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Throughout 12,000 years of human history, pandemics have killed an estimated 300 million to 500 million people, with the bubonic plague decimating an estimated 60% of the European population during the Middle Ages. Despite modern advances in medicine, 

 has caused more than 1 million reported deaths in less than a year. Aside from the death toll, the pandemic has triggered significant emotional, physical, and economic problems around the world. But even in the midst of this crisis, nations have an opportunity to share and learn from each other’s experiences.

The emerging literature measures the impact of various traumatic stressors related to COVID-19, as well as the effects of less severe types of stress exposures. COVID-19 has already led to diverse mental health problems, including anxiety, depression, posttraumatic stress disorder, and other trauma- and stress-related disorders. Different groups have met the qualifying criteria for posttraumatic stress disorder (PTSD) according to DSM-5 as a result of the pandemic: those who have themselves suffered from serious COVID-19 illness and potential death; individuals who, as family members and health care workers, have witnessed others’ suffering and death; individuals who have learned about the death or risk of death of a family member or friend due to the virus; and individuals who have experienced extreme exposure to aversive details (eg, journalists, first responders, medical examiners, and hospital personnel).

Moreover, studies have explored other stressors adding to individuals’ emotional burdens, such as social isolation, unemployment and economic losses, and working from home while caring for children and other family members. Among health care workers, strains include lack of personal protective equipment (PPE), fears of virus exposure, burnout, patients perishing despite heroic efforts to save them, and difficult decisions about which patients should receive limited resources. A few studies have examined posttraumatic stress symptoms (PTSS), as well as anxiety, depression and other symptoms, and substance use in the general population during the pandemic.

More time is needed, of course, to conduct and publish systematic investigations on mental health sequelae, such as formal psychiatric diagnoses. Studies generally have been conducted through diverse internet platforms, which may affect generalizability. Methods and validated rating scales vary.

At the same time, it is not too soon for clinicians to read the emerging literature and base treatments on the latest research. We will explore some representative international studies of various groups affected by COVID-19, as well as protective factors and suggested interventions to help those in need (Figure).

Much of the current research emerges from China, the first country confronted by the pandemic. A 

 in China exposed to COVID-19 found a PTSD incidence of 16.8%, with highest scores in avoidance symptoms.

 Job satisfaction was associated with lower PTSD symptom scores and positive coping. The authors recommended supporting nurses who are having difficulty coping with their work by providing counseling.

A web-based, cross-sectional survey of more than 7000 Chinese individuals in February 2020 found that health care workers had the highest rate of poor sleep, and those aged 35 years or younger had more mood and anxiety symptoms.

 Overall, 35.1% of respondents reported anxiety symptoms, 20.0% depressive symptoms, and 18.2% poor sleep quality.

Other international studies have examined stress responses in health care workers treating patients with COVID-19. A study of 900 health professionals caring for hospitalized patients with COVID-19 in Singapore and India found relatively low symptoms of anxiety (15.7%), depression (10.6%), and stress (5.2%).

 However, among health care workers reporting these issues, more than half had symptoms in the moderate to extremely severe range. In addition, 67% of respondents reported physical symptoms, especially headache, lethargy, anxiety, and insomnia, suggesting somatic expressions of distress. United Kingdom military health care workers were assessed for the effects of inadequate safety equipment on their mental health during the COVID-19 medical response. Those with inadequate equipment had greater odds of having common mental health disorders (2.49), PTSD (2.99), poorer global health (2.09), and emotional problems (1.69).

Only a few studies of mental health problems among patients hospitalized with COVID-19 have been published, with more to come. A study of hospitalized but stable patients found a high prevalence of PTSS (96.2%).

 A chart review of hospitalized patients with COVID-19 in Spain found more than half of the 841 patients hospitalized with COVID-19 had a neurological symptom. Of these, nonspecific neurological symptoms were identified, as well as disorders of consciousness (19.6%), mostly in elderly patients and in those with severe COVID-19 disease; myopathy (3.1%); dysautonomia (2.5%); and other less frequent symptoms.6

Neuropsychiatric symptoms were reported by 19.9% of these patients, including insomnia, anxiety, depression and psychosis; these were not associated with disease severity.

Some studies have drawn inferences based on other severe respiratory viruses. A meta-analysis of long-term clinical outcomes for survivors of adult severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) who were in the intensive care unit (ICU) revealed PTSD prevalence in 39%, depression in 33%, and anxiety in 30% beyond 6 months after discharge, as well as reduced lung function and reduced exercise capacity.

 Italian experts also concluded that we might anticipate similar outcomes in survivors of COVID-19.8

Acute respiratory distress syndrome (ARDS) in ICU survivors of COVID-19 may occur, with an expected survival rate of approximately 25%. Survivors of ARDS may experience persistent fatigue and poor exercise tolerance, pain and weakness, neurological sequelae, and the psychological effects of prolonged ICU stays, as noted in patients with MERS and SARS. Stressors included immobility, separation from family and friends, prolonged sedation, anxiety about health conditions and survival, and subsequent job loss. The authors emphasized the need to identify PTSD (anticipated in up to 30% of ARDS survivors) and other mental health problems, and to provide appropriate and timely multidisciplinary therapy that should continue after discharge.

 A literature review of studies linking panic disorder with patients who had SARS suggested that aggravation of panic attacks is highly likely in survivors of COVID-19 in the face of prominent respiratory symptoms, as panic may be triggered by fear conditioning to abnormal breathing problems.

 The authors urged monitoring for panic as well as obsessive compulsive disorder, PTSD, and generalized anxiety disorder.

Some mental health care advocates believe the general population may be suffering from various levels of vicarious traumatization, although strictly speaking this would not qualify for PTSD’s Criterion A for trauma exposure. Along these lines, in August 2020 the CDC published results of a large US web-based survey of more than 5000 adults (

 in which 40.9% endorsed at least 1 adverse mental or behavioral health problem related to the pandemic. Symptoms of a trauma- and stressor-related disorder were reported by 26.3%, symptoms of anxiety or depression by 30.9%, substance use to cope by 13.3%, and serious consideration of suicide in the prior days by 10.7%. Suicidal ideation was significantly higher for younger respondents aged 18 to 24 years (25.5%), minority groups (Hispanic individuals, 18.6%; Black individuals, 15.1%), nonpaid caregivers for adults (30.7%), and essential workers (21.7%). The authors stressed the need to identify at-risk individuals to develop policies to address health inequities, and to increase resources for identifying mental health problems and offering new treatment options, including telehealth treatments.

In a study of home-quarantined youth in China during the first month of the COVID-19 outbreak, 12.8% had PTSS levels consistent with PTSD, with PTSS and distress associated with negative coping styles.

 Symptom levels were expected to increase with time as quarantine continued. This is important since a formal diagnosis of PTSD requires symptoms to persist for more than a month.

In another online survey conducted early during the Wuhan outbreak, researchers looked at anxiety and depression symptoms (rather than specific PTSS) in relation to social media exposure (SME) to COVID-19 news. The study, which included approximately 5000 adults in China, found high SME was positively associated with higher odds of anxiety and a combination of depression and anxiety, compared with low SME.

 A longitudinal survey of the general population in China during the initial outbreak, and again 4 weeks later, found the mean Impact of Events Scores to be above the cutoff scores for PTSD symptoms at both times, with moderate to severe stress, anxiety, and depression levels.

Results of an Italian cross-sectional, web-based 

 showed a relatively high percentage (29.5%) of PTSS related to the pandemic, suggesting that the pandemic itself could be considered a traumatic event.

 Similarly, an online survey of almost 3500 people in Spain found symptoms of PTSD (15.8%), depression (18.7%), and anxiety (21.6%), with loneliness the strongest predictor of symptoms.

 Other factors associated with these problems were female gender, previous mental health or neurological problems, having physical symptoms similar to those of COVID-19, or having a close relative infected.

Nursing home residents have been particularly vulnerable to poor health outcomes; early in the COVID-19 pandemic many facilities adopted strict lockdown policies. However, social isolation is particularly detrimental to the elderly, who may have increased risk for depression, anxiety, worsening dementia, and even earlier death.

 Given these issues, the Centers for Medicare and Medicaid Services (CMS) recommended safe communal activities for locked-down nursing homes.

In Canada, researchers explored prenatal maternal distress before and during the COVID-19 pandemic.

 Women assessed during the pandemic had higher levels of depression and anxiety, with levels more likely to be clinically significant, compared with women assessed before COVID-19. During the pandemic, dissociative and PTSD symptoms and negative affectivity were also greater, underscoring the need to carefully assess pregnant women to help prevent negative, stress-related outcomes in mothers and infants.

Perhaps not surprisingly, when compared with a control population, psychiatric inpatients in China had more PTSD, anxiety, and depression symptoms; more anger, impulsivity, and worries about health; and intense suicidal ideation.18 Hospitalized psychiatric patients and their mental health caregivers are at high risk for COVID-19 infection, compounding their existing stress. This was noted early in February 2020 in Wuhan, when the virus was diagnosed in at least 50 inpatients with psychiatric disorders and 30 mental health professionals. Factors included lack of protective gear and difficulties isolating.

 Outpatients with psychiatric disorders are also vulnerable to emotional distress during a pandemic. An online survey of more than 2000 outpatients in China discovered that 20.9% of patients with preexisting psychiatric disorders had seen their symptoms get worse during the pandemic.

How can we help individuals whose mental health has been harmed by COVID-19?

To support medical caregivers assigned to the front line during the pandemic, experts advise addressing burnout, as prolonged problems may overlap and lead to acute stress disorder and PTSD.

 Suggestions have ranged from practical measures (such as ensuring adequate PPE, handwashing, and decontamination of surfaces) to developing personnel policies that reassign at-risk medical personnel away from high-risk sites, ensure the safety of their family members, and stress the importance of self-care.

 Also recommended is providing health care workers access to child care services during expanded work hours and school closures. Workers should have adequate rest and breaks, be excused from less-essential tasks, and have regular information and feedback sessions with managers and the community. In many areas, hospitals provide telephone hotline teams trained to provide psychological assistance. Professional organizations offer physician wellness programs to provide free, confidential sessions to deal with burnout, adjustment problems, family issues, and other mental health sequelae.

The increasing numbers of people who were seriously ill with COVID-19 should be assessed for physical symptoms of chronic pain,

 with physical therapy and medications adjusted to avoid opioid dependence. Survivors of ARDS should receive evidence-based medications, cognitive behavioral therapy, and other psychotherapies for PTSD, panic, depression, and other mental disorders.

To combat isolation among locked-down nursing home residents, CMS recommends safe communal activities such as book clubs, movies, bingo, and outdoor family visits (ie, on lawns or in parking lots) with precautions of social distancing and PPE. Some nursing homes have provided live music, parades, therapy animals, recordings and photos of loved ones, physical contact with loved ones through plastic protective barriers, and even physical and occupational therapy sessions held outdoors.

Psychological first aid provided by trained community personnel might help the general population as they experience distress during the COVID-19 pandemic.

 For individuals enduring fallout from personal stressors, experts have recommended expanded use of telehealth to identify and treat mental health conditions, including depression, PTSD and other trauma-related disorders, substance use disorders, and suicidal ideation. Self-help groups, 12-step programs, spiritual and religious services, interest groups, and employee groups working from home are all increasingly using interactive internet-based platforms. And it is essential for societies to provide citizens with assistance for jobs, housing, food, medical care, education, internet connections, and many other basic survival needs.

The current international pandemic and possibly future ones will challenge us and give us the chance to continue to learn and share with other nations, hopefully linking us cooperatively rather than polarizing us.

 is professor and vice chair of education, Department of Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City. 

is assistant professor and residency training director, Department of Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City. Authors have no relevant financial conflicts of interest. This article was originally posted on October 5, 2020, and has since been updated.

 Factors associated with post-traumatic stress disorder of nurses exposed to corona virus disease 2019 in China

2. Huang Y, Zhao N. Mental health burden for the public affected by the COVID-19 outbreak in China: Who will be the high-risk group? 

3. Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. 

4. Simms A, Fear NT, Greenberg N. The impact of having inadequate safety equipment on mental health. 

5. Bo HX, Li W, Yang Y, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. 

6. Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. 

7. Ahmed H, Patel K, Greenwood DC, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalization or ICU admission: A systematic review and meta-analysis. 

8. Vittori A, Lerman J, Cascella M, et al. COVID-19 Pandemic acute respiratory distress syndrome survivors: pain after the storm? 

9. Javelot H, Weiner L. Panique et pandémie: revue de la littérature sur les liens entre le trouble panique et l’épidémie à SARS-CoV-2 [Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic]. 

10. Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. 

11. Liang L, Gao T, Ren H et al. Post-traumatic stress disorder and psychological distress in Chinese youths following the COVID-19 emergency. 

12. Gao J, Zheng P, Jia Y et al. Mental health problems and social media exposure during COVID-19 outbreak. 

13. Wang C, Pan R, Wan X, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. 

14. Forte G, Favieri F, Tambelli R, Casagrande M. 

COVID-19 Pandemic in the Italian Population: Validation of a Post-Traumatic Stress Disorder Questionnaire and Prevalence of PTSD Symptomatology

15. González-Sanguino C, Ausín B, Castellanos MÁ, et al. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. 

16. Abbasi J. Social isolation—the other COVID-19 threat in nursing homes. 

17. Berthelot N, Lemieux R, Garon‐Bissonnette J, et al. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. 

18. Hao F, Tan W, Jiang L, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. 

. 2020;87:100-106.19. Xiang YT, Zhao YJ, Liu ZH, et al. The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. 

. 2020;16(10):1741-1744. Published 2020 Mar 15.

20. Zhou J, Liu L, Xue P, et al. Mental Health Response to the COVID-19 Outbreak in China. 

21. Restauri N, Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. 

22. Adams JG, Walls RM. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. 

The pandemic has triggered an array of emotional, physical, and economic issues but in the midst of this crisis, nations have shared and learned from each other’s experiences.

Post-COVID Stress Disorder: Another Emerging Consequence of the Global Pandemic

is a practicing psychiatrist in Providence Healthcare System, Portland, OR.

Question and consider how people adapt, how families/communities cope, and how physicians should engage with trauma. 

Trauma Informed Care

The field of psychiatry needs to pay close attention to the long-term psychosocial impacts of trauma, not only on trauma survivors as individuals, but also on their families and communities.

Trauma that affects 1 member of a family system has the potential to fundamentally change the whole family structure. It threatens to erode the very foundation of the family unit, and family members may start to see each other as enemies. 

 has the power to make or break a family.

, out of cultural taboos and stigma, is seen as a source of shame and kept a secret, it can manifest in different ways, especially relationally, leading to a dysfunctional environment of toxic stress and silent suffering, a deadly web many families find themselves tangled in.

Early prevention is always better than late intervention because trauma can span generations. Trauma survivors can repeat the cycle and become part of the problem, or they can become part of the solution by investing in their families, normalizing the process by speaking up, and expressing emotions. To continue to choose the narrative is to choose to continue the vicious cycle and feed the fires that eventually destroy everything in their way.

Trauma that happens to children can shatter and confuse core beliefs they hold about themselves and the world. Children need to believe that the world is a safe place and that adults can be trusted to care for them. When these foundational basic needs are violated, these young beautiful creatures lose hope and start to wrestle with existential issues, doubting their own self-worth and beauty.

Psychiatrists working with traumatized populations need to establish safe spaces that serve as platforms where people can regain their voice and reclaim their narrative. Through encouraging and supporting open channels of communication and building bridges of trust, they help break the cycle for their clients, and that in turn helps bring hope in healing.

Interpersonal trauma that casts dark shadows on our beliefs about our innate goodness and shared humanity is arguably more harmful to the psyche than a largescale destruction caused by natural disasters. But the trauma story, if viewed as a learning tool, can help us become more resourceful and resilient.

We owe it to our loved ones to break the cycle. Not everything we inherit is worth passing to our children, especially not our trauma story.

Post Traumatic Slave Syndrome: America's Legacy of Enduring Injury and Healing

From Generation to Generation: Healing Intergenerational Trauma Through Storytelling

Trans-generational Trauma and the Other: Dialogues across history and difference

Patients want to pass on many things to their children; trauma is not one of them. 

The Unforgiving “Gift” of Generational Trauma

Omar Reda, MD, emphasizes several points in his video on how to take care. Here are some suggestions:

-Consider all parts of your health. Dr Reda cites 4 focal points: body, heart, mind soul. Are you caring for each part of yourself, or focusing on only 1 or 2?

-Improve your family dynamic. Pay more attention and appreciation to your loved ones. Make eye contact and establish safe touch. Ensure you are spending meaningful time with your family. 

-Take breaks. When you take them, are you actually relaxing? Be sure to carve out time to truly unwind. 

is a practicing psychiatrist in Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article.

Times are hard but they are easier if we get through them together. Omar Reda, MD, provides activities and insight on ways to actively care for yourself and your family. 

How We Can Take Care of Each Other 

Coronavirus disease 2019 (COVID-19) blindsided the world. It exposed gaps in public health emergency planning at every level, including in the strategic planning to support mental health and wellness. Studies of the SARS and 

 epidemics as well as natural disasters have taught us 

 about the importance of planning for and responding to the mental health needs of health care and frontline workers.

 Thus, this is a pivotal moment, a chance to implement systems and structures for staff support in every organization and advance staff wellness and resilience initiatives.

The literature on disasters and public health emergencies describes pervasive emotional distress, feelings of extreme vulnerability, uncertainty, and threats to life, particularly during the rapid spread of an outbreak.

 A recent COVID-19 web-based survey supports this finding. More than 40% of respondents reported symptoms of depression, anxiety, traumatic stress, substance use, and suicidal ideation. Symptoms were notably elevated in black and Hispanic individuals, essential workers, unpaid adult caregivers, and those with psychiatric conditions.

 research has shown that, ultimately, most people are resilient even after the most severe traumatic event.

 In the immediate aftermath of large-scale catastrophes, a majority of negative mental health symptoms are recognized as distress reactions to intense and overwhelming events. They are not pathologized or labeled psychiatric disorders. The disaster literature emphasizes the importance of acknowledging the normality of distress reactions, identifying high-risk populations, promoting effective coping and adaptation strategies, and encouraging overall wellness and resilience.

 Disaster mental health assistance during the acute phase is often more practical than psychological in nature. In this case, such assistance includes Centers for Disease Control information and updates, access to food and cleaning supplies, access to COVID-19 testing, protective equipment, financial assistance, and links to community resources.

After the acute phase of the disaster, long-term stress responses can emerge. Lancee et al.

 that 2 years after the SARS outbreak, health care workers who treated these patients had elevated rates of smoking and drinking, absenteeism due to stress or illness, decreased face-to-face contact with patients, and decreased work hours.Yet rates of depression, posttraumatic stress disorder, and other mental illness were not elevated. This is consistent with existing research, which has found that the long-term impact of massive 

 is predominantly in the range of subsyndromal stress responses rather than an increase in psychiatric morbidity. Limited long-term studies suggest that post-disaster symptomatology peaks in the first year and then declines, but the course of recovery is variable.

 The challenge for mental health clinicians is to distinguish normal distress reactions to catastrophes from exacerbation of existing mental health susceptibilities or new-onset disaster-related pathology.

Disaster trauma is characterized by exposure to personal loss and community disruption. Cultural, political, and socioeconomic factors all influence the shared 

 Looking through a disaster trauma lens, a better understanding of the emotional stages of public reaction can help: anticipate community responses to large-scale catastrophic events (

), identify the changing goals of recovery at different phases (

), and inform mitigation strategies. It is important to note that the timing of the phases is fluid. They do not occur in an exact sequence. Phases can overlap and move forward or back across a timeline, depending on the type of disaster.

 depicts the stages of public reactions to natural disasters like 2012’s Hurricane Sandy and even the 9/11 terrorist attacks in 2001, but the community response to a pandemic seems more unpredictable. The immediate COVID-19 experience in New York state in the spring of 2020 was marked by safety concerns, deaths in the thousands, food and job insecurity, financial hardships, and anger at government response. We do, however, see a heroic phaseexemplified by the emergence of heroes, such as Anthony Fauci, MD, on the national level and Governor Andrew Cuomo in New York state. We then witnessed community cohesion typical of the honeymoon phase as New Yorkers connected with each other from stoops, windows, terraces, and rooftops, all cheering for frontline workers at 7:00 PM each night to show gratitude and appreciation.

New York successfully flattened the curve by the summer. The number of daily deaths fell dramatically, from a high of nearly 800 per day across the state down to none in New York City by June. Now the focus is shifting to economic recovery, while keeping community viral transmission low and bracing for a potential second wave. This could be the beginning of the reconstruction phase: figuring out a new normal and how to live with a persisting virus. Disillusionment is certainly felt when other states are unable to control the virus, in spite of the availability of immense resources and clear and concrete directions from world-class health experts to wear 

, avoid crowds, maintain social distance, and wash hands.

 that during an infectious disease outbreak, the operational response of an organization is likely the single most important factor influencing staff perception of both stress and safety.

 Traumatic events can disrupt feelings of safety, trust, control, esteem, and intimacy. As a result, staff can exhibit maladaptive behaviors or experience traumatic stress symptoms.

 Best practices to mitigate the disruptions and support staff during a pandemic involve 4 key elements: leadership, communication, education, and social support.

 Strong leadership and supportive teams influenced the resilience of health care workers during the SARS and Ebola outbreaks.

 Capable and effective leadership over the course of a major disaster makes staff feel safe and supported by the organization. Best practices include:

Visible and prepared leaders at organizational, departmental, and team levels.

Setting the tone for a positive and supportive organizational culture.

Skilled assessment of team strengths and weaknesses.

Proactive outreach and crisis support from all levels of leadership.

Creativity and innovation in increasing staff resilience and reducing stress.

Role modeling infection control and safety practices—wear masks, practice physical distancing, and wash your hands.

 is communication, coordination, and collaboration.

 Delivery of clear, transparent, timely, trustworthy information in a rapidly evolving situation is essential. Organizations should be prepared to:

Communicate timely and trustworthy COVID-19-specific guidance.

Acknowledge and normalize feelings of anxiety related to the pandemic.

Communicate efforts to address the negative impacts of the pandemic, including financial concerns.

Communicate supportive organizational practices (eg, working from home, flexible work schedule, reduced hours, job rotation, location rotation, availability of PPE, testing).

Widely disseminate available self-care and wellness information and resources.

Training and education on the issues of infection control, disaster mental health, and the disaster response system increases confidence and moderates the risk of stress. Just as Federal Emergency Management Agency (FEMA) provides appropriate resources and training for disaster responders before deployment, organizations have a responsibility to provide education and training to better prepare for and respond to a pandemic. Organizations should be prepared to offer staff:

General information on disasters and pandemics.

Education on infection control and universal precautions.

Targeted education on key sources of distress from COVID-19 (eg, quarantine-related distress, fear of contagion, concern for family, job stress, financial concerns, interpersonal isolation, stigma).

Studies indicate that social support, both personal and professional, is a consistent protective factor and a strong mitigator of emotional distress in the wake of a massive disaster.

 Unfortunately, the battle against COVID-19 calls for decreased interpersonal contact. Quarantine, physical distancing, and remote and virtual work have all increased social isolation. This unprecedented public health crisis requires creativity and innovation to restore a sense of community and connectedness. In order to provide much-needed social support during difficult times, organizations should prepare to:

Hold virtual meetings and virtual lunch/coffee breaks/happy hours to improve team cohesion and morale.

Build in formal time during work hours for peer consultation to reduce feelings of isolation and increase feelings of efficacy.

Use in-person or virtual service meetings and huddles to build relationships and improve responsiveness.

Establish buddy system to check and balance each other’s stress level.

The scarcity of existing research on staff support and mitigation strategies during pandemics presents an opportunity to develop new programs that can be tailored to specific organizational contexts and cultures. Evaluation of best practices and robust analysis of the impact and sustainability of staff support plans during COVID-19 can inform future strategic planning and policy recommendations for staff wellness and resilience.

is clinical assistant professor of psychiatry, New York University School of Medicine and psychiatrist at the Department of Veterans Affairs New York Harbor. Dr Quitangon discloses that she receives royalties from Routledge for her book

 Vicarious Trauma and Disaster Mental Health: Understanding Risks and Promoting Resilience.

— The author wishes to acknowledge Mary Docherty, MA, MBBS (Hons), MRCP, MRCPsych, for her work in planning and development of the COVID-19 staff support response at St Thomas’ Hospital and King’s College Hospital in London, England.

1. World Health Organization. WHO checklist for influenza pandemic preparedness planning. 2005. Accessed September 8, 2020. 

https://www.who.int/influenza/resources/documents/FluCheck6web.pdf?ua=1

2. Chong MY, Wang WC, Hsieh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. 

3. Czeisler ME, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic. 

4. North CS, Pfefferbaum B, Hong B. Historical perspective and future directions in research on psychiatric consequences of terrorism and other disasters. In: Neria Y, Gross R, Marshall R, Suzzer E, eds. 

9/11: Mental Health in the Wake of Terrorist Attacks. 

5. Norris, F. Community and ecological approaches to understanding and alleviating postdisaster distress. In: Neria Y, Gross R, Marshall R, Suzzer E, eds.

 9/11: Mental Health in the Wake of Terrorist Attacks. 

Cambridge University Press; 2006:141-156.

6. North CS, Pfefferbaum B. Mental health response to community disasters: A systematic review. 

Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak

8. Norris F, Friedman M, Watson P. 60,000 disaster victims speak. Part 1: An empirical review of the empirical literature, 1981-2011. 

When a community weeps: Case studies in group survivorship

10. Zunin, LM, Myers, D. Training manual for human service workers in major disasters (2nd ed.). DHHS Publication No. ADM 90-538. Department of Health and Human Services; 2000.

11. Quitangon, G. What do we need to know about disasters? In: Quitangon G, Evces MR, eds. 

Vicarious Trauma and Disaster Mental Health: Understanding Risks and Promoting Resilience

12. Grace SL, Hershenfield K, Robertson E, Stewart DE. 

The occupational and psychosocial impact of SARS on academic physicians in three affected hospitals

13. Quitangon G, Evces, MR. What can organizations do to address vicarious trauma in disasters? In: Quitangon G,Evces, MR (eds.). 

Vicarious Trauma and Disaster Mental Health: Understanding Risks and Promoting Resilience.

14. Perrett K, Al-Wali W, Read C, et al. 

Outbreak of meningococcal disease in Rotherham illustrates the value of coordination, communication, and collaboration in management

15. Norris, F, Kaniasty K. Perceived and received social support in times of stress: A test of the social support deterioration deterrence model. 

Journal of Personality and Social Psychology. 

16. Brewin CR, Andrews B, Valentine, JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. 

Journal of Consulting and Clinical Psychology. 

We have learned that in order to provide much-needed social support during difficult times, organizations should prepare to take certain steps.

Managing Distress in Health Care Workers During COVID-19: Lessons From a Disaster Trauma Lens

As a psychiatrist for over 10 years, I have had the privilege of bearing witness to a great deal of human suffering.

The current pandemic has shown us, mental health professionals, the dire consequences of human disconnection and social isolation. Humans do not do well alone. We need to bond with others, and we need to feel seen, heard, touched, and loved, not only to thrive, but also to survive.

It seems that COVID-19 has taken the mask off the tip of a huge iceberg. It has forced us to come face to face with a profound challenge. We might not be able to heal trauma, but the process of facing trauma can itself become the source of light, delight, and healing.

Many trauma survivors continue to go through the revolving door of a broken system. This is in part because many therapists are not comfortable listening to painful traumatic and graphic details.

I owe it to my clients and trauma survivors worldwide to be ready to listen when they are ready to share. I focus on these seven themes in my model, which I call Trauma Heals:

Finding safety: the focus is on fostering hope and faith

Finding a voice: building safe spaces and giving people permission to talk

Finding meaning: regaining the shattered core beliefs that the world is a safe place and others can be trusted, and realizing that they are not broken because of the trauma they endured

Finding forgiveness: unconditional self-forgiveness (making and receiving amends), knowing that they have done their best given the circumstances

Finding healing: harnessing resilience through self-care and altruism (offering grace through acts of kindness and community service)

Finding closure: mourning past relationships and redefining or reconstructing new ones

Finding beauty: integrating the trauma story, finding beauty in one’s self, family, others, humanity, and the world

My beloved mentor, professor Richard Mollica of the Harvard Program for Refugee Trauma, taught me to search for beauty in every interpersonal encounter, and my late mother left me with her last words: “if you cannot be the source of someone’s joy and delight, don’t be the source of their pain and distress.” Love does indeed heal even the most extreme of traumatic stories.

 is a Practicing Psychiatrist, Providence Healthcare System, Portland, OR. He reports no conflicts of interest concerning the subject matter of this article

While recovering from trauma, survivors have a chance to find a voice, meaning, and even beauty. 

Traumatic Stress Disorders

Post-COVID Stress Disorder: Another Emerging Consequence of the Global Pandemic

Trauma Informed Care

The Unforgiving “Gift” of Generational Trauma

How We Can Take Care of Each Other

Managing Distress in Health Care Workers During COVID-19: Lessons From a Disaster Trauma Lens

Unmasked: Face to Face with the Trauma Story

3 Essential Elements of Trauma-Informed Care

Fears, Outbreaks, and Pandemics: Lessons Learned

Vicarious Trauma in Clinicians: Fostering Resilience and Preventing Burnout

Recognizing and Treating Trauma in the Inpatient Psychiatric Setting