An hour before her shift starts in an emergency room at University Hospital in London, Ont., Dr. Allison McConnell has isolated herself upstairs in her home so she can talk without being disturbed by her two young children.

Downstairs, her husband, a firefighter who has just finished a 24-hour shift, keeps an eye on the kids — one, a-year-and-a-half, the other, 4-and-a-half — while she talks.

In a few minutes, McConnell is going to hang up the phone, say goodbye to her husband and children and then head off to work. After that, she’s not sure what’s going to happen.

She doesn’t know if she’ll see another set of young, once healthy COVID-19 patients wheeled off to ICU. She doesn’t know if there will be enough personal protective equipment for herself and her co-workers — so far there has been. She doesn’t know if the hospital’s resources are going to be outstripped by a rush of COVID patients. She doesn’t know if tonight is the night one of her colleagues will be exposed to a coronavirus infection.

She doesn’t know if, by the time she returns home, she might have one too. She doesn’t know if she’ll pass that along to her husband or her children.

“In the back of your mind at all times, home or work, you’re anticipating something bad is going to come out of this and it’s going to be someone close to you. Whether it’s a colleague or a friend or family member — someone is probably going to get sick and may or may not die,” she said.

“I think that’s the most difficult part. Is not knowing what form that’s going to come in as you go to work every day and as you come home every day.”

This is the world that front-line health-care workers live in now. It’s a world filled with uncertainty, anxiety and trepidation, both at work and at home. And history tells us if these aren’t dealt with early, at the end of this road lies more anxiety, depression and post-traumatic stress disorder (PTSD).

What McConnell and her colleagues are going through has a name: anticipatory grief — that feeling we get about the future when the future is uncertain. Usually that feeling is centred around death.

A recent study conducted in China surveyed some 1,200 health-care workers from 34 hospitals, mostly in Wuhan, close to the peak of the outbreak there.

It found 50 per cent of those workers reported depression, 45 per cent reported some anxiety, 34 per cent reported insomnia and 72 per cent suffered some form of psychological distress.

For ER physicians like McConnell, it can be difficult to leave those worries at work. Ultimately, there’s a toll on family life.

“I feel like (sometimes) I’m not as present as I should be,” said McConnell. “And I definitely see it taking its toll from that perspective in some of my interactions with my kids when I’m stressed, or when I’m maybe not as present as I could be.”

“I can tell it’s always on everyone else’s mind as well that we’re not escaping this. Whether we’re at work or at home, it’s always there.”

To help share the load, the London Health Sciences Centre, where McConnell works, has installed a “buddy system.” Physicians are encouraged to pair up, and check in with their buddy daily to see how the other is doing. The purpose is to make it easier for ER physicians — a group notorious for generally being reluctant to ask for support — to speak with colleagues about their concerns.

It’s one of a growing number of methods — along with social media-based technology, like group chats — that front-line workers use to support each other.

That support, that camaraderie, that feeling “we’re all in this together” amongst health-care workers represents a culture shift, says Dr. Randy Wax.

Wax, a critical care physician at Lakeridge Health in Oshawa, worked through the SARS epidemic in 2003. He says what he’s seeing during this epidemic is something new.

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“One thing that’s very different in 2020 is social media. And it’s been very interesting, the role of social media, not only exchanging medical tips from people experiencing the pandemic all around the world, but there’s a certain ability to connect with others who are fighting the same battle that’s created a whole new source of support for people that they didn’t have,” said Wax.

When ICU staff at Markham Stouffville hospital danced in the hallways after removing a recovering patient from a ventilator, every other front-line worker who saw the video on social media celebrated along with them. When health-care workers see musicians serenading health-care workers in Spain, or applauding from balconies in Vancouver; when lines of fire trucks and police cars drive by hospitals with lights flashing in tribute each evening, it boosts spirits and adds to a newly-thriving esprit de corps.

“For other work cultures, like police, fire, paramedics, and military, there’s a certain supportive culture, brotherhood and sisterhood,” said Wax. “I would say that in the hospital environment, doctors, nurses, respiratory therapists, others — I don’t think until now, we’ve really moved into that understanding of how important we are to each other. That change in culture is something that has helped everyone cope with the stress of this pandemic.

“I think the health-care system and health-care workers are never going to be the same in Ontario and Canada after this.”

Other health-care workers have different experiences, however. Each province has its own protocol for dealing with the burdens placed on their health-care workers, and within those provinces, each hospital administration may have different ideas.

What’s needed is a consistent approach across the country to supporting front-line health-care workers.

“Right now in the front lines, it’s very, very quiet,” said Dr. Rodrick Lim, chairperson for the wellness committee at the Canadian Association of Emergency Physicians. “It’s the calm before the storm. Everyone knows that’s the situation. And in some ways, it’s a harder place to be in. When you’re preparing, there’s things to do, there’s plans to be made. And now we’re sitting, waiting to see how bad it’s going to be.”

There’s a term coined for this too: pre-TSD. The stress caused by waiting, anticipating there will be trauma up ahead. Dealing with it, making sure it doesn’t grow is difficult because, across the country, front-line health-care workers have different kinds of access to different types of help.

What’s needed, says Lim, is policy at a national level.

“I think we need to guarantee that any worker no matter where they are, or who they are, can have access to free, immediate resources through the duration of this crisis and beyond,” said Lim. “I think that someone in the federal level needs to say that this is going to happen.”

Psychotherapist Karen Dougherty is trying to make that kind of easily accessible, widespread support happen. She’s the founder of the Ontario COVID-19 Mental Health Network, a grouping of mental-health professionals supporting front-line health-care workers in Ontario on a pro-bono basis.

Dougherty and some colleagues put together the network three weeks ago after having conversations about a similar network based in New York. Within hours of making the decision, a website (covid19therapists.com) was up and running. Within three days, they had 450 volunteers; two weeks later, that number was up to over 800 Ontario licensed mental-health professionals.

When a front-line health-care worker feels they’re in need of help, Dougherty’s network takes some information through the website, and then matches them with two or three mental-health professionals. The worker touches base with one of the professionals and together they decide how the therapy will work.

“I think people generally speaking don’t ask for help until they reach a level of intolerance for the way things are — they can’t stand it. But if it’s difficult to do or if you need to make a bunch of calls and do your own research or tip your hand to your employer, you’re probably not going to do it.

“I think the fact that this is sort of pro bono, simple, it’s just an email and then you just call the therapist yourself. We’ve already done the selecting for you. I think that’s helping.”

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