Winter 2025

Winter 2025 Issue

COVID’s Impacts: Enduring the Invisible Battle
By Acanthus Fairley, LCSW; Zoe Liu, LMSW; and Cristian Bernabe, LMSW
Today’s Geriatric Medicine
Vol. 18 No. 1 P. 28

The lasting impacts of the pandemic and traumatic symptoms among health care workers.

As of March 2024, there were 676 million COVID-19 cases worldwide.1 The United States accounts for 110 million of those cases. For health care workers in New York City, the epicenter of the American outbreak, COVID-19 has been traumatic. The fluctuating demands of patient care and institutional needs since the initial surge in March 2020, coupled with personal obligations and needs, made COVID-19 not just a health crisis but also a psychological one. The pandemic left lasting impacts on health care workers, exposing them to extraordinary levels of stress and uncertainty over the last four years.

For health care workers on the frontlines, this experience has been a collective and cultural trauma, impacting mental health on a widespread scale. Research increasingly points to prolonged COVID-19 exposure as a risk factor for PTSD, with many health care professionals displaying symptoms lasting well beyond the pandemic’s peak. Through three case examples, this article will examine the traumatic impacts of the COVID-19 pandemic and explore how social workers can play a pivotal role in supporting health care workers.

COVID’s Lasting Effects
On March 12, 2020, the federal government declared COVID-19 a nationwide emergency, which lasted until May 11, 2023.2 Health care workers on the frontlines faced the virus head-on for more than 36 months. Acute fears for their own safety, separation from their families, moral injuries, elevated work stress, and daily distress3 were major impacts of being a health care professional during this time.

The COVID-19 pandemic stands as an example of cultural and collective trauma. Cultural trauma occurs when a shared experience shatters a group’s sense of identity and meaning.4 COVID-19 did just that as it upended societal norms and professional expectations for health care workers and fostered collective grief. For health care professionals, the trauma was also collective, as they faced the unique burden of witnessing and enduring the pandemic’s human toll together.5 Shared exposure to loss, moral injury, and chronic and acute stress highlights the collective dimension of their experience. Understanding the pandemic as a dual trauma helps illuminate the psychological effects on health care workers.

As an emergency department nurse for a decade, Janay Z treated acute medical emergencies, such as severely injured and dying patients. During this time, she encountered workplace violence and witnessed the emotional reactions of family members to their loved ones’ adverse outcomes. Although her unit was demanding and called for quick reactions, the demands of her work were contained to the hospital. However, COVID-19 changed everything. The demands of work became ever-present, and there was no compartmentalization of crises she faced at work. As such, the culturally traumatic impacts of the pandemic were the primary reason for her decision to leave the emergency department.

Suzane is a seasoned nurse of over two decades who held a leadership position as the COVID-19 pandemic was unfolding. Due to staffing and PPE shortages, Suzane took on dual responsibilities, rejoining frontline nursing to provide direct patient care while fulfilling leadership responsibilities. One event highlighted her perception of the pandemic. As Suzane was leaving her shift, she heard a young woman whose mother died of complications from COVID-19 let out a bone-chilling scream. Due to visitation restrictions, she was not able to say goodbye to her mother. As a parent reflecting on her relationship with her mother, Suzane sprang into action and asked what could be done to make her feel better. The answer was getting her mother’s necklace, and by searching bodies in the morgue for hours, Suzane found it. In this moment, she was able to bring a modicum of relief, but it was just one of countless instances where solace wasn’t always possible.

The impacts of being a frontline professional during the COVID-19 pandemic caused extreme anxiety, insomnia, and the inability to enjoy the simple pleasures in life that persist today. Due to the traumatic stress symptoms, Suzane decided to step back from the frontlines but remain on as an administrator.

The prolonged exposure to a collective traumatic event like the pandemic has left a lasting psychological and physical impact on these workers. For 36 months, they provided the best care they could under challenging circumstances, putting their lives and those of their families at risk. The instability and acuteness of health care workers’ lived experiences can manifest into emotional exhaustion, burnout, anxiety, and depressive symptoms.6

This group of health care workers who took on complex roles with heightened demands are at a significantly higher risk of developing long-term psychological disorders, such as PTSD.7

As a newly graduated nurse entering a medical-surgical unit in July 2020, Sheryl P knew that she would be on the frontlines of the pandemic. Assigned to a unit that is historically fast-paced, Sheryl thought she would be equipped to manage the influx of patients. She prided herself on her crisis intervention skills. However, depleted resources, high caseloads of patients, and lack of PPE tested her ability to keep up. Over the course of three months, Sheryl had 10 patient deaths. All of which she made death notification calls to the families. Sheryl reused two N95 masks for weeks, worrying she would not find another one in her unit. In September 2022, when the intensity of the initial surge waned, Sheryl reported feelings of fear at the start of her shift and dissociating while at work. In her personal life, she could not sleep and became reclusive in her social circles.

Sheryl’s experience with PTSD symptoms is not an anomaly. The result from a meta-analysis conducted by researchers indicates that the pooled incidence of PTSD symptoms in the health care worker population during COVID-19 is 34% and 14% for severe PTSD symptoms.8 Research has also found that the strongest predictors of PTSD among health care workers with respect to the COVID-19 pandemic were working on a COVID-19 unit, feeling socially isolated, being a nonphysician health care worker, and being female.9

Clinical Implications
Internal employee assistance programs in medical centers, along with social workers and other providers, play a vital role in supporting health care workers exposed to COVID-19’s traumatic effects. Psychological first aid is a powerful tool to help address the psychological, biological, and social factors that influence health and recovery.10 This is especially useful for health care workers who are not ready to fully process the prolonged exposure to COVID-19’s traumatic effects. With the use of psychological first aid, providers can leverage health care workers’ lived experiences to identify protective factors that mitigate PTSD symptoms and foster resilience. Trauma-informed approaches, including cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and group therapy, can assess and address the pandemic’s psychological impact. CBT helps make sense of what has occurred and separates one’s thoughts, behaviors, and emotions. DBT seeks to regulate one’s emotions to help tolerate distress. Group processing or collective healing, with the use of CBT and DBT techniques, is increasingly useful for providers who feel they suffered collective trauma in isolation.

Avoidance of mental health support is common among health care workers as they often suppress negative emotions, fearful that accessing painful memories will hinder their ability to perform their duties. However, the suppression of trauma-related memories can hinder recovery and reinforce PTSD symptoms.11 For this reason, health care workers should not shy away from seeking insight from social workers and therapists as they play a critical role in facilitating memory processing in a safe and supportive environment. Thus equipping health care workers with coping mechanisms that promote healing.

Conclusion
The COVID-19 pandemic has profoundly impacted health care workers, exposing them to cultural and collective trauma. Addressing these mental health needs requires trauma-informed care. CBT and DBT used in individual and group settings can be used by providers to foster resilience and help process trauma. These interventions support recovery and reduce long-term distress in frontline health care workers. Ensuring health care workers are supported not only aids their healing but also strengthens health care systems and communities, ensuring they are equipped to face future challenges.

— Acanthus Fairley, LCSW, is a workforce retention coordinator at an NYC-based hospital and a PhD student in social welfare at CUNY’s Graduate Center. She also runs Blackwell Counseling Firm, PLLC.

— Zoe Liu, LMSW, received her Bachelor of Arts from Gustavus Adolphus College and her Master of Social Work from the Silver School of Social Work at New York University. As an EAP counselor and a first-generation immigrant, Liu provides a warm, collaborative, solution-focused, culturally sensitive, and inclusive approach toward all types of issues impacting staff well-being. Outside of work, you can find Liu running, hiking with her dog, and enjoying learning about different cultures.

— Cristian Bernabe, LMSW, is an employee assistance counselor In New York City. He is passionate about supporting health care workers and the veteran community. Bernabe works at two large NYC health systems and volunteers with veteran organizations.

References
1. COVID-19 Dashboard. Johns Hopkins Coronavirus Resource Center website. https://coronavirus.jhu.edu/map.html

2. CDC museum COVID-19 timeline. Centers for Disease Control and Prevention website. https://www.cdc.gov/museum/timeline/covid19.html. Updated March 15, 2023.

3. Phillips A, Kucera J. Extreme anxiety, illness fears, and acute stress in COVID-19 frontline healthcare professionals. Psychosociological Issues in Human Resource Management. 2021;9(2):35-48.

4. Demertzis N, Eyerman R. Covid-19 as cultural trauma. Am J Cult Sociol. 2020;8(3):428-450.

5. Hirschberger G. Collective trauma and the social construction of meaning. Front Psychol. 2018;9:1441.

6. Mitchell K, Lăzăroiu G. Depressive symptoms, emotional exhaustion, and psychological trauma symptoms in frontline healthcare workers during the COVID-19 outbreak. Psychosociological Issues in Human Resource Management. 2021;9(2):119-132.

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.

8. Andhavarapu S, Yardi I, Bzhilyanskaya V, et al. Post-traumatic stress in healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2022;317:114890.

9. Bayazit H, Ozel M, Arac S, Dulgeroglu-Bayazit D, Joshi A. Posttraumatic stress disorder among health care workers during the COVID-19 pandemic. J Psychiatr Pract. 2022;28(5):354-361.

10. Draze L. COVID-19 and PTSD in frontline nurses. American Nurse website. https://www.myamericannurse.com/covid-19-and-ptsd-in-frontline-nurses/. Published October 4, 2022. Accessed November 18, 2024.

11. Pineles SL, Mostoufi SM, Ready CB, Street AE, Griffin MG, Resick PA. Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship? J Abnorm Psychol. 2011;120(1):240-246.