Doctors felt like 'Covid cannon fodder'

Psychologists and experts in emergency medicine have been involved in a series of multidisciplinary studies exploring frontline doctors' mental health and experiences of Covid-19 over the course of the pandemic. Dr Jo Daniels, Senior Lecturer and Clinical Psychologist at the University of Bath and principal psychologist in the research team, then went on to lead the development of an evidence-based model of psychological care informed by doctors' experiences.

The research team's first study, called CERA, was led by the Royal College of Emergency Medicine Trainee Emergency Medicine Research Network (TERN). It used a longitudinal design to follow the experiences of doctors working in emergency medicine, anaesthesia and intensive care during the first wave of the Covid-19 pandemic in the UK. Analysis of the survey results from the start of the first wave of Covid-19, which heard from more than 5,400 doctors in the UK and Ireland, found that just over 44 per cent were experiencing psychological distress. 

Results from the later phases of the first wave found that distress (measured with the General Health Questionnaire (GHQ-12) was highest while the virus was accelerating, declined slightly to 37 per cent when the first wave reached its peak, and declined to 32 per cent towards the end of the first peak. Levels of trauma in the sample were 23.7 per cent during the first wave peak and 17 per cent as it began to decelerate. In January 2021, during the second wave, further surveys found that both trauma and psychological distress had increased to levels higher than during the first wave.

These initial studies led researchers to qualitatively explore the best ways to help clinicians by asking the doctors involved in the CERA study about the worst aspects of working through the pandemic. Daniels, who led a team including psychologists Dr Liz Jenkinson, Sophie Harris and emergency medicine colleagues from TERN, said the results were 'deeply disturbing'. Doctors spoke of feeling like 'Covid cannon fodder' rather than heroes, and said they had felt unprotected from the virus. Some said they felt the government and NHS trusts were not supportive of frontline workers and many pointed to the overwhelmed system in which they were working.

Daniels and colleagues have been working with input from doctors and national experts, creating the Covid-19 Clinician Cohort (CoCCo) model of wellbeing, which Daniels reported as 'grounded in evidence and led by what doctors actually wanted'. The model emphasised a need to provide doctors with the basics first – places to sleep and rest and access to hot meals. It suggested that clinical settings should have visible and compassionate leadership, good communication, and access to destigmatising information. The model emphasised that the reactions to trauma which some doctors have experienced should be normalised and acknowledged. 

The model also suggested that support for doctors' wellbeing should be embedded into clinical teams, for example by introducing peer support, providing opportunities for staff to reflect and access to a known psychologist. Finally, the model acknowledged that some staff may need further support and suggested that any psychological interventions should be tailored to an individual's needs and the unique demands of frontline working. 

After speaking with us, Daniels was back in touch to add: 'I've just found out that I have won a UKRI Policy Support fund so that I will be seconded to the Royal College of Emergency Medicine to develop policies and services around doctors and their wellbeing – hopefully pushing forward some of the work I have been doing. Exciting stuff!'

Animation about the CoCCo project 

Open-access paper on the CoCCO project  

Open-access qualitative paper on doctors' experiences during the pandemic