番茄社区

It's not uncommon for healthcare workers to encounter patients who still think COVID-19 is a hoax -- even when they have the disease themselves.

Last week, Ashley Bartholomew, RN, cared for a patient in her El Paso, Texas, hospital's COVID ICU who was awake and watching the news. He was the first patient she had spoken to in the ICU, with the other 24 lying unconscious.

"He mentions hating 'fake news.' He says, 'I don't think COVID is really more than a flu,'" Bartholomew this week.

She described to the man the deaths she'd witnessed and the CPR she'd administered that day. "His tone changes, he seems to have understood the gravity of what I'm saying. He apologizes."

Then she just started crying.

In addition to myriad other pandemic stressors, clinicians must care for disbelieving patients while they see continued disregard for masks, social distancing, and other recommendations as part of a . It has all proved too much for some healthcare workers.

Jodi Doering, RN, a nurse in South Dakota, has also cared for COVID-19 deniers. During a night off last weekend, she vented : "I can't help but think of the COVID patients the last few days. The ones that stick out are those who still don't believe the virus is real. The ones who scream at you for a magic medicine."

"They tell you there must be another reason they are sick," she tweeted. "They call you names and ask why you have to wear all that 'stuff' because they don't have COVID because it's not real. Yes. This really happens."

Doering that her vent session was due to "a culmination of so many people. Their last dying words are, 'This can't be happening; this isn't real.' ... It just made me really sad."

"Even after positive results come back, some people just don't believe it," she added. "It's just a movie where the credits never roll. You just do it all over again."

Doering has since suffered backlash for expressing her sentiments -- including death threats, .

A nurse in Washington, D.C., who asked to remain anonymous has been caring for a COVID patient in her hospital's ICU for nearly a month.

The patient's family is irate, demanding to know what their relative is actually suffering from. They have complained about the limited visitation policy and even recorded conversations with caregivers.

"They don't give any evidence why it's not real. They just keep saying it isn't," the nurse told 番茄社区. "It is emotionally and mentally draining."

"I hate being called a hero but we are literally risking our lives to take care of these people," the nurse said. "I always get frustrated watching the news. ... These people have no idea how hard we're working behind the scenes, and for them to discredit that is just heartbreaking."

Psychological Toll

Jessica Gold, MD, a psychiatrist at Washington University in St. Louis, has talked with many similarly frustrated healthcare workers.

Some COVID-19 patients have used their last words to argue with Gold's colleagues about their diagnosis, while others have resisted calling family to say goodbye because of their denial.

Gold calls this conscious denial because patients choose to refute their condition. "This is a belief system and I don't know that it's an informed belief system. I think it's a preyed-upon belief system," she said.

Gold's colleagues don't care what their patients' political or scientific beliefs are; they just want to help them. Still that's "challenging because in some narratives, providers have been painted as the bad guy," she said. "People maybe clapped at the beginning and cared at the beginning, and have turned on us now."

Compound these experiences with the same stressors that everyone else is dealing with, and Gold sees a perfect storm to worsen depression, anxiety, substance use -- and, probably soon, PTSD. Providers, she notes, are already more likely to suffer from depression.

Calling It Quits

Researchers at the University of Arizona's College of Nursing exasperated healthcare workers about this issue. Jessica Rainbow, PhD, RN, is monitoring a voicemail box she set up to capture their stories.

"I hear a lot of hopelessness," Rainbow told 番茄社区. "There really isn't an end in sight, as far as when this will go away. It's continuing to build and they're already feeling so burned out."

Rainbow's respondents feel that not wearing masks shows that the public does not value healthcare workers' lives. They seem to appreciate being able to share their stories. "It's really surprising how often 'thank you' is something that comes across," Rainbow said.

Rainbow is also analyzing data from a Twitter survey with doctoral student Chloe Littzen, MSN, who is separately interviewing nurses under 30.

Some nurses told Littzen that dealing with COVID-19 deniers compounds systemic problems they cannot tackle. "Anything the nurse is saying, patients aren't believing that. They're believing what they hear on the news," Littzen said. "No matter what [nurses] do."

"It's not until a patient is put in the face of death that they start realizing the severity of this," she said.

The frustration is pushing nurses to quit. About half those who spoke to Littzen indicated they are leaving their jobs.

Healthcare workers have been able to sustain themselves because of their training and skill set, Gold said. They are bred to focus on their work and push their feelings down; medical training also prepares them for working long hours with little rest.

But everyone has their breaking point and confronting too many COVID deniers is pushing many of Gold's colleagues closer to that point, she said. That is problematic because the Defense Production Act cannot be used to quickly cultivate more human help, she noted.

Gold is "100%" certain that the healthcare workforce as a whole will start burning out soon if COVID denial does not stop, among other needed reforms.

"Mental health is part of this and physicians aren't robots and nurses aren't robots," Gold said. "If beds are limited, if ventilators are limited, if PPE is limited, so are humans."

Hope may be a saving grace. As Bartholomew transferred her COVID-denying patient via wheelchair to a medical COVID floor, they passed less fortunate patients stuck in the ICU.

"He says one more thing," Bartholomew recalled. "'I saw a lot of the other ones when you were wheeling me out of ICU. It's much more than a flu, I was mistaken. ... I will tell everyone that denies how bad this is about my experiences.'"

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