As Bob Dylan once said; “Times, they are a-changin’”. With respect to the novel coronavirus-19 (COVID-19), the situation in Canada and around the globe is changing rapidly and aggressively. As part of the first responder network, Emergency Departments (ED) and it’s health care teams are in a powerful position to mobilize and act fast to respond to the pandemic.

First-line providers, y’all are superheroes, so to steal a quote from Superman; “With great power comes great responsibility, and with great responsibility comes sacrifice”. The sacrifice from front-line providers in terms of health and wellness has the potential to be astronomical, and many workers are worried. Will I have to make difficult decisions like having to ration resources such as ventilators for sick patients? Will I myself get sick, or transmit this infection to my vulnerable family members? How can I function if I am isolated for days on end? These fears are real.

We’d like to share with you some strategies ED health care workers can adopt to manage increasing levels of anxiety related to COVID-19.  Special thanks to Drs. Caroline Gerin-Lajoie and Kerri Ritchie (Psychologist), experts in physician health and wellness, who have provided us some valuable content.

1. Knowledge is power but reduce the noise.

Don’t go down the rabbit hole. Seriously.

Read reputable news sources. Filter your information so you are only getting reliable information coming through. Think about turning off notifications, e.g.: Twitter, news outlets and limiting your information from selected ones. Ask your work colleagues to bundle messages on a platform outside of the group email ‘reply all’ in order to keep the high yield information available yet mitigate the hundreds of emails you will then have to read through.

Also, give yourself a time limit on social media and the 24-hour news cycle. Take your own vitals. If it is making you anxious, step away. You can come back once you have had a news break.

2. COVID-19: Facts versus Fear

If you are feeling anxious or overwhelmed by the information coming your way, stop and ask yourself what is an established fact? What is a possible or even unlikely scenario that is weighing on your mind and causing anxiety? Try to stick with the facts of what we know right now.

For some reliable sources:

3. Hope for the Best, Plan for the Worst

  • Is there any way to plan for the fears that are more likely to occur? For instance, talk to your spouse about a logical plan if you were to be on self-isolation. Where would you sleep? Who could help your family get through this?
  • Can you prevent any of your worries from happening? Many are worried about the potential financial impact. If possible, talk to your financial advisor to come up with a strategy. Keep receipts of any costs incurred if you were to be in a situation where you couldn’t work for a period of time. You never know what can be reclaimed after the fact.
  • Are there other strategies that can help you mitigate any other potential negative consequences? Crowdsource with a group of trusted peers.
  • Recognize that there are some things you can control (like good personal hygiene and protective personal equipment) and some things you cannot. Try not to percolate on the things that are out of your control.

4. Now is the time for Self-Care

In chronic stressful environments, our systems easily start to accumulate stress, and we start feeding off of everyone else’s stress. Research has shown that emotions are contagious, so projecting your stress will cause others to be more stressed. We are not advocating for bottling up your emotions, more so, it is important to get your stress-response system to re-set twice a day so that your body can keep going. Two minutes would be great… even 30 seconds helps.

  • Identify your energy makers, whether they be a physical, social, emotional, mental or spiritual activity. Commit to it more than ever.
  • Surf your emotions: Use your imagination to picture your emotion as a wave. Allow the emotion to rise and fall in its natural rhythm. Use your breath as a surfboard to ride it out rather than to try to push it away or hang onto it. Alternately put on music that has a soothing rhythm to you and try to breathe to the music.
  • Pick a song and listen to the lyrics and breathe with the mu.sic
  • Try Box breathing: Breathe in through your nose while counting to four slowly. Feel the air enter your lungs. Hold your breath inside while counting slowly to four. Try not to clamp your mouth or nose shut. Simply avoid inhaling or exhaling for 4 seconds. Begin to slowly exhale for 4 seconds. Repeat steps 1 to 3 at least three times. Ideally, repeat the three steps for 4 minutes, or until calm returns.

COVID-19

5. Talk it out, Don’t completely self-isolate

Find your people. Create online messenger groups where you can share your emotions and seek support (but limit your time there… see point 1). Social networks are vital, just choose them wisely. If you find yourself increasingly anxious about COVID-19 and it is affecting your level of functioning such as your sleep, please seek help from a licensed mental health professional. Most hospitals and medical associations have resources available for individuals feeling at risk.

Lastly, and more importantly, let’s look out for each other. The next weeks and months will be challenging to say the least. Stay measured, stay patient and stay kind with your patients, your families, yourselves, and each other.

Lisa Fischer

Lisa Fischer

Dr. Fischer is an attending Emergency and Palliative care physician at the Ottawa Hospital. She is also the Director of Wellness in the Department of Emergency Medicine.
Caroline Gerin-Lajoie

Caroline Gerin-Lajoie

Dr. Caroline Gérin-Lajoie is the Executive Vice-president, Physician Health and Wellness at the CMA.
Kerri Ritchie

Kerri Ritchie

Dr. Kerri Ritchie is a Clinical Psychologist at the Ottawa Hospital, specializing in Health Psychology.
Shahbaz Syed
Dr. Syed is an staff Emergency physician at the Ottawa Hospital, with an fellowship in Digital Scholarship and special interests in rational resource utilization.