Combating COVID-related mental health problems: The experience from Wuhan.

Dear Editor

Since December 2019, novel coronavirus pneumonia has spread worldwide. On January 30th, the World Health Organization (WHO) recognized it as a public health emergency of international concern (World Health Organization, 2020a) and officially named it “COVID-19” on February 11th (World Health Organization, 2020b). Given the particularly serious situation in Hubei, the Chinese government had urgently coordinated to establish a working mechanism for inter-provincial counterparts to support COVID-19’s medical treatment and make overall arrangements from 19 provinces to support the 16 cities, prefectures, and county-level cities in Hubei Province. Finally, about 344 national medical teams with 42600 healthcare workers reached to help Hubei province (China Daily Global, 2020).

COVID-19, like the previous pandemic, has caused a significant psychological impact on people, resulting in varying degrees of psychological crisis (Pfefferbaum and North, 2020). In the clinical frontline, the medical staff shoulders the responsibility of treating diseases and promoting the rehabilitation of patients, faces the risk of infection due to having close contact with patients, and also experiences higher occupational pressure in their daily work. Thus, healthcare workers combating with COVID-19 may be in a unique and difficult working environment, which may induce a high level of psychological stress (Greenberg et al., 2020).

Adjacent to Wuhan, Chongqing is one of the four municipalities and the largest city in southwest China. From January 26th to February 28th, Chongqing continuously dispatched 18 teams of 1636 healthcare workers to assist Hubei (CQNews, 2020). As a vanguard to support Wuhan, Chongqing’s medical rescue team not only emphasized COVID-19 treatments but also stressed the importance of psychological intervention for all the members, which achieved good results and became an example for other teams to learn from during the anti-pandemic period.

Wuhan’s successful experience in combating COVID-related mental health problems provided several strategies that can be used as a reference by other institutions and countries. Firstly, early dynamic actions can expand the coverage of public mental health interventions and mitigate mental health challenges. Secondly, digital technology can be a useful tool for providing knowledge and delivering interventions, particularly during the situation of increased social isolation, loss of professional workers, and difficulties in accessing basic necessities and information. The details include:

Before assisting Hubei, Chongqing formed a psychological support group and sent them to the clinical frontline with the rescue team. All medical members received intensive psychological protection training before being assigned to isolated wards. It mainly focused on the possible physical and mental reactions under pressure, ways to cope with these reactions, methods and techniques of self-psychological adjustment, and the way to obtain help and resources.

During the rescue, mental health assessment had become the third-largest health index after temperature and respiratory symptoms. The mental health status of the medical team in isolated wards was screened regularly through Welink, Wechat, and other Internet platforms. The results were initially diagnosed using artificial intelligence that provided automatic suggestions of psychological self-help intervention.

After the rescue, all medical workers required 14 days of self-isolation before they could return to their normal life. During this period, healthcare workers experienced a strong sense of loneliness; some of them constantly recalled the events and negative feelings during the pandemic, such as sadness, self-remorse, sleep problems, uncertainty about the infection, as well as worry and anxiety about returning to normal life. At this stage, the psychological support expert group continued to perform dynamic psychological assessments of the medical staff and provided psychological support and guidance according to their different emotional responses.

After the medical staff returned to their normal life, the psychological support group continued to follow up on their mental health status, focusing on screening for the existence of post-traumatic stress reactions and providing timely interventions.

These measures were currently proved effective. From February 10th to 20th, the team completed the psychological assessment of 13,560 medical staff and found that 1553 had moderate to severe anxiety and depression, as well as suicidal tendencies and behavior. In the following week, all the 1553 people received a one-to-one telephone, video, and offline intervention, and more than 10 suicide crises were managed. Additionally, the team conducted a second analysis of all the previously identified focus groups from March to April. Most people gradually recovered after the psychological crisis intervention, with a 93.3 % improvement rate. However, it still requires long-term efforts, and Chongqing psychological support group has formed a three-year follow-up longitudinal study protocol.

The pandemic has also made us rethink the existing mental health care system, particularly regarding timely identifications and appropriate interventions for the general population and vulnerable groups (Tandon, 2020). Firstly, we suggest that the construction of psychosocial crisis management system and relief system under major public health events should be accelerated, and the resilience of institutions and individuals should be increased (Huang et al., 2020). Secondly, we emphasize the need to attend and support healthcare workers in public health emergencies, which is consistent with the theme of the World Patient Safety Day 2020 “Health Worker Safety: A Priority for Patient Safety” (World Health Organization, 2020c., n.d.). Finally, we should understand that the care for medical staff is not provided by the government or a certain organization, but requires the attention and participation of the whole society. Since the response and impact of the pandemic among nations were different (Tandon and Nathani, 2018), global collaborations and sharing of local experiences are encouraged.

Authorship contribution

All authors have read and understood your journal’s policies, and we believe that neither the manuscript nor the study violates any of these.

Ethical statement

Not Applicable.

Funding

This study was funded by Key Projects of Chongqing Science and Technology Commission Foundation (cstc2018jscx-mszdX0013) and COVID - 19 Emergency Clinical Research Project of Chongqing Medical University (2020−13-19).

CRediT authorship contribution statement

Huanhuan Huang: Conceptualization, Writing - original draft, Writing - review & editing. Jian Zhai: Conceptualization, Writing - original draft, Writing - review & editing. Chunfeng Jiang: Conceptualization, Data curation. Zhiyu Chen: Conceptualization, Writing - review & editing. Qinghua Luo: Resources, Writing - review & editing. Qinghua Zhao: Resources, Writing - review & editing. Mingzhao Xiao: Conceptualization, Resources, Writing - review & editing.

Declaration of Competing Interest

The authors have no relevant financial information or potential conflicts to disclose.