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Post-Traumatic Stress Disorder

Bracing for an Epidemic of PTSD Among COVID-19 Workers

The lessons we must learn from prior pandemic and disaster research.

Doctors, nurses, first responders, hospital staff, and essential workers all over the world represent the frontline in the global war on COVID-19. In recent weeks, television networks, newspaper columns, and social media have been flooded with reports from health care professionals who are finding themselves overwhelmed with the sheer numbers of sick patients and fears about medical equipment shortages, including protective personal equipment. Their stories tell not only of their extreme exposure to the pandemic, in the course of their professional duties but of a painful struggle to reconcile their need to take care of their sick patients with fears for their own health, the health of their colleagues and loved ones.

As a PTSD specialist, it’s my job to wonder about the cost of this war on the psyche of health care professionals, hospital staff, and other essential workers. What happens when a pandemic, such as this, impacts large swaths of essential workers in a discrete time period? What is the long-term impact of such mass traumatization? The last two decades have seen exponential growth in our understanding of disaster-related PTSD and, hence, an invaluable opportunity to apply these hard-earned lessons to the COVID-19 Pandemic.

First, we know that while most frontline health care personnel will heal naturally from the psychological toll of this pandemic, a substantial minority won’t. Indeed, PTSD is a well-established consequence for health-care workers who worked through deadly pandemics, such as Ebola. Case studies from doctors who worked through the 2014-6 Ebola Outbreak describe the unique stressors faced by health care workers such as the death of colleagues (a chilling reminder of their own vulnerability), the high stakes demands that force them to “carry on and defer” grieving and the processing of emotions and subsequent self-quarantine mandates which left them isolated from their traditional support systems.

Second, the intensity of exposure to disaster plays a big role in determining who will develop PTSD in the aftermath. Following the 2001 terrorist attacks on the World Trade Center, tens of thousands of both trained and untrained disaster responders were involved in the rescue, recovery, and clean up. In one study of over 3,000 responders, nearly one fifth developed PTSD and World Trade Center exposure, especially to death and human remains, was strongly associated with having PTSD years later. Indeed, half of the responders still had active PTSD more than ten years after the attacks. Such chronic PTSD takes a huge toll on individual life and often goes hand in hand with addiction, depression, and suicide as well as an increase in health conditions such as chronic pain syndromes and heart disease.

Finally, the pre-pandemic conditions of any given community or hospital system must be given due consideration. Research done after Hurricane Katrina showed the pre-disaster conditions of disaster-hit communities mattered a great deal in determining the success of recovery efforts. Hospital systems that serve patients who routinely face poverty and social adversity will likely bear the brunt of COVID-19 related devastation and this, in turn, will translate to a larger psychological price paid by the health care workers caring for these communities.

To add to this, American Medicine was reporting an epidemic of burnout among doctors and nurses before COVID-19 hit, so pre-existing issues related to the morale of these essential workers need to be factored in. Proactive steps to prevent further moral injury, vicarious traumatization and burnout will be vital in limiting further damage to staff emotional well-being and workforce attrition.

The collective lessons we have learned from prior disasters tell us what needs to be done to prevent an epidemic of PTSD among COVID-19 essential workers: in the immediate term, fundamental resources to help secure their personal safety and in the mid to longer-term a systematic, coordinated response that provides active outreach, identify vulnerable subgroups and, if necessary, offers psychological treatment. Fortunately, the mental health community has developed effective psychological therapies specifically tailored to treat and manage PTSD. There is no reason for this side effect of the COVID-19 pandemic to persist.

There is a dire need for systematic action to combat the mental health burden COVID-19 is placing on frontline health care personnel. For such actions to succeed requires more than lip service, trite words of sympathy and rhetoric, rather a long-term commitment to resources, funds and unequivocal societal support is what is needed.

Along with post-COVID-19 plans to resume normal living, reopen schools, businesses, and airports, we also need a well-defined pathway to ensure the psychological rehabilitation of those who served on the frontlines.

We all have too much to lose if such pathways fail to materialize.

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