COVID-19 Long-haulers Syndrome in Healthcare Workers?

Lillian Lockwood, MD, FACEP
ACEP, Disaster Medicine Section Secretary and Newsletter Editor

The stress and fatigue are palpable. We have all been working harder and juggling multiple demands. Many of us have reached a level of healthcare fatigue that we have never experienced before with other changes in healthcare. The effect of COVID-19 has permeated every circle of our lives. COVID-19 has necessitated drastic changes in our professional and personal lives. Changing our check-in and triage processes, attempting to maintain adequate PPE supplies, rearranging hospital units to accommodate patients suffering from COVID-19, incorporating public health measures to keep our loved ones safe from COVID-19, and restricting businesses and personal activities to curtail the spread of COVID 19 are only a small fraction of the changes made. Most have missed their routine social and support circles. Those who have children have experienced an entire other dimension of how COVID-19 has disrupted their lives. Children’s social circles are important to them and often they do not completely understand the necessity of new rules. For that matter, the rules keep changing as the virus evolves. We have realized more than ever how we rely on close interpersonal relationships to keep us and our loved ones emotionally healthy. The sad truth is that COVID-19 has not only sickened and killed patients and healthcare professionals from its physical effects, but its mental health fallout has contributed to the morbidity and mortality of healthcare workers as well. The goal of getting “back to normal” has been elusive. It seems that “normal” stays just out of reach. Our hopes were lifted when rates of COVID-19 slowed, only to be dashed as variants resulted in escalating infection rates and death. All of this collectively has caused a specific type of physical and mental burnout that has been long-lasting and accumulated over the course of the COVID-19 disaster. I refer to as Long-haulers Syndrome in Healthcare Workers (LHS-H).

Anyone that has tried to go UP the DOWN escalator knows the extra effort it takes to get to the top. The image that comes to mind is somewhat like that but more similar to the circus performer running on a spinning wheel (termed the wheel of death) trying to stay on top, juggling other tasks and seemingly not getting anywhere. There is harm that can come to you if you fall off.  If you are not familiar with this stunt, click on the link below to see an example.

Celestia: Wheel of Death - YouTube

We are running on the wheel struggling with physical and mental exhaustion and trying to meet family challenges and keep our families safe from COVID, socially engaged, as well as psychologically, intellectually, and physically healthy. Even the routine requirements of scrubbing, masking, social distancing, wiping surfaces, and maintaining proper isolation take a cumulative toll. However, we take this upon ourselves in hopes of not contracting COVID with the potential of infecting our loved ones or causing prolonged or life-long complications in ourselves or our family, thus forever changing quality of life or even causing death. The numbers of healthcare providers that have persistent symptoms or have lost their lives to COVID-19 is not insignificant. According to the April 2021 article in Kaiser Health News, more than 3,600 U.S healthcare workers died in the first 12 months of the pandemic. Additionally, the Federal Register: The Daily Journal of the United States Government notes in its rule Occupational Exposure to COVID 19; Emergency Temporary Standard, that as of May 24, 2021, over 491,816 healthcare workers have contracted COVID-19. This is all prior to our more recent higher levels of exposure to the Delta and other variants.  Absences incurred by COVID-19 illness must be covered by an already strained workforce. The mounting tensions have resulted in personnel leaving the healthcare profession causing even more strain on medical institutions, remaining staff, and the ability to provide ongoing medical care. According to a survey by Vivan Health, 43 percent of those surveyed considered leaving the healthcare profession in 2021. Physicians have contributed to finding COVID-19 treatment solutions and have diligently spent many hours striving to learn and stay abreast of this ever-evolving disaster. Many have spearheaded efforts to educate the public and effect positive changes in healthcare policy and institutional procedures to lessen the spread of this deadly virus. This has required attendance at extra virtual meetings, additional duties, and less free time. We continue to focus our energy on improving outcomes in COVID-19 and endeavoring to reach a semblance of “normal”.  Hopefully we can jump off the wheel and grab onto “normal”. Sometimes having a name gives an entity more credence and recognition. Long-hauler’s Syndrome in Healthcare Workers (LHS-H) exists whether one uses this term or not. The diagram below provides a very simplified illustration of the conundrum.

I would welcome hearing about your experiences with COVID-19 and would like to remind readers of ACEP Resources that may be helpful to you. You can also visit the ACEP website to view additional helpful resources.

ACEP Resources:

1. ACEP COVID-19 Field Guide
2. COVID-19 Clinical Alerts 
3. COVID-19-Related Webinars at the following link:
4. Physician Wellness 

References:

1. LOST ON THE FRONTLINE 12 Months of Trauma: More Than 3,600 US Health Workers Died in Covid’s First Year By Jane Spencer, The Guardianand Christina Jewett APRIL 8, 2021
2. the Federal Register: The Daily Journal of the United States Government. Occupational Exposure to COVID 19; Emergency Temporary Standard, A rule by the Occupational Safety and Health Administration on 6/21/21 https://www.federalregister.gov/documents/2021/06/21/2021-12428/occupational-exposure-to-covid-19-emergency-temporary-standard
3. One-Year In: What’s Next for America’s Healthcare Workers Posted on May 3, 2021 https://www.vivian.com/community/announcements/one-year-in-whats-next-for-americas-healthcare-workers/