PTSD, Covid – 19 and Health Care Workers

An unexpected explosion detonates near a group of people as they sit quietly drinking tea. A flash and a bang followed by smoke and dust, muffled screaming heard through sound blasted ears and then the pain; something from the bomb has torn into your flesh. You feel the blood, warm and now liberated rushes to flee from your body. One moment happy and content now you are staring an uncontrollable sprint to death. You can do nothing and no one else can reach you.

A week later you are recovering comfortably in your hospital bed, glad to be alive. The emergency services were on the scene of the attack in moments, your body was far more resilient than you would have ever given it credit for and a less injured person applied pressure to the wound effectively enough to give the paramedics time to expertly jump in. You couldn’t be happier. Could you?

Anytime we face a shocking incident that leaves us fearing for our lives we might develop post-traumatic stress disorder or PTSD. Note I said, ‘might’. Any horrible incident, life threatening or not will leave us with a memory that is difficult to think about, that changes our emotions, that might worry us to think about its reoccurring, but this, although stressful and ‘after – trauma’ is not necessarily PTSD.; troubling and it could well benefit from therapy but not PTSD. Usually in the sufferer of PTSD the memory hasn’t been processed or coded correctly, perhaps due in part to the excessive amounts of cortisol we are exposed to as we experience the horror.

So, let’s look at what it is.
The NHS website describes it thus: Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

A therapist looking to diagnose PTSD in a person would be looking for symptoms within several groupings. Firstly, the classic PTSD sufferer would almost definitely experience a frequent and distressing mental revisiting of the event often referred to as flashbacks. These are very different to simple remembering as they almost feel as though one is reliving the event as it happened. We do need to be mindful that any memory can be problematic, and we certainly aren’t suggesting that anything that isn’t PTSD doesn’t require professional help, but the form that help might take would be very different.

Typically, a person experiencing true PTSD will also try to avoid having the memories flashback at them. This could be by removing any physical reminders, avoiding the place the incident occurred or using any number of mental or physical tricks to ‘downplay’ the memory; whiskey anyone?

We will as therapists trying to identify PTSD also look out for other anxieties, anger (different to the person’s presentation prior to the event) and often an increased ‘startle’ response. This is not an exhaustive list and appropriate diagnostic manuals would be used alongside measuring tools such as the ‘impact of events scale’.

The sudden fear of imminent and unexpected death isn’t the only cause of PTSD. Victims of terrible sexual assaults can develop enough symptoms for a diagnosis to be given and people who experience repeated traumatic events can likewise develop the condition as is sometimes the case with people who were, as children, repeatedly abused.

And now we have Covid – 19. With the spread of Covid – 19 many hospital staff are aware that they might be exposed to more sadness and death than usual. Amidst this gloomy backdrop is a heightened anxiety for their own health and the health of their loved ones who might be secondarily exposed simply because they live with a member of a caring profession. So, will this increase in death, dying and sickness result in PTSD? It would be a brave therapist who offered a definitive answer, but the likelihood is that it won’t. Most people who work as nurses or doctors etc, have an expectation of bearing witness to death so people passing from the new virus is actually nothing new. The Covid – 19 illness doesn’t seem to have remarkable symptoms that we would find outrageous or alien and the passage of the pathogen from one host to another is not in Hollywood style creatures bursting from our intestines or violent in anyway. It gets around in much the same way that colds or flu gets around and we are all habituated to this process. It remains very sad of course when people die of anything but nurses, health care assistants, doctors and others involved in the care are generally used to this.
It can also be said that most people cared for as they shuffle off this mortal coil in the UK’s world beating care system do so in relative peace, a peace brought about by the excellent care they receive in their last few weeks, days and hours, so even the point of passing isn’t horrifying; sad and upsetting but rarely traumatic for the care team. Whilst a death is often outside of our control, the care we give and the effort we put in and maintain is not, unlike the trauma faced by an abused child or the conditions experienced by a bomb victim.

But PTSD could happen. It probably won’t, but it could. It has happened to nurses and others doing their normal work in their normal way. I’ve certainly seen it in paramedics but only after truly horrific incidents but the but remains. So, what could we be doing?

I myself and my colleagues Dr Rick Norris and Fran Morris have been seconded to offer psychological support to a hospital during this time and I would imagine most other hospitals have recruited similar teams.
One of the methods we are employing is ‘Group Huddles’, a method familiar to sports people. A group huddle is a structured chat wherein staff are encouraged to reflect on what went right and small successes, so closure can be achieved at the end of a shift. This methodology has a cumulative effect on psychological well-being and also retrains our brains to look for the positives about our work. We have also adopted a system of support that can be accessed quickly and easily and are hearing from people how comforting it is to know that this exists even though they haven’t yet used it; many have but there seems a positive benefit of simply knowing it is there.
Being able to advise people of longer-term coaching and therapies to help in the aftermath seems also to be quite comforting to people for whom hope is a therapeutic tool in and of itself.

PTSD is a serious and life changing condition and, to sit on the fence, our carers might get it and they might not. It is certainly not a given that many will although with or without true PTSD psychological support will be extremely useful during and after the Covid – 19 situation.
If you have any questions about this article or PTSD in general, please don’t hesitate to send us a comment or use the Contact Us section.

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