Impact of epidemic on frontline staff

How we might expect staff to react

During the immediate outbreak of COVID-19, China found that 75% of healthcare staff report symptoms of traumatic stress, 50% depression and 44% anxiety. Such immediate distress is expected in large numbers and can be considered a normal response. It is a minority of staff who are resistant to distress during this phase. Most, people, do recover their peace of mind after the threat passes. For a smaller percentage this can persist over time. In the two years after SARS staff burnout did increase significantly.

Some of this variance is predicated on things the organisation can do:

• Protection from perceived unnecessary risks.
• Prioritising staff’s physical safety.
• Adequate training and support to carry out their role.
• Showing staff they are of value in themselves.
• Having a clear steer and guidance whilst allowing staff autonomy.

There are some personal risk factors for developing significant immediate distress or later ongoing problems that needs specialist help:

• Having pre-existing mental health problems.
• Having pre-existing psychological trauma or lack of support (including domestic abuse).
• Suffering a bereavement directly or indirectly from the outbreak.
• Being significantly ill during the outbreak (or a loved one).
• Being separated from family (because of work or because of isolation or quarantine).
• Losing an income.

Common fears of staff

• Many healthcare staff do not worry significantly about catching the disease themselves.
• They do worry about passing it on to their family, some of who may be in high risk groups.
• They worry about passing it on to vulnerable patients.
• They can be concerned about managing uncooperative patients.
• They worry about not having the right equipment to help people.
• They are concerned they won’t be able to do a good job.

Factors affecting wellbeing

As mentioned previously in the page ‘The traumatic nature of an epidemic’ there are several factors that make an epidemic particularly challenging.

These factors can make the trauma of an epidemic harder to deal with than many other major incidents, disasters, mass casualty events or bereavements.

For this reason a trauma informed approach to wellbeing during the epidemic would be recommended. This is a practical, value driven, system wide approach to the impact of trauma. It appreciates people’s responses in the environmental context in which they arise; seeks to promote physical and psychological safety; considers potential inadvertent harms from actions intended to be helpful; and sets up relationships that empower and value people.

Looking after ourselves as staff

Turning up for work during such time requires us to manage our fears and trust that our leaders will be making wise decisions about our safety and contamination. Extreme emotions are normal during abnormal times. The widespread nature of the problem might rally more people to collective positive action. Sometimes it can make people irritable, controlling, avoidant, needy or ‘hard’. The things that affect us the most may not make sense to us.

• Stay grounded in your motivation to do a job as well as is possible under the circumstances.
• Be forgiving of others.
• Keep well informed and well connected.
• Raise concerns and ideas for action.
• Informally support each other emotionally.
• Focus on the things you can control rather than those you can’t.
• Find safe people to talk through your worries.
• Use the same resources and advice for yourselves that you give others.
• Rest and slow down when you can.
• Smile when you can.
• And breathe…