When Debra O’Neall gets home from her overnight shift at a nursing home in Danbury, she removes her scrubs and jumps in the shower before she does anything else.
Later, she settles in on the sofa, turns on the news, picks up a sketchbook from the coffee table and begins to draw.
“I find this is really calming to me in expressing how I feel,” O’Neall said on a recent Wednesday morning at her home in Waterbury.
O’Neall, 52, is a certified nursing assistant at Western Rehabilitation Care Center, where 23 residents have died from COVID-19 or related complications, according to state reports.
Drawing has been one way to help her process the onset of anxiety, stress and other symptoms of trauma.
“I dream about work, it’s horrible,” O’Neall said. “The never-ending rounds. I have night terrors now, my husband tells me, and I scream. I don’t like to go to sleep.”
After a summer of low transmission and few hospitalizations, COVID-19 activity is again picking up in Connecticut -- the state’s one-day positivity rate Tuesday jumped to 4.1%. State and public health leaders predict that this is the beginning of a second wave of widespread outbreak.
For front-line health workers, it means they’re once again preparing for an uphill battle. For some, it means dealing with lingering or new symptoms from psychological trauma caused by that first wave of cases.
“I feel like I’m in limbo, because I just feel like things are going to get really bad again,” O’Neall said. “So, I really don’t even know how to feel. I’m scared. I really am.”
Experts estimate that this wave will be less severe than the spring, which saw high numbers of cases, hospitalizations and deaths. Testing was imperfect, there were shortages of personal protective equipment, little was known about the novel coronavirus and experimental treatments had limited evidence on efficacy.
Public health leaders say the state and health providers are better prepared this time around, with improvements in testing, treatment and emergency planning.
Clinical psychologist Karen Alter-Reid said that may help in reassuring workers, but there are many people still struggling with acute, chronic or delayed-onset of post-traumatic stress from earlier this year.
“I think it depends on what happened between May and now,” she said. “Did people get treatment who had symptoms? Did they notice to get some restoration? Did they realize how depleted they were? I think that’s going to be a big factor in terms of who’s impacted.”
Stress And Trauma Following First Response
Early studies and reviews worldwide have found that a significant portion of health care workers responding to the pandemic have experienced or will experience psychological distress, to varying degrees.
High levels of workers also report an increased sense of purpose and meaning since the outbreak. Alter-Reid, who is based in Stamford, said everyone is experiencing the pandemic differently.
“The chronicity coupled with the uncertainty, it’s unique in adult life for people,” she said. “I think we can all agree across the profession that there’s going to be a lot of trauma responses that are going to emerge over time.”
Alter-Reid is a volunteer and co-coordinator for the Fairfield County Trauma Response Team, which is currently providing free, short-term counseling for COVID-19 first responders.
“Trauma isn’t just about what happens,” Alter-Reid said. “It’s about what happens, and then it’s about what happens next.”
It’s the next part that Linda Rost, a licensed clinical social worker and trauma co-coordinator, said her clients are worried about.
“I’m hearing a lot of people saying, ‘Yes, there’s definitely going to be a second wave and I don’t think I can do it again,’” she said. “Hearing that from a number of nurses.”
The team uses a psychotherapy called EMDR, short for Eye Movement Desensitization and Reprocessing, which has been proven effective in treating trauma and post-traumatic stress disorder or injury.
It helps people access natural and positive coping mechanisms to process traumatic memories. If successful, the treatment can relieve or lessen mental and physical symptoms associated with trauma.
Requests by health care workers for counseling sessions were few in the beginning, and Rost said that wasn’t unexpected.
“We work with populations that don’t want to ask for help,” she said. “They’re the rescuers. We’re not supposed to be helping them, they’re supposed to be helping us.”
But appointments began to fill up over the summer and fall. With the colder months ahead and no coronavirus vaccine yet, Rost said it can be unnerving.
“I think the uncertainty is the biggest thing,” she said. “When is it going to end?”
Resiliency On The Front Lines
The pandemic has triggered new or unresolved stress and mental health issues for a lot of people, but Alter-Reid and Rost said it has also strengthened resilience and coping abilities in many health care workers.
The trauma co-coordinators call this post-traumatic growth, or a positive psychological change following trauma.
“It just renews your passion. This is why I went into this, this is why we’re doing this,” said Dr. Jaclyn O’Connor, an internal medicine physician at Bridgeport Hospital, a member of Yale New Haven Health. “That feeling of accomplishment and really focusing on that sense of pride is really protective when it comes to preventing things like post-traumatic injury.”
O’Connor served as chief resident of the internal medicine residency program in the spring. She’s now the associate program director.
She said the hospital was well prepared at the beginning of the pandemic, given the equipment supply chain issues happening worldwide. She said the hospital provided and coordinated things like child care, laundry services, groceries, meal deliveries and hotel accommodations for staff to try to lessen the burden on its staff.
Still, it didn’t take away all the fear, anxiety or moments of distress that some workers experienced, O’Connor said. That’s why she helped coordinate a presentation and counseling sessions from the Fairfield County Trauma Response Team for hospital staff.
“Before we move forward, we really need to empty those containers now and address those issues now so that we’re better equipped to handle future stresses,” she said.
The Next Wave
Many of the residents Debra O’Neall was close with at the nursing home in Danbury died during the first wave of the pandemic. Familiar faces have disappeared, and new people are left to care for.
“I don’t see myself forming any kind of relationship like that anymore. I still see them as human beings. I’ll never forget that. But for my own sanity, my own heart …,” she trailed off. “Because that was just horrible, watching people go who didn’t have to go.”
But O’Neall said she’s found better ways to deal with what happened. She accesses mental health services and makes sure to draw or garden to relieve lingering stress or anxiety. She also advocates for safer working conditions on behalf of herself and colleagues as a union delegate for Local 1199 SEIU.
As they all face a second wave of cases, O’Neall is determined to go on.
“I just get prepared. Get prepared,” she said. “There’s no time to wallow. And I’m there. Get prepared and protect yourself.”
For a list of COVID-19 mental health resources and support for individuals, families, health providers and first responders, visit ct.gov/DMHAS