Tanzina Vega: The United States is now months into the COVID-19 pandemic with no signs of slowing down. While health care professionals are on the front lines, helping patients fight the virus, the battle is taking a mental and physical toll on them as well. A new study shows that during the peak of COVID-19, emergency medicine, physicians felt a significant increase in stress and anxiety in their work and their home lives and we've heard from some of you on how this work is affecting your mental health.

Caller: My name is [unintelligible 00:00:45]. I'm calling from Charlotte, North Carolina. I've been a certified nursing assistant since 1999. I usually work a full-time job, six days a week, but unfortunately with the pandemic and my husband being a cancer survivor, I can no longer do that. I refuse to take the risk of getting him sick with this situation and sadly with a front for it but I just mentally can't go out and do something that I know could possibly put him in danger.

Joyce: I'm Joyce and I'm calling from Snohomish, Washington. I'm a home care provider. Although I am very careful, my client has a spouse who works full time with the public. That's why I'm needed and there are two teenagers living at home. I worry quite a bit that someone will bring COVID into the house and that I will end up carrying it home. My husband is diabetic and my 87-year-old mother lives with us. I will try not to obsess over it, but I am concerned you do wash hands often and wear our masks whenever we leave the house. It's only I could count on everyone else to do their part.

Tanzina: Thank you for sharing as always and we're going to talk about it now with Dr. Robert Rodriguez, a UCSF professor of emergency medicine, who also works in the emergency department and intensive care unit at San Francisco General. Dr. Ania Wertz is an administrative director of the Frontline Workers Counseling Project and a licensed clinical psychologist. I started by asking Dr. Rodriguez, whether working in an ER during the pandemic had affected his own mental health.

Dr. Robert Rodriguez: Without question, I have felt heightened anxiety, a sense of burnout. It's impacted my mental health significantly on a personal note, had gone to my hometown of Brownsville, Texas, to help out in a covert ICU down there and in a small community hospital and that experience was very difficult for me and coming back from that, that felt considerable, just overall shock and anxiety. I definitely had difficulty sleeping and other issues that the COVID pandemic has clarity affected my mental health, and talking to others in similar situations, overall, it's had a deep impact on the mental health of frontline providers.

Tanzina: Dr. Warts, as you listen to Dr. Rodriguez, are you hearing echos in the healthcare workers that you're working with are some of the main strains of mental health what Dr. Rodriguez was laying out there?

Dr. Ania Wertz: Yes. I hear a lot of echoes of frontline workers that we've been talking to through the project. There are all kinds of different manifestations of trauma. I think Dr. Rodriguez mentioned some of them, anxiety, but it can also show up as numbness as a deep depression. It has all different kinds of manifestations.

Tanzina: The prognosis right now, I guess we're seeing a high point right now in terms of infection rates. New York City is hovering about 1% of the parts of the country. Texas, I think is about 17% right now, give or take. This is the best we're looking at. We are hearing from epidemiologists that come the fall, things are going to get worse. We are being told to this may linger for months, if not years. Dr. Rodriguez does the uncertainty of that timeline, add to the stress, the expectation that if we're already tired and burned out now, this is the level that things are going to be at, if not worse going forward?

Dr. Rodriguez: That definitely adds to our stress. In March and April, we were looking at the surgeon in the pandemic. We all, I guess, maybe somewhat naively thought, "Okay, well, we can deal with this for a few months, six months, if need be. We can just plow through this, but as things go along and as it appears that the pandemic in cases are going to extend through the fall and through the winter, perhaps into next year, it takes a huge toll. In the emergency department, we're already burnt out, but facing the prospect of six months to another year of this is is daunting, and undoubtedly is adding to everybody's stress.

Tanzina: Dr. Wertz, when you hear what Dr. Rodriguez is describing, when we think, just generally speaking, about right now people are eating it outdoor cafes and trying to make the best of the little time that they have, but the truth is this is going to be around for a while, as far as we can tell. What are the mental health effects that we can expect to see long-term on health care workers right now provided they stay in the industry?

Dr. Wertz: Well, I think that's one of our major concerns now because PAMA is cumulative and the longer that this pandemic goes on, the more people are going to start to show signs of post-traumatic stress. It is very concerning that we don't have a clear endpoint to the pandemic, and as it goes on, it's becoming more and more crucial for people who are in the healthcare field to have mental health support. If you're in a rural community where you are more likely to be burned out because you need to work more. There are also fewer mental health resources in that area. We really need to make sure that everyone who is in the healthcare field can get help.

Tanzina: Your thoughts on what health care workers and other Frontline Workers can do, in addition to seeking mental health services for themselves. Is there anything else they should do or be aware of to help cope in these times?

Dr. Wertz: Well, I think as both of you noted, health care workers and anyone in a helping profession is someone who likes to take care of other people, and they often forget to take care of themselves. It really is about making sure that you value your own mental health and your own physical health to the same degree that you value others. I mean, one of the challenges we have an outreach is that these are people as you said, you have doctors in your family, they tend to be stoic, they tend to say they don't need help. It's really recognizing that there's nothing shameful or weak about needing to take time for yourself and needing to focus on your own needs.

Tanzina: Ania Wertz is the Administrative Director of the Frontline Workers Counseling Project, and Dr. Robert Rodriguez is a UCSF professor of emergency medicine who also works in the emergency department and intensive care unit at San Francisco General Hospital.

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