Behind the Mask

It would be hard to write about A Year in Science without the obligatory COVID article. We hear constantly about the stresses of being a frontline healthcare worker, the signs and symptoms of long COVID, and the endless vaccine scepticism.

I’d like to tell a slightly different story. During the COVID pandemic, other infections didn’t just take a holiday and cancers didn’t just stop growing. More ordinary illness and injury continued behind the headlines. As a consequence of the pandemic, healthcare workers are additionally dealing with an abundance of patients, delays with diagnosis and some very complex medical cases.

Megan Gifford worked in a hospital that didn’t primarily treat COVID-19 patients, but still had to adapt to the constant changing of rules, regulations and policies put in place to protect staff and patients alike from the virus. Now at the Peter MacCallum Cancer Centre in Melbourne, Gifford spoke to me about her experiences working at Townsville University Hospital in the only bone marrow transplant ward servicing a large population across regional Queensland.

Gifford experienced the stress and burden of trying, not only to assuage their own anxieties but to also provide current, up-to-date information to patients and deliver high quality care. There were the frustrations of unavoidable logistical problems like border closures, stay-at-home orders, preventing access to crucial materials and patient transport. There was heartbreak of watching transplant patients deteriorate mentally, as their will to persist with treatments began to fade.

Pathologists and haematologists also found themselves facing an unprecedented logistical nightmare, including re-allocation of diagnostic equipment and protective equipment for mass COVID testing. Access to essential biomedical material like blood and plasma became increasingly difficult and many suffered as a result.

While pandemic consequences like long COVID and the increased prevalence of affective disorders, like depression and anxiety, are well documented in media and academia, post-traumatic stress disorder (PTSD) hasn’t gotten the same amount of attention. Statistics and anecdotes alike are staggering, both for patients and healthcare workers.

With stressors like an unprecedented number of critically ill patients, capricious disease progressions, high mortality, and ever-changing treatment guidelines the world was sympathetic to healthcare workers’ struggles (3). Yet with the lockdowns and restrictions over, it would be naïve to think everything would just return to normal. It was found that 29% of healthcare workers had clinical or sub-clinical symptoms of PTSD (1), and that this figure was significantly higher for healthcare workers directly treating COVID patients (2). Gifford recalled anecdotes of “patients suffering anxiety attacks when they smell the hospital alcohol rub and hear the familiar beeping of the various equipment”.

Even beyond the mental health scope, logistical issues like delayed learning for medical students or the backlog of elective procedures is still placing an enormous burden on healthcare workers, despite the immediate threat seemingly behind us.

But to say that everything remains in shambles would frankly be insulting to healthcare workers, who are working tirelessly to deliver good quality healthcare. The speed at which pathologists and scientists have adapted to limited resources and supply shortages, and the way in which doctors and frontline workers have shifted their style of care and developed new problem-solving skills, are exceptional and should not go unnoticed or unappreciated.

Importantly, the COVID-19 pandemic and its ripple effects have brought centre stage the consequences of under-resourced healthcare centres in a way that affected all people, irrespective of geography, class or reputation. The reality is that the conditions in which many metropolitan hospitals found themselves in, with never enough staff or supplies, is a condition that some hospitals experienced long before COVID-19 ever appeared, particularly in rural settings.

To say that every dark cloud has a silver lining would be horribly cliché, but in this case, there may be truth to it. This edition of A Year in Science is a chance for us to reflect on all that COVID-19 has called attention to and decide to do something about it. REFERENCES

Carmassi C, Foghi C, Dell’Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Research. 2020 Oct;113312.

Janiri D, Carfì A, Kotzalidis GD, Bernabei R, Landi F, Sani G. Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection. JAMA Psychiatry. 2021 Feb;

Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. Vickers K, editor. PLOS ONE. 2020 Oct 21;15(10):e0241032.