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How the Covid pandemic may be causing injuries to NHS staff that we cannot see – Professor Harry Burns

The pandemic has caused extensive loss of life in every continent. Worldwide, we have seen more than 1.7 million deaths due to Covid and many Scots are mourning loved ones.

Being on the frontline of the fight against Covid, nurses and other health staff can suffer from exhaustion, post-traumatic stress and 'moral injuries' (Picture: Steve Parsons/PA)
Being on the frontline of the fight against Covid, nurses and other health staff can suffer from exhaustion, post-traumatic stress and ‘moral injuries’ (Picture: Steve Parsons/PA)

Many of those who have had the virus and survived it are living with long-term consequences which are significantly impairing their quality of life.

Economies have been shut down, jobs have been lost and individuals and families are now struggling with poverty, hunger and, possibly, homelessness.

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The damage to mental health done has been immense. Increases in depression, suicide, domestic violence have all been documented but the problems faced by health workers struggling to overcome the new wave of the virus are significant and, largely, unrecognised.

During the first wave of infection, NHS staff were being hailed as heroes. The Thursday night applause, the treats delivered by local businesses to hospital staff, the sense of comradeship that kept hard-pressed clinicians going all seem to have disappeared during the second wave.

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Ethical dilemmas

Doctors, nurses and allied health professionals are now experiencing exhaustion and burnout. Like the rest of the population, they are fed up and want a break.

However, there is a more significant problem affecting the mental health of clinical staff. This is the concept of moral injury. In 1984, the philosopher Andrew Jameton first described the psychological conflict experienced by nurses facing ethical dilemmas.

He described the moral distress that they feel when they know the right thing to do, but “institutional constraints make it nearly impossible to pursue the right course of action”.

The concept of moral injury has been talked of mainly in the context of military operations when soldiers are ordered to do something that offends their sense of what is right.

This is the situation being faced by many doctors who are struggling with inadequate support and facilities. When your intensive care beds are full and someone is admitted who needs intensive care, what do you do? If you do nothing, the patient will die.

Doctors want to be able to say to relatives “we did everything possible to save him”. When the patient dies because the facilities that might have saved him are unavailable, staff justifiably feel both guilty and angry.

‘Protect the NHS’

When they face this situation repeatedly, their mental health is seriously at risk. Like soldiers, they can develop post-traumatic stress disorder.

During the first wave, the public were urged to “protect the NHS”. The present surge in infections and hospital admissions presents staff with huge pressures, similar to those seen in the first wave.

We know people are fed up with lockdowns. They have been unable to party at Christmas and may be tempted to let their hair down at New Year. Please don’t. Sticking to the rules supports hard-pressed NHS staff who are working round the clock to save lives.

The end of 2020 brings hope as effective vaccines are being delivered across the country. However, it will take some months to achieve the level of immunity that allows us to get back to normal life. In the meantime, the more infectious strain of the virus brings added risk. Protecting the NHS supports the well-being of our doctors and nurses. Please don’t give up when the end is in sight!

Professor Sir Harry Burns is director of global public health at Strathclyde University

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