The COVID-19 pandemic is an unprecedented crisis that requires us to develop critical stress-coping mechanisms as we protect ourselves against infection.
Much like a natural disaster, this pandemic is likely to cause psychological distress among the public. In the United States, Hurricane Katrina caused widespread trauma and survivors experienced elevated mental and physical health problems for years following; one study found post-traumatic stress symptoms in residents twelve years later.
Following the 2006 Dawson College shooting in Montreal, researchers found that service utilization among students and staff increased. They exhibited a higher prevalence of post-traumatic stress syndrome, depression, substance use, and other anxiety disorders.
But the COVID-19 pandemic differs from other mass trauma events in ways that make it especially toxic: large geographic scope, unpredictable in nature, and the sudden wide-spread disruption to our economies and health systems.
What is particularly difficult about the pandemic is not knowing when or how it will end says Portia Jackson-Preston, a public health professor at California State University in Fullerton.
As scientists race to find a vaccine and public health officials wrestle with strategies to contain its infectious spread, coping mechanism experts say a critical survival strategy must include the practice of at-home self-care.
“If we don’t learn how to manage ourselves, [then] how are we going to get through this? Because this is definitely a marathon, this is not a sprint,” says Jackson-Preston, who researches burnout and self-care practices among hospital and public health workforces.
A recently published review summarized some of the adverse psychological effects of quarantine, including post-traumatic stress symptoms, confusion, and anger. Longer duration of quarantine, fear of infection, financial loss, inadequate supplies or information, frustration, and boredom were identified as specific triggers.
Compared with the pre-COVID baseline, there was a dramatic 16-percent drop in the mental health of Canadians, according to the Morneau Shepell mental health index. And a staggering 81 per cent of respondents reported that the pandemic is negatively impacting their mental health.
Stress and psychological distress can chronically activate our stress-response system, or “fight or flight,” producing high and sustained levels of cortisol, weakening our immune system over time.
Taking care to mitigate that weakening means managing stress levels as much as possible, says Jackson-Preston.
Practicing self-care can help alleviate the psychological distress and anxiety caused by the pandemic and prevent lasting adverse psychological outcomes. The Canadian Mental Health Association recommends self-care as a coping strategy.
The World Health Organization defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” Broad in concept, it encompasses hygiene, nutrition, and lifestyle as well as environment and socioeconomic factors.
Because many of us are self-isolating or in quarantine, at-home self-care activities are important right now. These can include listening to music, gardening, meditating, calling a friend or loved one, taking prescribed medications, and showering.
The Mental Health Commission of Canada has published a self-care and resilience guide and the Quebec government also recently released an English version of its COVID-19 self-care guide, detailing specific information on caring for children, those who are ill, and people with disabilities.
Roberta K. Timothy, professor at the University of Toronto’s Dalla Lana School of Public Health, says it is important to acknowledge the collective impact of the COVID-19 pandemic and to monitor depression and anxiety levels as time progresses.
In an email correspondence, she wrote: “there is a need to grieve what is happening, especially with our communities seeing or experiencing so much loss…Take time to adjust to [the] many changes and added challenges.”
Jackson-Preston adds “we’re all going to experience some elements of [depression] and it might be scary to people who have never experienced it before.”
The advice to practice self-care is particularly relevant for front line health care workers.
The “second victims syndrome” is the term coined by Dr. Albert Wu, an internist and professor at Johns Hopkins Bloomberg School of Public Health, to describe the unique traumatization of health care workers who live with stressful, patient-related events, like unexpected deaths or complications.
The stress of COVID-19 is compounded, Wu says. “It’s a little bit unique because there is a fear of contagion, a fear of becoming infected, and the fear of potentially taking infection home to family or loved ones.”
Wu co-founded the Resilience in Stressful Events (RISE) program – a peer support team of trained on-call physicians, nurses, social workers, and chaplains who respond to staff members’ calls about stressful events and experiences.
“We are seeing a huge spike in the number of calls [to RISE]. We’re getting as many calls in a day as we usually would get in a month,” says Wu.
The 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto caused similar distress among health care workers. Between 29 to 35 per cent experienced psychological distress. And those who worked in high-risk hospital units experienced greater post-traumatic stress symptomatology.
Health care workers did benefit from resources that encouraged them to reflect on their stressors, as well as tangible support from their institutions – for example, meetings in which workers discussed and normalized feelings of stress and shared coping strategies were helpful.
For health care workers currently on the front lines, many of whom may already be burned out, rapidly changing protocols and less than ideal working conditions – like inadequate personal protective equipment – contribute to ongoing stress.
And without the usual team of mental health professionals present, many front line workers may find themselves in the difficult position of providing mental health care for COVID-19 patients.
Maintaining staff mental health is critical to effective infectious disease control. For responders who face secondary traumatic stress, the Canadian Psychological Association endorsed recommendations from the U.S. Centers for Disease Control and Prevention to create “a menu of self-care activities that you enjoy.”
When asked what sort of self-care activities healthcare workers need, Wu emphasizes getting adequate sleep, taking breaks without feeling guilty, and maintaining a routine. He also says it’s important to engage in activities and distractions that you typically enjoy.
“[A]sk yourself for a moment, in a quiet moment, how you’re doing. I think it is worth honouring your own service, appreciating that you are doing real good for society,” says Wu.
He also suggests health care workers thank their colleagues and co-workers “more frequently than you would otherwise” and reach out to friends, family, and colleagues for regular check-ins.
Organizations and systems could make self-care for staff and workers more conducive by first acknowledging that they are in high-risk environments, in which the risks of psychological trauma are greater than normal, says Wu.
Hospital and clinical systems should foster communication about workers’ safety needs and resources available to help physicians cope and remind workers to be patient and kind to themselves. “They should care about the wellbeing of their workers, both in the short-term and longer-term,” he adds.
Wu says his own program is currently collaborating with other resources at Hopkins to answer calls, either by phone or in person, while checking in with the units that are most in need – all while abiding by guidelines on hand hygiene and keeping six-feet of distance from other people.
In order for us to practice self-care individually, it’s critical to note that we first need a robust public mental health response and a broader social safety net to ease the burden of economic duress.
When we are able to care for ourselves, we are stronger, more resilient, and able to care for others – which is exactly what we need right now.