It was, perhaps, a fortunate stroke of fate.
Christine Ngaruiya was already working on a meditation room as the coronavirus pandemic took hold. “I actually had been working on a meditation room before this all happened,” Ngaruiya, an academic emergency physician in the Yale School of Medicine’s emergency-medicine department and a graduate of Yale’s Public Voices fellowship, told MarketWatch.
While she had not been meditating every day, creating a room was her way of making it front and center in her life and mental-health regime. “The prioritization of meditation in my life as a wellness strategy has become more central, and to that end, the completion of this project to develop a meditation area within my home has been expedited,” she said.
“ ‘I sat down and realized I would have to be creative with exercise — going out more, but I also invested in some gym equipment.’ ”
COVID-19 took away many of Ngaruiya’s primary “wellness go-tos,” she said, including exercising at the gym. “I’m someone who’s an almost daily sauna-goer, and I also really like to travel,” she added. “I sat down and realized I would have to be creative with exercise [by] going out more, but I also invested in some gym equipment for my home because I realized that’s such essential part of my wellness.”
She has also stayed connected to her communities in a healthy way. “I’m also a little bit more involved in some of my social media, which primarily focuses on travel, so [I’m] staying connected with people and continuing to share my love of travel on there with the anticipation that with time, like all things, it will return,” she said. “It’s kind of a way to keep the dream alive.”
Over the past few weeks, Ngaruiya’s emergency department has seen a reduction in overall patient volume — driven by a reduction in people with less-severe illnesses seeking care from the emergency room — as well as an influx of coronavirus patients, amid a rise in deaths in her state. As of Saturday morning, Yale’s home state of Connecticut had nearly 24,000 confirmed coronavirus cases and 1,764 associated deaths.
Workers on the front lines of COVID-19 carry a substantial mental-health burden while everyone else stays at home. But there are ways for these essential workers — and the people in their lives — to help lighten that load.
“ ‘Sources of distress may include feelings of vulnerability or loss of control and concerns about health of self, spread of virus, health of family and others, changes in work, and being isolated.’ ”
A recent JAMA study of 1,257 health-care workers from 34 hospitals across China, where the new coronavirus was first detected late last year, found that substantial shares of participants reported symptoms of depression, anxiety, insomnia and distress. Frontline workers were among a handful of groups reporting more severe mental-health symptoms, possibly compounded in some cases by a shortage in PPE, or personal protective equipment.
“Sources of distress may include feelings of vulnerability or loss of control and concerns about health of self, spread of virus, health of family and others, changes in work, and being isolated,” the authors wrote. “The fact that COVID-19 is human-to-human transmissible, associated with high morbidity, and potentially fatal may intensify the perception of personal danger.”
Of course, health-care workers aren’t the only essential employees feeling additional strain. Some grocery workers across the U.S., who risk their health and safety by showing up to work during the pandemic, have also expressed concern over customers’ failure to practice social distancing and wear masks.
MarketWatch spoke with Ngaruiya about what it’s like to treat COVID-19 patients, the stressors that come with the job, and what the public can do to help make health-care workers’ jobs a little easier.
MarketWatch: How often are you treating COVID-19 patients?
Christine Ngaruiya: Every shift. The absolute number of patients with COVID-19 has gone up, and the proportion of those patients that we’re seeing in the emergency department are predominantly very ill and/or mandating hospitalization for higher levels of care. That proportion of patients that actually classify as moderate to severe has also gone up and is much higher.
“ ‘It’s still unprecedented territory. These patients come in alarmingly ill when they’re sick, and they’re alarmingly ill in a way that you’ve never seen before.’ ”
MarketWatch: And before the pandemic ramped up in your state a few weeks ago?
Ngaruiya: It was like watchful waiting — we were waiting for the surge, so to speak. We knew it was coming; we knew a couple of patients probably had it. We didn’t have as many tests at that time. But [a majority of] people were not showing severe symptoms.
MarketWatch: What is it like to treat COVID-19 patients?
Ngaruiya: I work at an academic institution, which means there are a lot of scientists, researchers, etc., that are helping to guide development of new tests to diagnose the disease and helping to guide treatment for the disease. Like everybody else, we are being diligent and rationing our PPE, but we have enough supplies at this time.
It’s still unprecedented territory. These patients come in alarmingly ill when they’re sick, and they’re alarmingly ill in a way that you’ve never seen before. I had a patient a week ago who was a young, healthy person who had tested positive. I rushed in right away, put on my PPE. They were panting, like the person had run a marathon or something, and had signs on their body that their oxygen was low.
There are scant other diseases that will “take someone out” the way COVID-19 does — that debilitates their lung function so alarmingly, that literally takes their breath away. It’s seeing a healthy person take two steps and literally become so winded that they are unable to speak to you and are basically turning blue.
“ There are scant other diseases that will ‘take someone out’ the way COVID-19 does — that debilitates their lung function so alarmingly, that literally takes their breath away. ”
In my career in medicine for the past 10 years I have never seen anything like that before. It’s frightening to see that. I will never forget the image of that patient. We all come to work knowing what we signed up for, eager to help and hoping to make a dent in this thing.
The frustrating parts come around not having known some of the best treatments, the best medicines or techniques to guide care, because it was such an evolutionary process. We’ve reached a steady state with the knowledge base where we have a much better handle on what to use to guide treatment and what to consider staying away from.
MarketWatch: Do you feel safe when you go to work?
Ngaruiya: We’re thankful at places like Yale, where they’ve developed a novel way to help sterilize PPE between usages so we don’t have to use the same PPE, like masks, multiple days in a row. We’re being kept as safe as possible given the current knowledge or expectations that are established nationally.
MarketWatch: Have any of your coworkers gotten sick?
Ngaruiya: A couple of my colleagues have gotten sick. We’ve been very encouraged that it’s truly been a very, very small proportion, to the tune of numbers you can count on one hand. And all of them are actually back to work. Of course, I’m aware that that’s not necessarily the case in places like New York, where they’re under a deluge of patients.
MarketWatch: What happens when you go home? Do you have any family members you’re afraid of getting sick?
Ngaruiya: Thankfully, I have that one less fear. I live alone, so I’m very careful about trying not to contaminate anything in my home when I do get home. I sterilize and shower almost immediately to reduce the risk of contaminating other items in my home.
MarketWatch: What do you do to unwind?
Ngaruiya: My greatest recommendation to people is just to be active and mindful about compartmentalizing what happens at work, and also anything COVID-19-related. We are held to a standard to be aware of what’s going on, but also to follow communications from our jobs.
The wakeup call for me was probably about a month back when this was just all sort of coming to a head. I remember losing an entire afternoon on a group chat about COVID. When I looked up, I realized that my whole day was gone.
Something clicked for me, and I said, “I’m not going to let this be my existence for the next month or several months of this thing, so I have to figure out how to operate better.”
“ ‘I force myself every day to do some form of exercise or go outside, even if it means just walking around outside in my condominium complex.’ ”
Talking to friends and keeping the conversation COVID-free; watching some TV. I force myself every day to do some form of exercise or go outside, even if it means just walking around outside in my condominium complex.
MarketWatch: What do you want people to know about what frontline workers like yourself are seeing and experiencing right now?
Ngaruiya: Be kind if you’re interacting with them as a patient in the next few weeks, which hopefully won’t be the case.
There’s a common notion that anger, for example, is a mask for many other emotions, including fear. If you’re finding your loved ones who work in health care are more angry than usual, I would just pray that people would be patient with them. Try to understand where they’re coming from.
As you may have your own need and concerns right now, including wanting to have all the answers from them about the virus itself, I would also just say: Please be patient. Someone could have just walked off of a very exhausting shift or day. They could have had a bad encounter with a patient that day.
If I’m at the point where I can’t take on another set of challenges from someone’s life, then I’m OK with setting a boundary on that conversation and saying, “Hey, let’s pick this up where we left off another day.”
MarketWatch: What are the biggest stressors for workers on the front lines?
Ngaruiya: People have framed the process that especially those of us at the front line have experienced in the past few weeks as going through the first few phases of the Kübler-Ross stages of grief, which are denial, anger, bargaining, depression and acceptance.
I’ve been doing quite well for the past few weeks, and I think many people that I know have also gotten to that level of working in a place of acceptance, but I can say that the last few days have been extremely saddening.
The recent news of potentially opening up states for business without a clear plan or strategy of action of how this is going to affect frontline workers, and where the buffer is going to come from if there is another surge … has been extremely disheartening.
“ ‘Just spreading kindness in the world at this time is key — and by doing so, you’re helping us by helping one another.’ ”
MarketWatch: What can we all do to take care of our mental health?
Ngaruiya: Compartmentalize. Do not allow this thing to take over your life. You have to step away for a period of time in a day or several periods of time in a day. Take breaks.
Exercise affects the way you eat, affects the way you sleep, affects your mood and is a natural source of dopamine. Just make time for it.
Sleep is the core of so many other health and wellness-related issues, so as much as possible, try to keep it regular. Don’t slack on it. If you’re having trouble with sleeping, I recommend reaching out to your doctor for advice.
No. 4 is checking in on your colleagues. I’ve found a lot of community and camaraderie in my setting.
MarketWatch: What can the rest of us do to help frontline workers?
Ngaruiya: Stay home. Responsibly social distance. Check in on one another also — your friends, your family. People are stressed, and many are not dealing with this very well. A lot of people are not going to ask for help or reach out.
Be mindful about giving, as well. There’s no one particular organization right now that probably wouldn’t benefit from giving. Any local small business is probably hurting.
There are obviously tons of people who are donating things to health-care workers. It’s definitely been a welcome surprise and it’s definitely built up spirits to have cloth masks that people donate [and] to have food donated to the emergency department.
But there’s so many others that are in need in our own communities. You probably have a neighbor that’s been laid off. There are elderly people who can’t get to where they need to be.
If there’s some way that your community can reach out and help these people, be mindful and reach out. We just need each other more than ever right now.
(This interview was edited for style and space.)