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For Many Frontline Health Workers, COVID-19 Comes with an Emotional Toll

November 10, 2020
by Matt Kristoffersen

A new Yale School of Public Health study suggests that the coronavirus pandemic has taken an extreme psychological toll on health care workers across the country — and for many the effects could be long lasting.

In the study, recently published in PLOS One, researchers polled workers at 25 medical centers across the United States in an effort to gauge the pandemic’s early impacts on health care workers. What they found was shocking: Of the 1,132 people who responded to the survey last May, almost a quarter had probable post-traumatic stress disorder, and nearly 43% reported probable alcohol-use disorder.

The results help shed light on the hectic first months of the coronavirus pandemic, when COVID-19 patients overwhelmed much of the American health care system. But to Rachel Hennein, who led the study, the findings can also help guide responses to future pandemics.

“There was a lot of strain on the health care system because of COVID-19, and a lot of that strain ended up trickling down to the health care workers,” Hennein said. “It's really important to be able to identify how we can help them.”

The survey included two open-ended questions in which health care workers could elaborate on their most upsetting and most hopeful experiences during the pandemic. Their anonymized responses range from harrowing to uplifting.

One emergency medical technician wrote that she felt heartbroken after loading a dying man into an ambulance as his wife and children looked on, terrified and crying.

“As we pulled out of the patients driveway, we left his entire family sitting in front of their house grieving, scared, wanting to believe there was a possibility we could save their father, knowing there was a good chance that that was the last time they would see him alive,” she wrote. “In 30 years as an EMT, this felt different than any other similar call I have done.”

In another response, a 40-year-old nurse detailed the pain she felt when she had to keep her young son from hugging her after a long day at the hospital. “The look of sheer confusion and disappointment on his face has stayed with me all of these weeks. I cannot get that image out of my head,” she wrote.

The study’s responses also include stories of hope. Frontline workers said that the pandemic gave them more opportunity to enjoy time with family, and that hazard pay made their financial situations more bearable. Many health care workers noted that seeing community members wear masks and abide with physical distancing policies made them feel like they were all fighting the pandemic together.

It's really important to be able to identify how we can help them.

Rachel Hennein

And the nightly health care hero celebrations that consisted of a cacophony of pots and pans cheering on first responders had a noticeable impact on their mental health.

“I think it's a really important message for the general community to recognize that their little acts of kindness towards health care workers do a ton in improving their wellbeing and making them feel appreciated,” Hennein said.

Hennein, a Yale M.D.-Ph.D student, said she helped come up with the survey idea shortly after her clinical rotation was cut short at the start of the pandemic. Assistant Professor of Public Health Sarah Lowe also worked on the survey. Their study’s approach is unique, Hennein said, because while other surveys have included only close-ended questions about health care workers’ experiences, theirs includes open-ended ones — a hybrid model that can better encompass workers’ thoughts.

They plan to roll out additional surveys in the coming months to gauge how widespread and permanent the pandemic’s effects have been for health care workers.

The upcoming questionnaires will also help to improve the data pool with more diverse responses, Hennein said. Of the 1,132 participants in this study, nearly 75% identified as white, and most were women. More than half of the responses were from hospitals in the Northeast.

Still, Hennein explained that the study contains important lessons for the future.

“If we had a better pandemic response, if we had a national government that wasn't spreading misinformation, then that would not only improve public health,” she said, “but it would also really help the frontline workers who are dealing with the pandemic — emotionally and psychologically.”

Submitted by Ivette Aquilino on November 11, 2020