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  • Writer's pictureLilian Chiwera

Thinking of our leadership & front-line colleagues during COVID-19

There is no doubt that the COVID-19 pandemic is causing so much anxiety as most of the ‘world’ is coming to a standstill due to several social distancing and lock-down measures being enforced by governments. These measures are aimed at reducing the spread of the deadly coronavirus and consequently flattening epidemic curves and hopefully reducing the number of people dying (UK updates and Global picture). A lot of healthcare staff and volunteers, as well as public services staff keeping essential work going are giving it their all. And yet we acknowledge that at some point, all of us will feel the pressure. I’m saddened to learn that some of our leaders including our United Kingdom (UK) Prime Minister, have the virus or are experiencing symptoms. I wish them all and everyone who is currently unwell a speedy recovery. I am praying for our political leaders across the globe, those in key strategic leadership positions in the National Health Service (NHS), NHS England & NHS Improvement, private sector, Public Health England (PHE), World Health Organisation (WHO) and many other global Healthcare Leaders. People in leadership positions carry a huge burden and are often required to make those key decisions timely which is not always easy in crisis situations.

Decision making alone elicits a stress response, let alone decisions made under pressure. A paper by Starcke & Brand which explores decision making under stress couldn’t be more explicit. At a time like this, love, sensitivity and compassion towards our leaders in key strategic positions will go a long way in boosting their decision making skills as they are human beings just like us all. These attributes should of course be extended beyond those in leadership positions. As an example, it’s easy for us Infection Prevention & Control (IPC) practitioners to tell people what to do and possibly ‘get annoyed at staff who consistently ask the same simple infection control questions’. What we don’t tend to see (my own experience) is how stressful frontline care can often be especially during pandemics like COVID-19. There has been several discussions on Twitter 1, 2 on what constitutes the correct personal protective equipment (PPE) for various procedures and which procedures are considered as aerosol generating procedures (AGPs). These discussions demonstrate increased anxiety among frontline staff. But this tweet which suggests that working calmly and precisely can reduce the level of anxiety that people may experience, also highlights the key role IPC practitioners can play through training and reassuring staff into this mindset. The Healthcare Infection Society (HIS) recently shared updated COVID-19 guidance via Twitter, accessible via this link. All staff are expected to follow these evidence based guidelines; with support from IPC experts and should also use their clinical judgement accordingly when deciding which PPE to use at any given time. I personally think that we should be showing more compassion and understanding and be more willing to support staff not only from an IPC expert perspective but with due consideration for staff anxieties at this time. I like this idea from Gloucestershire NHS Foundation Trust IPC team of using PPE Safety Officers to support front-line staff.

There is nothing simple or basic about IPC expectations in complex pandemic situations where there is an interplay of various human factors. The stress on front-line whose usual instincts are always to save a life, reassure patients and families can be overwhelming and here’s why:

1. It’s not always possible to hold a patient’s hand and offer reassurance

2. With social distancing also comes visiting restrictions to reduce risk of COVID-19 spread

3. Staff must wear AGP PPE before commencing Cardiopulmonary Resuscitation (CPR)

My brief return to the front-line last week was an eye opener and an emotionally draining experience. I have taken time to recover and am now ready to go back. I look forward to giving it my all, caring for those who need us right now. I will follow the correct PPE guidelines, watch out for and support my front-line colleagues; I know they will do the same for me.

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