Zyg Dembek investigates the extent of stresses put on healthcare and first responders during the Covid-19 pandemic 

The past year has been highly stressful for all healthcare workers and first responders globally. When the first Covid-19 pandemic wave struck, no country or healthcare facility was adequately prepared for the magnitude of what was to come

By mid-March 2021 there had been over 29,000,000 Covid-19 cases and over 530,000 deaths in the US (174,000 in homes for the elderly). The UK had logged over 4,225,000 cases and about 125,000 deaths. Worldwide, there have been about 120,000,000 cases and 2,600,000 deaths. 

The infamous 1918 influenza pandemic is estimated to have caused about 50,000,000 deaths worldwide, with 676,000 in the US and 228,000 in the UK. The present Covid-19 death rate exceeds all deaths during Word War II (85,000,000).

The toll on healthcare 

There has also been a commensurate personal and emotional toll among healthcare providers and their families. By March there were more than 300,000 Covid-19 infections worldwide among healthcare providers, with over 17,000 deaths. In 2020 over 2,900 US healthcare providers died of Covid-19, with over 850 healthcare deaths in the UK.

Among essential features missing for healthcare personnel during the first Covid-19 pandemic wave were access to basic medical needs, especially personal protective equipment (PPE) and patient ventilators, sufficient critical-care staff, and day care for their children. An immediate acute threat morphed into months of long-lasting critical care concerns.

As the Covid-19 pandemic has persisted into a second year, it has transformed an acute health threat environment into a chronic one. Having experienced continuing critical care cases and deaths, healthcare providers were confronted by anxieties over a second pandemic surge. 

Some healthcare facilities had most of a state or region’s Covid-19 patients diverted solely to them, adding to staff stressors with subsequent emotional burdens. Crisis fatigue was nearly universal, and included exhaustion caused by months performing healthcare in a constrained and unforgiving environment.

Stress multipliers

Examples abound of horrific death rates in Covid-19 hospital wards and homes for the elderly worldwide during the first pandemic wave. In one instance, five patients on a Covid-19 unit went into cardiac arrest in an hour, and three died. 

The death rate in a Massachusetts Veteran’s Care Facility was so horrendous (76 deaths out of 247 long-term nursing beds) that two Administrators were charged with criminal neglect. The sheer volume and condition of Covid-19 patients has been unlike anything ever experienced in modern healthcare. Many hospitalised Covid-19 patients had to be placed on ventilators and suffered from combinations of acute respiratory distress syndrome, blood clots and heart failure. Many patients died as a result of these complications. Nurses may have been required to frequently titrate as many as eight medications for a single patient in these circumstances.

Understandably, healthcare personnel experienced stress and trauma from patient’s deaths. Some also had family members who contracted Covid-19 with subsequent deaths. Many developed feelings of isolation from the necessity of avoiding contact with family members within their own homes or being forced to live at the hospital or nearby hotel to reduce risk of viral spread.

While burnout is common in medical professionals, the risk was highest for frontline healthcare workers. An early study of healthcare workers in China found that over 50% had symptoms of depression.

“Working in the frontline was an independent risk factor for worse mental health outcomes in all dimensions.”

CHINESE HEALTHCARE WORKERS STUDY

Loss, grief and fear

This pandemic stress has taken a deep toll among many healthcare providers. Healthcare staff may have experienced intense feelings of loss, grief and fear. This may lead to increased symptoms related to post-traumatic stress disorder (PTSD), depression, anxiety and other mental health conditions. 

The pandemic’s potential psychological consequences on healthcare workers surfaced in March 2020 amid reports that several nurses caring for Covid-19 patients in Europe had committed suicide. This was a global phenomenon. The psychological impact of the Covid-19 pandemic on healthcare staff working in a highly-impacted area of northeast Italy was found to be greater than that reported in China.

“For many physicians, Covid-19 may be the proverbial straw that breaks the camel’s back as they isolate themselves physically from their family and friends while encountering a surge of sickness and death.”

Unsurprisingly, physicians are leaving Medicine because of the pandemic. In the US, 8% (~16,000) have closed their practices, and ~25% of all physicians are considering early retirement.

Innovative solutions

In response, some hospitals have created the position of Chief Wellness Officer. Others have offered resilience and meditation workshops, social hours and tips for maximising productivity. 

Last year, the American Nurses Foundation launched a Well-Being Initiative, intended to help nurses manage Covid-19 stress and overcome trauma. This programme provides access to digital mental health and wellness-related tools, connecting nurses to trained experts to provide support.

Other hospital programmes aim to help healthcare providers by reducing administrative burdens, provide greater flexibility over their work schedules, and offer mental health support. Our healthcare workers have continuously proven themselves during the Covid-19 pandemic and are invaluable to our respective nation’s well-being, and deserve our enduring support and gratitude.

Col (Ret) Zygmunt F. Dembek is an epidemiologist and biochemist. He has written extensively on biodefence and has conducted pandemic preparedness exercises worldwide.

A general duty corpsman assigned to Naval Medical Center San Diego and a US Navy staff nurse don 3D-printed face shields before entering a Covid-19-positive, non-critical patient’s room in San Diego last August.
©US Department of Defense