The rapid spread of the novel Covid-19 virus, an unpredictable and potentially very serious issue, has created a worrying time for everyone. How is the health service going to cope? How are we going to manage? Are we going to be completely overwhelmed with work? What about our elderly/vulnerable patients, friends and relatives? What will happen if we get sick?
The uncertainty and intense media scrutiny of the situation, in addition to the vast amounts of speculation and conjecture, can significantly add to our own anxiety about an unprecedented situation.
As frontline workers in the healthcare system, we are particularly at risk because we encounter very sick people every day. However, we also have the advantages of being able to understand the risk, interpret the data correctly, and utilise our training in hygiene practices and the correct use of Personal Protective Equipment (PPE) to prevent infection spreading to ourselves and those around us.
This is a rapidly evolving situation. We are fortunate in that we have both the data and the experience of other countries, particularly China, Italy and The Netherlands, who have encountered many cases before we have, in order to understand more about how Coronavirus spreads within populations and how containment measures work.
We are also extremely privileged to have the expertise of our superb public health, infectious disease and microbiology specialists who are working tirelessly to interpret and communicate the ever-changing news about how the virus is behaving in our community.
Helping people to hear the truth above the din of fake news is a challenge, in addition to carefully balancing decisions about the cancellation of public events without creating undue panic or unnecessarily disrupting people’s lives. It is important to remember that these are the experts and have many years of proficiency in this type of scenario. We applaud the amazing job they are doing.
The issue of mental health care for medical staff has been raised in several correspondence pieces published in Lancet Psychiatry. There, it is reported in the Xiangya Hospital China, staff attempted to alleviate pressures on caregivers by building a psychological intervention medical team, which provided online courses to guide medical staff to deal with common psychological problems; a psychological assistance hotline team, which provided guidance and supervision to solve psychological problems; and psychological interventions, which provided various group activities to release stress.
However, medical staff were reluctant to participate in the group or individual psychology interventions provided, with some nurses denying challenges despite signs of irritability and distress.
To meet the needs of frontline healthcare workers, the intervention was adjusted by offering a place for rest and time alone and facilitating leisure activities to reduce stress. In addition, the hospital guaranteed food and other necessities. Some nursing staff ‘showed excitability, irritability, unwillingness to rest, and signs of psychological distress’, but refused any psychological help and stated that they did not have any problems.
Several reasons were discovered for this refusal of help. First, getting infected was not an immediate worry to staff — they did not worry about this once they began work. Second, they did not want their families to worry about them and were afraid of bringing the virus to their home. Third, staff did not know how to deal with patients when they were unwilling to be quarantined at the hospital or did not cooperate with medical measures because of panic or a lack of knowledge about the disease. Additionally, staff worried about the shortage of protective equipment and feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly helps these patients.
The hospital guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. In addition to disease knowledge and protective measures, just -in-time education pre-job training was arranged to address identification of and responses to psychological problems in patients with COVID-19, and hospital security staff were available to be sent to help deal with uncooperative patients. The hospital developed detailed rules on the use and management of protective equipment to reduce worry. Leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counsellors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly.
This is in line with refresher training in infection prevention and control, self-care, transmission and family protection, and normal stress responses as advised by the WHO.
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Gaye Cunnane, PhD, MB, FRCPI, is Director of Health and Wellbeing at RCPI. As Director of Health and Wellbeing, Professor Cunnane is responsible for overseeing initiatives to improve the health and wellbeing of RCPI Trainers and Trainees. She is also a Clinical Professor of Rheumatology and a Consultant Rheumatologist at Trinity College Dublin (TCD) and St James’s Hospital. After graduation from medical school in TCD, she completed her basic clinical training in Medicine and then undertook PhD studies at University College Dublin and St Vincent’s University Hospital, where she investigated serological and tissue prognostic markers in early inflammatory arthritis, in collaboration with universities in Switzerland, (Zurich), The Netherlands (Leiden), the UK (Cambridge) and Sweden (Karolinska, Stockholm). She then completed a 3 year clinical and research Fellowship at the University of California, San Francisco, USA – the focus of her research there was on new treatments for lupus. In 2001, she moved to the UK as a Senior Lecturer at the University of Leeds, and in 2003 returned to Ireland to take up her current post. She was the National Specialty Director for Rheumatology training in Ireland from 2005 – 2012, Programme Director for Basic Specialist Training with RCPI from 2009 – 2017 and is a past President of the Irish Society for Rheumatology. Her recent research interests have focused on lifestyle risks in the rheumatic diseases.