When Daniel Baldó put his wellness startup on the back burner and offered to work as an ICU nurse at Madrid’s giant Hospital Universitario La Paz, he found a system overwhelmed by COVID-19 cases, with medical workers pushed to the breaking point by staffing shortages amid an ever-increasing flow of critical patients.
“There are fewer and fewer of us and, despite having the resources, the health system has not being able to speed hiring,” said Baldó, who adds that several emergency hires stopped coming to work after a day or two on the job. “There are people who are afraid, who have anxiety…and you will not attract those people if you offer them the same in exchange for more work, more effort and more risk.”
More than 12,000 Spanish health workers have been infected, some 14% of the total infections, exacerbating a worker shortfall just as hospitals improvise new ICU wards to face the pandemic’s peak. At least eight medical workers are among the more than 10,000 people who have died in Spain.
The intensity of the experience is such that the thousands of medical workers still on the front lines in Spain—and in other COVID-19 hotspots—are likely to be marked in ways not normally seen outside of warzones and disaster sites. The inability to save patients, the fear of infection, and a feeling of helplessness inspired by a shortage of personal protective equipment (PPE) early in the outbreak, is already inspiring emotional trauma that will, for some, become Post-Traumatic Stress Disorder (PTSD).
“It’s been seen repeatedly that first responders or disaster relief workers will experience emotional trauma, which results in an acute stress reaction, and this is characterized by confusion and anxiety, and, potentially, depression, and can lead to either rapid burnout, and even PTSD,” said Albert Wu, a professor of health policy and medicine at the Johns Hopkins Bloomberg School of Public Health who in 2000 coined the term “second victim” to describe health care workers emotionally traumatized on the job.
Dr Wu describes PTSD as a reaction that persists for more than a month and includes “stress, flashbacks, and avoidance of things that remind you of the stimulus.”
“What we are really doing is putting our healthcare workers in harm’s way by subjecting them to a traumatic experience, which is exacerbated by worries of contagion and worries about one’s competence and ability to handle this enormous problem,” he said.
“We’re dealing with a lot of death”
In Spain, these levels of trauma and worry have been especially high in the country’s approximately 5,400 geriatric residences that look after some 375,000 people. These homes, which are often small, private institutions that lacked the PPE stocked by hospitals, were hit early and decimated by COVID-19 cases; one Spanish radio station estimates that more than 3,000 residents of these homes have died in the pandemic.
Pilar, who works in a Madrid geriatric home and is isolated at home after showing COVID-19 symptoms, says nine residents in her residence have died in the last 10 days, compared to a normal rate of one per month.
“We’re dealing with a lot of death. As nursing home workers, we’re used to living with death. But to see elderly people die so quickly without being able to do anything, without the family there—it causes an incredible feeling of impotence and generates a lot of stress,” said Pilar, who asked not to use her last name for fear of reprisal from her employer. “And physically, we work in a rush, and we have little protective gear so we all end up infected.”
Her residence is working at 50% staffing, she says, because of the sheer number of infected aides.
Juani Peñafiel, who overseas workers in private geriatric residences in Madrid for the Comisiones Obreras (CCOO), Spain’s largest trade union, says that at least four Madrid residences have seen more than 50 deaths in the last 15 days.
“People are sad, they are exhausted but they are working so much they can’t analyze what is happening. They don’t have time,” said Peñafiel. “After this all passes, the workers in residences will be very damaged, because it’s not the same to see two die in a week as to see five die every day.”
Italy tells a similar story. As of Friday, 73 doctors were among the country’s 14,000 coronavirus dead, and more than 10,000 health workers had tested positive for the virus.
One doctor, working on the front lines in Monza, one of the country’s hardest hit regions, told an Italian journalist the thing that most terrifies him is the prospect of putting his family at risk.
“We’re not heroes. We’re ordinary men and women, with a fear of coronavirus,” he said. “Every day I enter the hospital, taking all the necessary precautions. And still I’m scared I’ll get infected and bring the disease home to my partner and to my kids.”
Meredith Mealer, an assistant professor at the University of Colorado Anschutz Medical Campus who studies psychological distress in healthcare providers, says that between 21% and 28% of critical care medical workers suffer PTSD during their lives, compared to 8% in the general population. Those on the frontlines in the coronavirus pandemic could approach 50%, she says. “We’re seeing not just a higher percentage who are dying but you’re adding in fear for personal safety because of a lack of PPE, fear of contracting COVID, fear of bringing it back to your family, and fear of colleagues getting sick or dying,” she said. “The scale is so much larger than with everyday ICU or ER experiences. There’s just so much uncertainty.”
For Dr Wu, this will require a coordinated response from the healthcare sector to keep medical workers healthy—and working.
“The wellbeing of these workers can be rapidly eroded, and absence or dropout is predictable and this makes it hard to keep an adequate workforce to face the problem,” he said. “What’s needed is recognition that this is predictable and expected, and to maximize wellbeing and resilience of workforce you need to provide them psychological and emotional support.”
In Madrid hospitals, the PPE shortage has been largely solved, but the intensity of the ordeal continues. “There is protective material (and more every day) but there are no personnel. The protective gear doesn’t work alone, so it’s not enough,” said Baldó. “[The hospital] opens beds and buys materials but they do not realize that this does not work by itself: it needs nurses who can care and heal.”
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