DOTHAN, Ala. – Pickens County Medical Center in Carrollton closed the week before Alabama confirmed its first case of COVID-19 in March 2020.
All of a sudden, patients with broken arms and high fevers who would have gone to the emergency room began showing up at the clinic run by Dr. Julia Boothe in Reform.
“We had that on us in addition to now we’re in a pandemic that no one has seen in 100 years,” Boothe said. “You know, we’re trying to manage that without even a local hospital to fall back on.”
Boothe and two other providers at her clinic were among almost 24,000 health care workers in the state who contracted COVID-19 during the pandemic, according to the Alabama Department of Public Health. Workers in hospitals, clinics and nursing homes had some of the highest risks of infection. A joint investigation by Kaiser Health News and the Guardian identified 80 deaths from COVID-19 among Alabama health care workers.
Experts have begun to worry that unprecedented amounts of sickness and stress from the pandemic could hurt the medical field for years to come.
The impact of the virus on physical health is just one part of the picture. Dr. Walter Schrading, an emergency medicine physician and professor at UAB School of Medicine, worked on research that found workers in emergency departments suffered high rates of anxiety, depression and post-traumatic stress disorder.
“We basically see everybody who comes through the door of the emergency department and at some points in the year, the majority of our patients were COVID patients,” Schrading said. “But we would never really know who had COVID and who didn’t. So you sort of had to take the precautions with every single patients. And that led to feelings of stress and anxiety.”
Schrading’s team polled more than 1,600 emergency department workers around the country and found that more than half had at least one symptom of post-traumatic stress disorder, such as nightmares, and 20 percent screened positive for high PTSD risk. He’s even heard stories of workers who died by suicide after becoming overwhelmed by tragedy and stress.
Doctors outside of hospitals faced different stressors. In the beginning, Boothe could not get swabs to test patients with COVID symptoms. Federal agencies sent personal protective equipment to nursing homes and hospitals hit hard by the virus, with little left over for a family practice in rural Alabama. She and two other providers at her clinic became infected with COVID during the late spring and early summer as cases crept up.
“The priority was again, hospitals,” Boothe said. “But our issue was, well, we don’t have a hospital, so we are the first option. But that didn’t work in anybody’s algorithms. Nobody could account for that.”
A poll by the Kaiser Family Foundation and Washington Post found that three in 10 health care workers had considered leaving the field last year. Boothe, who also serves as president-elect of the Medical Association of the State of Alabama, said she hasn’t heard from Alabama doctors leaving medicine, but some have decreased their hours or moved into concierge medicine, where they see fewer patients.
The uncertainty of the last year hasn’t relented. In addition to supply shortages and an influx of patients, Boothe has had higher staff turnover than ever. Employees got burned out trying to balance regular visits with drive-through testing and telemedicine. Providers who could find a rhythm moving from one exam room to the next got disrupted by phone visits and electronic messages piling up from remote patients.
Schrading said his research has found ways hospitals can improve employee mental health in the future by stocking up on protective equipment for potential pandemics, improving testing and access to mental health professionals. Regular testing lowered anxiety levels for workers who worried about getting sick and transmitting COVID to family members.
“The way that we view our positions and our jobs, that’s all sort of changed for some people,” Schrading said. “I still have a very positive outlook for what I do. I felt like I played an important role and all my colleagues played an extremely important role.”
Boothe said she learned to be more flexible with time off to help relieve the pressure on her staff.
“We’ve probably had the most changes in that year for any singular year that I’ve seen before,” Boothe said. “Change was the key word for 2020 and we just kind of kept problem-solving day by day.”
Things have kept changing with the vaccine roll out. Boothe said she never knows how many shots she might receive in any given week, which makes it difficult to schedule appointments. She urges her patients to get vaccines wherever they are available, but some only want to receive treatment at her clinic.
Now she worries about vaccine hesitancy, and how she can convince patients who have resisted for 16 years her annual flu shot pitch.
“I’ve had four patients admitted to the hospital with COVID waiting on a vaccine,” Boothe said. “We’re still in the thick of it.”
