Like many health professionals, you are probably scared and uncertain. Last month, your life was normal, even mundane. Over the last few weeks, horrifying reports of the pandemic overwhelming healthcare systems have been bombarding our senses.
Many are finding it difficult to think of anything else. Some are struggling with anxiety and stress insomnia. It’s hard to escape the tsunami of doom when your phone alerts you every few minutes with another report.
This epidemic needs to be taken extremely seriously . We need to follow public health advice on the actions needed, and when to initiate them.
Confirmation bias is very common in medicine, and the rest of life– looking for evidence to support your point of view, and subconsciously discounting evidence that opposes it.
If you are expecting the end of the world, you will keep confirming that by seeing, reading and hearing opinions supporting that dismal outlook. If you cling to hope, you will start to find the positive stories hidden amongst the doom and gloom.
My suggestion is to concentrate on factors you have control over. Stubborn optimism will help us face this pandemic with energy and determination, caring for patients and ourselves to our best abilities. A little faith and solidarity will help us get through this health crisis.
The Human Cost of Coronavirus
This may be your first viral pandemic, or you may have worked through H1N1 in 2009. Swine flu caused a horrific 151,700-575,400 deaths worldwide. The illness was particularly severe in young people and pregnant women. My personal memories of the pandemic include a couple of sad deaths and the annoyance of putting on and taking off PPE. I was a junior doctor at the time, so was mainly involved in less severely unwell patients.
Influenza causes ~ 12,000-60,000 deaths per year according to the CDC, but is a lot more predictable.
COVID-19 has sadly caused 7,982 deaths, expected to continue rising for several months. It is highly unpredictable, with models of coronavirus ranging from Armageddon to quick containment and herd immunity through vaccination. There are probably too many variables to really make a likely projection of what is going to happen. Due to the rapid transmission of the virus, with a relatively high mortality rate, we have been warned resources will be overwhelmed, limited mainly be insufficient staff and critical care resources
But Australian hospitals have had weeks of notice. We’ve been preparing all this time, and are as ready as we can be with the resources available.
It is obviously impossible to train extra healthcare professionals in a few weeks, and everywhere is affected so we can’t fly them in to help.
But the warnings from China and Italy have given us realistic expectations – and this is a massive help.
Health services have been recruiting medical and nursing students, retired, non-clinical and non-practicing staff. Leave has been cancelled.
Those of us who work part-time have more capacity to increase hours to help with the load. Non- ICU/ED/Paediatric specialities are collaborating like never before, all offering help, ideas and strategies to manage the work.
There are, of course, ongoing challenges. Concerns about supplies of PPE are worrying. The UK are apparently producing their own in factories designed for other things. There must be a way we can produce adequate PPE for this health crisis.
Fear among staff and patients is a significant issue. We will be head down working extremely hard for the next few months. We need to support each other as best we can to get our patients, our health system and ourselves through this.
The cooperation and collaboration going on between specialities that don’t always see eye to eye is something to be celebrated.
Social distancing measures put in place to control the spread will obviously take an economic toll, damage business, and put casual and low-income workers in an extremely vulnerable financial position. Stimulus packages need to be well targeted for those who really need help, mortgage payments may need to be frozen and we need to be swift to step in help those who lose jobs and are suddenly vulnerable. Flight cancellations and possible closure of schools will obviously have negative financial implications for the economy and families.
Over the last month, the stock market has shown enormous volatility and massive losses, a big worry for retirees who depend on investment income. Uncertainty is always bad for prices in highly liquid assets. Predictions for stock market performance are frequently suggesting a rapid and dramatic recovery, with some predicting complete economic collapse of the world with no recovery in sight.
Public levels of concern are extreme, emptying supermarkets of shelves, and unfortunately causing hoarding and some violence.
Tourism has already been massively impacted, with flight and hotel bookings cancelled, as well as fewer people out in restaurants. Workers in these areas are often poorly paid, on casual contracts and will be the ones unfortunately struggling through this crisis.
I am optimistic with correctly targeted and timed interventions, this too shall pass! Australia got off pretty lightly comparatively in the GFC, lets hope we can do it again.
We are almost all invested in the stock market through our superannuation. Now is not the time to be changing your superannuation allocation. To be honest, I would highly recommend not logging in to your account for the next few months. Your superannuation is invested for the long-term. The value will recover – and while the market is low, as long as you are still earning, you are buying through your stock market at great prices. There is even a guided meditation to help you keep calm and avoid making rash decisions!
The coming months may be a good time for some readers to begin investing in the stock market outside superannuation. If you don’t have much cash to spare, the microinvestment apps are a reasonable place to start, and the experience of watching your small purchases plummet and recover, whilst practicing not selling will be invaluable for the stock market crash that occurs when you have significant amounts of your net worth in the stock market.
Control what you can control
There comes a point, when you have all the information to prepare as much as is possible. You know how to put on, and take off your personal protective equipment (PPE), have familiarised yourself with your local protocols and you understand your role in the pending healthcare crisis. You are as prepared as you can be. Your department have been through the frenzy of preparation, and are now just organising smaller details. You have controlled everything within your locus of control.
Many factors are outside of your control. You have no control over rhe speed at which the virus continues to spread globally, mortality rate of the disease, or behaviour of the general public.
Instead of focussing on these things, which will bring no benefit to anyone (unless your public health expert or politician), focus on the factors within your control.
- Ensuring use and meticulous following or donning and doffing procedures (most health professionals contaminate when removing or doffing PPE). Work in pairs and make sure you are both following procedure
- Don’t come to work with a cold. You could be spreading coronavirus or any other virus that will cause many more staff members to quarantine
- Practice social distancing – you are at higher risk of contracting and therefore spreading COVID-19 as a healthcare worker. You could be spreading it for days before showing symptoms. So medical professionals need to be strict about avoiding crowds wherever possible, and staying home when not at work (you’re going to need a good rest between shifts anyway)
- Avoid travel by public transport including air travel. This is not banned domestically currently, but an infected (even asymptomatic) healthcare worker on a plane seems like the fastest way to spread this disease to different towns and cities
- Hand washing, more handwashing and a bit more handwashing
- Spreading the social distancing information online through your social media accounts.
Whenever possible, choose cautious optimism
- Hope that the vaccine currently undergoing initial human trials is highly effective and puts a rapid stop to the contagion through herd immunity
- Hope that through consistent messaging, social distancing, hand washing and staying home as much as possible, the virus spreads slowly enough for Australian healthcare to cope, resulting in lower mortality and better outcomes for COVID-19 and unfortunate patients that happen to become injured or sick with something else during the crisis
- Look forward to several months time, when this is a painful memory. When life will return to (a different) normal, and we will appreciate our mundane routines for what they are -safety and security
- Hope that the Australian people reflect on our treatment of refugees so far, and person see them as just like us. Living a normal, routine life until something unexpected exploded their world. Hope this breeds more empathy for people fleeing danger, now everyone wishes they could flee to a safe place
- Appreciate the professionals who risk their lives every day, routinely, to keep us safe. Feeling unsafe at work is new to most of us, and very uncomfortable. Police officers, fire fighters and soldiers for example, accept risk to their lives as part of their jobs. We probably don’t say thankyou enough to these everyday heroes.
- Hope that we can support those families who have lost their income fast enough to keep them safe and well until the economy and job market recovers
- Hope the retirees have some cash savings stashed away that will support them until their investments recover
We well get through it. We will care for these patients, as we did with SARS, and H1N1 and all the other severe viral outbreaks we have managed over the years. And eventually, this too shall pass. It will be many months before we know the full human toll of this virus, but it is expected to be significant. The full economic effects may take many years to be understood.
What ways have you discovered to reduce the stress of the health crisis? Leave your tips for other docs to read and use.