This article is part of the University of Nairobi, College of Health Sciences coverage and updates related to coronavirus disease (COVID-19).
Who is afraid: Fear is universal and everyone at one time or the other has felt fear. Fear is that emotional reaction we get when we feel threatened or when we don’t feel safe. Fear is nothing to be ashamed of, without fear the human species would not have survived because fear is linked to that physiological reaction that we call fight/flight or even freeze.
We however know that in the modern world fear and the fight/flight response kick-in under situations from which we cannot fight or runaway. Rather than being a survival reaction, it becomes an incapacitating and debilitating reaction that can plunge us into a state of psychological distress.
The outbreak of COVID-19 pandemic caused by the novel coronavirus 2019 (SARS-CoV-2) has plunged us into just such a state; the enemy is invisible, among us and we can’t fight and can hardly run away. We are only left with the hiding option, which is definitely good because it keeps us safe from the other and the other safe from us.
But how about those of us who provide essential services, what about the responders, the health workers who the world is looking upon to save the situation? The responders are trying to ensure that there is a protective barrier between us and the pathogen (in this case SARS-Cov-2).
For our doctors, nurses, technicians, ambulance drivers support staff and many others who work as frontline responders COVID -19 has become an ever present threat. Health workers are not only at risk of getting infected but are exposed to psychological distress as they treat patients with this highly infectious and contagious viral pandemic.
Psychological distress includes anxiety, burnout and depressive symptoms. Additionally, exposure to the traumatic experiences of others, predispose frontline health workers to secondary traumatic stress or vicarious traumatization.
Response to threat: People will react differently to threat and stress, based on their personalities and coping skills, with some being able to come to terms with the threat and live in the now, while others get caught up in a scary future. Fear is linked to negative thinking in which the future has the worst possible outcomes. In the mind of the person plagued with fear, runs a never ending film, which rewinds over and over, in which he/she sees- themselves infected with the virus, sickening, ICU, death and burial with ‘15 mourners’.
The mind captures even the mourning and suffering of the family and the friends and the eulogy is written over and over again. This way the person dies over and over again even though they may never get infected. Helplessness and hopelessness sets in, and a feeling of inevitability that may lead to carelessness.
Psychological distress, Fear anxiety and depression have a big impact on us and our capacity to function and to protect ourselves, our families, our patients and those around us. Fear leads to mistakes and mistakes can be costly at this time. There are many questions out there and many will remain unanswered, but Health Workers need full support for both physical and psychological protection.
Psycho-social support for Health Workers: While there are many programs around the world and many forms of therapies from individual to group, we acknowledge our limitations in resources and skilled man power. However, there is a lot we can do to support our health workers and WHO and other Organizations like UNICEF and CDC have put out a lot of useful materials.
Recommendations for responders:
- Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
- Take care of your body.
- Take deep breaths, stretch, meditate/pray -
- Eat a healthy and well balanced meals and drink plenty of clean water
- Exercise regularly indoors or outdoors- whatever you can
- Try to get plenty of sleep
- Avoid alcohol and drugs- including hypnotics
- Make time to unwind.
Try to do some other activities you enjoy.
- Connect with others.
Talk with people you trust about your concerns and how you are feeling, a good working buddy who understands what you are going through.
And keep in touch and communicate regularly with your family and friends- on the available platform (telephone- and other platforms). Physical distance should not be social distancing.
Other recommendations include
A ‘Worry Window’- trying to suppress worrisome thoughts and fears is not a very effective strategy. Some people find it more useful to set aside a time- like 15 minutes or whatever at the same time every day and call it a worry window. Fearful thoughts and worries can then be postponed and allowed to surface at that time- even written down.
Deep breathing also referred to as diaphragmatic breathing is a powerful strategy to overcome fear and panic. There are several good you-tube videos on this.
Other strategies require the support of your supervisor and workplace
- A clear understanding of your role in the response.
- Limited working hours to no longer than 12-hour shifts.
- Arrangements on travel and duration away from home to allow you to communicate clearly with your family and make realistic arrangements
Let me conclude with a light touch: “Fear cuts deeper than swords” George R. R. Martins
References:
- CORONAVIRUS DISEASE 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
- WHO ( 2013) Self-care for health: a handbook for community health workers and volunteers. New Delhi: World Health Organization Regional Office for South-East Asia
Article by Prof Muthoni Mathai: Department of Psychiatry, College of Health Sciences, School of Medicine, University of Nairobi.
