Coronavirus (COVID-19): Press Conference with Shekhar Saxena, 05/12/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Shekhar Saxena, professor of the practice of global mental health at the Department of Global Health and Population. This call was recorded at 11:30 a.m. Eastern Time on Tuesday, May 12.

Previous press conferences are linked at the bottom of this transcript.


SHEKHAR SAXENA: I’m pleased to be joining this media briefing. I would like to begin by saying that the Harvard T.H. Chan School is very well known for research as well as for policy advice. And you can see the name in many media channels and in many news reports and on givings. But today, I would like to brief you on an initiative that is on the practice of public health, directly assisting a segment of population that is very critical for public health. I refer to, as Nicole has said, frontline health care workers, doctors, nurses, your professional technicians and many others.

While all of us have been asked to stay home, these are the people who have been asked to go to the frontline and spend not only their routine hours but also extra hours. Some of them are doing 12-hour, 16 hour shifts. And these people are under tremendous pressure for work also, and sometimes in situations when they could possibly bring harm to themselves in terms of infections. The initiative that I refer to is called First Responders First. This is an initiative founded by the Harvard Chan School of Public Health with Thrive Global and Creative Artists Agency and many other organizations, including J&J and many others, have joined in as partners.

We established it just six weeks ago, and the objective is to protect and promote the mental health and wellbeing of frontline health care providers all over the world. Obviously, we have begun much more by assisting people within the US. What do we do? We have essentially been able to do a [INAUDIBLE]. That means with the help of Creative Artists Agency, we have been able to have a number of celebrities talking about the mental health and well-being of frontline workers. We have also been able to collect donations in terms of cash and in-kind. And some of the donors have invested a lot of money to seeing the situation at the front lines.

And we provide assistance, very practical assistance in terms of providing PPE in hospitals, in areas where there is a need and a scarce availability. We have been able to provide child care when healthcare providers did not have any. And they certainly don’t want to take the risk of folks having their children being infected. And hotel rooms where the healthcare providers did not have the flexibility to go home because they were distant or were scared that the family members may get infected. These are practical assistance. But on the mental health and wellbeing side, we have been able to provide resources which are online to help everybody who is under stress, who’s facing anxiety, sometimes even going on to anxiety and depressive disorders which are very direct and frank. And these are online resources. Some of them are called micro steps, which don’t take much time. But if practiced routinely, they can actually be extremely helpful for decreasing the stress and anxiety right in the middle of the working hours.

And also self-care, because we do believe that health care providers need to help themselves before they can help others. And that is a very large problem because the provider side is spending a lot of time and effort in helping others. And sometimes they forget that their own health, including their own mental health and wellbeing, is equally important, because if they’re not looking after that, they’re their efficiency at work and their own health will be in danger.

So by helping people who are the frontline, we’re not only helping them, but we’re actually increasing the efficiency and effectiveness of the healthcare system that they’re part of. I would like to also say that although the initiative has begun as a response to the crisis that we are all facing because of COVID-19, but the objective is medium and long term, because even before the crisis, health care providers were under pressure and this pressure obviously has increased a lot. But something needs to be done which is more sustained, which is more enduring to look after the mental health and well-being of these populations. So we have plans to continue from the relief to the recovery phase and hopefully this will make a distinct difference.

MODERATOR: Thank you, Dr. Saxena. First question.

Q: Hi, Dr. Saxena. I wonder if you could talk a little bit about the numbers of people you’ve reached so far. And I realize this is a new initiative. And also, are are you using this at all to conduct research and understand the problem of mental health among frontline health care workers as well?

SHEKHAR SAXENA: So thank you very much for the questions. Yes, it is a new initiative. So we are gathering information as we are going ahead and we have some numbers about the kind of about the number of people who have been helped.

But we are collecting the data as we are going. We have been able to provide child care for more than 120 parents over a period of many weeks. And that initiative does continue. We are looking at the areas where the need is very high and we are working with Bright Horizons, wonderful partners to establish and run the childcare facilities. We also have a partnership with Marriott, who is providing hotel rooms for in areas where the need is very high. And we have been able to marshal a couple of thousand to rooms for people who are in need of that. And a large number of them have actually been used. We are able to provide PPE to the extent of more than 50000, PPE is going to the areas that are needed. And we are also expecting more PPE to come in, although the demand for that has decreased a little bit in the last week or so.

But what I would really like to say is that after these initial practical assistance have been managed, to some extent, we are now hearing that the mental health and wellbeing needs are at the top of the mind for the healthcare providers and also a very major concern for health administrators and the hospital management people. And we are increasing the amount of resources, the variety of resources that we have online. And and that is being updated almost every day. And we are working with J&J to start strengthening those.

And we are also providing links where our own material is not enough. And we believe that hundreds of thousands of people are accessing these links and are using them. Your question was also on research at this time. We are not doing of our own research because we are too busy looking after the needs as we believe there are.

And we are getting a lot of feedback from many, many health care providers themselves and administrators as to what the needs are. But we do have plans for systematically assessing the needs that are coming out. We are in touch with many nursing associations to use their data that they already have, but also to institute some quick surveys by which we will be able to get some more data about what kind of full needs are there amongst nurses especially, but also many other healthcare providers sorts action comes first. But research and evaluation of the program that we are running is going to follow very soon. Thank you.

Q: Thank you.

MODERATOR: Next question.

Q: Thank you so much for the session. As always, the Chan School sessions have become part of my COVID fixture. So thank you for that. I’ve learned a great deal. And my question is related to Al’s and I should specify ahead of time. This isn’t for a story yet. So this is off record or whatever. It’s not for attribution in any way. It’s more just I’m I I did a story well before the this pandemic crisis on compassion fatigue. And so my interest is drawn back to that. And I’m just curious if we have any sort of diagnostic data in terms of how, you know. And again, I understand, you know, you just said. I mean, the reason you haven’t had time to conduct research yet with good reason. But just even if you can speak in generalities of how serious we think a mental health crisis amongst first providers could well be in the coming months and years.

SHEKHAR SAXENA: Thank you very much. There have been data even before the crisis began. For example, a very systematic search of literature amongst people who have conflicts and disasters showed that the incidence of mental disorders is five times in that population compared to the general population. Now that is about general population, not about health care providers, but also very distinctly in the last few weeks, a number of articles have come up with research or at least a quick research on the health care providers as to the kind of problems they’re facing in terms of mental health.

And it turns out that the vast majority of them are feeling stress and symptoms of anxiety. And about 30, 40 percent of them are having symptoms, which could actually be indicative of an anxiety and depressive symptoms, which is sufficient to affect their mood, their thought and their working, which is much larger than what one would expect in normal times. And we also know here that at least about between 5 to 10 percent are disabled because of these feelings of anxiety. And they’re finding it very difficult to work. Some of them are leaving work, actually, because they just cannot handle the kind of mental health and wellbeing problems that they’re facing, especially with the overwork that is happening.

We’ve all heard the stories about self-harm, which are very, very unfortunate. Whether it is more than what could be expected, we do not know because we do not have the data for that. But certainly these are red alerts or red flags that are coming up and we are going to very systematically examine that. You also referred to the compassion fatigue. And that’s the problem that we are hearing, that the situation at work place is so demanding in terms of compassion. And I give you an example, many of the nurses, the doctors are actually looking after people who are very seriously ill and in many cases are dying. And there’s no family member around because of isolation. And they are the sole providers of any kind of reassurance or any kind of advice to people who are very, very sick. And that takes its own toll on the mental health and well-being of the people doing it. Hour after hour, day after day, it really requires a lot of resources, internal resources.

And the resilience of these people is being tested all the time. I’ll also just make a related point that health care providers are especially reluctant to take help themselves because they are always in the mindset of helping others. So they don’t have the inclination even to realize that they are undergoing so much stress and to seek help and to receive help. They sometimes feel that it is not fair. It is not just for them to spend time on seeking help themselves. And that is a mindset that we are studying more seriously because that’s a big barrier in providing the kind of care and support that some of these people need very urgently.

Q: Thank you.

MODERATOR: I have a couple of questions. And so as media relations manager, periodically, I don’t get and receive emails from other organizations and other people. In fact, you have been interested in contributing to this effort. And I was wondering if there’s also been an outreach going from First Responders First to other organizations or other countries even to help them deal with the same issues that their health care providers have been addressing. Have you? Do you know of any sort of outreach such as this or other organizations modeling themselves after this one?

SHEKHAR SAXENA: That’s a very good question, because as I said, our objective is global, although we are beginning with the US, but we already have works. But let me also say that we have about twenty-five organizations as partners in either implementing of a program or as donors and supporters. So, for example, AmeriCares is a large organization that we are partnering with them and they have a very large number of programs and we are assisting them in making their mental health and wellbeing much more suitable to the kind of population that they are serving. But we also have for now outreach to countries outside the US. And we are talking to some of the healthcare providers in Uganda and Kenya, in Africa and also in India, so that we can try to understand better in some of the environments and settings where the problems are to some extent similar, but also a scarcity of resources.

Even the practical resources is much less so. Maybe the pressures that health care providers are facing in these countries is going to be quantitatively much larger. And the kind of assistance that we can provide remotely or in some cases using their local resources is sometimes going to be even more difficult and sometimes different than what we are experiencing in us. So we’re on the job and hopefully we will make more progress there. I just want to add that the small mental health problems well, there is still very large. But still people who are coping up reasonably well. But we do we want to increase their resilience, are able to be helped by online assistance, for example, micro steps. But some people who are facing much more severe issues have to be coached or assisted one to one. Even that is possible using remote methods. And we’re tying up with certain online health providers so that we can provide that kind of more intensive help. And we have a collaboration going on now with a couple of organizations which are going to provide free services, even if they’re in with more intensive.

MODERATOR: Next question.

Q: Hi there. I wonder if you could talk a little bit about how you are viewing the current move- it seems like virtually everywhere – to reopen society. I recall several weeks ago other folks talking about reopening in more of an abstract sense. And one of the things I recall thm saying was that it should happen when cases were low enough so that health care providers could take a bit of a breather. And I’m not an expert in any of this, but it seems that we’re not, cases aren’t quite low enough yet to allow that breather. Are you concerned at all that the workload may, in fact, increase with reopening or I just wonder what your thoughts are about the next phase that we all seem be moving into.

SHEKHAR SAXENA: [00:17:58] Thank you very much for your questions. I also must admit, just like what you did, that I’m not an expert in this, actually. And there are many other people within the Harvard Chan School who will talk much more authority about it. But seeing it from what my colleagues thinks, opening up is a balancing act. And the opening up should be done carefully so that the risks are minimized.

But yes, you’re right, that opening up will have some pressures on more people getting infected and acquiring the kind of health services which are much more intensive. So the risk that the health care providers can be facing either continued high pressure work or will get into what sometimes has been called a second wave of infection, which many other countries are facing is the real risk. And that has to be watched against so that you’re not overwhelming the healthcare system and the healthcare providers.

I must also add one more thing, that it is not that every area of a country or every country for that matter is in the same state, because there are areas where the pressures on health care system has been extremely high. Worse is that other areas where actually hospitals don’t have patients. So that has to also be to be taken to account as you make policy decisions about opening up restrictions and keeping a watch on the infection rate, but also the pressures on the healthcare system locally within the area, because that’s very important.

Q: Thank you.

MODERATOR: I have a question kind of following up on that. So some of the experts, your colleagues at the school have mentioned that there’s likely going to be a series of waves going through 2022 which is daunting for any of us. And how do you see supporting these health care workers for the next two years if we if we really are going to be going through this for another two years? Are there special resources that you think will be necessary for that?

SHEKHAR SAXENA: Absolutely a very, very good question, a very important one, because we believe that the impact on the mental health and well-being of healthcare providers is going to be long lasting. And there are immediate but also longer term needs that that have to be met with. We are getting ourselves prepared for that kind of long run. And we want to establish partnerships so that we have the kind of resources that will be needed for doing that. We also believe there is a responsibility of the health administration, administrators, and health management managers to actually keep this very much in their minds as they’re planning for the health care services to continue to have the kind of law that will be there. We also have another risk in mind seeing that the situation of health care providers is particularly alarming at this point of time because of this pandemic.

We believe there will be a downside risk for people taking early retirement, people getting burnt out and leaving the workforce. And also some students who were thinking of joining the work steam for health care providers training, deciding not to do that. And that, as we hear from the associations, is a real risk. And we want to really start thinking long term to see how can we provide not only to support that health care providers need right now, but also create an environment where they feel supported and they take pride in the work that they do. So that future students will have more inclination to join the work stream for health care provision and will feel rewarded, will feel valued so that there is not a dearth of manpower coming into these these work streams.

And that is a concern that we have and we have heard and we want to assist organizations that are responsible for these things to create that kind of environment. We believe that the Harvard Chan School has a responsibility to look after the longer needs of health care systems as a public health challenge. And we are willing to play our part in that.

MODERATOR: Thank you. I had another quick question. So you’ve talked about all the amazing things that this initiative is already doing. Are there gaps that you see that the initiative could be filling? Are there areas that you think that the initiative could help the mental health of first responders, opportunities you see that you could move into?

SHEKHAR SAXENA: Absolutely. In fact, we are just scratching the surface of what we believe is a very, very big problem. So we have many partners, but we need more partners. We are talking to many hospitals and and give provider associations what we need much more. And I think even within us, the need is much, much larger than what we were able to do. Globaly, we are just beginning. So we would like as an internationally inclined school, to actually reach out to many countries where we need to understand what is happening and to be able to have resources which are able to help with them.

And in that direction, we would like to make partners outside the US and talking to governments, talking to public health schools and civil society organizations so that we have a much larger teams and collaborators so that we can really function in a manner that is very much needed. Eventually by the work that we’re doing, but also by the evidence and information that we will collect, we would like policymakers to more fully understand that this is the time, that they need to open their eyes to the primacy of public health in public policies and to safeguard the interests of public health organizations in keeping our societies healthy and safe. That is the ultimate objective and we are far from even visualizing what is needed on that direction. Thank you.

MODERATOR: Alright. Looks like that maybe it. And Dr. Saxena, did you have any final words before me end the call?

SHEKHAR SAXENA: We would like, as I was saying earlier, to have more partner. So if there are any additions, we would like to hear about them. And if there are any other ideas that any one of you have so that we can serve the constituency that we are trying to serve better, please feel free to contact us. And we will be very keen to hear your thoughts and suggestions. Thank you.

This concludes the May 12 press conference.

Nancy Krieger, professor of social epidemiology in the Department of Social and Behavioral Sciences, and director of the interdisciplinary concentration on women, gender, and health (May 11, 2020)

Michael Mina, assistant professor of epidemiology (May 8, 2020)

Yonatan Grad, the Melvin J. And Geraldine L Glimcher Assistant Professor of Immunology and Infectious Diseases (May 7, 2020)