At the Epicenter of COVID-19

How a Duke professor helped front-line medical workers across the world in Wuhan

As the COVID-19 crisis began to emerge in Wuhan, China, a Duke psychiatrist and her colleagues banded together to provide immediate mental health support to their front-line colleagues from the other side of the world.

Dr. Wei Jiang, who leads the neuropsychocardiology laboratory at Duke University Medical Center, helped organize a volunteer group of Chinese-speaking mental health professionals from the U.S., Canada and Australia. She spoke about the program, its challenges, and the lessons learned about providing mental health support via mobile apps, in a virtual presentation to digital health professionals on May 25. Here are excerpts of her remarks:

Dr. Wei Jiang Jiang: “Because of the huge flush of cases in Wuhan, all the hospitals were overwhelmed and the central Chinese government had to inject more than 40,000 physicians and nurses and respiratory technicians to that city, and those people could not travel back home. So their life was taking care of a patient, and then living in a hotel worrying about what's happening with their family members and with their own health … So even if they are not infected with COVID, just the stress brought to their body would create a lot of inflammatory process and lots of immune suppressive processes.”

How the effort came together:

Jiang: “We felt like those health care providers’ stress is too high, and we would like to help them to get through the most difficult time, and we started a group to provide peer-to-peer mental health support. … Several of us who wanted to do so already had an organizational group together, and a good amount of people followed up to respond to the call. And then we defined the criteria to be part of it, that people have to be trained as mental health providers.”

The 35-strong volunteer group comprised psychiatrists, psychologists, clinical social workers, professional counselors, mental health counselors and registered nurses. They teamed up to provide coverage for 16 hours a day.

Jiang: “We decided to have each shift to be two hours, and then we preferred to have at least two members to sign up for the shift. So those two people will be primarily responsible for that two hours of the service, and our other people if they have time, they can also log on to this platform.”

The counselors used WeChat, a mobile messaging and social media app with more than a billion users in China.

Jiang: “The first principle is do no harm. And we kept strictly with confidentiality. The people who get online talking to us, they do not have to use their real name unless they wanted to. This is a strictly peer-to-peer support, we're not like a clinician who is out there treating diseases. We made the system very clear that this is short-term crisis support, and there is not any thought that we would move to a longer relationship.”

The counselors used a combination of approaches to help their peers.

Jiang: “We wanted this to be a multidisciplinary treatment, we didn't want it just to be a psychiatrist or psychological counseling, so we included a social worker and some school counseling. … Our goal was to restore their baseline function. We didn't think any of those health care providers had a significant mental illness that would prohibit them from delivering frontline COVID management. But because of the humongous stress and uncertainties and unfairness, a lot of them were stressed out. We just wanted to help them to cope with the current of stress, which was unusual, but to which their reaction is normal. We worked with them to get back to their baseline function as fast as they can.”

The counseling group noticed providers going through a series of emotional responses to the pandemic, akin to the stages of grief, but with extra steps. They noted 10 in all: Bewilderment, shock, anger, anxiety, burnout, desperation, acceptance, hope, recovery, and an aftermath.

Jiang: “The shock was coming from that all of a sudden, the entire city was completely shut down, followed by the entire country. People were so scared, and they rushed into the hospital and now the hospitals were over-jammed. And then the health providers started getting infected because they were not ready. They did not know how to cope with such a profound infectious disease. … Then they went into anger, anxiety and desperation, feeling a lot of burnout symptoms when they were working extra-long hours.”

The team found some cultural challenges in getting people to open up about their stress.

Jiang: “The characteristic of the people in China, generally speaking, is more conserved, it's not outgoing and chatty like we are in America. So to have them engage with us took some time. And in China, starting from very young age, you are told that you have to sacrifice yourself for society, for other people. So they have a lot of emotional and physical burnout, but in their mind, their superego is still telling them that they must do for others.”

Jiang said the effort showed large-scale mental health support via mobile app can work in similar situations in the future.

Jiang: “We really could build up more electronically-based and electronically delivered mental health support services, either to health care providers or to patients. … Lots of materials actually already exist online, but not in an organized way, and not instructive.”

About the expert:
Wei Jiang is a professor of psychiatry and behavioral sciences and a professor of medicine at the Duke University School of Medicine. She studies how the mind and brain intersect with the cardiovascular system and how to mitigate the negative effect of emotions on that system.