It was National Nurses Day on Wednesday, but that evening, as her neighbors stepped outside to bang their pots and pans, Maureen May’s mind was somewhere else.
She was thinking about a recent day at Temple University Hospital, where she works in the infant intensive care unit. In a blur it became clear that a mother positive for COVID-19 would need an emergency C-section. The second the baby was born, May had to take the child away from her.
“It was one of the most difficult shifts of my career,” said May, who has been a critical-care nurse for 37 years. The woman would not get to hold her baby until she tested negative for the coronavirus. That would be days.
The long-term consequences of these difficult shifts are the focus of a national study launched this week by Villanova University’s Fitzpatrick College of Nursing. Dubbed the COVID-19 Caring About Health for All Study (CHAMPS), local clinicians will rely on surveys to examine the long-term physical, mental, and social health effects of the pandemic on up to 20,000 front-line workers over the next two decades.
Those front-line workers will include nurses like May, but also police officers, firefighters, ambulance drivers, and non-medical hospital workers such as receptionists, temperature screeners, and custodians. “We’re very worried about post-traumatic stress disorder,” said Donna S. Havens, dean of the nursing college. “In many respects, some of these people may be very wounded after this experience.”
The psychological toll of treating COVID-19 has been well documented since the pandemic first unfolded in corners of the United States earlier this year. Doctors and nurses witness tragedy every day, then sleep in garages or campers to avoid infecting their families. Rates of depression have ticked up among children, and for adults, the use of anti-anxiety medications has surged. Even Holocaust survivors have compared the psychic toll to dodging the Nazis during the Second World War.
May, who is president of the Pennsylvania Association of Staff Nurses and Allied Professionals union, said some nurses have resigned amid the stress. Others drive home and can’t remember how they got there. Another watched a husband and wife, within hours, die in the same hospital room.
“I have advised several colleagues in the COVID-19 units to take a break,” May said. “But there’s no break in the pandemic.”
Peter Kaufmann, the associate dean for research and innovation at Villanova’s nursing college, said the study will look at how this trauma manifests over time, both mentally and physically. Initial studies suggest that some patients who survive COVID-19 will have long-term respiratory damage. Kaufmann — the study’s principal investigator — also plans to look at rates of heart disease and other illnesses that are associated with stress but may not show up for years.
“This particular situation here with the pandemic is actually one of the more extended periods of stress we’ve ever seen in a civilian population,” he said. “We may not understand it for a while, and it will have effects on people’s lives beyond the immediate."
Villanova is hardly alone in its interest in studying the mental effects of the pandemic. Penn Medicine and Children’s Hospital of Philadelphia have partnered on a short online survey examining resilience among both healthcare workers and regular citizens, with the goal of giving participants helpful feedback on their mental health and sleep.
“Many events happen where we have no control, and we try to, but we really don’t,” said Raquel Gur, director of the Lifespan Brain Institute and a professor of psychiatry, neurology and radiology at the University of Pennsylvania. “What we’d like to do is develop resilience calculators, and figure out, how can we build it in people?”
Temple University is urging its hospital workers to share their experiences in the Healthcare Worker Exposure Response and Outcomes (HERO) Registry, a national effort to engage these workers in research projects ranging from drug treatment effectiveness to stress and burnout.
But few efforts are as expansive or long-looking as Villanova’s CHAMPS study, which will also examine the social effects of exposure to COVID-19, including the impact of trauma on relationships and families. Just as some couples may divorce after the death of a child, the coronavirus has wrought similar tragedies and rifts. “Even people’s careers are sometimes affected,” Kaufmann said. “They feel like this is a career they no longer want to continue, and they drop out.”
Many of these workers are struggling with “moral stress" as they are forced to deviate from the ways they’ve learned to practice health care, said Havens, the dean. “In the midst of all of this, they don’t have all the equipment, all the things they need, to do the perfect job,” she said. “When they think about it after the day is done, it’s, ‘I wish I could have done this differently,’ and it takes a toll on people.”
Chas Carlson, a paramedic who lives in Berwyn, said his job already made him think about his mortality more than most 26-year-olds would. “I think it makes it a challenge for me to sometimes interact with people my age and be as free and enjoying life,” he said.
Recently, Carlson had a 911 call that put him straight into a chaotic scene at a nursing home: “This guy is really sick. I’m there by myself. I’m on the second floor. I’m just kind of isolated, and I obviously have no help from the staff and this guy is, like, tanking on me. I knew I could handle it, but I felt a little overwhelmed.”
He was dripping in sweat by the time he loaded the patient into the back of the ambulance. He said to his partner, “Just get me there.”
Finding participants through professional organizations, emails and “the snowball effect” — enlisting people to ask their colleagues to join and tell others — Villanova leaders say they are casting a wide net in hopes of teasing out variables like age, race, socioeconomic status, and level of exposure to the virus.
Havens said she is hopeful to learn how hospitals can better prepare for future pandemics and other widespread disasters that fall heavily on health-care workers and emergency personnel. “Everyone’s doing their very best, if you will, but there’s a lot of training being done on the fly, and we may find we need more disaster training, more training on how to work with a team," she said.
“In the future, we need to do a better job of protecting these workers.”