In This Article
- COVID long-haulers are those who have suffered from COVID-19 that have lingering symptoms 4-6 weeks past infection
- Reduced work hours, flexible scheduling, avoiding night shifts, rest and allowing for recovery, work best to prevent debilitating fatigue
- Health care institutions should ensure that resources promoting wellbeing and self-care are available to their staff members
- Health care workers require a safe space for discussion to find the support they need
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Zeina Chemali, MD, MPH, director of the Neuropsychiatry Clinics and Training in the Department of Psychiatry, and unit chief at the McCance Center for Brain Health in the Department of Neurology, and team provide neuropsychiatry education and training in low resource settings and develops resilience training programs for health care professionals to address burnout in under-resourced areas. In this Q&A, she reports on the COVID-19 pandemic, its profound neuropsychiatric impacts and the needs to be addressed now and in the future.
Q: Who are COVID long-haulers?
Chemali: These are patients who have suffered from COVID-19, who have a positive PCR and still have lingering symptoms past four to six weeks from COVID-19 infection. Reports put them at 3% to 4.5% for longer than two months, and 2.3% longer than three months. We have seen cases of patients whose symptoms began early in the first wave in the U.S. who are still symptomatic.
Q: How can medical institutions support health care personnel that are COVID-19 long-haulers?
Chemali: In our experience, reduced work hours and a flexible schedule avoiding night shifts to promote rest and recovery work best to prevent debilitating post-exertional fatigue. The creation of a backup or supervision system for employees returning to work could avoid coverage gaps in the event of post-exertional fatigue while work hours are being gradually increased. Most importantly, we recommend dialogue between employers, employees and occupational health about what is helpful on an individual basis and to have clear guidelines to follow.
Q: Would the implementation of these changes affect health care at a systemic level?
Chemali: We think supporting health care workers struggling with long-term sequelae of COVID-19 as they return to work will help maintain the workforce as it continues to handle the pandemic. This is quite positive for the institutions. Failing to do so would amount to moral injury among health care workers and contribute to burnout, leaving the job, retiring early and the like.
Q: What effect might this have on patient treatment?
Chemali: Exhausted, overworked and a burnt-out health care force may not be working at the best of its capacity. Performance may be subject to avoidable medical errors impacting negatively on patient's care and experience.
Q: How will hospitals overcome the loss of skilled personnel if health care workers are not supported?
Chemali: This topic should make all hospitals and institutions pause and address it now. What is at stake is the livelihood of the hospital and the sustainability of its operation. Validating employee's experience, opening up specialty clinics and addressing those issues is paramount. In addition, the importance of diminishing meta-distress in the form of secondary anxiety and depression, as well as diminishing burnout, cannot be understated. For this reason, we believe health care institutions should ensure that resources promoting wellbeing and self-care are available to their staff members.
Q: Do you see any parallels between your work in war zones and today with the coronavirus and health care workers?
Chemali: It is a "war on COVID." Health care workers are in scary environments every day. They cannot control the uncertainty (including high morbidity and mortality) of this environment, which is similar to being in a war zone. Vulnerabilities are exposed and negative coping mechanisms often are the first ones to appear as people try to manage as best they can in this fearful situation. No one really knows what happens in a war zone except for the people living it. A birds' eye view of suffering is too distant to see, quantify and understand. Health care workers need to have a safe space—like the humanitarian safe space created during a war—to discuss their pain, get the support needed, without stigma so we all move towards a positive resolution of the conflict.
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