COVID-19 EFFECTS ON MENTAL HEALTH OF MEDICAL PROFESSIONALSDr. Muhammad Arsalan Sharif - September 01, 2021
The first case of Covid-19 was reported on 26 February 2020 in Pakistan1 kickstarting the pandemic rollercoaster in our country. On a quiet morning my colleague doctor Ali sat besides me when I noticed he was shaking and seemed anxious. When I asked him what was bothering him, he said he longed to go to his hometown, but the worry of transferring the virus to his parents and family was consuming him.
I felt as if he had just expressed my own thoughts. His fear was the same reason why I had not dared to visit my parents for over six months. I had been so lonely and overworked for a prolonged time, all I really wanted was to be with the people who care about most about me. But the fear of harming them was tearing me up.
Looking back we made the right decision to stay away. The chaos of the pandemic was huge at that time, not just for us, but around the world. Almost 90% of Healthcare Professionals2 across the globe are battling the exact same fear and faced the same challenges.
Covid-19 was and is a newly discovered disease caused by a new strain of coronaviruses for which we don’t have a proper treatment yet and even the efficacy of rapidly developed vaccines is not 100%. This and less obvious factors have greatly affected the mental well being of Healthcare Professionals on so many levels.
Like many of my respected colleagues I have faced some of the worst medical situations that came hand in hand with the outbreak.
Lack of proper knowledge
Because we dealt with a new strain of the coronaviruses3 there was no proper knowledge about its mode of action, transmission and treatment of the disease caused by it. Today we know so much more, yet there is still little authentic knowledge on Covid-19. The main reason behind it being the rapidly developing variants4. Our knowledge and the data we rely on is changing almost daily. This leads to recurring panic and continuous confusion among healthcare professionals.
Fear of contracting the virus
On a global scale over 100,000 Healthcare Workers have already been infected by the novel coronavirus5. Most of the hospitals were understaffed at the start and lacked sufficient personal protective equipment, with death as the ultimate result. Sadly, more than 3000 of our colleagues6 have passed away after contracting the infection and succumbed of the complications. This scenario alone has been horrific and more than enough to have a detrimental effect on the mental state of Healthcare Professionals.
It’s safe to say that Healthcare Professionals are terrified of transmitting Covid-19 to their loved ones. Probably more so than getting infected themselves.
In any country you can think of Medical Professionals are generally overworked. Long hours of duty and significant responsibility automatically leaves less time for leisure and much needed unwinding. But during the waves of the pandemic, the patient load surpassed our already stretched capacities. The duration and extend of huge patient influxes has negatively affected every capacity; our medical machines, available beds, but especially our medical staff.
Having to go through extended duties at ICU’s, CU’s and general wards often without proper personal protective equipment and a shortage of medical equipment has been an inhumane circumstance. This enormous burden is topped of with the immens fear of getting infected and dying yourself is the single biggest factor of work related stress and anxiety.
At the moment of writing the fear of transmitting the virus to others has not yet eased. The Delta variant of Covid-19 is highly infectious. Data shows this variant to be the most contagious and leading to increasing transmissibility when compared to other variants, even in vaccinated individuals7. Doctors, Nurses and other Healthcare Workers are the main carriers of this variant and transmit it into society. Requiring them to be even more careful and concerned about their own safety as well as that of others.
Negative peer pressure
Despite working in utmost stressful and often miserable conditions during this pandemic, Healthcare Professionals don't get what they deserve in many countries. Facing the lack of administrative support, negative peer pressure from colleagues, pay cuts, intens workloads, aggression from patients and inadequate as well as insufficient medical and protective facilities. The trend in the medical world has always been to work hard to prove yourself while dealing with traditional peer abuse. Even under normal circumstances this severely affects mental health.
Those who get infected
Anxiety and depression are common for anyone who gets sick, it’s natural response. When you are part of the medical community and get infected with SARS-Cov-2, your anxiety levels double, because you have inside knowledge and experienced the worst scenarios in the hospital you work at.
Recently I was infected myself with the virus during my surgical rotation. My anxiety level was so high it caused my saturation to drop to 93%. It was the continuous support of my wife and her efforts to calm me down that saved my life. Loving support from our families and dear ones are undoubtedly crucial to cope with stress, anxiety, and post-traumatic stress disorder. Thankfully through to progressive research proper treatment guidelines are now available8. This has reduced the fear amongst Health Professionals at least a little.
The pandemic has affected nearly every business and jobs are lost around the world. Ironically, the unemployment rate among doctors, Nurses and other Healthcare Workers has increased as well. The restrictive measures have led to a sharp reduction in elective procedures in both government and private hospitals. Elective surgical procedures are the financial backbone of medical facilities and the lack of income the pause on elective procedures has caused several facilities to close departments. The cumulative of all recent events combined with lay-offs, is adding financial challenges for the ones who face unemployment and added workload for remaining peers9. The disaster is unfolding as suicides rates among Healthcare Professionals are increasing at alarming rates.
Many Healthcare Professionals working in corona wards encountered difficulties with the general public due to common misconceptions about the disease. People outside the medical field did their best to avoid Healthcare workers. Medical workers found themselves ignored and scorned at the their loneliest hour.
Several of my coworkers were kicked out of their homes by their landlord because they were feared to spread infections. Finding a new home was a precarious and difficult challenge for them. Colleagues working private jobs got deprived of these jobs due to government policies.
Witnessing the impact of social anxiety as a side effect of the pandemic was a sad and disturbing experience that kept my morals way down. Unemployment and social rejection are predisposing factors to depression.
Coping with mental health issues
Upon sharing the events that I personally experienced in, what I hope to be, the hardest period in my career, I’d like to look forward. We need to take our learning points and make sure Healthcare Professionals are better equipped to deal with mental health issues in their profession.
The following points need to be addressed:
All hospitals should have a separate department to look after the mental health of their staff, especially doctors and nurses.
The duty hours should be defined and reasonable so that everyone can have time to rest, including during a pandemic.
Hospitals should make sure that all necessary facilities and personal protection are readily and sufficiently available.
Efforts should be made to ensure there’s enough hospital staff. Extra jobs should be created.
The government and concerned departments should take care of medical staff who get infected while performing the duties. They should be provided with free treatment and receive financial aid.
Authorities should speed up the vaccination process, everyone should be offered vaccinations.
The hospital administration should be supportive, listen to their staff concerns and take action accordingly.
The public should be educated about the sacrifices of Healthcare Professionals during this pandemic, so that they are respected and rewarded.
Doctors and nurses should be provided the safety and security of the administration so they don’t fall victim of patient’s not their attendant’s aggression. Anyone should be able to work with mental peace.
I believe that implementing positive changes will allow for a better work environment with less added stress.
My final and most important note on staying mentally healthy in Healthcare; if you feel depressed, lonely and overworked as a Healthcare Professional or working in a supportive clinical position please don’t ever hesitate to ask for help. Share your story with someone you can trust, allow yourself proper treatment. You are not the only one, many of us went through or are going through the same, especially now. Taking care of yourself is not only good for you, it’s good for the people around you. It’s only human to make mistakes and be afraid.
Until we see impactful changes being made we need to make an effort to have each other's backs. Let’s make sure we tolerate each other, respect each other and be aware of each others mental health.
About the author:
Dr. Muhammad Arsalan Sharif, MBBS (Pakistan), MS Urology (Resident), is a proud and enthusiastic Urology resident at Mayo Hospital in Lahore - Pakistan with a taste for writing. Having gone through the motions of the pandemic himself, he recognises the importance of a support system and mental care for all Healthcare Professionals.
Dr. Sharif is a registered member of PONSIST. He looks forward to meeting you for a deeper discussion and learning about staying mentally well in the medical world as well as sharing tips and tricks on Urologic surgery with amenable peers.