New study reports moderate to severe stress levels in COVID-19 front-line physicians

Amid the novel coronavirus (COVID-19) pandemic, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to new research published in the journal Academic Emergency Medicine.

For the study, researchers assessed stress levels of U.S. physicians during the coronavirus pandemic. Doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.

The study found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.

Lack of personal protective equipment (PPE) was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.

The results also showed clear-cut ways of mitigating anxiety, including Improve access to PPE, increasing availability of rapid turnaround testing, clearly communicating COVID-19 protocol changes, and assuring access to self-testing and personal leave for front-line providers.

The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.

The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana, and New Jersey. Researchers noted that most study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. The study also found that median levels of anxiety in the California sites were like those in the New Orleans and Camden sites, which were experiencing surges at the time.

The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the emergency room, and possible development of long-term post-traumatic stress.

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