By Professor M. Adil Khan and Dr. Rebecca E. Olson[i]
4 September 2020
“Social distancing at home was hard — setting guidelines, having separate utensils, no other stuff in the toilet and shower room. Each person has their own basket for toiletries. For two months, not sleeping with [my] spouse and not being able to kiss and hug my kids. It was hard, really hard,” said Ms. May Villanueva, a Nurse at Auckland Hospital’s COVID Ward in New Zealand. Ms. Villanueva was speaking at the Australasia (Australia, New Zealand) and South Asia Webinar on COVID 19 and the experiences and perspectives of frontline health workers – the webinar was held on July 27, 2020.[ii]
These feelings of grief and loneliness expressed by the New Zealand COVID nurse Villanueva are very similar to those experienced by most COVID-19 frontline health workers namely, the doctors, nurses, paramedics and other health professionals.
Since the outbreak of the virus in February this year, many health professionals working on the frontline have been infected, scores have died, and many are wearing the emotional effects at multiple levels.
COVID-19 induced stress and trauma
Associate Professor Dylan Flaws of the Queensland University of Technology (QUT), Australia, a panellist at the 27 July Webinar, informed viewers of a global survey that he and his colleagues have recently conducted on security, safety and stress aspects that are being faced by the COVID-19 frontline health workers and reported that while most frontline health workers experienced stress and trauma at multiple levels, given the pandemic’s infectious nature and its deadly consequences, tensions among health workers were at their highest during the initial stages when there was a noticeable, “split amongst staff between those not in a position to or unwilling to see COVID-19 patients (the ‘clean’) and those willing to and involved in treating COVID-19 patients (the ‘unclean’).” There was also spike in “bullying and because of social distancing, an erosion of usual mutual coping strategies.”
Flaws survey further revealed that while experiences of trauma and stress among the health professionals are similar worldwide, some countries seem to have lessened some aspects of these by putting in place proactively, safety and counselling measures. This has been duly corroborated by Dr. Hasan Shohag, a Staff Specialist in Internal Medicine at the Gold Coast University Hospital, Australia who reported at the Webinar that early and effective infection-preventive measures at his hospital greatly helped in averting fears of health risks among health workers.
Dr. Shohag’s very first, if not Australia’s very first COVID patients were Hollywood actors Tom Hanks and Rita Wilson who in March this year were on the Gold Coast, a seaside resort city in Australia, on a movie shoot. It so happened that within a few days of their arrival, they started showing symptoms of COVID-19 and thus were admitted to the Gold Coast University Hospital and soon after they were diagnosed with COVID 19. “The hospital went through a complete restructuring and my department and I were put in the front line,” explained Dr. Shohag.
Indeed, in conjunction with arranging treatment for Hanks and Wilson, the hospital took steps to restructure its epidemiological governance. For example, in order to offer the best treatment and at the same time to protect its health workers against infection and stress, the hospital put in place following COVID safe structures: established Hospital COVID teams (responsible for treating patients with COVID within the hospital); Community COVID teams (responsible for advising the community about containment and home treatment); Hospital COVID wards (departments with restricted access, open only to diagnosed patients and required staff); Fever Clinics; a Virtual COVID hospital; a separate COVID patient entry point in Emergency; and a separate ICU for COVID patients. These measures ensured that there were no fatalities of COVID patients nor infection of its health workers at the hospital.
Furthermore, in order to minimise pressure on doctors and nurses Gold Coast University hospital also arranged “shift duties…. Daily briefings and provisions for multi-disciplinary meetings were made to evaluate progress and track difficulties…. PPE was always a major issue.” While measures to create a COVID-safe environment successfully prevented spread of the virus among the health workers and breaks in duty minimised fatigue, Dr. Shohag reported that the sense of powerlessness and helplessness were particularly harrowing and acute in the early months. “The stress of your patient deteriorating in front of your eyes and that you are unable to do anything became unbearable…this is the worst fear a doctor and/or a nurse can have.”
Gold Coast University Hospital became aware of these stress issues and in order to assist its health workers to cope with the trauma, they established an ‘Always-there-peer support program.’ In addition, the State government of Queensland (Queensland is a State in Australia where the Gold Coast University Hospital is located) also amplified their ‘employee wellbeing program,’ giving government health employees access to social, emotional, physical, financial and workplace wellbeing support. These measures alleviated health workers’ experiences of trauma and stress.
Similarly, at the Auckland Hospital in New Zealand, the ‘buddy system’ among the COVID nurses, which paired nurses with each other during their shifts on the COVID ward, greatly helped in ameliorating feelings of isolation and mitigating anxiety, especially associated with the challenges of ‘PPE donning’ and other infection control measures. Further to the COVID-safe environment established at the hospital, the New Zealand government also put in place back-up complementary trauma management facilities throughout the country to reduce the spread of infection, along with the fear of infection, among health workers
Traumas are multi-layered, so are their sources
COVID-19 frontline health workers experience stressors from multiple sources. The global survey conducted by Associate Professor Dylan Flaws and his colleagues has catalogued several of the sources of stress: “Staff resources/capacity, [in]sufficient PPE, death anxiety, family wellbeing, moral injury from triaging/treating colleagues.” Flaws’ study also revealed that while most emotional challenges faced by the health workers are universal and common to both male and female, some are gender specific. For example, in comparison to males, female health workers reported a greater sense of isolation from their families and showed much greater “concern for children” and thus described COVID-19 has having a greater “emotional toll of loneliness during isolation.”
Another unfortunate but not so uncommon source of stress is the stigmatization of COVID health workers within the community. For example, Dr. Shohag of the Gold Coast University Hospital, Australia reported that thanks to the changes made at his hospital to control the spread of infection and protect health workers, “I never felt unsafe at my workplace….my stress came from outside the hospital, from the community.” However, he also reported that “…because of my involvement with COVID patients, some in the community told me that I am a threat to them and thus should not come home and spread the disease. [I] should stay at the hospital.”
These revelations indicate that health workers are experiencing stress at multiple levels and from multiple sources and the fact that the virus is unlikely to go away any time soon, adequate measures must be put in place to protect the health workers from the multilayered challenges of COVID related stress. Indeed, Dr. Deborah Harris, Lecturer at Victoria University of Wellington, New Zealand and Advisor, New Zealand Contact Tracing Services, and a panellist at the July 27 Webinar, reminded the Webinar that “the virus has one goal – to infect the host (us)…. Our job is to stop that from happening.” Therefore, as the virus continues to undermine our way of life, along with the search for treatments and a vaccine, the health – both physical and emotional – of frontline health workers, the people who risk their own lives to save those in the community must be a priority.
Furthermore, as the second wave of COVID 19 has shown, abatement of the disease in one country without similar outcomes in other countries will not stop the spread of this deadly pandemic nor its layered challenges. Therefore, continued dialogue about protecting health at the biomedical, psychological and social level across national divides is more important than ever.
[i] The authors: Professor M. Adil Khan is a professor of development practice, School of Social Science, University of Queensland, Australia and former senior policy manager of the United Nations (email@example.com); Dr. Rebecca E. Olson is a Senior Lecturer and a health sociologist, School of Social Science, University of Queensland, Brisbane, Australia (firstname.lastname@example.org)
[ii] Jointly organized by the Centre for Governance Studies (CGS), Dhaka Bangladesh and School of Social Science and Faculty of Humanities, Arts and Social Science, University of Queensland (SocSc-UQ), Brisbane, Australia, the Webinar: COVID-19 and Frontline Responders: Health Professional Perspectives was held on Monday 27 July 2020. The Webinar included 10 frontline health responders/panellists, 5 each from Australasia (Australia and New Zealand) and South Asia. Worldwide, more than 230 participants registered and participated at the webinar. Mr. Zillur Rahman of CGS and Professor M. Adil Khan and Dr. Rebecca Olson of SocSc-UQ jointly moderated the Webinar. Link to the Webinar Summary and Video of Proceedings: