'Eye of the Storm:' U.S. Nurses Already Facing Extreme Stress Over Coronavirus
"I have worked the last four days, and I have cried every day."
Eileen McStay, a registered nurse at the Mount Sinai Hospital in New York City, is on the front lines of the COVID-19 pandemic, and it is mentally and emotionally wearing her and her colleagues down.
McStay works on a hospital floor filled with nothing but lonely, scared coronavirus patients, some of whom are fighting for their lives.
She goes home to an empty apartment -- her four kids are staying with their father during the crisis, and she won't let her boyfriend come around for fear of infecting him.
"They are telling us at work to treat yourself as if you're positive," McStay said. "The infectious disease doctor told us that statistically, 100% of health care workers will be positive by the time this is over," she added.
"I haven't had a hug in seven days," McStay said. "Not from my kids. Not from my parents. And it kills me."
Most people are struggling with the isolation of staying home to prevent COVID-19 from spreading.
But the health care workers who must go out to care for those in need are paying an even greater price, in terms of their own emotional health.
Lessons from Wuhan
A new study of Chinese health care workers provides some insight into what McStay and her colleagues say they are dealing with as they care for others.
Researchers found that front-line health care workers in Wuhan, the epicenter of the pandemic, were much more likely to report depression, anxiety and insomnia than people working elsewhere in China.
Frontline health care workers directly engaged in treating patients with COVID-19 are three times as likely to suffer insomnia and more than 50% more likely to suffer depression or anxiety, according to the results published online March 23 in JAMA Network Open.
Dr. Roy Perlis is a psychiatrist with Massachusetts General Hospital, in Boston, who wrote an editorial accompanying the study. "The important point the paper makes is just how much depression, anxiety, insomnia we're already seeing in health care workers. They describe levels of stress that are strongly predictive of risk for post-traumatic stress disorder later on," he said.
McStay agrees that people's lives and psyches are going to be permanently altered by their experiences in this pandemic.
"I've worked for the last four days on a floor with all COVID-positive patients. It can't get more of the 'eye of the storm' for me," McStay said.
There are more than 20,875 confirmed cases of COVID-19 in New York, Gov. Andrew Cuomo said during a media briefing Monday. That's far more than any other states.
'Scared and alone'
McStay came close to tears when talking about patients struggling for air, and the life-and-death choices being made about where to direct resources.
"These people have no visitors. There are no visitors allowed in the hospital. People are so scared and so alone, and so are we," McStay said.
McStay's colleagues are all self-quarantining when they're not at work, to protect their families, so they fluctuate between despair on the job and isolation at home.
Nerves are fraying, even among these professionals.
"There were arguments at work yesterday, where there never are, never those kind of hostile arguments," McStay said. "The fear is palpable in all of us."
Mount Sinai is doing its best to support them, McStay said.
The CEO sends down platters of granola bars and cereal bars and fruit, with hand-signed notes of support. Managers and administrators visit regularly to share the latest information from public health.
Spiritual care advisors and peer support networks are up and running, reaching out to patients and staff in need. All workers have been given an app with which they can track their symptoms, so other staff can tell them whether they should worry about being infected.
"Our minds are playing games with us," McStay said. "The fear is winning."
Heroes, but human
McStay said she walks up a big hill to work every day, and yesterday she got worried when she became short of breath on the way up.
"I'm like, I'm out of breath! I'm out of breath!" McStay recalled. "Then I'm like, you're an idiot, you're out of breath every day."
Perlis said the best thing that can be done to help professionals like McStay is to make sure they have all the resources they need, in terms of masks and gloves and access to COVID-19 testing.
"They're being asked to do a very difficult task without the appropriate resources," Perlis said. "There are very practical things that need to happen to diminish that stress."
Psychiatrists like himself also need to be deployed, to give health care workers the counseling they need, he added.
"There are an awful lot of heroes right now, and it's easy to lose sight of the fact that these heroes are also human," Perlis said. "When they pause for breath, when they get home from a shift, they're just as susceptible to the consequences of this stress as anyone else."
The U.S. Centers for Disease Control and Prevention has more about mental health and coping during the pandemic.
SOURCES: Eileen McStay, R.N., nurse, Mount Sinai Hospital, New York City; Roy Perlis, M.D., psychiatrist, Massachusetts General Hospital, Boston; March 23, 2020, JAMA Network Open, online