LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

The Fourth Wave of COVID-19: The Effects of Trauma on Health Care Workers

This post is the introduction to our newest digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce. All contributions to the symposium will be available here.

By Stephen Wood

On this day one year ago, World Health Organization Director-General Tedros Adhanom declared COVID-19 a pandemic, sounding the alarm about the international threat posed by the virus.

Today, one year later, I fear the end is not in sight. In fact, I believe that we are on the precipice of a fourth wave.

The fourth wave will strike the people on the frontlines of this pandemic — health care workers. It will be the effects of the trauma that health care workers entrenched in this pandemic have faced. And it is likely to have significant and lasting effects on our health care system.

The fourth wave will be moral injury, post-traumatic stress disorder, depression, anxiety, and an exodus of human resources from health care. This will have far reaching effects into all the health care fields, including not only nurses, doctors, paramedics, respiratory therapists, lab and radiology techs, but also physical therapists, ultrasound technicians, unit coordinators, and environmental services workers, among others. It is imperative that we recognize this looming crisis.

Day after day over the past year, providers have fearlessly headed into settings known to be high risk. Health care workers have served on the front lines without the proper gear to ensure their own safety. Knowing their duty, they carry out their responsibilities without question. They bear witness to the horrifying mass casualties that occur daily. Often they are the last to hold someone’s hand as they slip away, distant from family and friends.

History has taught us that these burdens weigh heavy on health care workers, not just during, but also after, a crisis. The Spanish influenza pandemic of 1918 provides some insight, as rates of suicide increased among both health care providers and laypersons alike.

Similarly, following the devastation of the September 11th attacks, rates of suicide increased among rescue workers. There are already several case reports of suicides among health care workers in the COVID-19 pandemic, with fear that this could be a growing trend.

At first, support for health care providers during the COVID-19 pandemic was overwhelming. Banners and signs, parades and donated meals helped to boost morale. This, unfortunately, was short lived, as the news cycle shifted to other matters. Protests about wearing masks and anti-vaccination campaigns further chipped away at the morale of our exhausted health care workers. Their home life has been disrupted, creating even greater isolation. Many health care workers have had to sequester themselves from their own families to keep them safe. There is the constant fear of spreading the illness to loved ones or getting the disease themselves.

To help temper what may be an impending exodus from health care careers, there needs to be a culture change with respect to mental health services. These services must be readily available, and workers should be incentivized to access these resources. A restructuring that focuses on wellness and includes built-in mental health breaks, integration of meditation, and expanded time off are several interventions worth considering.

For those who decide to leave the field, they should have access to resources for entry into a new career. Erasure of health care-related student debt would help to facilitate this, and could help to retain some providers, as well. Federal programs aimed at helping affected providers train and finance new careers should be instituted. These programs will need to be coupled with initiatives aimed at identifying and treating the accompanying depression, anxiety and in some cases, PTSD that will continue to affect providers.

The mental wellness of our health care providers, who have been particularly affected by this pandemic, should be an absolute priority. Both funded programs and cultural change are needed to mitigate the potential devastation of a fourth wave.

Stephen Wood

Stephen P. Wood, MS, ACNP is an acute care nurse practitioner practicing emergency medicine in Boston, Massachusetts, and a fellow in bioethics at the Center for Bioethics at Harvard Medical School in Boston.

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