On the Front Lines of the Pandemic

As hospitals struggle, healthcare workers become anxious and depressed.

Posted Apr 22, 2020

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No rest on the front lines.
Source: gpointstudio/iStock

As a science writer, I count myself lucky to be able to chronicle breakthroughs in research with an objective journalistic eye. I am, typically, an outside observer. But this article hits close to home: My wife is a nurse and her world has been pitched upside down. This is my admittedly subjective report on how the pandemic is affecting her.

As a healthcare worker, she is on the front lines against the deadly COVID-19 pandemic. Not since the Spanish Flu of 1918 has the world been locked in such a dreadful spiral of sickness and death. Sadly, we seem to have learned very little about pandemics in the ensuing century. We failed to set aside emergency stockpiles of medical equipment and personal protective equipment (PPE). Today we send our healthcare workers into battle with meager weaponry and deficient gear. Some are wearing garbage bags for protection.

The cavalry is not coming

It's too early to tell if we are winning this war. There is no vaccine against coronavirus, and no treatment. The government insists anyone who wants a test can get one, but that appears to be aspirational. Neither my wife nor any of her co-workers have been tested. The government, which has a duty to protect us, seems to have dropped the ball. Shockingly, hospitals have found themselves in bidding wars against the federal government for PPE. Who knew our healthcare system was so fragile?

My wife goes to work knowing that she doesn't have the PPE she needs in order to stay safe. She knows that, consequently, she stands a higher risk of contracting the disease. Yet she feels obligated to serve, unlike medieval physicians who avoided the plague like, well, the plague. Their mantra was "flee early, flee far, and return late."

Of course, a real pandemic means there is no place to flee. No matter how friendly they appear, everyone is a potential disease vector. People are dying, and because they are so contagious, they die alone. A healthcare worker may be the last person to talk to them. No one, no matter how jaded, is unaffected by this.

American spunk

My wife uses cloth masks made by our amazingly supportive local community, which has tried valiantly to pick up where our government has left off. The standard procedure for a communicable disease is straightforward: Gown up and use an N95 mask before entering a room with a sick patient. When done, discard the mask, because it is likely to be contaminated. But still, in the fourth month since the pandemic started, there are not enough gowns and there are not enough masks. There are not enough test kits – there aren't even enough swabs, which are a bit of cotton on a stick. These are astonishing failures for a 21st-century healthcare system. It's even more embarrassing for the country the rest of the world looks to for competent leadership.

During this pandemic, many hospitals are on the edge financially. Their lifeblood is elective surgery, but in many states, that is on hiatus. Why? In most cases, it's because all the meager PPE that they have on hand has been allocated to COVID-19. These hospitals simply can't do what they were built to do, thereby putting both them and their employees in peril. Healthcare workers, when they are needed most, may be furloughed to keep hospitals afloat. Many nurses and doctors have been forced to take pay cuts. That's right: As their jobs have become more deadly, their compensation is being reduced.

Depressed, anxious, and tired

We know where this will lead, because we have the experience of the Chinese to guide us. A report in JAMA fleshes out the grim details. In a study with 1257 healthcare workers in Wuhan, China, over 50% reported depression and 45% reported anxiety. They also found 34% suffering from insomnia. In all, 72% reported some kind of mental distress. Interestingly, the distress was higher among nurses than doctors, and higher among women than men. This was almost double the rate of distress and triple the rate of insomnia in areas outside of the coronavirus epicenter.

One contributor to stress is powerlessness. Not knowing whether you will contract a disease when you enter the room with a coronavirus patient is stressful. The public, staying safe at home, is unlikely to get close to a coronavirus carrier, but many doctors and nurses are guaranteed to run into several every day. Even more stressful is knowing that you don't have the proper protection. This is the worst kind of stress: helplessness in the face of danger.

With hospitals turned inside out, healthcare workers are being reassigned to completely different tasks. Nurses are resilient, and they are quickly adapting to their new roles, but it's stressful to be fixing the engines while you're in flight.

While the rest of us shelter in place, doctors and nurses are dealing with the most intense aspects of the pandemic. They face patient death on a daily basis. They have seen their coworkers succumb. They are concerned about infecting their families. Many healthcare workers are living separately in order to protect their loved ones. They are heroes, but feel like lepers.

What to do?

Eat well. A strong gut is a great defense against the virus, which tends to pick on people with poor health. Concentrate on fibrous foods including beans, onions, and greens. This will nourish beneficial gut bacteria which can improve both your health and your mood. Eat fermented foods for their probiotic boost. You can make these foods at home and minimize your trips to the store. Kraut is made with cabbage and salt and can last you for weeks. You can make your own yogurt, and you can even use powdered milk in a pinch.

Exercise. Muscle can buffer you against illness. It helps your body store sugar, protecting against diabetes and obesity, thus strengthening you against COVID-19. It can also serve as an emergency source of amino acids, which can help when fighting pathogens. Exercise even pumps up your gut microbiota, increasing diversity and numbers of beneficial bacteria.

Try to get some sleep. It can be difficult to sleep when your job keeps invading your dreams. Insomnia, as the Chinese study showed, is a major problem with stressed healthcare workers. They are continually on call, and work erratic schedules, which both disrupt sleep. You may not have much control over the quantity and quality of your sleep, but you do have some control over diet and exercise. If you get those right, it can help you sleep better.

What can the rest of us do?

Support your healthcare workers. If you are a spouse, start helping with the housework. Cook, vacuum. Be supportive, attentive, upbeat. Humor, to the extent that you can muster it, is powerful medicine.

I'm a science writer. I spend most of my time on my butt. I've been social distancing for decades. I don't really have a dog in this race. But my wife gets up at 4 and heads off to work at 5 in the morning. She wakes me up to kiss me goodbye.

I tell her every morning: "You're my hero." That has always been true, but never so heartfelt.

References

Lai, Jianbo, Simeng Ma, Ying Wang, Zhongxiang Cai, Jianbo Hu, Ning Wei, Jiang Wu, et al. “Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.” JAMA Network Open 3, no. 3 (March 2, 2020): e203976–e203976.

Moloney, Rachel D., Lieve Desbonnet, Gerard Clarke, Timothy G. Dinan, and John F. Cryan. “The Microbiome: Stress, Health and Disease.” Mammalian Genome: Official Journal of the International Mammalian Genome Society 25, no. 1–2 (February 2014): 49–74.