Impacts of Covid-19 on Healthcare Practitioners Self-Care and Practice Recommendations

Studies showing the benefits of integrative therapies for COVID-19 provide an opportunity for integrative medicine to emerge as something that can’t be ignored, said Lise Alschuler, ND, FABNO, at the 2023 Integrative Healthcare Symposium in New York City.

It’s well-known that with the COVID-19 pandemic came a drastic increase in the level of burnout among healthcare providers. According to Alschuler, professor of clinical medicine at the University of Arizona, integrative and conventional practitioners alike reported significant increases in feelings of burnout as well as a decrease in overall wellbeing. In response a movement came about that encouraged healthcare practitioner wellness and self-care through lifestyle interventions.

To better understand the impact of these lifestyle interventions on practitioners, Alschuler and a team of researchers surveyed healthcare providers on which interventions they valued most during the pandemic. In addition, they asked practitioners about how their personal experiences with lifestyle interventions informed their prescribing practices.

“There’s an urgent need to support these practitioners,” said Alschuler. “This is not going to be the first pandemic we see.”

The study focused on evidence-based lifestyle changes that promote immunity and help to prevent viral entry. In a prior study, Alschuler and her colleagues identified several integrative interventions shown to improve overall wellbeing and prevent or lessen the effects of COVID-19.

Diet

The first lifestyle intervention Alschuler mentioned was an anti-inflammatory diet. According to Alschuler, research suggests a low-glycemic, low-saturated fat diet reduces inflammation. The diet has also been associated with improved pulmonary function in non-asthmatic Hispanic adults, said Alschuler.

Although the evidence is still emerging, there are preliminary findings that link diet to COVID-19 outcomes. Alschuler cited a study that found people with COVID-19 are more likely to have nutrient deficiencies, particularly vitamin D. On the other hand, other studies have shown consuming a nutrient dense diet high in fruits and vegetables is associated with improved respiratory function.

“That’s a correlative data point but it’s an important one,” said Alschuler. “We have to remember that infections are very catabolic, so we can reduce our nutrients really quickly.”

Consumption of plant flavonoids, quercetin², garlic, and epigallocatechin gallate (EGCG), may help COVID-19 outcomes as it has been shown to reduce NLRP3 inflammasome activation, Alschuler said.

Exercise

Exercise, said Alschuler, has also proved to be an important factor in decreasing COVID-19 infection and severity. One study Alschuler cited suggested that eight weeks of resistance and endurance training in adults with post-covid improved cardiopulmonary fitness, strength, and symptom severity.

“Physical fitness has a lot to do with how we meet this virus,” said Alschuler. “The more physically fit we are prior to encountering the virus, the more likely we are to experience severe infection.”

Stress management

Research has also suggested that interventions for stress management have positive COVID-19 outcomes, said Alschuler. Mind-body interventions such as mindfulness meditation, yoga, and Tai Chi, lower the stress response, increase parasympathetic output, and increase anti-inflammatory cytokines.

According to Alschuler, results from a randomized control trial indicated that after a four-week mindfulness program, long covid patients have improved cognitive performance and mental wellbeing.

Dietary supplements

In their research, Alschuler and her colleagues found several dietary supplements with emerging evidence of improved COVID-19 outcomes, such as:

• Astragalus membranaceous extract
• Quercetin
• Vitamin D3
• Vitamin D
• Elderberry
• Zinc
• Zinc ionophores
• Vitamin C
• Melatonin
• Omega-3 fatty acids
• Full mushroom extracts

Alschuler was particularly optimistic about vitamin D supplementation for COVID-19. She explained studies have shown people with vitamin D deficiency are more likely to suffer from greater COVID-19 severity. Research has also shown that vitamin D deficiency is more prevalent among people who have severe cases compared to mind cases.

Alschuler recommended an initial loading dose of vitamin D. Then, once vitamin D levels are sufficiently increased, she said the dose can be significant decreased for maintenance.

“Vitamin D essentially helps us meet the viral infection and tries to sequester it early,” said Alschuler. “As the inflammatory response continues, vitamin D also helps to downregulate it and quell it a little bit.”

Preliminary findings

For their study on physician wellness and prescribing habits during the pandemic, Alschuler and her colleagues received a total of 504 questionnaire responses from providers trained in integrative medicine along with 432 responses from non-integrative healthcare providers.

Preliminary findings suggest that 71 percent of non-integrative medicine respondents had a history of positive COVID-19 test results. Of those who had been infected, fifty percent reported mild-to-moderate infections, while 20 percent had a moderate-to-severe infection, and only one percent were asymptomatic. Vaccination rates between groups were comparable.

“We still need to do the stats on this, but already the data is starting to tell an interesting story,” said Alschuler.

Similarly, 61 percent of those who practiced integrative medicine had previously been infected with COVID-19. Of those, 84 percent experienced mild-to-moderate infections, thirteen percent had moderate-to-severe symptoms, and two percent were asymptomatic.

More than half of all participants reported no co-morbid conditions. Both groups also reported significant levels of burnout and a decline in their wellbeing as a result of the pandemic.

“This is persisting, by the way, so this is a really big problem,” said Alschuler.

The majority of patients reported that post-pandemic, they considered factors like diet, physical activity, mind/body interventions, social time, and dietary supplements to be more important in their recommendations for patients, and in some cases, themselves.

“This is good news,” said Alschuler. “This suggests that when we encounter something like the pandemic there’s an opportunity for integrative medicine to emerge in people’s consciousness and awareness as a potential part of standard care.”

Compared to conventional practitioners, those who practiced integrative medicine valued dietary supplements more. In addition, they reported less stress and burnout. Among conventional providers, the only supplement that was thought to be more important post-pandemic was vitamin D3.

“But that’s something,” said Alschuler. “At least there’s an awareness of the importance of it and the potential in their minds for a vitamin supplement to do something for their patients.”

According to Alschuler, healthcare provider burnout has significant consequences. Burnout not only impacts the wellbeing of the provider, but it can also adversely affect patient care. Physician wellbeing is of critical significance to healthcare quality, she said. Understanding what integrative medicine strategies work best for healthcare providers, and how they translate to prescribing practices, is crucial in maintaining quality care.

“The significant of this study is several folds,” said Alschuler. “Getting our physicians to feel more well is really important not only for themselves, but for the care of their patients. Therefore, there’s an opportunity for us to ascertain the potential impact for integrative medicine strategies to augment that wellness.”

Editor's note: This article is part of Integrative Practitioner's live coverage of the 2023 Integrative Healthcare Symposium at the Hilton Midtown in New York City. Click here to catch up on the live coverage.