key: cord-1054927-kwigfkv8 authors: M, Vasudevan; Mehrolia, Sangeeta; Alagarsamy, Subburaj title: Battle fatigue of Covid 19 warriors – Heal the healers date: 2021-11-01 journal: J Affect Disord DOI: 10.1016/j.jad.2021.07.068 sha: 6ef232d2a46beadfafa7b73c83efdc1c80388800 doc_id: 1054927 cord_uid: kwigfkv8 nan Frontline healthcare workers or medical soldiers are fighting the war against the surging spread of COVID-19. Interviews conducted among a dozen healthcare workers showcased the unrelenting stress faced because of the healthcare crisis across the globe (Wu, 2020) . Spikes in anxiety, depressive thoughts, chronic sense of hopelessness, trauma and burnout were also found to be hitting the healthcare workers (Feinstein et al., 2020; Smith, 2020) . Battle fatigue or shell shock is a combat stress reaction resulting in adverse behaviors because of stress from battle. There may be emotional, physical, mental and behavioral reactions because of this stress. Healthcare workers, including doctors, nurses and other healthcare staff, are the COVID warriors who are risking their lives to protect people's lives from the dreadful disease. These warriors experience an array of emotions from being angry to anxious, frustrated, helplessness and despair to a small ray of hope (Rajhans and Godavarthy, 2021) . India is the worst affected by the second wave of Covid 19 in Asia (Tandon, 2021) . In India, from January 3, 2020 to May 5, 2021, there have been 20,665,148 confirmed cases of COVID-19 with 226,188 deaths reported (World Health Organization, 2021). As of April 16, 2021, Indian Medical Association Registry showed that 747 doctors have died because of COVID-19 (Mascarenhas, 2021) . Healthcare workers, whose mission in life is to care for others are on the verge of collective collapse emotionally and physically (Rajhans and Godavarthy, 2021) . The isolation in quarantine rooms, feeling of loneliness, patient deaths, wearing PPE kits for hours affected the mental health of frontline healthcare workers. Even they are scared to remove the PPE kit to drink water. Prolonged usage of PPE kits results in exhaustion, dermatitis, dehydration, latex allergies etc. They also have to be very careful at home and maintain distance from the family members. "It has been months since I hugged my children," was the statement was given by a nurse on COVID-19 duty (Mani, 2021) . Doctors find themselves helpless when the patients are dying under their supervision. Healthcare workers are in a situation to provide emotional support to the patients who are already in fear. Similarly, they also had to deal with their fear of contracting the disease. The doctors also faced a worst situation of being unable to help their family members because of a lack of beds and sufficient medical infrastructure to handle many cases. The doctors found themselves to be helpless, upset and angry at this situation (Kumar, 2021) . Healthcare workers across India, as well as the globe, are facing tremendous mental pressure leading to psychological pathology. They were found to be suffering from acute stress, depression and anxiety. Healthcare professionals face many psychological consequences because of excessive workload, exaggerating media news, feeling not supported adequately, insufficient protective equipment, and infection rate among their fellow medical professionals (Spoorthy et al., 2020) . Though mental illness and burnouts are considered to be epidemic in medical professionals, they may result in negative consequences if untreated. It is found that physicians with depression were more likely to commit medication errors, 6.2 times more likely than resident without depression. If a physician avoids treating such mental health issues, it may worsen illness or even death by suicides. After all, medical professionals are also human beings and need care like any other people (Kalmoe et al., 2019) . Physicians are healers. This letter is focused on highlighting the toils faced by healthcare workers in India during the second wave of the COVID-19 pandemic and possible coping strategies to heal the mental health issues of healers. Healthcare is considered one of the noblest professions, and it takes much time, effort and hard work to produce skilled professionals. All the stakeholders should volunteer and address this worst situation of healthcare workers on priority. Government must take adequate steps to ensure legislation for ensuring the safety of healthcare professionals and their families, adequate PPE kits, job and economic safety, vaccination to all healthcare workers (Rajhans and Godavarthy, 2021) .The Government of India should also extend the Pradhan Mantri Garib Kalyan Package, an insurance scheme for healthcare workers who die in the line of COVID-19 duty or introduce a new and equivalent scheme to support the families of healthcare workers who sacrifice their lives in the battle of COVID-19. Indian Government can follow the intervention models implemented by the Chinese Government, such as setting up psychological intervention teams, online platforms with medical advice. The psychological intervention team had four teams comprising the psychosocial response team, psychological intervention technical support team, psychological intervention medical team, psychological assistance hotline teams (Kang et al., 2020) . Hospitals should monitor the health of their staff and their family members; they can also spread positivity through pep talks, messages, broadcasts etc. Hospitals should also provide a helpline for psychological first aid to the healthcare workers (Rajhans and Godavarthy, 2021) . Hospitals should improve the work environment of healthcare workers by ensuring less patient load, sufficient isolation wards, adequate training on COVID-19 management, proper supply of PPE, nutritious food and adequate rest (Suryavanshi et al., 2020) . Family members of healthcare workers should feel proud of having a COVID-19 warrior in their family, have a better understanding of the situation and provide moral support to the healthcare workers, identify if there are any signs of stress among them and talk to them, plan for financial goals and support to reduce further stress of healthcare workers. Healthcare workers should understand the limitations of the present scenario and be strong. They can practice relaxation techniques like yoga, meditation, watching movies, listening to music, reading, focusing on physical fitness, talking freely with coworkers and help them in case of any problems, and avoiding addiction. The media should talk about the selfless and tiring work of healthcare professionals, highlight their success stories, educate the general public about the disease and follow precautions, build awareness instead of spreading myths, and create cooperation, support, and empathy from society for the COVID-19 warriors (Rajhans and Godavarthy, 2021) . At the individual level, staying home, following adequate social distancing, wearing masks, using sanitizers and protecting themselves from the disease would be a great help by the citizens for the healthcare workers. This would ensure reduced patient loads and stress for the physicians. The COVID-19 pandemic revealed the weakness in the structure of our health care system and public health preparedness. People are vulnerable, and every individual must share the responsibility of addressing the weakness in the system. The approach should be collective problem solving instead of blaming and shaming (Tandon, 2021) . Therefore, every stakeholder should ensure their complete support to the COVID-19 warriors in combatting their battle fatigue. Not Applicable. There is no funding sourced for this study. No human subjects and/or animals were used in this study. No minor subjects/children/infants participated in this study. Framework and concepts used in this study were not copyrighted materials and proper referencing was given. Dr.Vasudevan M -Identification of the issue, causes and impact of the issue Dr.Sangeeta Mehrolia -Possible interventions Dr.Subburaj Alagarsamy -Role of Stakeholders Vasudevan M, Sangeeta M, Subburaj A We have no conflicts of interest to disclose. Vasudevan M, Sangeeta M, Subburaj A. 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