BEYOND BURNOUT: ENSURING HEALTHCARE WORKER WELLBEING DURING THE COVID-19 PANDEMIC AND IN THE FUTURE

BY KAREN MIOTTO, JESSE SANFORD, AND SETH FREEMAN

On Sunday, April 26, 2020, Lorna Breen, a respected emergency department physician who worked at a hospital in Manhattan, committed suicide. She had been treating the Spring surge of COVID-19 patients and was feeling overwhelmed. She had told her father, also a physician, about the tragic toll of suffering she had witnessed. “She tried to do her job, and it killed her,” Breen’s father told The New York Times.

Eight months later, a record number of daily COVID-19 infections continues to challenge and strain hospitals and healthcare workers. Overeating, drinking, and taking pills to sleep after long shifts at the hospital. Feeling stressed, depressed, and lonely. Dreaming vividly and disturbingly about intubated patients. Facing stigma and being avoided because of their contact with COVID-19 patients. Becoming disillusioned by others who are not taking this pandemic seriously. Considering retiring early or leaving their jobs. These are just some of the behaviors and experiences reported in recent months by numerous frontline healthcare workers.

We know from past infectious disease outbreaks that the psychological footprint of epidemics and pandemics far surpasses and outlasts the strictly medical impact. In fact, healthcare workers who provided direct patient care during the 2003 SARS outbreak experienced symptoms of burnout, psychological distress, and post-traumatic stress up to 26 months after the epidemic receded. Clinicians who treated infected patients during the 2015 MERS outbreak were similarly at high risk for prolonged PTSD-like symptoms.

Health systems across the country and around the world have attempted to support the wellbeing of frontline healthcare workers throughout their institutions, but healthcare economic models do not typically focus on wellbeing and many efforts to-date have been improvised, short-term oriented, and limited to personal wellness. Regrettably, due to the devastating financial impact of the pandemic, healthcare institutions are under pressure to divert, rather than enhance, resources designed to support and heal the healers. However, giving in to these pressures would be a critical mistake, not only for the wellbeing of healthcare workers but also for the welfare of patients these personnel are treating.

In the U.S. the incoming presidential administration will face tough choices in determining how to allocate finite resources for a long list of challenges, including fighting the COVID-19 pandemic, repairing the economy, updating infrastructure, addressing systemic racism, and mitigating climate change. Historically, when budgeting for public health emergencies, concern for the wellbeing of those actually involved in caregiving often becomes a lower priority. We must not let that happen.

As we increasingly realize that the race to ensure healthcare worker wellbeing during the COVID-19 pandemic is a marathon and not a sprint, we must adjust our response to playing the long game.

We do have an opportunity to tackle this complex, multi-faceted challenge and begin to address the wellbeing needs of healthcare workers. Pending legislation in Congress includes the Dr. Lorna Breen Health Care Provider Protection Act. With related bipartisan bills currently before the Senate (S.4349) and House of Representatives (H.R.8094), the Act seeks to: study healthcare professional mental health, especially in the context of the COVID-19 pandemic, create a national campaign that encourages healthcare workers to seek support and treatment for mental and behavioral health concerns, and establish grants for the development and promotion of mental and behavioral health treatment interventions among health professional workforces.

The legislation has strong support from numerous influential professional and advocacy organizations, including the American Medical Association, American Nurses Association, American Psychological Association, American Psychiatric Association, American Foundation for Suicide Prevention, and National Alliance on Mental Illness. Backers of the bill tried to get at least some of its provisions included in the recently passed COVID relief package but were unsuccessful, making advocacy for this act even more critical.

Although we do not expect the proposed legislation to immediately improve healthcare worker wellbeing or completely reduce the stigma surrounding seeking support for mental and behavioral health concerns, federal recognition of this issue and increased funding for this type of work would be an important first step.

Early in the COVID-19 pandemic, people across the country and around the world stepped onto balconies and porches at an appointed hour in the evening and clapped to thank frontline healthcare workers for their sacrifice and service. Now, as the pandemic drags on month after month, the enthusiasm for showing appreciation has waned. However, the reality for caregivers is that the longer the pandemic persists, the more their distress intensifies.

As we increasingly realize that the race to ensure healthcare worker wellbeing during the COVID-19 pandemic is a marathon and not a sprint, we must adjust our response to playing the long game. Let us channel our appreciation into action by decreasing hurdles to accessing needed support and encouraging our lawmakers to pass much-needed legislation. Hopefully, then, healthcare workers may feel like they have a country that truly supports their work and their wellbeing.

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Karen Miotto, MD, is a professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA.

Jesse Sanford is a researcher at UCLA’s Semel Institute of Neuroscience and Human Behavior.

Seth Freeman, MPH, is a Pacific Council member, an Emmy-winning writer/producer for television, a playwright, and a journalist who writes about technology, policy, and public health.

The views and opinions expressed here are those of the authors and do not necessarily reflect the official policy or position of the Pacific Council.