COVID-19 and PTSD in Hospital Personnel

Nurse washing hands to avoid Covid 19 virus.The outbreak and spread of the novel coronavirus (COVID-19) has multiplied the already difficult challenges experienced by hospital staff and first responders. During this pandemic, health care professionals and first responders are exposed to a variety of potentially deadly hazards (1). In addition to the risk of infection and serious illness, health care workers also face psychological distress, direct and vicarious traumatization, long work hours, fatigue, stigma, and occupational burnout (2).

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).

Additional trauma on an already-stressed population

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.

Demands of caring for COVID-19 patients

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.

Healthcare workers fear for their own health

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).

The coronavirus pandemic creates a “perfect storm” for PTSD

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.

How we can support healthcare workers

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.

  • Short timeouts for basic bodily care and refreshment.
  • Regular check-ins with colleagues, family, and friends.
  • Brief (however brief, even 5 minutes) relaxation/stress management breaks. Taking a few minutes to quiet yourself and take several deep relaxation breaths are likely to help stress levels. Even just three long, deep breaths with slow exhales will have an effect on calming your nervous system.
  • Regular peer consultation and supervision.
  • Keeping informed with accurate information helps you maintain a sense of control and can help manage stress levels.
  • Focus on what you can control and practice accepting there are certain things you cannot control.
  • Practice self-compassion

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.

References:

  1. Center for Disease Control (April 1, 2020). Stress and Coping. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
  2. World Health Organization (2020). Guidance for health workers. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/health-workers
  3. Danella, N., Hamilton, S., & Heinrich, C. (2017). Posttraumatic stress disorder in critical care nurses. Nursing 2019 Critical Care, 12(3), 40-46.
  4. The Advisory Board (2019). Why 1 in 4 nurses suffers from PTSD (and how to help them).
  5. Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., … & Hu, S. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study. Brain, behavior, and immunity.
  6. Center for Disease Control (April 2, 2020). People who are at higher risk for severe illness. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
  7. The New York Times (2020). The calculus of coronavirus care: A shortage of ventilators is bad. A shortage of doctors and nurses critically compounds the problem. Retrieved from https://www.nytimes.com/2020/03/20/well/live/coronavirus-covid-doctor-nurse-shortage-staff.html

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