Frontline personnel worldwide have experienced professional and personal challenges as a result of the COVID-19 pandemic. Typically, medical professionals and researchers welcome the study of new conditions and infectious diseases. However, this virus arrived too fast in major cities for experts to have sufficient knowledge and information on how to handle it and treat it. Therefore, the intensity and severity of this virus left frontline personnel such as Doctors, Nurses, EMT’s, and other hospital employees exposed to increased work stress. Having frequent and direct contact with patients diagnosed with the virus increased the chances of becoming physically and mentally unwell. During this time, healthcare workers in units treating COVID-19 patients experienced the loss of patients at a higher rate than usual. All of these experiences increased physical, mental, and emotional exhaustion in many workers.

Rapidly growing cases in large cities overwhelmed the healthcare system and resulted in a scramble to secure the necessary resources. These events led some medical providers to experience distress and moral injury. Many healthcare professionals experienced having to make difficult decisions based on prioritizing treatment and the use of limited resources for their patients and themselves. As a result, healthcare workers experienced high pressures to provide effective treatment under extraordinary times while making decisions based on their clinical experience and professional oath. During the peak time of this pandemic, some of these professionals may have witnessed what they may have perceived as unfair or unjustifiable acts that led to their feelings of anger, guilt, or betrayal. While suffering these professional stressors, they also dealt with personal concerns regarding their wellbeing and their fears of spreading the virus to their loved ones. Many healthcare workers decided to distance themselves from families and friends by moving to temporary housing or maintaining physical separation from them. Separation from family and support systems resulted in increased burden, stress, loneliness, and isolation. These experiences, combined with mental and physical exhaustion left these professionals vulnerable to mental and physical fatigue.

The concern of becoming infected from the virus, spreading it, and witnessing extreme suffering and death of patients may increase the risk of developing psychological disorders such as post-traumatic stress disorder (PTSD). It is important to note that the majority of people who experience a traumatic event will not ultimately develop PTSD, and many who do can recover with effective treatment. Frontline personnel exposed to a traumatic event may also be at a higher risk of developing depression, anxiety, compassion fatigue, burnout, grief, and moral injury. It is possible that healthcare professionals may experience significant preoccupation even long after witnessing their patient’s physical and emotional suffering. These symptoms are associated with compassion fatigue and are not unusual in the healthcare industry. In fact, it is common for healthcare professionals and frontline workers to experience grief due to the nature of their work. However, when symptoms persist and become overwhelming, an individual may suffer from traumatic grief and may benefit from mental health services. Due to the circumstances of COVID-19 and recommendations for social distancing, many of these healthcare professionals may not have had their usual family and professional support. It is likely that many individuals who worked with COVID-19 patients experienced increased symptoms of burnout due to physical, emotional, and mental exhaustion. The expectation is that employers will take care of their workers and have appropriate behavioral health services readily available to them.

It is anticipated that State Health Departments will conduct research on the impact of COVID-19 related stress on frontline personnel. Once this data becomes available, it will provide a clear perspective on the short-term and long-term effects of stress and trauma-related to COVID-19.  It is essential that employers work promptly and consistently with their behavioral health departments or contracted agencies to provide behavioral health support to their employees. Even highly resilient individuals can suffer from the effects of traumatic experiences, so it is crucial that the support is available to help these professionals overcome and return to their highest functioning level. The impact of fear, social distancing, and unexpected loss of life and grief have already begun to affect the general population.  It is important not to disregard the mental health needs of frontline personnel who have provided critical care and support to their patients.

The COVID-19 pandemic has affected all facets of life for individuals around the world, so protective factors have been limited to many. As a result, it may take some time for individuals to develop and employ new coping skills to help them adapt. Healthcare professionals and first responders have specialized training in crisis response and have had exposure to medical emergencies. So it is likely that they will utilize those skills under these circumstances and be able to bounce back. Individuals that did not previously have the experience of working under high-level stress and crises may have more difficulty coping. Yet, history shows that even under horrific circumstances, individuals can return to their previous level of functioning.

In the same way that the work environment presents the risk of vulnerability for frontline personnel, the environment also presents opportunities for growth and resilience to develop. Having to show up to work and be exposed to trauma or stress triggers can help individuals confront similar situations in different ways. These workers also have opportunities to bond with their colleagues over clinical and personal shared experiences which can help to minimize feelings of isolation. The benefits of this unity can help to diminish stress or trauma-related symptoms. It can also help these individuals to work together through past challenges and develop new ways to work as a team.

Medical facilities such as hospitals have quality assurance guidelines to meet in order to provide meaningful statistics that demonstrate their clinical and patient satisfaction outcome levels. Therefore, healthcare organizations have the responsibility to re-assess their level of preparedness in dealing with future crises such as this pandemic. As more medical facilities begin to have adequate support and knowledge on ways to help their staff and their patients, healthcare personnel may be able to re-evaluate or accept issues associated with moral injury. As professionals begin to see changes in protocol align with their moral beliefs and expectations, those that struggled with feelings of anger, guilt, and betrayal may begin to see a reduction in symptoms. Since the aftermath of any crisis can leave individuals suffering for years to come, it is important for employers to encourage mental health support and promote a culture of mental health awareness. It is likely that many people will experience the psychological effects of this crisis once the adrenaline begins to settle and their survival mode is off; therefore, it is important to provide continuous support and services to these individuals.

Coping Strategies and Recommendations for Healthcare Workers

• You may feel that your thoughts, feelings, and behaviors are not normal, but they may be. Feeling helpless or lack of control will make you feel sad, depressed, or anxious. You may experience the loss of normalcy in your life, as well as the loss of your patients. Your experiences may leave you feeling worried about becoming sick or spreading illness. Reflecting and expressing your thoughts and feelings can help to normalize your experience.
• Seek out support. Reach out to colleagues, mentors, supervisors, family, and friends. Express your worries and feelings and allow others to be your support.
• Be aware of negative thoughts and feelings. Use evidence to help you monitor thought patterns that may contribute to negative emotions and behaviors.
• Making time for healing. Working long shifts may leave you feeling exhausted and depleted, so take time to focus on nutrition, sleep, and self-care. Providing a high level of care requires mental, physical, and emotional energy, so focus on your needs. Don’t minimize your own experiences. Take a few minutes to fit in a routine that fits your current living environment, such as stretching, exercising, breathing, meditating, journaling, listening to music, or any other healthy activity that you find pleasurable. Practicing progressive-muscle relaxation, breathing techniques, or grounding can help reduce stress levels and help you stay in the present moment.

• Avoid unhealthy habits. Substance misuse or abnormal alcohol consumption can be detrimental. If you find yourself developing a problem, seek out support before your behaviors worsen. These problems can lead to professional and personal consequences.
• Seek professional help. The impact of current times has broadened the availability of telemental health or online counseling. Reach out to your employer for referrals, call your insurance company, or search the internet for mental health professionals trained to provide effective treatment. Telehealth is as effective as in-person counseling services, and it has the benefits of time flexibility for those with busy schedules. If you are feeling overwhelmed and your symptoms persist, understand that your symptoms may be a normal reaction to abnormal circumstances. You are not alone, so don’t suffer in silence.

Author: Johanna Gomez, Ph.D., is a Licensed Mental Health Counselor (LMHC) in NY, NC, TX, and FL.