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Managing a pandemic's emotional toll

December 11, 2009
by Philip T. McCabe, CSW, CAS, CDVC, DRCC
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Clinicians must practice self-care while trying to meet the needs of others

This article is written to assist addiction professionals and staff at treatment centers in addressing the psychosocial aspect of a pandemic flu outbreak. It is not intended to take the place of pandemic behavioral health training or to develop federal, state, local or agency policy. It is intended to be a quick reference guide to assist in meeting community needs and to remind providers to maintain good health and self-care for themselves and their families, as well as to acknowledge the anxiety, distress and grief that people experience during long-term, major public health events.

Additional information on how a pandemic outbreak can affect the delivery of inpatient and outpatient services is available from several federal sources. Most important is that during a pandemic, in addition to education and coordination for clients and staff on receiving H1N1 flu vaccine and on personal protection, plans need to include a disruption of direct face-to-face contact with clients. Proper hand-washing, covering your cough, not sharing personal items, and washing and disposal of personal items need to be reviewed with all staff and clients. In residential treatment and sober housing, adequate planning for providing appropriate care for those who become sick also needs to occur. Isolation, quarantine and social distancing are just three levels of protective factors that will directly affect patient care.

Information dissemination for the staff and general public is very important to mitigate the concerns of the community. Specific training, policy and access to current health risks and updates for spokespersons on public health crisis response and risk communications principles is an essential component of pandemic preparedness.

What is a pandemic?

A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic. An influenza pandemic may occur when a new influenza virus against which the human population has no immunity appears. With the increase in global transport, as well as urbanization and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world, and become a pandemic faster than before. The World Health Organization (WHO) has defined the phases of a pandemic to provide a global framework to aid countries in pandemic preparedness and response planning. Pandemics can be either mild or severe in the illness and death they cause, and the severity of a pandemic can change over its course.

Current epidemiological models project that a pandemic could result in 2 million to 7.4 million deaths globally. A pandemic that becomes severe and widespread over time would result in:

• Vaccines, antiviral agents and antibiotics to treat secondary infections being in high demand and potentially short supply;

• Medical facilities being strained with demands to care for both influenza and non-influenza patients; and

• Potentially significant shortages of personnel to provide essential community services.

A flu pandemic is an act of nature that, as of now, scientists cannot prevent. Because there is little natural immunity, the disease can spread easily from person to person. However, we can decrease the impact that a flu pandemic can have on our physical and emotional health. By taking action now, as well as during a pandemic and in the months that follow, both individuals and entire communities can better overcome the challenges that a flu pandemic might bring.

Special circumstances
Many of the recommendations we have to address the emotional and psychosocial aspects of a crisis are based on experiences with current disaster response preparedness for other hazards. They are considered evidence-informed, based on assumptions from previous health crises. Yet a pandemic also has some unique considerations that make it different from other disaster situations. The impact and duration can be more widespread and long-lasting than for other traumatic disaster events.

People might become quite fearful about the risk of becoming infected. They might worry about how they will manage their sickness, and about the potential threat to life if the condition is severe. Healthcare and treatment providers will have concerns about becoming infected themselves while caring for patients in residential settings. Providers also will have concerns for their family members. Social distancing, isolation and quarantine recommendations and possible mandates will also intensify emotional reactions. The severity of the pandemic combined with the anticipated number of lives lost will multiply provider and community reactions to the situation.

There are many emotional challenges that could face individuals and families during pandemic influenza. These challenges are not limited to the medical impact of a disease outbreak, but also include reactions to organizational and governmental response; the impact on society; personal and global economic disruption; pre-existing medical or mental health issues; separation from natural sources of support; and loss of and grief for friends and/or family members.

Experiences with disaster relief efforts suggest that enhanced workforce support activities help workers remain effective during emergencies. During a pandemic, the occupational stresses will likely differ from those faced by relief workers in the aftermath of a natural disaster. The severity and duration of illness along with potentially high numbers of deaths will add considerably to personal and social stress.