The COVID-19 Pandemic has changed our lives in so many ways that sometimes it is difficult to remember how life was without all these changes. We got used to the “new normal”, which includes a constant concern about contamination, economic crisis, and isolation. When we consider emergency physicians and other healthcare professionals, technical and scientific challenges regarding the pandemic response are also added to the equation.
Recently we completed three months since the first case of COVID-19 in Brazil and, since then, more than 300.000 have been infected and at least 23.000 people have died. These astonishing numbers could be 8 to 10 times higher if it wasn’t for under-notification¹ in countryside areas. The psychological effect of these numbers can be seen every day while people try to cope with the situation, and it may be even more intense in those who are in the frontline of the healthcare system. With this in mind, the question emerges: Who takes care of you while you take care of others?
What are the major psychological symptoms we can expect in healthcare providers three months into the COVID-19 pandemic?
After 3 months of COVID-19, we are not dealing with acute and immediate psychological response anymore; this next phase can be called assimilation, where we already understand better the new workflows, protocols and forms of living. However, we are still in a context of insecurity, fear, and loss of control over things we used to know how to deal with. The major psychological symptoms that are expected and considered to be normal in this context are:2
- Fear (of getting sick and dying, losing people, being socially stigmatized, being separated from people you care about and transmitting the virus to other people);
- Stress reactions such as anger, anxiety, confusional states, apathy
- The recurrent feeling of impotence, irritability, anguish, and sadness;
- Behavioral changes: changes in appetite and sleep habits, and interpersonal conflicts
Which strategies we can use to minimize these effects?
It’s very important to understand these reactions as being normal reactions in the context we currently live in. However, that doesn’t mean there is nothing we can do to ease them. It’s very important to intervene as early as possible as a way to prevent the chronification of those symptoms and progression to psychological disorders. Here are some strategies that can help2:
- Recognize these feelings and accept them as real and valid; try to talk about them with people you trust
- Think back to the strategies and tools you used in moments of crisis in the past. When it comes to dealing with difficulties, everybody has some preferred methods, which were tried and worked. Resume those actions that have worked for you and try to find ways of applying them to this new context
- Keep your social network active by establishing -even if virtual- contact with family, friends, and colleagues,
- Avoid watching, reading or listening to news that makes you feel anxious or distressed; look for information only from reliable sources
- Avoid using alcohol and drugs as coping mechanisms
- Ask for help if you find your strategies inefficient
There are lots of health professionals who are self-isolating from their families to prevent “bringing the enemy home”. How can self-isolation affect our mental health?
Isolating from family and friends means physically isolating from your support network. It’s relevant, in this context, to understand that physical isolation doesn’t mean affective and emotional isolation. As said before, it’s important to find new ways to be present in people’s lives and keep the social network active. Maintaining these contacts is also a way to ensure that when you leave the hospital and arrive at your rest place, you can actually disconnect from the routine and difficult times by talking to family members and listening about their day, their stories, and so on. In this moment of isolation and fear, we also witness the stigmatization of healthcare professionals3. People can direct their feelings of fear and uncertainty at health professionals, potentially causing behaviors of avoidance, rejection, aggressiveness and violence. If you find yourself in this situation, it’s key to understand that these reactions are not directed towards you personally, but to the global state of insecurity and fear, we are currently living.
Have you seen any changes in the problem-solving and decision-making capabilities of the physicians in the ED due to the stressed environment?
Interpersonal conflict, due to constant changes in protocols and workflows is expected in times of crisis and might be affecting problem-solving and decision-making processes. Here are some strategies to prevent it:
- Try to maintain a supportive work environment, including designated spaces to eat and rest
- Have moments to let the team talk about their mental state to help to develop a sense of community
- Alternate workers between activities of high and low attention and tension, if possible,
- Recognize effort made and encourage mutual respect among professionals
- Map and disseminate mental health care actions. Even if most workers will not need individual assistance, knowing that there are services that they can rely on when needed makes them feel supported
Finally, do you have any special tips for emergency physicians who are in the frontline against COVID-19 at this moment?
It’s important to know and to understand when the frequency and intensity of the normal symptoms indicate that you should see a specialized mental health professional.2
- Persistent symptoms
- Intense suffering
- Risk of complications, especially suicidal ideation and substance abuse
- Significant impairment of social and daily functioning
- Significant difficulties in family, social or work life
- Major depression, psychosis, and PTSD are conditions that require specialized attention
We know that healthcare workers bear considerable suffering and symptoms, but usually, this group of people refuses to seek or receive help. Among others, the main reason is that having difficulties to deal with all the emotional demands is -wrongly- seen as a sign of weakness or incompetence. At this moment, it’s more important than ever to understand that we can only take care of others if we, first, take care of ourselves. And taking care of our mental health is as important as our physical health to be at the front lines of COVID-19 response.
Gabriele H. Gomes
Psychologist, current Critical Care & Emergency Psychology Resident at Hospital de Clínicas de Porto Alegre (HCPA)
References and Further Reading (Portuguese only)
- https://ciis.fmrp.usp.br/covid19-subnotificacao/
- https://www.fiocruzbrasilia.fiocruz.br/wp-content/uploads/2020/04/Sa%c3%bade-Mental-e-Aten%c3%a7%c3%a3o-Psicossocial-na-Pandemia-Covid-19-recomenda%c3%a7%c3%b5es-gerais.pdf
- https://www.sbponline.org.br/arquivos/To%CC%81pico_4_Trabalhando_com_profissionais_de_sa%C3%BAde_que_enfrentam_rea%C3%A7%C3%B5es_negativas_das_pessoas_ao_redor_durante_a_COVID-19_No_T%C3%B3pico_4_abordamos_como_entender_e_minimizar_a_estigmatizacao_dos_profissionais_de_sa%C3%BAde1.pdf
- https://www.fiocruzbrasilia.fiocruz.br/wp-content/uploads/2020/04/Sa%c3%bade-Mental-e-Aten%c3%a7%c3%a3o-Psicossocial-na-Pandemia-Covid-19-recomenda%c3%a7%c3%b5es-para-gestores.pdf
