Kudos During a Crisis: A Letter to My Colleagues and Other Brave First Responders

Background:

As the people of India are met by unprecedented loss and illness during the 2nd wave of COVID-19 infections, they face a public health crisis that has not been seen for the last century. Current statistics point to more than 300,000 new cases of infection every day and over 3000 daily deaths. On top of that, we are hearing horror stories of younger deaths and numerous children being infected by the disease. This is paired with a rapid decline in clinical conditions and a crisis made of an insufficient supply of hospital beds, ventilators, antiviral drugs (like Remdesivir), and oxygen. It is particularly tragic to have to witness so many deaths in hospitals due to that lack of oxygen, as it is an essential treatment modality for those suffering from acute respiratory distress.

India came out strong during the first wave of COVID infections due to resolute political leadership and strict lockdown measures. The lockdown was enforced through extensive work by first responders (police personnel and healthcare professionals). Unfortunately, the second wave has not followed suit and is experiencing problems due to the existence of mutant strains of the virus that spread more rapidly and are much more contagious. Additionally, the public acceptance of the vaccine appears to be rather low despite excellent execution during the initial rollout. To make matter worse, the virus continues to mutate so rapidly that the scientific community is unable to come up with a bridging trial to figure out vaccine variations that could be more effective against the mutant variant.

I witnessed and studied a number of epidemics in India while attending medical school and in an internship, and also while working as a tutor for two years in a Civil hospital in Ahmedabad. During that time, I saw plague, outbreaks of gastroenteritis, dengue, malaria, and tuberculosis. Despite the severity of those situations, they were nothing compared to what I have witnessed during this 2nd wave of COVID. As I study the current situation in India from my current location in Northern California, I am met with a helpless feeling that is shared by many physicians and professionals that are away from the action while their colleagues and friends respond to the crisis. I am humbled by the tremendous work and long hours that the healthcare workers are putting in for the people of India. They are working exhaustive hours away from their families and are doing it in strained, dangerous working conditions with limited resources. The frustration and heartache they feel must be more than one can imagine.

For healthcare workers and first responders, attending to your mental health and psychosocial well-being while caring for patients is as important as managing your physical health. Take time to take care of yourself. It is vital to recognize and take steps to cope with depression symptoms or other emotional issues during the pandemic. It is reasonable and necessary for healthcare workers to take some time to themselves to focus on their own needs. In fact, doing this is critical to remaining healthy and can lead the practitioner to a better emotional state, allowing them to provide a higher level of care for COVID-19 patients and their families. I have listed below some recommendations for managing and maintaining one’s mental health during a pandemic:

• Engage in reflective, low-stress activities, such as journaling or going for a walk. These are relaxing, but also provide an opportunity to connect with your inner-thoughts and feelings, as opposed to other relaxing activities, like watching a movie or taking a nap.

• Do not be afraid to ask your loved ones for help with simple tasks, such as meal preparation or child care. This can be necessary for accomplishing work/life balance in a very demanding time. It is important to allow yourself time for the critical recovery that you deserve.

• Feel free to feel your feelings. There is no reward for stoicism or for ignoring your emotions. Be aware of them and allow yourself to connect with them. Remember, your feelings are real and they are justified.

• Feel no shame about your struggles to deal with stress. At this time, you and your colleagues are likely feeling immense, unprecedented pressure due pandemic and the potential for more surges in care demands, risk of infection, and equipment shortages, among other stressors. Experiencing stress and the feelings associated with it are by no means a sign of weakness or a reflection of your ability to do your job.

• Intentionally employ coping strategies

• Put into practice strategies that have worked for you in the past. Nobody knows what works for you like you do. To get to this point in your life, you have no doubt overcome obstacles, coped with negativity, and found ways to succeed despite the pressure and stress you’ve encountered at various times. Take a moment to reflect on the struggles you have previously encountered and consider how that iteration of you found the strength and knowledge to persevere. These can include getting enough rest, finding respite time during work or between shifts, eating meals (ideally, healthy food, on a schedule), engaging in physical activity, and staying in contact (with appropriate social distancing) with family and friends.

• Perform regular check-ins with yourself. Just as you have committed to looking after others, you must also turn your attention inward with great regularity. Monitor yourself for symptoms of depression/stress disorder, such as prolonged sadness, difficulty sleeping, intrusive memories, and/or feelings of hopelessness. Talk to a trusted colleague or supervisor. Be open to seeking professional help if symptoms persist or worsen over time.

In addition to the recommended approaches to maintaining one’s mental wellbeing, I also strongly suggest limiting Social Media and news whenever possible. At most, I believe two to three hours of use per day is manageable, but just recognize that every moment you engage in with the information on those platforms, you are essentially volunteering to be bombarded with negativity and despair.

First responders are special people with the capacity to actively and remarkably put in the work that others are afraid to do. Because of this, it is often hard for a committed professional to know when their personal situation has become problematic and it is time for them to step away from the work for a while to focus on their own recovery. I advise my colleagues and all healthcare professionals to be responsive to any signs of the following:

1. Pervasive depressed mood with crying spells that last for 2 weeks

2. Extremely poor focus due to intense anxiety or depression

3. Insomnia with less than 4 hours of sleep for 7 days

4. Suicidal thoughts are never normal

5. Panic attacks

6. Excessive ruminations about the deaths that you witness while taking care of your patients. This accompanied by increase startle, cognitive problems, and hypervigilance may points toward a possible diagnosis of PTSD

7. Excessive guilt with helpless and hopeless feeling

If you have some of these symptoms please seek out professional help. Please speak to a psychiatrist colleague or a psychotherapist.

As I watch my brave-hearted colleagues and other health care professionals battle through the current crisis, I notice that my immense respect and appreciation for them is not necessarily shared by the general public. I have seen an increase in anger and frustration by citizens directed towards healthcare professionals. I have been saddened to see atrocities and abuse hurled at them, when it is they who just want to help others. I ask people to be patient toward the healthcare providers (doctors, nurses, and other staff), and to please adhere to strict mitigation efforts, like wearing a mask, staying at home, and keeping social distance. I am also attaching a link to a home monitoring tool which can be helpful for those who are quarantine at home. This tool can help you monitor your vitals and also symptoms and help inform your health care providers for appropriate treatment related decision.

There is still great hope for the future and a belief that we will soon be able to reverse the curve.

Until we get there, it is important for the people responsible for our health to take care of their own.

Dr. Anish S Shah, MD,

Psychiatrist, CEO, Siyan Clinical

www.siyanclinical.com

www.siyanresearch.org