Balance vs burnout during COVID-19

On April 1^st 2020, Medscape listed the names of more than one hundred healthcare workers who had died of COVID-19.¹ Many thousands of people worldwide have been infected.

The need to survive this crisis is paramount. But there are less obvious risks to the health of those who are looking after unparalleled numbers of critically ill patients.

Emotional exhaustion and feelings of failure contribute to the condition commonly referred to as “burnout”.² Among the mental health consequences of burnout are depression, alcohol abuse and suicidal ideation.³ Burnout is unfortunately common among clinicians in normal times.^2,3 And these are not normal times.

Emotional exhaustion and feelings of failure are unfortunately common among clinicians in normal times. And these are not normal times.

Challenges never seen before

Two specific examples reflect stresses of a kind not previously encountered.

A recent study noted how full societal lockdown leads to signs of exhaustion among nursing home staff within a month.⁴ Secondly, those working in intensive care face what has been termed “the toughest triage” doctors are ever likely to encounter when they have to ration ventilators among equally sick people.⁵ When such decisions violate a physician’s moral or ethical code, the “moral injury” can be profound.⁶

Suggestions as to how the mental health consequences can be mitigated include preparing staff honestly for difficult decisions they will have to make, providing forums in which the emotional challenges of doing so can safely be discussed, and supportive supervision.⁶

Practical suggestions on prevention and coping

In terms of managing the mental wellbeing of healthcare providers more generally, How Healthcare Personnel Can Take Care of Themselves is among a set of resources made available by the American Psychiatric Association in response to the COVID-19 pandemic.⁷

“Physician heal yourself” is an age-old exhortation. To that we could now add “Physician, keep yourself healthy”.

Among the recommendations are:⁸

• Ensure you meet your physical needs for hydration, food and sleep
• Take regular breaks
• Check in with loved ones
• Monitor yourself for stress reactions
• Taking care of yourself and encouraging those around you to practise self-care can help reduce the risk of impairing the ability to care for those in need

Those working with people who are infected are urged to have frank discussions with their family about the risk to themselves and their loved ones; steps being taken to minimise that risk; and the possibility of quarantine.

This advice is based in part on the publications Taking Care of Patients During the Coronavirus Outbreak: A Guide for Psychiatrists; and Psychological Effects of Quarantine During the Coronavirus Outbreak. Both are from the Centre for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD.