paramedics, and other healthcare employees braced for a massive influx of sick patients. Hospitals launched government recommended stringent infection-control protocols as they went into “surge mode.” They set up triage tents on site and dedicated floors and wings to coronavirus patients. And they prepared themselves for the grim likelihood that a shortage of beds and ICU equipment would force them to make impossible life-and-death decisions.
An ounce of proactive anticipatory prevention can be worth a ton of playing catch up, once healthcare workers begin to experience unrelenting traumatic stress, which we’re all witnessing too frequently as they report what’s going on in their overwhelmed ERs and ICUs.
With that in mind, hospital leaders would do well to tell their teams that they know they are going through incredibly stressful times and that even though they are performing heroically, they need to be aware of early signs of excess stress and address them early when they will be easier to manage than waiting until they feel too overwhelmed by them.
Establishing an Employee Assistance Program (EAP) to provide access to psychological support and peer-peer support groups is critical – and making sure that everyone is aware of their availability and importance of mental well-being – is paramount. Which makes communication a vital component of supporting frontline healthcare workers.
During any crisis, but especially when it hits as close to home as the COVID-19 pandemic has for healthcare workers, good communication is fundamental to ensure accurate and timely information is provided, clear directives are given, and the risks to essential workers are minimized. To accomplish this, the following are considered best practices:
On March 26 of 2020, the U.S. had the highest number of COVID-19 cases in the world, with at least 81,321 infections and over 1,000 deaths*. By March 27 of 2020, data from Johns Hopkins University showed that the U.S. had 101,707 cases of coronavirus and 1,544 deaths**.
As of June 3, 2020, when Why Cope When You Can Heal? was being written, the coronavirus had infected at least 450,000 health-care workers worldwide, according to a report issued by an international nursing federation. Of the healthcare workers infected, nearly 600 died as of June 8, 2020. This includes doctors, nurses, and paramedics, along with support staff such as administrators, nursing home workers, and hospital janitors.
For more information on the current inflection rate of the coronavirus, please visit the Center for Disease Control and Prevention’s website.
Healthcare and frontline workers are impacted by COVID-19 three fronts. They are exposed directly to the coronavirus working with infected patients while, at the same time, they continue to risk exposure through normal day-to-day activities outside of work. Because of their increased risk to COVID-19, additional stress comes with potentially exposing their partners, children, parents, and other family members at home to the virus, not to mention their entire communities. They must be supremely vigilant to avoiding bringing the virus home, and many have chosen to isolate themselves or their family members to decrease the chances of a transmission.
On the third front, healthcare and frontline workers are impacted greatly by traumatic stress. Stressful experiences are nothing new for healthcare providers. It is a grueling industry that physically and emotionally grinds on its employees. Many in healthcare work long hours, experience sleep loss due to call, and have limited free time. They also face more than their share of psychological demands, including the constant pressure to save lives, grief after losing patients, encounters with tragedy, and fighting against a sense of cynicism and futility in the presence of so much death. These factors and others contribute to high instances of burnout and suicide in healthcare workers. For example, the American College of Emergency Physicians shares that even before the pandemic, about 60 percent of emergency physicians experienced burnout in their career. The COVID-19 pandemic is only increasing this and makes the potential for development of PTSD so much greater.
PTSD is a serious medical condition that occurs in some people who have witnessed or survived traumatic, terrifying, shocking, or dangerous experiences. On the surface, people with PTSD might appear to be healthy, happy, and functioning. But in reality, they may be struggling to survive, and are likely nowhere near thriving.
Nightmares, anger, irritability, disrupted sleep, increased startle reflex, and anxiety are some of the symptoms of PTSD. While it’s normal to experience some of these symptoms acutely after a traumatic event, they usually go away in time. When symptoms last longer than four weeks, cause great distress, or disrupt daily life, PTSD may be diagnosed. Hypervigilance, isolation, depression, and increasing use of substances to self-medicate are among the warning signs that a person may have developed PTSD.
PTSD shows up in four major ways: Intrusive Thoughts, Avoidance, Negative Thoughts, and Hyperarousal. Often people with PTSD experience nightmares, anger, irritability, anxiety, hypervigilance, and may be easily startled by loud noises or sudden movement. They may withdraw from social activities, become increasingly isolated from others, and appear depressed. Many report that they just can’t stop thinking about what has happened.
If you feel you might be suffering from PTSD, make sure you reach out for help. You can find resources at the American Psychiatric Association site. If you feel suicidal, call the National Suicide Prevention Lifeline at 800-273-8255.
It is possible to not just learn to cope with, but to fully heal and recover from PTSD and relieve the symptoms associated with it. True recovery requires processing the trauma you have experienced. In the case of COVID-19, the threat of infection and traumatic stress may still be ongoing – so it is important to begin processing your experience and memories, addressing the impact on your psyche in a measured and safe manner, and taking care of your body as soon as possible. While we generally think of the impact of traumatic stress on the mind, it has tremendous impact on your body, too. With help of qualified professionals, you can move out of survival mode and regain peace of mind (and bodily health).
There are multiple treatment options available to those suffering from PTSD. It’s important that all healthcare and frontline workers, and their employers, be informed about the options available to them during COVID-19 pandemic.
Mark Goulston, MD, has recently introduced another treatment modality, “Surgical Empathy,” to augment the others commonly used. Surgical Empathy is helpful when a person’s mind is so overwhelmed from external stimulus and internal pain (pain that has been suppressed, repressed, unfelt, unprocessed, and/or undealt with). It’s an approach which uses empathy with surgical precision to meet them where they are and help them “feel felt” and less alone in their feelings.
When someone you love struggles with post-traumatic stress, it can be very hard on you as well. You may feel frustrated, angry, or even afraid as you and your loved one navigate the choppy waters of PTSD. You may even feel it is your responsibility to “fix” them. The truth is, there’s not a lot you can do to alleviate their symptoms (aside from encouraging them to seek help from a mental health professional.)
The tips below can help you give them the kind of support and encouragement they need from you and draw boundaries to protect yourself from burnout.
DON’T deny your own suffering. It is normal to feel resentful or angry when another person’s PTSD disrupts your life. You may feel inclined to put on a happy face and press on, but this can create even more resentment. Acknowledge your own feelings.
There are a number of support groups available for PTSD recovery that can support healthcare and frontline workers facing COVID-related traumatic stress and PTSD. The National Alliance on Mental Illness (NAMI) has established groups in many local areas: https://www.nami.org/Support-Education/Support-Groups.
Additionally, most healthcare organizations have established an Employee Assistance Program (EAP) and have made access to peer-to-peer groups available to any employee who needs support. Contact your Human Resources Department or EAP – or reach out to your manager if you need assistance finding support.
If you feel suicidal or in need of immediate support, please call the National Suicide Prevention Lifeline at 800-273-8255.