Yesterday, there was a news story published here in NZ, about a Business representative organisation (BusinessNZ) advocating that employers should be actively preparing for a coronavirus outbreak. Though we have no cases here yet, this is good advice. It is far more likely to be a question of when, not if.
With the plane carrying people home from Wuhan scheduled to arrive in New Zealand later today, and the people then being screened and transported to a designated quarantine facility for 14 days, I wanted to talk about what we should be doing to protect and care for those health and welfare workers who will be working in environments where they potentially may be exposed to the novel coronavirus.
Of course, infection control processes and procedures are very important. But I want to focus here on the emotional and mental health and well-being needs of those workers, their families and friends, and the communities they live in.
Staff can often have complex and conflicting thoughts and feelings about working during a public health emergency. Healthcare staff asked to work during the SARS outbreak in Toronto in 2003 reported feeling conflicted between their roles as healthcare providers and parents, feeling professional responsibility but also feeling fear and guilt about potentially exposing their families to infection.
One research study interviewed 10 healthcare workers in Toronto who were quarantined at home for 10 days because of their exposure to SARS. They described experiences such as loss, duty, and conflict.
A predominant theme in the SARS literature is whether healthcare workers have a duty to treat high-risk patients. While none of these participants in this particular study refused to perform their duties, the fear and and anxiety associated with the risk of contracting SARS was prominent in their minds.
They also found that although their duty as healthcare workers was performed, the dual role of both healthcare worker and family member caused several conflicts. Participants were particularly concerned about infecting family and friends they considered vulnerable. Conflict was also reported between workers who continued working in high-risk situations and the so-called ‘non-essential’ staff members who remained at home and were paid. However, the sense of camaraderie that prevailed amongst those who continued to work and the social contact of working together were seen as positive developments.
A study of emergency department staff in Taiwan during the SARS outbreak of 2003 also found that healthcare workers were worried about their anticipated overtime hours if other staff were quarantined, as well as the stigma of the illness and the health of their families and themselves.
So what can be done?
For those healthcare professionals or other front-line staff working in dangerous conditions, accessible and timely referral paths should be developed for the few who may require mental health services. For example, a confidential telephone support line set up by staff with knowledge and training to be made available for those staff members in quarantine. Just the knowledge that support is available may suffice for many resilient staff members. There is also an opportunity for leadership by example where service-managers advocate and use peer-support. Issues regarding stigma and health workers or front-line staff involved in quarantine responses are understandable but need to be attended to and are likely to subside only when public information and role modelling by authorities at all levels are improved. Racist attitudes require a far stronger response.
I think it’s also important for those workers on the front line, including ancillary staff, are contacted to understand whether they possibly have vulnerable dependents at home, meaning that the impacts of them falling ill or themselves having to enter into quarantine will have an impact on their availability to work in these situations, or potentially generates increased anxiety and worry for their families and community.
Help people to manage their potential conflict between duty and obligation and desire to protect members of their family and wider community; through education, good processes and procedures, and considering protection and support for all family members, not just the worker.