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Montefiore in the News

August 5, 2021

‘It was just an avalanche’: US health workers struggle with burnout Experts face threats over Covid-19 restrictions while officials push to improve vaccine uptake Stephen Starr | Thu, Aug 5, 2021, 01:00pm

Even as the US powered towards its goal of vaccinating more than 70 per cent of Americans against Covid-19 by early July, the country’s medical professionals and clinicians were still struggling with burnout, personal targeting and bureaucratic workloads – the effects of which could damage the country’s health system for years to come. All this is not helped by a steep decline in vaccination rates. With almost 35 million cases, more than 605,000 deaths and the virus continuing to spread, US president Joe Biden said his administration would send people door to door, set up clinics at workplaces and urge employers to offer paid time off as part of a renewed push to reach tens of millions of unvaccinated Americans. US president Joe Biden said his administration would send people door to door, set up clinics at workplaces and urge employers to offer paid time off as part of a renewed push to reach tens of millions of unvaccinated Americans.

Photograph: Doug Mills/EPA But health experts warned it was simply not enough, and recommended the president should take the potentially unpopular step of encouraging states, employers and colleges and universities to require vaccinations to slow the continuing spread of the virus. When Dr. Amy Acton became the face of Ohio’s response to the pandemic as the crisis worsened in March 2020, she was lauded nationally for her professional insights and empathetic approach with the public. As the director of Ohio’s department of health, she appeared on television every afternoon, calling on citizens to follow government advice and stay at home. But all the while, many residents of the midwestern state were outraged by the restrictions and closures she recommended. Within weeks, protesters were turning up at her home in the state capital, Columbus.

By early summer Acton, a physician, was assigned her own security detail, so serious were the threats being made against her. All the while, Republican representatives in Ohio were seeking out ways to undermine her (even as she worked hand-in-hand with Republican governor Mike DeWine) – proposing legislation that would restrict her ability to offer medical advice, and potentially see her forced to give up doctor-patient confidentiality.

By June, such was the toxicity directed at herself, her religion and her family that she resigned. The state of Ohio had lost a key expert in its battle against the virus. On top of the vitriol Acton and many medical professionals have faced as a result of calling for restrictions on movement, is the enormous workload forced upon medical staff over the past 15 months.

Top scientists at the Centers for Disease Control and Prevention (CDC), the country’s public health agency, are moving towards early retirement such has been the level of burnout they are experiencing. Reports abound of intensive care (ICU) physicians who, having been faced with losing dozens of patients in short periods of time, have been asked to work 48-hour shifts.

“This question of burnout, personal and professional, is the No 1 thing I talk about with friends,” a senior, unnamed CDC epidemiologist who has “worked at a high level in the pandemic response” told Science Magazine.

The emotional and psychological needs of the workforce have not been adequately addressed, in part because you can’t measure it

Dr Carol Bernstein, past-president of the American Psychiatric Association and professor of medicine at Montefiore Medical Center in New York City, has seen up close the toll 15 months of crisis mitigation and mounting deaths has exacted on the mental health of medical staff. Based in the Bronx, she has found herself at the “tip of the spear” of the Covid-19 emergency in America, she says. “It was just an avalanche,” she says. “The fear of ourselves getting sick and infecting our families. It created a terrible crisis.”

One of the major pre-pandemic issues facing clinicians, she says, was the huge amount of time they were asked to spend on paperwork, regulations and guidelines, rather than focusing on being with and treating patients. Over the course of the pandemic, it’s been medical staff working in critical care that are most at risk of burnout, according to the Medscape National Physician Burnout & Suicide Report 2021.