Caring for the Frontline

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Throughout the COVID-19 pandemic — now more than 10 months and counting — we’ve rightly been lauding health care workers and other frontline workers as heroes. New Yorkers have taken to their balconies and porches at 7:00 p.m. to bang out symphonies of appreciation on pots and pans. We’ve hung thank-you signs in our windows and planted them in our front yards. We’ve contributed to programs that deliver meals to frontline workers both to boost their spirits and to support local restaurants. But our health care workers need more than cheers and free lunches during this stressful time.

People from all walks of life are feeling isolated, anxious, and depressed these days. In some ways, we’ve all experienced a collective trauma. Trauma is often the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless in a dangerous world. Research bears this out: surveys consistently show increased symptoms of anxiety and depression during the pandemic compared to the prior year and that large percentages of Americans are experiencing mental health and/or substance use issues.

Health care workers’ levels of stress and trauma during the pandemic are of particular concern. Think back to the spring in New York City: a new virus, without clear treatment protocols. A shortage of personal protective equipment so bad that nurses and doctors were reusing gloves and masks over the course of a full day or even longer, when they should’ve been changed between every patient. A reliance on strangers to donate their hand-sewn cloth masks to extend the life of disposable masks. Not enough staff; not enough beds. The possibility of not having enough ventilators, and having to make impossible decisions about which patients would get them and which wouldn’t. The emotional labor of holding up an iPad so loved ones could say goodbye. Refrigerated trucks lined up outside to hold corpses.

We’ve made progress in fighting the pandemic. Our understanding of the virus and effective treatments has increased. We are better supplied with stockpiles of necessary equipment. Testing is more widely available. Several effective vaccines have emerged.

But more and more health care workers are hitting a wall. They’re exhausted and drained from having battled coronavirus for 10 months and counting. With post-holiday spikes and new, more contagious forms of the virus emerging, the pandemic is far from over and some hospitals are edging closer to being overwhelmed. Going to work each day evokes fear of getting sick themselves or putting family members’ health at risk.

A survey of health care workers over the summer found that 86% reported experiencing anxiety and 82% felt emotionally exhausted. The word “unprecedented” is overused these days, but it fits here: nurses, doctors, and other health care workers have been overwhelmed as they care for endless numbers of very sick patients, many of whom they aren’t able to save, sometimes including their own colleagues. In a recent New Yorker article, Bellevue Hospital’s chief medical officer put it this way:

“Our staff had never seen so much death. Normally, a patient dying would be such a big deal, but, when you start having a dozen patients die in a day,
you have to get numb to that, or you can’t really cope.”

What can be done to help health care workers cope? A number of programs are underway at hospitals and health care systems throughout New York State. Some of these programs — like NYC Health + Hospitals’ Helping Healers Heal initiative — had been in place for many years, but have been adapted and expanded to meet growing and changing needs during the COVID-19 crisis.

The Physician Affiliate Group of New York, or PAGNY, whose members work in H+H hospitals, health clinics, and correctional health facilities, has expanded its Emotional Supports Program to provide emotional and peer support and mental health first aid to frontline health care workers during the pandemic. It offers resilience and mental health training, outreach, and virtual support groups that also include family programming. Participants have found the program helpful in processing feelings of grief, guilt, and anger and addressing the many challenges that cause stress and anxiety during the pandemic.

In Central New York, Bassett Medical Center is rapidly expanding a program to help prevent clinician burnout during the pandemic and working ultimately to spread it statewide. Recognizing that health care providers are often reluctant to ask for or accept help for their own health needs in a clinical setting, the program focuses on peer-to-peer support networks for physicians, advanced practice clinicians, resident physicians, and nurses.

Other frontline workers also have struggled disproportionately with mental health issues during the pandemic: social service providers, grocery store workers, delivery workers, and public transit workers are all providing essential services without the luxury of working remotely, putting themselves in harm’s way. In New York City, Vibrant Emotional Health is offering support to frontline social service and human service workers through virtual interactive training focused on psychological first aid and self-care to help them cope with high stress and the risk of burnout. The program builds on Vibrant’s Staying in Balance program.

The mental health needs of frontline workers will continue to emerge and evolve over time. When exposed to intense trauma, some people initially go into survival mode. Emotions may be repressed. The focus is all on making it through the day. It’s hard to even conceive of getting to the end of the week, much less making longer term plans. Not every frontline worker needs or is ready right now for mental health supports. However, they very well might be down the road. Having the needed resources in place at the right time is what we owe those who put their lives on the line to care for us. Otherwise, banging on pots and pans to thank our health care workers is just noise.

David Sandman, Ph.D., is President and CEO of the New York State Health Foundation. www.nyshealth.org www.twitter.com/DavidSandman1

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