As the husband of a physician, I like to say that issues affecting health care workers aren’t just dinner tables issues — they’re breakfast, lunch and dinner table issues. This has never been truer than it is during the current coronavirus crisis.
When the greater Chicago area was overrun with COVID-19 patients this past spring, my wife, an anesthesiologist, was among those on the front lines placing intensive care unit (ICU) patients on ventilators. She did so while wearing a welder’s mask that she purchased from a hardware store because there was simply not enough personal protective equipment (PPE) to go around. Our children and I could not have been prouder of her bravery, but we worried about her constant exposure to the virus and the pressures of being a frontline health care worker during a pandemic.
Although case numbers have come down in our area, the virus is far from quashed, and any amount of progress feels fragile. For many who served in hot spots like New York City in the early days of the pandemic — and those in areas currently experiencing surges, like Miami and Houston — navigating the emotional toll of being on the front lines has proven to be among the pandemic’s greatest challenges.
As with so many other areas of policy, the COVID-19 crisis has forced us to confront the ways we have failed as a nation to look out for the well-being of our health care workforce. Too many have struggled in silence for decades; now, they have been called to respond to a once-in-a-century public health crisis without an emotional safety net. It is for these reasons that I introduced the bipartisan Coronavirus Health Care Worker Wellness Act (H.R. 7255), along with my colleagues Reps. John Katko (R-N.Y.) and Frederica Wilson (D-Fla.). This legislation seeks to accomplish two goals:
- First, the bill will authorize U.S. Department of Health and Human Services (HHS) to distribute grant funding to health care providers who wish to establish or expand programs dedicated to promoting the mental wellness of their workers on the front lines of COVID-19; and
- Second, the bill will authorize a comprehensive, multi-year study on the issue of health care worker mental health and burnout, including an assessment of underlying factors, barriers to seeking and accessing treatment, implications for the health care system and patient outcomes, and the impact of the COVID-19 crisis.
Studies and events of the past several months have confirmed that many health care workers are indeed struggling with their mental health as a direct result of COVID-19. Consider the following:
- Health care workers have witnessed death on an unprecedented scale, and social distancing orders have put them in the agonizing position of denying families access to their loved ones and notifying them of deaths over the phone;
- With morgues overflowing, some hospitals have parked refrigerated trucks outside to store additional bodies;
- Critical shortages of PPE in the spring forced health care workers to re-use equipment or go without it, and there is a fear that shortages could return if cases spike again this fall;
- Over 135,000 health care workers have been infected with COVID-19 to date, and more than 600 have died;
- Data from China — a country that experienced an acute outbreak much like our own in March and April — put startling figures on reported rates of depression (50.4%), anxiety (44.6%) and insomnia (34.0%) among frontline workers;
- Another study conducted between March and May found that the average U.S. health care worker — not just those on the front lines — reported enough depressive symptoms to be considered clinically depressed;
- Rates of post-traumatic stress disorder (PTSD) among frontline workers are expected to rival those among first responders to the 9/11 terrorist attacks; and
- Lorna M. Breen, MD — an emergency room physician in New York City who contracted COVID-19 herself — tragically believed she had no choice but to take her own life amid the devastation.
As dire as the current situation is, the unfortunate truth is that burnout and mental health challenges were common among health care professionals long before the world had ever heard of SARS-CoV-2 — something that likely comes as no surprise to members of the neurosurgery community.
- Over half of physicians — nearly twice as many as workers in other professions — experience symptoms of burnout, which is associated with fatigue, exhaustion, substance abuse, depression and suicidal ideation;
- A survey of neurosurgeons published in the Journal of Neurosurgery found 56.7% reporting symptoms of burnout; and
- The U.S. loses 300-400 physicians to suicide each year, which translates to a rate over twice that of the general population.
COVID-19 will, unfortunately, be with us for an extended period. Frontline workers needed our support back in March — not just with our words, but with Congressional action — and we failed to provide it. We simply cannot overlook this situation any longer, nor can we continue to ignore the importance of the long-term job satisfaction of our nation’s health care workforce. We must pass the Coronavirus Health Care Worker Wellness Act as soon as possible.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.
U.S. Congressman Raja Krishnamoorthi (IL-8)
COVID-19 has brought to light a new spectrum of difficulties for neurosurgeons. Of particular concern are increasing reports of significant morbidity and mortality among otolaryngologists in several countries that have been putatively linked to endonasal surgery. 
Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Finally, stroke, large vessel occlusions and mechanical thrombectomy have become an area of interest amid the COVID-19 pandemic. Evidence is emerging from epicenters of the crisis — like New York City — that patients, whether afflicted with COVID-19 or not, are seeking medical attention later in their stroke course due to fears regarding COVID-19. We expect many studies to be published in the ensuing months evaluating stroke and mechanical thrombectomy in COVID-19 patients. We are excited about what the future holds in cutting edge research to bring the best available care to stroke patients everywhere.
Justin R. Mascitelli, MD
Other Navy Reserve doctors and nurses are embedded into the New York City public city hospitals that have been decimated with COVID-19. Navy Reserve doctors and nurses are joining their civilian counterparts in treating COVID-19 patients in hospitals where they are most needed. Many are acting in new and expanded roles due to the dramatically increased ICU needs. The shortage does not call for additional neurosurgeons to perform neurosurgery but for additional coverage in overflowing ICUs. These are very sick patients, and neurosurgeons have a tremendous possibility to do some good within this structure. As our medical critical care colleagues take a pounding, neurosurgeons are very comfortable in the ICU, in treating critical patients, in dealing with mortality and in leading large health care teams to make pragmatic, direct and impactful decisions. Indeed, the 
It goes without saying that service in the Navy Reserve rests upon the service of others. Colleagues back home have taken additional emergency call, increased their workload and served the local community in similar ways. Even more so, spouses have to work overtime at home, especially those with small children and those juggling their own virtual careers. Multiple people have come together in numerous ways to serve the people of New York City. And, the welcome in New York City has been one of deep gratitude both inside and outside the hospital.
Initially, physical classes were canceled until late March, by which time any students who had traveled to a COVID-19 hotspot would have completed a 14-day quarantine. The plan was to resume regular classes and clinical experiences following this disruption. However, it became clear within a matter of weeks that this would be impossible. For the safety of students, faculty and patients, it was eventually decided that all physical classes and clinical experiences would be canceled for the foreseeable future. Students at all levels were placed in an uncertain position as it became increasingly clear that in-person learning would not be possible for the remainder of the year. This uncertainty fostered fear and anxiety among students — many of whom were also dealing with the stress regarding their safety and that of friends and family.
Stephen Susa
Life in neurosurgery changed in step with the sweeping changes across the medical community, necessitated by potential supply shortages and increased patient volume. As social distancing took effect, the coveted morning sign-out — the bedrock of day-to-day functioning of a busy neurosurgery service — was transitioned to video conferencing. Next was the cancellation of all elective cases, then semi-urgent cases, and eventually, in some hospitals, emergency cases could only be performed after chair/faculty committee approval. Clinic visits were canceled if deemed non-urgent or conducted as telemedicine visits to provide care while limiting disease spread. To protect residents from unnecessary exposure and maintain a reserve, call schedules were changed to limit the number of residents seeing consults at one time or available for cases. As these changes were implemented, unprecedented collaboration, flexibility and ingenuity was prevalent as everyone did their part to ensure care remained as safe and effective as possible.
Redi Rahmani, MD
Nathaniel R. Ellens, MD
Tyler M. Schmidt, DO
Then, for one-week, cases of COVID-19 filled the MICU. Shortly after that, our neurosurgical step-down — followed by the neurosurgical ICU — were rapidly converted into negative pressure rooms for COVID-19 patients. That same week, our hospital system placed a hold on all elective, non-emergent surgeries. By Friday, March 20, at a time when there were 
The CNS Town Hall Xperience provides an informal and interactive format, where experts discuss their experiences and answer questions from members. Members can submit topics and questions in advance of the session, as well as during the session. Sessions are facilitated by preeminent faculty.
John Ratliff, MD, FAANS, FACS
Before becoming a neurosurgery resident at 
Myron L. Rolle, MD, MSc