It's like being tied to a railroad track. You know the train is coming, but you can't get out of the way.
That's how a nurse in Kansas City described what it feels like to be a health care worker amid the COVID-19 pandemic to his therapist, Bruce Fletcher.
“There is very little they can do to avoid the catastrophe that's coming,” said Fletcher, a mental health practitioner in Warrensburg.
Four of his patients are either health care workers or work in a health care facility.
“They aren't able to grasp the meaning of the potential catastrophe,” he said.
As hospital administrators learn from harder hit areas of the country, frontline workers are still doing their jobs, trying to wrap their minds around what might be coming.
Last week the number of COVID-19 cases in Missouri increased by over 1,000. There have been 77 deaths. The first case of the virus in Boone County was detected March 17, and 78 cases have been recorded since.
According to MU Healthcare's website, there are currently eight COVID-19 patients being treated at its facility and 13 pending test results.
“The data appears to say we are seeing some flattening of the curve,'' said Scott Clardy, assistant director of the Columbia/Boone County Department of Public Health and Senior Services.
Clardy uses a model to anticipate when Missouri will need the greatest amount of resources, like ICU beds and ventilators. Right now, that peak is slated for between April 20 and 24. Missouri is projected to have enough ICU beds, but a ventilator shortage is likely.
“You don't want to have false hope so you want to be prepared for the worst,'' said Mary Beck, University Hospital chief nursing officer.
There have been no elective procedures in many Missouri hospitals since mid-March, including MU Health Care and Boone Hospital Center. Visitors have been limited, leaving facilities empty, eerie.
Statewide, frontline workers are watching their colleagues in New York and New Orleans, wondering when or if Missouri will find itself in similar circumstances.
Waiting, worrying, working
Although hospital leaders are grateful to have time to prepare, the slow approach of COVID-19 and frequently changing protocols cause stress for workers.
“Pretty much across the board they have all resigned themselves that they are going to get it,'' said Heidi Lucas, state director of the Missouri Nurses Association.
Lucas isn't a health care worker, but she hears from nurses from across the state regularly.
“I had four emails just today from nurses from the Kansas City, Saint Louis and Springfield areas,'' she said. “The supplies aren't there or they are on lockdown or they are telling (them) they are not allowed to wear (their) masks.''
Some health care facilities are discouraging workers from posting their experiences on social media, leaving them without an outlet to express their fears and concerns, Lucas said. All of this creates a real mental strain on medical workers.
Locally, MU Health Care says it has an adequate supply of personal protective equipment and has made the necessary staff changes to account for a possible surge. Still, anxiety is a normal response to a situation as expansive as the COVID-19 pandemic.
''When we are in a state of prolonged stress and have a lot of uncertainly about how this is going to go, that can really bring up a lot of anxiety,'' said Craig Rooney, director and counseling psychologist at the Office of Clinician Wellness at University Hospital.
“I think it begins to be a mental health concern when a person is unable to stop worrying,'' Rooney said.
But even as they're worrying, health care providers are working.
“You get ready,'' a local health care worker said. The Columbia Daily Tribune is quoting them anonymously to protect their employment, but verified their place of work with their ID badge.
“I went in … two weeks ago,'' they said. “My will was written. My bills are paid … everything I think is important to be done (is done).''
For them, COVID-19 poses an unknown, yet omnipresent threat. Will the equipment protect them? Will they linger too long with a patient? Who will they be able to save?
“Not that you did anything (wrong),'' they said. “It's just how it happened. This is disarming from our point of view.”
The threat is so imminent, yet life continues as it always has. Their dog chases a baby squirrel in the yard. They talk to their kids. They go to work.
“I'll handle it now, but in six months from now, will there be anybody there for us?'' they said. “Will people happily go back? How is anybody going to be supportive when life moves on?''
Mental health providers respond
Facilities in the area have mental health programs available, like Boone Hospital Center's Employee Assistance Program and Rooney's department at MU Healthcare.
His department was created a year ago to address physician burnout.
“So, we're at the ready,'' Rooney said.
Not every hospital has the resources to provide employee mental health support, though, particularly in rural areas. Fletcher has offered his services to hospitals in his area. He's waiving copays and working to make his practice accessible, but he worries it won't be able to serve all those with need.
As for Rooney, he's encouraged mental health providers are part of the response to the COVID-19 pandemic. He's not sure that would have been the case when he began practicing in the 1990s.
“People didn't really talk about mental health so much,” he said. “Now you see it every day. That's good to reduce stigma.”
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