ACMT COVID-19 Web Series FAQs

The spectrum of emotional responses to the COVID-19 pandemic is very large and can vary over time even within individuals, and by location and current or anticipated disease prevalence. Uncertainty, anxiety, fear, anger, mistrust, sadness, depression, guilt, feeling stressed along with physical manifestations of same such as difficulties with sleep, obsessive behaviors, misuse of sedatives and other drugs, and hopelessness are all within the expected range of psychological responses. Suicidal thoughts may intrude and some have committed suicide. Denial, bravado, or cynicism may also be seen. As with other human tragedies resulting in grief, the acute emotional reactions to the COVID-19 pandemic are not the same as psychiatric pathology - we should not rush to “diagnose”, but rather provide an open, listening environment with our colleagues, recognizing the ongoing stress that may precipitate a range of emotions that we all may experience to one extent or another. We should all be in this together.

REFERENCES:

Wang C, Pan, R, Wan X, Yan Y, Xu L, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17(5):1-25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084952/pdf/ijerph-17-01729.pdf  

CDC: Coronavirus Disease 2019 (COVID-19) Coping with Stress:
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Healthcare providers – at baseline – have an increased risk of suicide compared to the general population. The increased workload, changes in standard practice and procedures, concentration of ill patients and fear of infection – for themselves and loved ones, and the potential for substance misuse to deal with stress are added to the weight of our normal dealings with human tragedy and professional burnout. Nurses, in particular, may be at risk because of their long shifts with bedside care responsibilities. Young people may not have had prior experience with the magnitude of tragedy they encounter. On the other hand, older individuals may have particular concerns because of “high-risk” conditions (though certainly not relegated to older people). In short, any person who feels overwhelmed and isolated without a tested coping strategy or trusted person with whom to share their concerns is at particular risk. Thus, maintaining human contact – even virtually – and providing those dealing directly with the impact of the epidemic the opportunity to articulate their feelings without fear are critically important.

REFERENCES:

CDC: Coronavirus Disease 2019 (COVID-19) Coping with Stress: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

El-Hage W, Hingray C, Lemogne C, Yrondi A, Brunault P, et al. Health professionals facing the coronavirus disease 2019 (COVID-19) pandemic: what are the mental health risks? Encephale 2020;46(3S):573-580.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174182/pdf/main.pdf

[abstract in English; article in French]

 
While one’s background, training, experience, worldview, and personality are important determinants of an individual’s response to any stressful situation, the changing nature of the COVID-19 infection toll and the varied – and inconsistently communicated - response to this epidemic at multiple levels can alter one’s risk perception and coping response across various activities, over time, within and between individuals and communities.  Some “defense mechanisms” such as denial, cynicism and sardonic responses may help us to cope with daily dealings with personal tragedies. However, these are not effective long-term strategies, any more than are resigned fatalism or pessimistic surrender to fear. There are a number of national organizations with local or regional resources to help, in addition to your institution’s employee health service or medical staff office, and/or state or national professional society. The following principles may be useful in achieving resiliency and growing through personal tragedy:

1. We are in this together – Provide an opportunity to share problems and concerns, as well as to share coping strategies that have been personally helpful in past situations. This can be done informally, or incorporated as a team function into “huddles” or small support groups.
2. Have more than one tool in the toolbox – Adapting in the face of adversity and tragedy may require different responses for different individuals or within the same individual over time. Talking through an issue may be appropriate, while a “COVID-free” conversation may be needed at another time.
3. Extend compassion to yourself and others – We often sympathize with our patients in the pain and emotions they experience; we should extend that same grace to ourselves and our colleagues.
4. Aim for growth even while experiencing pain and distress – This is not the same as denying or dismissing tragedy or grief. Instead, it reflects the commitment to persevere. The expectation of “post-traumatic growth” shifts us psychologically from “just” reacting and suffering to the hope of facing challenges, learning, and developing new skills – making meaning – by continuing to relate to others and the world. Even when there is much we cannot control, we can attempt to move from fear-based responses to learning, and then growing.

REFERENCES:

CDC: Coronavirus Disease 2019 (COVID-19) Coping with Stress: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Kessler D. Finding Meaning: The Sixth Stage of Grief Simon & Schuster, Inc. New York, NY 2019.