Mental health advice for frontline healthcare providers caring for patients with COVID-19.

To the Editor,

Since coronavirus disease (COVID-19) was first reported,1 anesthesiologists, intensivists, and their healthcare teams have been at the forefront of the fight. Published guidance has focused on the protection of these teams from infection and physical harm.2 There is much less information to inform the protection of our teams’ psychological well-being. At the best of times, working under pressure in stressful occupations leads to exhaustion. Interventions that minimize fatigue, burnout, and medical error will improve the care of COVID-19 patients and their healthcare providers, alike.3 All healthcare workers must work together to enact effective strategies to promote psychological well-being.4 We base the following suggestions on our experience with COVID-19 in Iran:

Sleep sufficiently and efficiently. You need rest to recover from today and prepare for tomorrow.

Eat well, at least three times a day. You need fuel for the long and difficult work ahead. Now more than ever, do not let the day’s work make you skip a meal.

Maintain contact with your colleagues. Working with patients in isolation also isolates their healthcare workers. Share information and personal stories. Care for each other.

Share decisions with your colleagues. Use their skill, experience, and support to guide you in the challenging diagnostic and therapeutic decisions you will make.

Constantly update your knowledge. Information regarding COVID-19 grows and evolves rapidly. Develop an information-sharing network with your colleagues. Knowing you are providing the best possible care will ease your stress when patients suffer poor outcomes.

Maintain contact with your family and friends. They worry about your health as you worry about theirs. Call or video chat regularly to support each other.

Make time for your hobbies and daily routine. Listen to music, read a book, exercise. It will lend a sense of normalcy to your day and refresh you for your next shift.

Share your emotions. While patient confidentiality limits sharing the details of your work, you can share how this work made you feel. Sharing the emotional burden of COVID-19 care reduces mental and emotional fragility.

Self-care did not begin with COVID-19. You may have struggled with your physical and emotional health before the pandemic. Ensure that you continue to care for these pre-existing conditions in addition to the new challenges posed by COVID-19. Seek help from your primary care physician and your departmental leadership.

Get help. Reach out to a mental health professional if you are suffering anxiety, depression, symptoms of post-traumatic stress, or suicidal thoughts. Support a colleague in doing the same.

We hope our experience in Iran helps our colleagues around the world weather the challenges of the global COVID-19 pandemic.