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Government officials from President Trump to New York Gov. Andrew Cuomo have often referred to the coronavirus pandemic as a "war," and some people who survive war, particularly combat veterans or those who are displaced by the conflict, struggle with a psychiatric condition known as post-traumatic stress disorder (PTSD).
PTSD is also found in victims of abuse and sexual assault, natural disasters, accidents and even pandemics, affecting both patients and health care professionals who are facing the battle are on the front lines.
Symptoms include recurring memories of the traumatic event, flashbacks, nightmares and physical or emotional reactions to a memory trigger. People who suffer from the disorder can experience negative thoughts about themselves or others, emotional numbness and self-destructive behavior, among other things.
"We know pandemics are terrifying to people," Dr. Royce Lee, who leads the University of Chicago Hospital's new disaster recovery program, told Fox News.
One of the distinguishing factors with COVID-19 compared to other pandemics, however, is how friends and families have to distance themselves from each other, which makes coping especially difficult.
Separation anxiety, plus the build-up of other factors including respiratory distress; a difficult prognosis; inflammation; activation of the immune system, which can have an emotional effect on the brain; and studies that show COVID-19 itself can impact the brain leads to "a very big problem" for PTSD in COVID-19 patients with severe symptoms, Lee said.
In health care professionals, Lee said "studies from SARS show anywhere from 10 to 20 percent of doctors and nurses expect to get PTSD symptoms" from the pandemic due to a combination of factors including stress, fear and separation from loved ones to avoid spreading the virus, among other things. While symptoms only last for about a year on average, the experience is "highly stressful."
Two medical professionals who worked on the front lines of coronavirus, including a 23-year-old New York City EMT and a 49-year-old medical director of the emergency department at New York-Presbyterian Hospital, committed suicide on April 24 and 26, respectively, highlighting the mental toll health care workers fighting COVID-19 are facing.
Dr. Joe Parks, medical director at the National Council for Behavioral Health, pointed out that people face a higher risk of getting PTSD if they have to endure a threat for an extended period of time without the power to change their circumstances or get out of a situation.
"PTSD is most likely when things occur over an extended period of time where you just have to be in it or sit in it," Parks said. "Combat is like that: You’re in your foxhole, you’re being shot at, and you have to stay there. Women get PTSD from domestic violence and they can’t get out. Clearly, coronavirus can have that effect on people. You feel threatened and your life’s in danger, and you can’t do anything about it."
He mentioned a friend who has been practicing medicine for "30 or 40 years" and said the COVID-19 pandemic was "more difficult than 9/11" because the terrorist attacks were more sudden and immediate while COVID-19 is drawn out, leaving people simultaneously restless and fatigued.
"He saw ICU beds increase by 50 percent in two weeks," Parks said. "Slowly watching the number of ICU ventilator beds dwindling is almost like having your feet in concrete and watching the water level rise."
PTSD related to COVID-19 is an issue that some hospitals didn't see coming as they struggled to contain the spread as quickly as possible with a severe lack of personal protective equipment (PPE) and general knowledge about the novel virus from the outset.
"In times of a disaster or pandemic, every system has to make ‘Sophie’s choices,’" Lee said. "Some hospitals were hit so quickly, they had no time to prepare."
Now, hospitals across the nation are looking toward each other and past studies pulled from the SARS and MERS outbreaks to make sense of how to handle PTSD in COVID-19 patients and the health care workers who helped treat them. Lee said most PTSD therapy and general counseling programs for patients and workers are being set up within just months or even weeks. Some are getting funding from charities and nonprofits.
"We have some scientific knowledge about this — some from early data SARS and MERS — where studies have been done of patients in the ICU, their families, doctors and nurses," Lee explained. "Based on that data, we have a pretty good understanding of how PTSD might affect these groups [who suffered from COVID-19]. We looked at these data and based on that, we set up our program."
University of Chicago Hospital's relief program includes using technology to connect therapists with patients via iPad, a service in partnership with Emory University to speed up PTSD recovery training for therapists from 18 weeks to about six weeks, a support system for health care workers based on anonymous surveys, a stress resilience training program, and Zoom meetings focused on meditation and mindfulness, Lee said.
He added that recovery and relief programs like his at UCH are popping up all over the country. Fox News reached out to a number of hospitals across the U.S., as well as national health care systems and programs. While all hospitals acknowledged that PTSD is a relevant problem that is starting to appear more as death rates increase, not all hospitals seem to have invested the same amount of time and effort into creating PTSD relief programs.
New York's Mount Sinai Hospital has expanded its PTSD relief for health care professionals as they begin to start thinking about life after COVID-19. The hospital, which has been overwhelmed with COVID-19 cases since early March, even had to open an emergency field hospital due to its influx of patients on April 1.
Mount Sinai on Thursday opened its new Center for Stress, Resilience and Personal Growth, which provides resilience training for first responders; optional stress and mental health screenings for workers; and a number of interventions including workshops, support groups, individual assessments and mental health treatment, the hospital said.
Researchers at the hospital's Icahn School of Medicine, one of the leading institutions in the field of PTSD research, will also conduct a study of psychosocial factors associated with COVID-19 stress among Mount Sinai’s health care professionals and other front-line workers in the New York City community, according to the hospital.
"Health care providers are working at an intensity level so stressful that tens of thousands will likely suffer post-traumatic stress disorder in the wake of the pandemic," Mount Sinai president for academic affairs Dr. Dennis Charney said in a statement. "... Our goal through the Center is to understand and treat the profound anxiety and grief our heroic health care professionals are experiencing and will continue to face. We must help them recover to ensure the future of our health care system."
Henry Ford Health System in Detroit also launched a PTSD relief program this week, which includes a Community Emotional Support Line, a call center staffed by social workers, for adults and teenagers experiencing mental health difficulties associated with COVID-19. Henry Ford Behavioral Health Services' (BHS) providers, who have specialty training with PTSD, will supplement the call center team as needed, said Henry Ford Health System spokesperson Synthia Bryant.
The health system has also expanded its COVID-19 relief efforts for its health care workers, not only for those with PTSD but those who may be struggling with general mental health related to the pandemic.
"Since the beginning of the crisis, Henry Ford has expanded its real-time offering of mental health services for our health care workers," Bryant said. "Mental health resources include virtual employee assistance services (EAP), daily virtual support group meeting, an emotional support hotline, daily mindfulness sessions and training for leaders in how to recognize signs their staff may need support."
Banner Health System in Phoenix has dedicated several resources toward mental health for its team members on the front lines of the pandemic, including mobile-friendly support options, according to Banner Health spokesperson Alexis Kramer-Ainza.
One such option is a text-message support tool that gives team members links to access self-care tips, housing information, community offerings and more, and another is a telephone support forum for team members to have guided discussions; after-shift, call-in group conversations with trained discussion leaders.
The program also includes daily rounding with Banner teams, daily communication/updates and COVID-19 "town halls," the spokesperson said. All efforts are intended to update team members on the latest COVID-19 developments, provide valuable resources, and address questions or concerns about workplace safety.
Other hospitals said they are preparing PTSD programs and plan to hire new therapists and psychologists for their respective hospitals but did not share much additional detail.
Parks explained that "the nature of this kind of infectious disease had been theoretically planned for," but despite that planning, hospitals were unprepared for the actual reality of a pandemic at this scale, and future plans will have to contain "a lot more attention to the psychological effects of a pandemic or disaster."
"We're going to see an uptick of suicide and addiction, and we better be ready for it," Parks said. "You’re going to see a variation in how sophisticated the response is, and in this situation, leadership matters."
Audrey Conklin is a staff reporter at FOX Business. Follow her on Twitter @Audpants.