key: cord-0990360-lo84h1yf
authors: Lim, Rodrick; Ali, Huma; Gagnier, Rachel; Marlborough, Michelle; Northcott, Sandra
title: Emergency physician mental health during the subacute phase of the COVID-19 pandemic
date: 2020-07-03
journal: CJEM
DOI: 10.1017/cem.2020.442
sha: 162904125d1f0486494ec11cceb5fd8c03af24b7
doc_id: 990360
cord_uid: lo84h1yf

nan

The coronavirus disease (COVID-19) pandemic presents unique mental stressors for emergency physicians (EPs). In light of the literature on the mental health of EPs during the severe acute respiratory syndrome pandemic, the wellbeing of EPs during this prolonged COVID-19 pandemic is of major concern, as they are at significant risk of depression, anxiety, and other mental health complaints. [1] [2] [3] [4] EPs pre-pandemic experienced chronic stress, perceived lack of control, inefficiency, and moral distress, which were all leading to burnout. 5 Tools that worked well to cope during the acute phase may not work well in the subacute phase, as natural decompression occurs and EPs face the unpredictability and chronicity of COVID-19. We propose that three important themes during the subacute phase are important to identify to support EP mental health: uncertainty, lack of control, and discord.

Uncertainty presents as the everevolving clinical presentation of COVID-19, the lack of clarity regarding management of future influenza seasons, insecure personal protective equipment supplies, decentralized conflicting sources of information, continued fear of dying or bringing home illness to our families, and the moral injury and potential legal ramifications of providing suboptimal care.

The lack of control that EPs experience with decisions, such as use of personal protective equipment and procedural protocols, and the instinct to help those in need are tempered by the timeconsuming requirements to properly don personal protective equipment. We feel powerlessness and frustration when witnessing the actions of community members disregarding physical distancing and masking guidelines.

When an acute phase ends, the sense of unity dissipates as well. Discord has led to an increased feeling of isolation and lack of support from others and the creation of a more hostile work environment.

To support EPs' mental health during the prolonged COVID-19 pandemic, we propose the following action items: 

The mental health of hospital workers dealing with severe acute respiratory syndrome

Mental symptoms in different health professionals during the SARS attack: a follow-up study

The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk, perception and altruistic acceptance of risk

Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019

Emergency medicine physician burnout and wellness in Canada prior to COVID19: a national survey

Competing interests: None declared.