Coronavirus takes emotional toll, health workers suffer PTSD

DETROIT – Critical care nurse Kelsey Ryan wakes up choking at night, reliving the trauma of treating — and losing — patients to Covid-19 during the height of Michigan’s pandemic in the early spring. 

In her dreams, she’s laying in a hospital bed, unable to breathe as her colleagues at Beaumont Health in metro Detroit force a ventilator tube down her throat.

“I still have nightmares every night. My managers and best friend at work putting a tube down my throat while I’m crying and begging them not to. Just like all of my patients did. I wake up choking,” said the 28-year-old registered nurse in Michigan.

Ryan was also a Covid-19 patient after testing positive in late-March, but she was able to recover at home without being hospitalized.

She lost more patients in March and April than she had lost over the previous six years. For nurses like Ryan, the peak of the coronavirus pandemic felt like a war,  she said. And much like a soldier with post traumatic stress disorder, or PTSD, it left her with a scarred psyche and nightmares.

“It was a little bit of a shell shock. Everything just happened so fast. It just didn’t give us time to cope with everything that was going on,” said the mother of two. Life and death decisions of who would get a ventilator were made in seconds and multiple times a day. “It literally felt like we were in war.”

She and her colleagues “need a lot of mental health assistance,” but she hasn’t had the time or energy to deal with it until recently. Cases across the state have since fallen and the hospital system became less overwhelmed with Covid-19 patients.

“I know that it has changed me, and forever will,” she said. “I coded and intubated more patients in three weeks then I did throughout six years in critical care.”

Ryan isn’t alone. Health-care workers are fighting a new battle with the coronavirus as many struggle with PTSD, which can include flashbacks, nightmares and extreme anxiety. Many have witnessed more death than soldiers during war with the coronavirus taking more than 120,000 lives in the U.S. alone.

Many doctors and nurses with less severe symptoms are anxious and stressed and still live in fear of spreading the disease to family members. They also worry about a resurgence in cases as states allow more and more businesses to reopen as well as the financial stress on the economy, public health officials say.

“The pandemic and how it has impacted health-care workers and the population as a whole has been significant,” said Dr. Lisa MacLean, director of physician wellness at Henry Ford Health System in Michigan. “In this recovery phase, we are now noting a lot of exhaustion, guilt, anger and these PTSD-like symptoms – nightmares, a flashback, a sense of reliving the events.”

At the height of the pandemic on April 7, Henry Ford was treating 863 Covid-19 patients. That number was down to 13 to begin this week.

The coronavirus has taken an emotional toll on the country, but none have been affected more than front-line workers and their families, according to a Kaiser Family Foundation poll. About two-thirds of those living in a household with a health-care worker said they experienced at least one adverse effect on their mental health or well-being. That compares to nearly half of Americans overall.

In Covid-19 hotspots such as Detroit and New York, where health-care systems were overrun with patients, hospitals are offering outreach programs, interventions and support groups for workers. They’ve launched peer-to-peer groups and online programs with access to one-on-one assistance with mental health experts and psychologists.

But not all could be helped in time. After the suicides of two New York City health-care workers in April, Mayor Bill de Blasio said U.S. military trauma specialists would assist the city’s front-line workers. In recent months, the city has significantly expanded efforts to also help citizens, many of whom couldn’t afford counseling. De Blasio called it a “mental health crisis within the crisis.”

The father of Dr. Lorna M. Breen, a Manhattan doctor who committed suicide, told The New York Times that she had “described devastating scenes of the toll the coronavirus took on patients.”

“She tried to do her job, and it killed her,” Dr. Philip C. Breen, her father, told the newspaper.

The hospital system where Breen worked, NewYork-Presbyterian Allen Hospital, started offering support programs for employees in March, according a spokeswoman for the hospital. They include team-based crisis support, urgent counseling services and a “Psychiatric Symptom Tracker and Resources for Treatment (START),” which is for staff to self-monitor their depression or anxiety symptoms and if they develop over time.

More than 1,800 sessions have been conducted with more than 10,000 of the hospitals 47,000 employees participating, according to NewYork-Presbyterian Allen Hospital. The system declined to comment on whether Breen sought any assistance.

“Recognizing that our colleagues have been facing sustained stress and anxiety, NewYork-Presbyterian began offering robust mental health services, including an urgent counseling service, to all of our front-line staff in March,” Williams said in an emailed statement. “Even as we hope to have confronted the worst of this pandemic, it is essential that our colleagues on the front lines continue to have access to emotional support and practical strategies to enhance coping as they process their experiences.”

Dr. Anne Browning, assistant dean for well-being at the University of Washington School of Medicine, said it will take about one to three years for health-care workers to emotionally recover from Covid-19.

“Some are reliving the hardest moments of their days and months in their dreams,” she said. “It can be incredibly disruptive.”

In Washington state — the first hotspot for Covid-19 in the U.S. — hospital systems such as UW Medicine and EvergreenHealth quickly mobilized to assist their workers who were battling with stress and anxiety. They launched peer-to-peer support systems, coping resources and other online tools as well as in-person counseling. 

Different methods of communication and outreach are meant to reach as many employees as possible in their preferred way, according to Dr. Joy Hampton, EvergreenHealth director of care management.

“The teams are experiencing a level of critical illness and death like most of them have not experienced,” she said. “In general, it’s hitting people a little bit differently.”

EvergreenHealth, which treated the first Covid-19 outbreak in the nation, started offering online resources for coping with stress and other issues, followed by team leader outreach and live webinars in March. The online conferences allowed those who wanted individual help to reach out.  

The hospital system also launched a web page where employees can anonymously submit their thoughts, called “55 Word Stories.” The page is filled with comments and issues about Covid-19, including some poems.

Browning and her team at UW Medicine have focused on assisting employees with coping with anxiety, stress and the uncertainty of the disease, for which there is no cure and a vaccine is still months, if not a year or more, away.

UW Medicine luckily established a peer-to-peer counseling program in January — weeks before Covid-19 took hold — to assist with regular burnout. That helped workers cope with the stress from the pandemic, Browning said. The system also launched group and online counseling, including Zoom sessions for family members.

“We were recognizing that people’s anticipatory fear was definitely spilling over to their families and the well-being of their family members was affecting them,” she said.

One of the hardest things is reaching employees who bottle up their emotions or pretend like they’re OK when they’re not, according to Henry Ford’s MacLean in Michigan. This can lead to depersonalization where the person feels detached from their body or attempts to numb the pain by self medicating.

Henry Ford has launched new mental health program focused on six goals: Process feelings about the pandemic; relieve suffering; validate feelings; teach about post traumatic growth; avoid becoming stressed; reduce future traumatic reactions and learn new coping strategies.

“There is a tremendous amount of psychological stress right now for our employees and we have a responsibility to help them,” said Dr. Betty Chu, associate chief clinical officer and chief quality officer at Henry Ford.

Ryan feels the same about her patients at Beaumont Hospital in Michigan. When discussing what’s happened and why she will continue to work despite the potential of a second wave, she says: “It’s my job.”