Hi everybody and welcome to another COVID-19 update. I'm Donna Prosser, Chief Clinical Officer at the Patient Safety Movement Foundation. I'm so excited to have with us today Dr. Albert Wu, who is a professor at the Johns Hopkins Bloomberg School of Public Health. Welcome Dr. Wu. I'm very happy to be here. So today you're going to share with us a little bit about how we can help to provide emotional support to the caregivers on the front line. Tell us a little bit about how you got involved in that work. So we've been doing peer support for healthcare workers for, gosh, for almost 10 years now. I'm someone who, you know, maybe it was because I was psych major once upon a time, but I've always been interested in how incidents, even including adverse events, affects not only patients but healthcare workers. And about 10 years ago we developed a program called Rise at Johns Hopkins, which stands for Resilience in Stressful Events. And this is a group of peers, doctors, nurses, social workers, chaplains and others, who volunteer and are on call 24-7 healthcare workers. Originally we thought we might be hearing about medical errors, but it turns out there are so many other things in usual healthcare, even pre-COVID-19, that of course can be upsetting to healthcare workers. And when people are too stressed out or just a little bit, just a little bit too much for them to take, they can call Rise on a pager or on the intranet. And someone will call them right back and meet with them, often within the shift, and basically do psychological first aid and provide emotional support. So this has been going in our hospital. And in fact, we have a training program which we've rolled out to over 30 other hospitals in the U.S. Wow, what a great program. Well, you know, right now healthcare workers are under a tremendous amount of stress as they're dealing with the COVID-19 pandemic. Have you spoken with some of these frontline workers and what are they telling you about what they're dealing with right now? So I've spoken to dozens of healthcare workers in the last four weeks since this really sort of hit Johns Hopkins Hospital as well as other major metropolitan areas on the East Coast. And people are, it's a little bit of a battlefield out there. You know, in addition to all of the usual stresses of work, healthcare workers are now also afraid for their own health. This is pretty uncommon. You know, this is something that may pop up occasionally in an episode of workplace violence or something like that, which unfortunately happens every now and then. But at this moment, healthcare workers are experiencing all sorts of emotions. First of all, they are worried, anxious, afraid for their own health that they might get infected. They're sometimes even more worried that they might get infected and then take that contagion home to their families. Perhaps they have someone at home who's frail or immunocompromised. People are also disoriented. They're being asked to take on roles that they haven't really quite had to before. They maybe has to move to a different unit. Their unit may be changed from a pediatric unit to an adult COVID unit. And this is really unsettling for people. And people are then sort of separated from a lot of their own support. So all of this is difficult. And sometimes people are angry. Sometimes they're frustrated because the message seems to be changing every day. Or because they feel like they're not getting all of the tools they need to do their work. They may feel like they don't have enough protective equipment, which in, fortunately, that's not really the case, you know, at Hopkins, but many places it's definitely true. And this just sort of adds insult to injury. That it does. Well, so what recommendations then do you have for hospitals? How can they better support their healthcare workers right now? So this, I mean, I think this is great. I think this is a great question. And one thing that they can do, of course, is first attend to the daily needs of those healthcare workers. So they need to make every effort they can to provide appropriate personal protective equipment, PPE, now a buzzword previously almost never heard uttered by anyone, even in healthcare. But they have to make sure that people have the tools they need to go out and do their job safely. If workers are still in fight or flight mode, it's going to be harder for them to do their jobs and harder to absorb the messages, which necessarily change sometimes from day to day about what we've learned about the virus, what you need to do to keep yourself safe, what the protocol is, what we need to do, given the limitations that necessarily are imposed on us by sometimes, you know, sort of nearly overwhelming numbers of patients. I think that hospitals also need to understand hospitals and top leaders and managers need to understand that people are stressed. And they're going to be upset for all the reasons that I described. In addition, there are people are just sad, they are patients that are sick, some of them dying, and there's this really strange situation where patients are separated from their families who are not permitted to visit or are only allowed to visit in very limited numbers because of trying to reduce, again, the spread of disease. So I think that hospitals need to understand that this is not business as usual. They need to shift into a little bit of a mode for communicating in a crisis. Crisis communications are a little bit different than everyday communications. You need to make sure that you get your message out. It's clear that it's somewhat optimistic that there is a plan and that you communicate it to people.  I think they also need to provide things to just take away some of the burden. In general, as I mentioned, healthcare workers work pretty hard and are somewhat stressed a lot of the time. Hospitals can be kind of traumatic work environments, but now people've got extra things. They leave the hospital and they need to drive around for an hour to try to get toilet paper or milk. And the more the hospitals can do to make things just a little bit easier for those workers by perhaps taking away some of those burdens by providing opportunities for groceries or childcare or pet care or transportation, all of those things can help. Yes, absolutely. Well, those are some really great tips. What about with healthcare workers themselves? Any suggestions or tips on how healthcare workers can support each other? Well, I would say that healthcare workers should support to do their best to support each other and should also try to make sure that they are okay themselves. I think the first thing maybe to do is to do a daily check-in with yourself to figure out, you know, how am I really doing? I just said when someone said, how are you when I said fine, what did I really mean? How am I doing? Am I? Do I need to talk to somebody? Do I need a shoulder to cry on? Do I need to avail myself of some of the services that might be available? I think that in interacting with each other, I think people need to be a little bit extra understanding and supportive. I think we are all a little bit on edge. And if someone says something to you that is not in a tone that you really love, I think that understanding that that person is stressed is the first step. And perhaps going one further and saying, boy, this is tough.  I think we should encourage each other also to take some time for themselves. I think we should advise people to take time off without guilt. We should encourage them to go and do some things that they like to do while they're off and really be off. I've been encouraging people to unplug as much as possible. It is really possible to overwatch media. And you can get into this really toxic echo chamber in which all of your worst fears are fulfilled and you learn about some new things you haven't thought of to be afraid of also. And I'd encourage people to contact the people who they care about, their family, their friends, maybe those high school classmates on Facebook that they've managed to ignore successfully for all this time. Maybe it's a good time to get back together with them. And certainly to talk to co-workers, talk about what you're trying to be honest, talk about what you're worried about. The funny thing is, is that today we are all worried about the same things. It's a really unique moment. And we can help each other and thereby all do a better job together. That's right. That's right. Well, that's what sounds like what you're saying is communication is the key here. I think that communication and slightly more mindful communication, then sometimes we exercise with business as usual. I like the way you said that. Well, thank you so much for joining us today. Are there any final thoughts that you have for our healthcare workers or for hospitals across the world? For hospitals, I think that I'm actually very pleased that at Johns Hopkins, we've managed to really pull together the resources that we have available, which include Rise, but also our chaplains, our employee assistance program, our well-being program, and our Department of Psychiatry. And we've gotten together and tried to work out a coordinated way to provide all of the different kinds of support, many of them which I've described, to healthcare workers, both being able to answer concerns and questions and also being able to reach out proactively to some groups that we understand or anticipate might be having problems. So, I think that health systems, hospitals and health systems can do the same. They should realize that there are a whole lot more mental health problems out there today and the sooner that they can get on top of that and maybe even get ahead a little bit, the better they'll do now and the better they'll do in a few months, six months when things begin to open back up again. All of this will not have gone away and we'll have to deal a little bit more with, you know, so the legacy of the psychological impact of this crisis. Yeah, I think you're right. This is going to be with us for some time. So, those are some really great thoughts for hospitals to consider in terms of helping their team with wellness. Well, thank you very much for joining us today. I'm so very excited to have you with us and I really look forward to speaking with you again in the future. That would be terrific. Thank you so much for the time.