By Kate O’Rourke

According to Elke Van Hoof, a professor of health psychology and primary care psychology at the Vrije Universiteit Brussel, in Brussels, Belgium, and an authority in the fields of stress and burnout, the multiple stresses people are currently experiencing due to the COVID-19 pandemic will result in a secondary epidemic of burnout and stress-related absenteeism in the latter half of 2020.

At a recent webinar of the American Society for Metabolic and Bariatric Surgery, Rachel Goldman, PhD, FTOS, a licensed psychologist and consultant in private practice and a clinical assistant professor in the Department of Psychiatry at New York University’s Grossman School of Medicine in New York City, addressed care for caregivers to avoid professional burnout.

“For the past few months, we have been worried about a world where hundreds of thousands of people were dying,” Dr. Goldman said. “We were worried about getting sick and worried about others getting sick. So much about life as we knew it became uncertain. Maybe if you were a working parent, you also became a full-time employee and full-time home schoolteacher, while protecting your family and perhaps your patients from the pandemic.”


“Pandemic fatigue” describes the intense tiredness and weariness that many people feel, and the irritability and disorientation of not knowing which day of the week it is, Dr. Goldman said. Why is this taking such a toll? For many reasons, but if you are working from home, you also don’t have mental breaks built into your day, you don’t have commuting time or transitions built into your day, and maybe you and your self-care are on the back burner.


A recent review and meta-analysis in the British Medical Journal reveals that in the past 20 years, other viral epidemics have caused psychological problems for health care workers (Br Med J 2020;369:m1642).


“The first research about quarantine in China found it can bring on insomnia, stress anxiety, depression, anger, emotional exhaustion and post-traumatic stress symptoms,” Dr. Goldman said. Preliminary data from China during the COVID-19 pandemic show that 50.3% of health care workers reported depression, 44.6% reported anxiety, 34% reported insomnia and 71.5% reported distress (JAMA Netw Open 2020;3:e203976). In an online survey from Eagle Hill Consulting, conducted in April 2020, that included approximately 1,000 respondents from a random sample of employees across the United States, 45% said they were feeling burned out with one in four reporting feeling that way because of COVID-19.

To avoid burnout, people can take several steps. First, people need to focus on what is in their control, which is behaviors, reactions and how they cope, and not on what is out of their control, which is daily stressors, other people’s behaviors and how other people react. Creating boundaries, checking in with ourselves, self-care, and disengaging from social media or the media in general are all important.

“Self-care” is a broad term that encompasses just about anything you do to be good to yourself. It’s about knowing when your resources are running low and taking a step back to replenish and recharge. ”Self-care is a necessity, not a luxury,” Dr. Goldman said. “Individuals who do not participate in self-care will eventually burn out and not be productive in any aspect of life, personal or professional. We will eventually get sick.”


Dr. Goldman suggested that a good place to start is with our key health behaviors which include sleep, water, physical activity, diet and stress management. “Have a toolbox full of tools that you can pull from. Have at least three stress management tools, one of which is something internal, something that you don’t need anyone else or anything else for,” she said. Your coping toolbox could include things such as cuddling a pet, reaching out to a friend, meditation, listening to music, walking, exercising, mindfulness, breathwork, journaling or turning to a spiritual community. “Check in with yourself on a regular basis. Ask yourself, ‘What do I need right now to be the best me?’ Ask yourself how you are doing with your health behaviors,” Dr. Goldman said. “It’s OK to say no in order to say yes to you and your health.”

Dr. Goldman talked about a “healthy selfishness,” which might seem like an oxymoron, but it is knowing what you need to do and allowing yourself to do it. “Taking care of you and your health is not selfish. The behaviors that we participate in everyday that contribute to our survival are acts of selfishness. The act of eating or sleeping is selfish, but if we didn’t, we wouldn’t survive,” she said. “We need to participate in these behaviors as well as others to be healthy, such as taking time out of our day for us, for ‘me time,’ and to relax or de-stress. These behaviors allow us to be healthy so we can be healthy and available for others.”

Scheduling daily “me time” and making it part of our daily routine is important. Creating breaks throughout the day to rest or recharge are critical, especially during this trying time of the COVID pandemic. Similar to being on an airplane, where you have to put your oxygen mask on yourself before you can help other people, individuals need to tend to their self-care before they can help other people.