"I started crying and I couldn't stop, it was an anxiety attack"

BarcelonaIt was an innocent question: "How are you?" But enough to tip her over. "I burst into tears and I couldn't stop. I thought I was fine, but I had an anxiety attack. They sent me home and I spent two months with psychological help," explains Marta –fictitious name– an A&E nurse at Bellvitge Hospital. The increased workload, fatigue and uncertainty impact on health workers' mental health after almost two years of the pandemic. Marta works in the emergency surgical block, the only one of the five blocks that attended everything but covid during the pandemic, "and we have found ourselves with a greater workload because operating rooms, outpatient clinics and diagnostic tests have stopped, pathologies have taken longer to diagnose and tumors longer to be operated on, and this means it is more likely for there to be complications," she explains. She assures that they are not back to 100% activity. "At each wave, when beds were needed for covid, we have had to stop our activity. And now, with the sixth wave, patients cannot go up to the ward because they are occupied with covid patients and they accumulate in A&E, it is a collapse". After two months on sick leave she has already returned to her job.

Maribel, a social services worker in a town with 20,000 inhabitants, who is on sick leave after having suffered a burnout, has not yet returned to work. "I've been working in social services for 30 years and I've never seen such tough demands, people who don't have enough to eat, for example, when we didn't see much of this. There is a lack of human resources to meet the increase in cases and resources for the people we serve. You feel very helpless, because they are not cases, they are people with serious problems. I have never felt I was listened to so little by my superiors", explains Maribel, who was overwhelmed by the situation. Joint pain, discomfort, headache, choking sensation, sleeping problems or tachycardia were some of the body's warnings, which one day said enough. "When the tachycardia started, I saw that I was going to fall and I said to myself "Either you stop it or it will stop you"," she says. "You go on resisting until one day you explode," adds Marta, who recognizes that in her ward professionals of all categories and shifts have gone through the same. "All this takes its toll on a personal level. This rhythm is not sustainable, but while you're doing it you don't realise, because we like the work," she adds.

Her situation is not isolated. If the majority of the population is tired of the pandemic, it is easy to imagine how health workers are. "A month and a half ago we thought we were at the end of the tunnel and the scenario has changed very quickly: we return to levels of pressure on care similar to those of a few months ago," says Toni Calvo, director of the Galatea Foundation, an entity created by the Council of Medical Colleges of Catalonia to ensure the health and welfare of health professionals. This pressure generates feelings of frustration among professionals, as well as physical and mental exhaustion that accumulates as the pandemic drags on

Anxiety and depression

The Galatea Foundation has noticed: demand for psychological help has increased by 30% as a result of the pandemic. They have already attended over 1,800 professionals since March 2020, including Maribel and Marta, and as the pandemic goes on the complexity of cases increases. If before the average was four therapy sessions per user, now it takes six or seven. "And the more complex the case, the more the psychological intervention also becomes pharmacological," Calvo points out. The most common reasons for consultation are anxiety and depression. "And in some cases, not significant but important, some substance use". The trigger is, above all, work overload. "There is a lot of anxiety linked to the reorganisation and restructuring of teams, the management of uncertainty and lack of resources," argues Calvo, who recalls that health workers are highly trained to care for others and little to take care of themselves. And the impact is at all levels: doctors, nurses, orderlies, administrative, psychologists, social workers...

The burden, once again, on the primary care system

The sixth wave has made its full impact felt, once again, in primary care: screening, antigen testing, contact monitoring, vaccines, covid passes..., in addition to the usual activity controlling chronic patients, as well as seeing patients face-to-face, over the phone or in their homes. "The professionals are really collapsed and with problems of anxiety and anguish. The staffing was already weak before and if you now add a pandemic with six waves in a row it is not surprising that professionals end up with anxiety attacks and have to take the sick leave," argues Glòria Jodar, director of the development area of the Chartered College of Nurses of Barcelona and director of Sant Andreu de la Barca health centre. Between 6% and 9% of primary care professionals have had to take medical leave between October 2020 and August 2021, according to data from the Department of Health

Meritxell Sánchez-Amat, a doctor at Besòs health centre in Barcelona and president of FoCAP, recognises that there is "pandemic exhaustion" also among health workers. "It's great that people turn to primary care, but we have been left very alone and the amount of work is very large," she admits. And measures to strengthen the system during the sixth wave – recruitment of students in their final years – are insufficient. "I'm doing the job the way I want to do it, but with a huge personal effort. We are assuming many shortcomings of the other levels of care and this wears you down a lot," regrets Sánchez-Amat. "Hospital visits, tests or operations that are delayed make me suffer for the patients and generate work and discomfort because they do not depend on me". However, she believes that we have to change the discourse towards primary care: "We are also doing a lot of work and we have to put it in value".

The emergency department, overwhelmed

In hospital emergency rooms the volume of work has also increased. The increase in cases arising from the sixth wave and boosted by the Omicron variant join respiratory infections, intestinal passes, heart failure or decompensated chronic diseases. "Activity figures are 8% higher than in the winter of 2019, when we had more activity than ever," says Mireia Puig, head of A&E at the Hospital de Sant Pau, who warns that the resources "are not infinite". "We are tired because we have had a lot of activity for many months and we have never de-escalated covid", she adds. Joaquín López-Contreras, head of infectious diseases at Sant Pau, also notes this "general feeling of discouragement" among health staff when they see that covid rooms that had already been closed are reopened, or non-covid procedures are de-programmed. "People are sad and worried because everything that comes our way is harmful. For how many weeks had we been seeing that Europe was doing terribly? This is a déjà-vu for everyone".

Both Maribel and Marta have thought about quitting their jobs. "But I put it out of my mind because I love it," says Marta. About 20% of all health professionals have thought about quitting their jobs at some point since the start of the pandemic, but only 2-3% have seriously considered it. The vocational component weighs heavily. Maribel has been on sick leave for two months and her goal is to return to her job: "Now I am more prepared to return, but I am also afraid that the conditions have not changed and that anxiety will be stronger than me," she concludes