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Ontario Medical Review
May 20, 2020
Ontario Medical Association

This article originally appeared in the May/June 2020 issue of the Ontario Medical Review magazine.

Easing the psychological burden of COVID-19

Dr. Samir Sinha, Director of Geriatrics at Sinai Health System and the University Health Network in Toronto, is quickly losing weight and sleep. After one frantic 18-hour day, he realized that he had only consumed a couple of coffees and a clementine. Yet he didn’t even feel hungry. “You’re running on adrenaline,” he says.

During COVID-19, work stretches beyond his days at the hospital. Dr. Sinha is also the expert lead of Ontario’s Seniors Strategy. “At home, I’m constantly on email.” Finally, he’ll collapse into bed for, if he’s lucky, five hours of rest. Then it starts all over again.

Some work stress is normal, but Dr. Sinha has never felt like this in his career. Where does he rate his stress on a scale of 1-10? “Eleven or 12,” he replies.

Along with infections, COVID-19 is spreading distress among everyone, and doctors are no exception. In fact, physicians may be particularly exposed to negative mental health impacts. Even before COVID-19, many were vulnerable. The Canadian Medical Association’s last National Physician Health Survey found that more than one-in-four doctors reported high levels of burnout. Now, layer on the challenge of confronting a pandemic, and the uncertainty surrounding the disease.

Concern about getting infected, and introducing the illness to colleagues or loved ones, is yet another stressor. Some doctors on the frontlines have given their lives. In Italy alone, as many as 100 doctors had died of COVID-19 by early April, according to a spokesperson for the country’s national federation of doctors (FNOMCeO).

The psychological burden can affect anyone. A survey of health workers who confronted COVID-19 in China revealed that large numbers had experienced symptoms of depression (50%), anxiety (45%), insomnia (34%) and distress (71.5%).

Doctors will bear that burden in different ways at different times, says Dr. Joy Albuquerque, Medical Director of the OMA’s Physician Health Program (PHP). Right now, she says many doctors are “battle-ready and amped up.” Yet it’s hard to stay in that vigilant mode forever. The health care response to COVID-19 takes enormous physical and emotional energy. The toll can come in waves.

“The body keeps score,” says Dr. Albuquerque. “We’re all human. With enough stress and without appropriate recovery, we’ll have to take stock. Find a way to take your mental health temperature.”

In this video, Dr. Samir Sinha, Director of Geriatrics at Sinai Health System and the University Health Network in Toronto, shares his workday as a geriatrician during the COVID-19 pandemic. This video was produced by The National at CBC News.

Getting a Stress Inoculation

As the PHP points out, many things that can add stress – limited disease knowledge, resource allocation and co-ordination, international factors – are beyond any one doctor’s control. What people can control is how they react to the new environment.

The PHP has promoted the need for resilience and “stress inoculation” during COVID-19. Some basics:

  • Get proper rest, nutrition and exercise.
  • Stay connected with those in your network of caring friends, family, and colleagues. Social distancing or self-isolation doesn’t mean social isolation.
  • Have a buddy system at work, to check in with one another.
  • Build cohesion at work, and normalize common concerns and stress reactions. That helps to foster a culture of wellness.
  • Set aside time (schedule it) to unplug, decompress and do something that brings joy.
  • Demonstrate compassion, goodwill and understanding. Relationships may become strained under high-stress conditions.
  • Show kindness to yourself. Accept the reality of the moment. Some fear and anxiety is normal.
  • Be aware of your own needs, and when to slow down and take a breath.
  • Look for trusted sources of information, and take news and social media breaks.
  • Practice self-reflection, and remember other times you’ve overcome challenges. That’s a positive mental skill, unlike persistent worry.

All of it is vital. “You can’t draw on your reserves without filling up again,” says Ted Bober, Director, Clinical Services, PHP.

The PHP provides confidential support for people suffering from or at risk of substance use and mental health disorders, and other behavioural issues that have a personal and professional impact.

The program serves physicians, residents, medical students and veterinarians, offering prompt intervention, referral to treatment, monitoring and advocacy. In addition, the PHP offers support and education to physician leaders, hospitals, other work sites, and anyone else concerned about a loved one or colleague. (Call PHP toll-free at 1.800.851.6606, open Monday to Friday 8:45 a.m. to 5:00 p.m., or email

Self-Care is Important in the Midst of a Crisis

Self-care is important any time, and becomes even more essential (yet often hard to do) in the midst of a crisis. Dr. Sinha, for instance, tries to catch up on sleep during the weekend. Still, there’s little time to tend to himself. He worries about his elderly patients, and as a government advisor he’s also deeply concerned about the tens of thousands of residents of long-term care and retirement homes.

“They’re in the line of fire. I feel that I have 144,000 lives across the province that I’m responsible for. Every time I see a new outbreak or death, it’s like I’ve let those families down,” Dr. Sinha says.

On a good day, he feels bolstered by being part of the fight against COVID-19. “I’m focused on saving as many lives as possible,” says Dr. Sinha. Yet the pressures are compounding. “You have all of this weighing on you.”

Dr. Sarah Newbery also feels waves of comfort and unease. She’s part of the family health team in Marathon, halfway between Thunder Bay and Sault Ste. Marie. The practice serves a population of about 4,500.

Being in a tight-knit rural community affects her reaction to the impact of COVID-19. On a practical level, her group of eight family physicians have had to provide the clinical leadership for the practice, the local hospital and the congregant living for seniors. They also established a COVID-19 swabbing process, which transitioned to a respiratory assessment clinic. All of the roles stack up, with no end in sight.

Still, Dr. Newbery says the expressions of gratitude from the community help to ease her mind. So does reminding herself of the contribution she’s making. “What a gift it is to have meaningful work and opportunities to make a difference. We’re so privileged. That grounds me,” she says.

Yet the feeling doesn’t always last. Dr. Newbery has worked in Marathon for 24 years. She knows everybody. Even if there’s no COVID-19 outbreak in the community, the ripple effects of the massive disruption hit hard.

Dr. Newbery has had to make tough decisions about limiting hospital visits and palliative care at home. Families don’t always have access to their loved ones. She has also seen the growing challenges in the community, like the economic damage and the demands on food banks, and knows who is affected. This isn’t the anonymous big city.

“Our lives overlap, and we carry some of the grief and pain of our patients,” says Dr. Newbery.

The pressures are unavoidable, and the way it can tax someone is understandable. Still, carrying the load without a release valve can compromise a doctor’s ability to function and best serve their patients.

“Soldiering on is doing the work and also making sure you’re okay,” Dr. Albuquerque says. “You have to take care of your own health and well-being. It’s absolutely necessary.”