COVID-19, health-care workers, and stress

My four-year child would say, “Had I been also infected, I would have got a chance to stay together with my parents……”

One of our Nursing colleagues brought out her memory of around 2 months ago; when most of her family members had been PCR positive, except for the child, who had to stay away from his parents for two long weeks.

Whenever I would pass by my neighbors while returning from my hospital duty, they would cover their unmasked face (mostly the nose area) and turn away…..

A nurse-staff was explaining her issues during the lockdown period.

My tenants had asked me either to leave their house or to resign from her job at the hospital….

A hygiene-staff was pouring her sorrow she had to bear during the corona season.

We were discussing regarding the stress the frontline health-workers faced, or still have been going through, during this corona era, now lasting for more than a year.

Yes, the stress was of paramount significance when most of the health-workers and their family members, received a report of PCR-positive status. Even when the PCR status was negative or unknown, anxiety and worry never faded away. When the colleague of the same department, or the staff with whom we lunched or dined together, or a patient with suspected Corona whom we had cared, turned out to be positive, we would definitely be concerned; our apprehension and fear would mount up. The seven days of isolation before going for PCR, and almost 24 hours of the report-waiting period, would make us uneasy and full of paranoia.

“What if my report is also positive? What would happen to my wife and daughters? What about my elder parents?”

That was my fear when I had gone for PCR when a colleague happened to be Corona positive. These were the concerns of most of us; and still are.

The above-mentioned lively examples clearly demonstrate the multiple factors associated with the front-line or any health-workers’ stress for the last one year. All of those concerns are due to COVID-19.

The stressors are related to family: their needs, expectations, supports, finance, work, roles etc. There are also factors in the workplace, i.e., hospital: safety or protective equipment, work-routines, workspace, support from the colleagues and the employers/ bosses. Community also plays a role in stress-escalation: awareness about the pandemics, stigma, local support, etc.

These concerns are not confined to our part of the world. Fears of infection among the frontline health workers are not hypothetical. Almost all over the world, mortality and morbidity associated with covid-19 infections are higher among the health-workers. Health workers are working overtime with inadequate sleep. They are staying away from their family: spouse, elderly parents, and younger children. They are minimally paid, their salary has been reduced. “More work, less pay”: how would they remain motivated? Also, the protective equipment and work infrastructure is substandard and insufficient. Work-environment is poor. People are still unaware of the real mechanisms of infection; instructions continue changing day-by-day, sometimes the information remains confusing or contradictory. Basic necessities like food, hygiene, transportation, and internet facilities are inadequate. All these factors pile up in the stress ladder of a health worker’s life during the covid era. Medical literatures clearly show stress-related medical issues among the health workers in the corona pandemic.

Despite these facts, health workers are unable to express their concerns, ventilate their feelings, and remain motivated to work. When they are unable to identify their own stress, how would they manage their psyche? Beyond that, how would they cope up? And, how would they take care of their family and patients?, when they are themselves stressed? Stress has been considered a very important psychosocial etiological factor for many different psychiatric conditions; mostly anxiety and depression. Medical literatures have always dwelled this issue.

From a psychiatrist’s perspective, self-identification of stress-related symptoms by the health workers themselves is the most important step towards healing and healthy living. The health-workers should be able to acknowledge the fact that though they may appear same, people are different. So, they can have different perception and concerns even towards the same problem. However, they should also validate their stressful circumstances and agree to the circumstance that most of the people (especially the health workers) have been suffering in almost the similar manner all over the world. When they self-identify their stressful issue, they need not hesitate to approach other people (colleagues, employers, or mental health workers) for support. We, the mental health workers, are trained enough to acknowledge, validate, and universalize these stress-related factors affecting the health workers, that too in this corona period. Empathy solves most of the problems.

We usually ask them to explore in their body what ‘stress’ has done to them. Palpitation, sweating, tremors, restlessness etc. are some of the sympathetic activation related symptoms among the stressed individuals. Tiredness, insomnia, sadness, anxiety, apprehension, anger-outbursts, worry are the mood symptoms. Changed appetite, altered bowel movement (diarrhea or constipation), stomach upset, disorientation, lack of concentration is additional symptoms. Sometimes, the stress can produce just the ‘pain’ symptoms: headaches, neck and shoulder pain, backache, abdominal pain, chest pain, lump in throat etc. All these physical, emotional and behavioral symptoms, leading to failure in handling daily routines and responsibilities, in the background of corona-related distress, are the perfect examples of stress-related problems. Stress reduces immunity; and may lead to multitude of physical and mental disorders.

Now, how to cope of with these stress-related worries?

The first and foremost step is to self-identify and acknowledge the role of stress in one’s life. Flexible but routine-scheduled daily activities, regular breaks, uninterrupted social contact (virtual), timely communication with near-and-dear ones, sharing and caring attitudes, are the important measures to combat with stress. Healthy diets, regular exercises, relaxation techniques, entertainment, music, working for fulfilling the hobbies, recreation and creative activities also help us to be stress-free. Deep breathing exercises and mindfulness meditation are the most-proven steps to overcome stress. The negative aspect of regular news-surfing has also been proven: limiting the news to just twice a day and only through the proven and reliable source, is allowed. Religious activities, for those who have trust and faith, may also help. Coping with substance use (alcohol, tobacco etc.) are the unhealthy mechanisms, one should refrain from that.

Anyhow, life does not end. We need to continue working. So, stress-free environment is the must. Corona, though a long-lasting pandemic, it will go one day. We should move on. So, let us identify our stress, ventilate our sorrow, and acknowledge its negative role in our life. Then, we should move towards healing our psyche. We are there to help and support 24X7.