Feeling like Cannon Fodder – researching the challenges of frontline doctors in the response to Covid-19

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By Dr Liz Jenkinson, Senior Lecturer in Health Psychology and Co-chair of the UWE Bristol Healthy University Group

With a new variant pushing healthcare capacity to its limits, understanding the challenges of responding to Covid-19 on the frontline is pivotal. As a Health Psychologist, I am driven to inform and develop evidence-based policy and practice in healthcare. I have been working with Jo Daniels and Sophie Harris at the University of Bath, Edd Carlton (University of Bristol/Royal College of Emergency Medicine) and Tom Roberts (North Bristol NHS Trust/Royal College of Emergency Medicine) to capture the scale of the challenge faced by healthcare professionals responding to the pandemic. Despite the popular media narrative of healthcare workers being our Covid-19 heroes, our research documents that many simply do not feel that way in terms of how they are being supported. The research highlights how frontline healthcare workers are angry at being treated as ‘Covid cannon fodder, not Covid heroes’ after responding to the virus for nearly two years.

‘It’s been ugly’: A large-scale qualitative study into the difficulties frontline doctors faced across two waves of the COVID-19 pandemic’ is the first study of its kind to capture the views of over 1,300 doctors in the UK and Ireland responding to Covid-19 since early 2020. The study was published in the International Journal of Environmental Research and Public Health this week and featured in the Sunday Times, BBC news and beyond.

Despite working at ‘100% capacity, 100% of the time’, the frontline healthcare workers told researchers of their frustrations at those not following public health advice, and towards Government for ‘failing in so many ways to support us.’ Doctors said they felt ‘expendable’ and left traumatised by events. The dual issues of a worrying lack of support for doctors’ basic needs (e.g. insufficient places to rest, food to eat, and relentless shift patterns), and a significant lack of appropriate psychological support to help them decompress was also highlighted.

Participants recruited for the study comprised frontline doctors who worked in emergency medicine, anaesthetics, and intensive care medicine in all parts of the UK and Ireland. All genders, ethnicities and seniority levels were represented in the sample of 1,379 participants who responded to a longitudinal survey asking them to answer freely: ‘What has been most difficult about the pandemic?’

Clinical psychologist at the University of Bath, Dr Jo Daniels, explains: “We are seeing increasing levels of staff attrition, absenteeism, poor psychological health, and loss of life, yet frontline doctors are expected to just carry on.”

These findings build on recent work, including the CERA study, which sought to quantify psychological distress experienced by emergency doctors during Covid-19, and the Covid-19 Clinician Cohort (CoCCo) study model, which highlighted a hierarchy of needs for frontline workers responding to the pandemic. These ranged from supporting workers’ basic needs with hot food and drinks, through to embedded peer support, psychological care, and interventions. The team say it is imperative policymakers learn lessons from this study as they respond to the impact from the latest Omicron variant.

Dr Edd Carlton, Professor of the Royal College of Emergency Medicine and Emergency medicine doctor, co-authored the research. He said: “This work demonstrates the massive impact the pandemic has had on our frontline medical workforce in terms of working conditions, morale and psychological distress. What is most worrying is that Covid-19 has compounded issues that were already commonplace pre-pandemic and now are putting a tangible strain on doctors’ own physical and mental health.”

My work at UWE Bristol continues to collaborate with the team, bringing my expertise in Health Psychology into this space. We are very grateful to those who gave up their time to tell their stories, which were striking in their agreement that this had been unrelenting, traumatic and had placed unsustainable pressure on frontline doctors. As we move into what may prove to be yet another wave of the pandemic, this research shows that there needs to be a renewed focus on properly supporting doctors to protect their health and wellbeing so that they can be there for all of us when we most need them.

Read the academic paper here and click here for an animation based on Covid-19 healthcare research.

The impact of lockdown on body image and eating behaviours

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By Dr Helena Lewis-Smith, Senior Research Fellow, and Sharon Haywood, Research Associate, from the Centre for Appearance Research

Lockdown has changed our lives in unprecedented ways. Not only has it transformed how we study and work, but it has also impacted how we socialise. Social media usage has soared to new heights, helping us feel less isolated, but could spending more time on your favourite social media site bring negative effects?

Long before lockdown, researchers from various countries established that a significant link exists between social media use and body dissatisfaction and disordered eating. Since lockdown, the message of “bettering” ourselves has been persistent, bringing with it a surge of diet and fitness tutorials, usually featuring “ideal” bodies. Past research has shown that the popular social media trend of “fitspiration”—intended to inspire people to exercise—can lead us to compare our bodies with those we see online, which can then increase body dissatisfaction, so this heightened pressure to be healthy might actually be counterproductive to our well-being. Adding to these demands is Covid-related fat-phobic content, such as memes about pre- and post-lockdown bodies, making us feel ashamed if we’ve gained weight. When we combine all these factors, it’s unsurprising that early research has identified adverse impacts on people’s eating behaviours and mental health.

Researchers in Australia found that since lockdown began, adults in the general population reported engaging in more dieting behaviours and binge eating. They also found that individuals with a history of disordered eating were particularly vulnerable to maladaptive changes to their eating and exercise habits. In the US and Netherlands research revealed that people with an eating disorder are facing greater challenges in moving towards recovery. Not only did they report worsening of their symptoms, but they also noted increases in anxiety and concerns related to their overall mental health.

Collectively, this early research highlights the importance of providing psychological support to individuals with disordered eating or a diagnosis of an eating disorder (past or present). For those struggling with this, we recommend contacting Beat, the UK’s largest eating disorder charity, which provides free support to anyone affected by disordered eating. Here at UWE Bristol’s Centre for Appearance Research (CAR), we are currently running a study to explore the impact of lockdown on recovery from an eating disorder or disordered eating to help inform knowledge of what support might be helpful. Although recruitment is presently on hold, additional participants may be required. If you (or someone you know) is interested in taking part, please add your contact details here.

Even though it seems that lockdown is coming to an end, the possibility of a second lockdown later this year is possible, so here are some tips on how to cope with body image and food wobbles—that you can also put to use when not in lockdown!

  • Avoid getting pulled into comparing yourself with others on social media. While it’s completely natural, it just makes us feel worse. Diversify the content you’re following so your feed contains a wide variety of body types and messages that promote self-acceptance.
  • Avoid viewing and sharing Covid-19 weight-shaming memes. Not only does it stigmatise larger bodies, it may also trigger negative thoughts about your own body.
  • Practice self-compassion. Difficult emotions are part of the human experience. Treat yourself with the kindness and patience that you would someone you love.
  • Remember that it’s natural for our bodies to change throughout different stages of life and when our routines change. Be kind to yourself if you’re eating due to stress, loneliness or boredom – this is a challenging time! Consider other ways to self-soothe, such as reading, going for a walk, or calling a friend.
  • Engage in movement that you enjoy and adjust your expectations about exercise. Instead of exercising to compensate for more sedentary behaviour or changes in eating habits, focus on engaging in physical activity that stimulates your mind and body. For example, you might want to play rounders with some friends, go for a walk with family members, or do an online dance class.
  • Appreciate what your body can do. Rather than focusing on what it looks like, shift your attention to the functionality of your body. Think of all the amazing things your body allows you do: Perhaps it’s playing football with your kids, taking in the fragrance of your favourite flowers, or restoring itself with sleep.

For more tips and strategies, listen to CAR’s 49th Appearance Matters podcast episode Managing Body Image and Food Wobbles During Lockdown.

Photo credit via Instagram @Meg.Boggs (www.megboggs.com)