Defining effective strategies to prevent post-traumatic stress in healthcare emergency workers facing the COVID-19 pandemic in Italy

To date, the number of confirmed COVID-19 cases exceeds 215 000, with a death toll exceeding 30 000, over 23 000 HCWs being infected and 161 of them—130 physicians and 31 nurses—losing their life to complications of the infection. [...]specific characteristics of COVID-19 added further burden: rapidly increased flow of critical patients forcing physicians to make extremely difficult decision tainted with pervasive helplessness; clinical presentation characterized by severe distress, rapidly worsening dyspnea with insidious and unpredictable course, requiring constant medical updating with worldwide emerging multiple clinical manifestations and treatment of the COVID-19 infection increasing distress at the time of patient’s death; constant need for complete isolation during patient care, both for the patient and the providers, given the extremely high contamination risk, and the shortage of protective personal equipment that lead to fear, anger, and resentment against the authorities. [...]the systemic impact of the disease and its social repercussions also included: rapid and sometimes chaotic reorganization of services and logistical challenges for recruiting new emergency departments and intensive care unit (ICU) personnel, both to managing the increasing number of patients and to substitute HCWs becoming ill; introducing unskilled HCWs in highly specialized units, leading to feelings of frustration, isolation, hopelessness, and irritability; lack of social support at work; the need to work with new colleagues or redeployed strangers; lack of social support at home with schools closures and children confined at home; fear of infecting family members leading to further isolation.