Being a healthcare worker during a pandemic requires courage in the face of uncertainty.
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On my 21st birthday I completed my training on how to properly use the Army M40 field protective mask. Our leader taught us how to put the mask on, make sure we had a good seal, had us run in place to increase our rate of breathing, and then released tear gas into the room. Nothing happened. Then we had to take our masks off, and I immediately realized the lesson – trust your leaders, your training, and your equipment. Instantaneously I began to cough, my eyes teared, and drool ran down my face. Today, we are asking the same of our caregivers except the mask is a N95, the gas is a virus, and this is not a drill.
In a COVID-19 world where so much is unknown, healthcare workers must trust their leaders and equipment; mere compliance with policies and rules will not sustain their courage in the face of great risk. There have been nearly 4 million documented cases since reports of the disease first emerged in December, with over 1.2 million cases in the U.S. alone. So far, over 265,000 people have lost their lives to it. There is apparently nowhere to hide from the SARS-CoV-2 virus on this planet except Antarctica – for now anyway.
During my 20 years as an Army physician, I cared for men and women who frequently placed themselves in harm’s way. They did their jobs in the face of great danger and many of them paid a heavy price. They were courageous, which Mark Twain reminds us is not the absence of fear, but the ability to act in spite of it. What allowed them to act? For some, it was their nature, but for most, they derived their courage from many sources which allowed them to displace fear and execute their duties.
Soldiers believe in a cause greater than themselves; they develop a strong sense of camaraderie with fellow soldiers, they place their trust in their leaders, training and equipment, and they embrace discipline. The U.S. is at war again, this time with an invisible enemy, and our Army of healthcare workers, requires all the courage it can muster.
Doctors, nurses and other caregivers place themselves at risk every day treating people with resistant bacterial infections, HIV, tuberculosis, and re-emerging diseases like measles. They accept their personal risk, put on their protective equipment, and care for their patients. All of these diseases can kill and many do not have a protective vaccine. Why then does COVID-19, a disease where 80% of people experience a mild illness, strike such fear into HCWs? Why is there so much doubt about the information being disseminated by institutions like the WHO and CDC? Why are caregivers at odds with hospital leadership over how to best protect the workforce? Like most complex questions, the answer is equally complex.
In addition to its global scope, the unpredictability of COVID-19 patients is extremely unsettling. People appear to be well one day, infected the next, clinically stable, and then, “fall of a cliff,” requiring a ventilator or more to keep them alive. Infection with the SARS-CoV-2 virus causes a myriad of problems including pneumonia, strokes, kidney failure, blood clots, nervous system disorders and now a new entity is emerging in children. That unpredictability, coupled with incomplete knowledge, makes it hard to feel like you are in control. As far as we know, COVID-19 is a new disease to humans and our fund of knowledge about its origins, how it infects, how it kills, and how to prevent infection and disease has numerous gaps.
The uncertainty around SARS-CoV-2 has created a lot of anxiety among medical workers.
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Every day my institution peppers me with questions, great questions, that I am unable to answer with a firm footing in data. How do we know this infection is not airborne, how will this virus affect my unborn baby, and how long is a COVID patient infectious are a few of the more common inquiries? My answers are unable to be definitive and so I speculate and extrapolate from my experiences with other infectious diseases; this approach can be frustrating for caregivers who just want to know how to best treat their patients.
Issues around personal protective equipment also anxiety provoking, causing caregivers to spiral as questions fill their mind: “Do I have the right PPE? Am I putting it on and taking it off correctly or did I contaminate myself? Why are they giving me this flimsy blue mask instead of the orange N95 mask? Will I be provided another mask when this one is no longer functional?”
The combination of all these factors means that healthcare workers require courage as much as they require a face shield or mask. They are soldiers in a global war and should channel sources of courage similar to their military counterparts.
Caring for severe or critically ill patients with COVID-19 is highly complex and requires a big team of doctors, nurses, respiratory therapists, environmental services, and the list goes on. Social and physical distancing in the hospital setting is near impossible, but feelings of personal isolation occur, especially if you spend most of your shift encased in PPE. Mutual self-sacrifice and teamwork among caregivers are strong bonds made stronger when a life is saved and support individual resilience when a life is lost.
Those mutual bonds are built on a foundation of intense training designed to instill discipline, but maintaining discipline can be hard when there’s so much uncertainly. With so much unknown, doctors, nurses and other caregivers are pulling information from every source, some credible and some not, and the ramifications occur in near real-time. News about the ease of virus transmission, persistence in the air and on surfaces, new therapeutics and preventive strategies are being constantly updated. Sometimes that information comes without context or thoughtful consideration of how to apply it. Sometimes it’s outright misinformation.
The result of this tsunami of data are healthcare workers living are in a constant state of anxiety, bordering on mistrust, and frequently calling for action to change the way things are done. Avoiding that uncertainty and anxiety requires discipline between healthcare workers and their leadership, which can foster tight processes for receiving, analyzing, and acting on information, but also the fortitude to stay the course when necessary.
The COVID-19 crisis in the U.S. is far from over. Strictly adhering to physical distancing policies, aggressive public health interventions, PPE for caregivers, properly resourcing hospitals, and making COVID-19 testing widely available would all contribute to flattening the arc of our COVID curve and save lives in the process. Our response, however, also requires healthcare workers to continue their exemplary demonstrations of courage as they face the threat of infection caring for the afflicted. The good news is that with discipline and thoughtful leadership, that courage can be learned, and it has the potential to be as infectious as the virus which has changed our world forever.
