How SARS-CoV-2 has changed the life of the anaesthesiologist

Marcelino Murillo Deluque – marcelmoro04@gmail.com

Sebastian Amaya, Nashla Fayad Fayad

Natalia González Zárate, Gabriela Rosero

The SARS-CoV-2 pandemic has changed priorities for the general population and has been a challenge for healthcare professionals as well. The situation has placed a burden of stress, trauma and panic on health professionals as the fear of acquiring the disease, transmitting it to their loved ones and dying as a result of the infection grows day by day (1, 2). Anaesthesiologists, due to their direct contact with the virus and their role in society, are vulnerable to social changes and emotional stressors, as well as extreme workloads and moral dilemmas (2).

Anaesthesiologists are doctors with specialised training whose function is to assure the smooth, efficient and safe development of surgery, protecting the patient’s vital functions, avoiding pain and/or consciousness and guaranteeing the safety of the patient. Likewise, they are in charge of the pre-anaesthetic consultation where they perform a medical assessment to determine the risk of each patient for a certain surgery and create the most adequate anaesthetic plan (3). In addition, the anaesthesiologist is in charge of the airway, postoperative pain control, chronic pain control, and patient surveillance in the postoperative resuscitation unit (3). This specialist is a key piece in the hospital both at the surgical level and at the pre- and post-surgical levels. Anaesthesiologists, however, are at high risk of infection because they are the physicians who handle a patient’s airway (4).

The SARS-CoV-2 virus has generated significant changes in the way health services are provided, including surgical activity (5). The Colombian Association of Surgery implemented norms and conditions to carry out non-priority elective surgeries after carefully evaluating the risks and benefits (5). On the other hand, the use of personal protective equipment (PPE) and personal protective actions by anaesthesiologists is essential in operating rooms, specifically the N95 mask, goggles, gloves, anti-fluid gown, cap, and leggings (5). PPE is not provided in all settings and in some cases must be paid for by the health care professional. In certain circumstances, PPE may not be readily available due to supply scarcity and physicians must continue to do their jobs with whatever PPE elements they can find, unfortunately.

COVID-19 has had a broad impact on the work overload of anaesthesiologists which includes added overtime in the intensive care unit and poor wages (1). This overload has brought with it a wave of job desertion, increased levels of stress and depression, thus causing conflicts in health care workers (1). These factors combined with the ethical and moral dilemmas that they are forced to face secondary to the overload, lack of resources and poor evolution of patients influence an evident and marked physical and mental exhaustion (2).

The risk of infection and work overload are contributory agents that can lead anaesthesiologists to develop certain psychological disorders. Recent studies, based on medical reports, have highlighted the main factors related to the aggravation of occupational stress and mental overload such as physical and mental exhaustion, complexity in making difficult decisions when managing possibly infected patients, suffering due to the loss of patients and co-workers, as well as dealing with the constant risk of infection (6). Taking into account the current health crisis, these factors are accentuated, so that the physician is subject to constant physical and mental stress.

A cross-sectional study of 531 Colombian doctors evaluated psychological symptoms and perceptions during the current pandemic and revealed that a third of those surveyed presented mild work stress, while 6% presented high or severe work stress (1); with anxiety symptoms identified in 72.9% of the participants, and being more frequent among those who worked in capital cities (1). Intense psychological stress is associated with a set of symptoms of anxiety, depression and related to the acute experience of post-traumatic events (7), that not only affects the health of physicians; but also decision-making, and ultimately clinical practise (7). However, psychological stress does not end when they leave the hospital; the anxiety extends to their homes, their family, and even public places. Several authors point out that health workers usually fear spreading the infection to their families, friends or colleagues, and also experience symptoms of stress, anxiety or depression with long-term psychological implications (1). Many anesthesiologists and intensivists have suffered physical (eg. spraying with bleach, hot coffee, disinfectant, etc.) and psychological violence (eg. threats, the pressure to leave home, and obstacles to access to hospitals), as well as stigmatisation (eg, derogatory insults such as “virus”, “infected” or the use of the word COVID as a derogatory adjective) and discriminatory behaviours (eg, being blocked from using public transport, and signs of disgust) (8). For this reason, it is important to generate social awareness campaigns and effective corrective measures, to prevent these acts of aggression and social rejection.

The consequences that this pandemic leaves are challenges for each person, especially for each doctor, anaesthesiologist or not, who faces these situations. There are general areas of intervention where it will be necessary to act soon, rescuing the humanity of each individual (9). Support is imperative at this time, as many physicians not only face the virus, but also a high risk of infection, insufficient or lack of adequate protection in many cases, as well as isolation and rejection. This influences the work overload, frustration and impotence that a doctor may feel and its consequent repercussions such as anxiety, insomnia, stress, depression, and exhausting fatigue from long hours as well as the lack of contact with their loved ones (10).

Overall, it is inescapable that communication should be established that allows the situation to be better elucidated and encompasses optimal self-care with a global approach where the target is the management of the physicians’ emotions, thoughts and behaviours. In addition, motivation to maintain or continue with healthy habits such as physical activity, time for preferred meals of good nutritional contribution, a good sleep cycle and avoidance of stimulants (alcohol, caffeine, etc.) should be encouraged. Additionally, there should be a reinforcement of activities that relax each person, such as reading or watching movies and resting, as well as restricting exposure to social networks and media. In the same way, staying connected with loved ones and allowing for help, establishing and recognising signs of sadness, exhaustion, anxiety and frustration can establish a must needed balance in the physician’s life (11, 12).

References

1. Monterrosa-Castro A, Dávila-Ruiz R, Mejía-Mantilla et al. MedUNAB 2020 Jul22,;23(2):195-213.
2. Téllez-Vargas, J. Asociación Colombiana de Psiquiatría Biológica. 2020 Jun.
3. Acosta Martínez J, Guerrero Domínguez R, et al. ELSEVIER. 2016 [citado el 26 de agosto del 2020]. Disponible en:https://www.sciencedirect.com/science/article/pii/S0120334716000198#:~:text=Tambi%C3%A9n%20pretende%20identificar%20factores%20relacionados,la%20existencia%20de%20intervenciones%20previas.
4. Xu J, Xu Q, Wang C, Wang J. Psychiatry Research 2020 Jun;288:112955.
5. Barrios Parra A, Prieto Ortiz RG, Torregrosa Almonacid L., et al. Revista colombiana de cirugía 2020 May 11,;35(2):302-321.
6. Astrês Fernandes M. Márcia Astrês Fernandes. Revista cuidarte [Internet]. 2020 [citado 14 agosto 2020];11(2). Disponible en: https://revistacuidarte.udes.edu.co/index.php/cuidarte/article/view/122
7. Neto MLR, Almeida HG, Esmeraldo JD, Nobre CB, Pinheiro WR, de Oliveira, Cícera Rejane Tavares, et al. When health professionals look death in the eye: the mental health of professionals who deal daily with the 2019 coronavirus outbreak. Psychiatry Research 2020 Jun;288:112972.
8. Orellana-Calderón CI. Revista de salud pública (Bogotá, Colombia) 2020 Mar 1,;22(2):1-5.
9. Macaya P, Aranda F.Revistachilenadeanestesia.cl [Internet]. 2020 [citado 14 agosto 2020];49(03.014):356–362. Disponible en: https://www.researchgate.net/publication/341268380_Cuidado_y_autocuidado_en_el_personal_de_salud_enfrentando_la_pandemia_COVID-19
10. Huarcaya-Victoria J.Revista Peru Med Exp Salud Pública [Internet]. 2020 [citado 14 agosto 2020];37:327–334. Disponible en: https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/5419
11. Bocanegra Rivera J. [Internet].Comunidadacademicascare.com. 2020 [citado el 25 de agosto del 2020]. Disponible en: https://www.comunidadacademicascare.com/420-recomendaciones-para-el-manejo-de-la-salud-mental-de-los-profesionales-de-la-salud-durante-covid-19.html
12. FEPASDE C, S.C.A.R.E. Internet]. Contenido.fepasde.com. 2020 [citado el 25 de agosto del 2020]. Disponible en:https://contenido.fepasde.com/medidas-para-atender-el-coronavirus-duranteposible-llamado-del-gobierno?hsCtaTracking=080912c8-a621-4d15-9493-b85bc1bf980a%7C35f94294-122a-4ba1-9ec4-c86f20b1d9d2

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