It is well known among the medical community that nurses and doctors work in an environment that makes them vulnerable to developing posttraumatic stress disorder (PTSD). This is because nurses and doctors are not only exposed to threats to their own physical and psychological well being, they are also exposed to details of traumatic events that have happened to the people they are caring for (3). For example, nurses tend to patients who are in extreme distress. They see people die on a regular basis. They are exposed to grieving loved ones, and regularly need to make rapid decisions with life and death consequences. In some environments, nurses are verbally or physically assaulted by distressed patients or family members. In normal working conditions, it is estimated that nearly 30% of nurses develop PTSD (4).
COVID-19 has added substantial additional risk factors for trauma into the lives of health care workers. Facing extreme stress on the job, high risk of infection, and lacking protective equipment, many health care workers and emergency room personnel have described their occupation as a dangerous mission. Their health, and the lives of their families, are in danger.
We already know the psychological effects of COVID-19 on health care workers as a result of recent studies coming out of Wuhan, China. In the first study assessing the severity of depression, anxiety, insomnia, and distress in a sample of 994 doctors and nursing staff in Wuhan, 36.9% reported subthreshold mental health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances, and 6.2% had severe disturbances (5).
In the USA, the situation may be even worse for health care workers treating COVID-19 patients without adequate personal protective equipment (PPE). Even the simplest of supplies, such as facemasks, are often not available in the quantity that is needed. In a reported case in Canada, health care workers were told to use their masks until they are “grossly spoiled.” The result is added stress and fear.
In New York, Seattle, New Orleans, and other areas that have experienced large numbers of COVID-19 cases, nurses and doctors work long hours and often lack adequate support. First responders undergo physical strain as a result of wearing protective equipment, sometimes leading to dehydration or heat exhaustion.
Health care workers treating COVID-19 patients must isolate themselves more strictly than the general public. Even after work hours, they need to maintain strict social distancing. The stress of maintaining constant awareness and vigilance regarding infection control adds to the burden on health care workers.
Although the most vulnerable populations are immunocompromised, already struggling with underlying health issues, and older adults (6), the risk for doctors, nurses, and first responders exposed to the virus is very real. A recent Newsweek article counted over 100 doctors and nurses that have died from COVID-19 as of the end of March.
At the time of this writing, in Italy alone, more than 60 doctors have died from the coronavirus. China lost at least eight doctors from COVID-19 including the 29-year-old physician who first reported serious concerns about the virus and another doctor who was only 34 years old.
A nurse at Montefiore Hospital in The Bronx – in a recent news broadcast – declared: “We are writing our last will and testaments … I am 28 years old.”
Fears of catching the virus and bringing it home are very real for all healthcare workers. Shortages of adequate protective gear cause many to feel it is not if but when they catch the virus (7).
In a recent interview, a physician who has seen coworkers get sick and die from COVID-19 likened his experiences to a soldier on the frontlines. Every morning he wakes up and checks himself, “do I have fever?” (NBC News, Live, March 31).
Our healthcare workers are experiencing challenges on many levels and are not getting adequate support from a system that was unprepared for a pandemic. While focusing all their attention on the needs of their patients, many healthcare workers during this time will have difficulty acknowledging or even recognizing their own needs and feelings.
Taken together, the cumulative pressures on healthcare workers in areas with intense COVID-19 outbreaks are overwhelming.
For healthcare workers in the thick of a pandemic, self-care is often not seen as an option in the thick of the crisis. However, there are some practical steps that can be implemented.
In the midst of the crisis, we have limited ability to moderate the emotional toll of the pandemic on healthcare workers. As the COVID-19 outbreak moderates, we need to collectively support the many nurses, doctors, and first responders who will experience PTSD.
If you or a loved one is experiencing symptoms of PTSD or heightened emotional stress due to the COVID-19 pandemic, consider connecting with a licensed mental health professional.
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