This article is written by Sabs Quereshi, senior public health managing associate at Hagerty Consulting and public health advisor for the State of California. Opinions are those solely of the author.

In the first microsecond between dream state and awakening, I am trapped in a foreign land, somewhere in Northern Syria, or maybe South Sudan.

I hear gunshots. Men are shouting. Babies are crying. I see a woman burying her husband who has just died from Ebola. I feel fear.

Seconds after waking up, I remember that I am stateside, safe at home in my cozy apartment in Cambridge Massachusetts. I’m far from imminent danger, though also far from the work I have loved as an advisor and expert on disease outbreaks.

I have been working in the public health and humanitarian sector for almost 15 years, both in the US and abroad, from United Nations (UN) health and children protection implementation agencies, to United States Agency for International Development (USAID) and other well-known international NGOs.

A country unprepared for burnout

It’s been years since my last flashback, but ever since the spread of Covid-19 in the US, I see things that recall my worst moments of physical and psychological fatigue in the field. Not just in my current home city of Boston, but across the entire country, America’s front line workers, public health professionals, supply chain specialists, essential grocery and postal workers, are experiencing the first stages of extreme burnout.

For any who aren’t familiar with the term, extreme burnout is the result of severe mental exhaustion, often diagnosed as a traumatic experience similar to post-traumatic stress disorder (PTSD).

Whether from governors and/or at the federal level, the US needs leaders to hold both the public and private sector accountable for ensuring mental health support, and to commit to removing the stigma of mental health from work in general

Many who have worked in humanitarian aid or served as front line responders to natural disasters or disease outbreaks, know all about extreme burnout. They have suffered from the condition for many years, though their organisations have not traditionally provided post-trauma care or support. Now, front line workers in the US are now going through the same turmoil.

What has taken decades for the international humanitarian sector to figure out, the US, UK and countries throughout Europe have been forced to address in the space of a year.

Without access to proper mental health support, front line workers across the developed Western world will experience life-threatening anguish, fatigue, trauma, and physical disorders. These conditions not only affect their own wellbeing, but their ability to care for others.

In the context of the US however, here are two key actions hospitals, governments, businesses, health care providers, as well as average citizens, can take to mitigate the toll this pandemic is taking on front line workers and on the country’s public health system as a whole.

Mental health “check-ins” for all front line workers

Every six weeks, hospitals and care providers should administer mandatory check-ins to medically assess and establish the status of these workers’ mental wellbeing. These check-ins should focus on the current psychological, emotional, and physical state of front line personnel, as well as coping mechanisms to strengthen the resilience of front line employees. Ultimately, all medical assessments should lead to a support plan.

Whether these procedures are part of a hospital’s human resources department or administered by a separate health care provider should be left up to individual organisations to decide. However, for them to work, these check-ins must first be legally required of all organisations, so that they stay staffed, properly funded, and easily accessed in the long term.

Without these services for front line workers, the consequences of current circumstances on front line workers’ mental health could be catastrophic.

Robust governance to ensure accountability

Whether from governors and/or at the federal level, the US needs leaders to hold both the public and private sector accountable for ensuring mental health support, and to commit to removing the stigma of mental health from work in general.

Under the Trump-Pence administration, it was up to individual state and local officials to exercise autonomy in the leadership responsibilities they had been given. Now, under the Biden-Harris administration, there is federal leadership committed to “building back better”, with a unified and qualified team that has the potential to ensure widespread support for the wellbeing of America’s front line. However, implementing this will take longer than an inauguration ceremony.

It’s worth at this stage pointing to an example of a successful mental health programme from the relief branches of the UN, particularly the 2020 Nobel Peace Prize recipient UN World Food Program, which sets mandatory “R and R” (rest and recuperation) interims for its staff at least every six weeks.

It has been said many times that this pandemic is not a sprint, but a marathon

R and R allows staff to take regular authorised paid time off from the dangerous, stressful, and often isolating living conditions in which they serve. During these periods, staff members are required to leave their country of duty and travel, either to see family, or for leisure.

Think of it almost like closing time at a bar. The principle of R and R is always the same: “You don’t have to go home, but you can’t stay here.”

The stronger our frontline, the stronger our health system, the quicker our country can begin to recover from this or any future pandemic, especially while it continues to roll-out vaccinations. Alleviating the short and long-term psychological damage done to those who provide care is as much as a practical means of preserving current infrastructure as it is a duty of care towards our front line in the US.

Extreme burnout is not foreign to any international aid worker, including myself. Although at one point it revisited me on occasion, I, like a number of my aid colleagues, addressed it proactively and it no longer affects me like it once did.

It has been said many times that this pandemic is not a sprint, but a marathon. Marathon runners invariably hit what is known as “the wall”, the point at which exhaustion stretches them to their very limits.

The best runners train to the push through this wall in order to reach the end-line. But if we ask our front line workers to do the same, we may be pushing them, and our public health system, to breaking point. – Sabs Quereshi

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