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Each COVID-19 surge poses a risk for health-care workers: PTSD

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ICU registered nurse Pascaline Muhindura wears PPE as she works at Research Medical Center amid the coronavirus disease (COVID-19) pandemic in Kansas City, Missouri, U.S., in this undated handout photo.    Pascaline Muhindura/Handout via REUTERS
Coronavirus disease (COVID-19) ICU nurses display tattoos they all got to commemorate their bond as frontline workers and the people they have lost, at Providence Mission Hospital in Mission Viejo, California, U.S., January 8, 2021. REUTERS/Lucy Nicholson

Nurse Chris Prott's knees jump, his heart races, his mouth goes dry and his mind floods with dark memories when he talks about working in the Milwaukee VA Medical Center's intensive care unit (ICU) during pandemic surges, writes Lisa Baertlein.

Prott shares a struggle common to many of the military veterans for whom he has cared for years: symptoms of post-traumatic stress disorder (PTSD).

Prott was among a half dozen ICU staffers who told Reuters of symptoms such as waking from nightmares bathed in sweat; flashbacks to dying patients during the pandemic's fear-filled early days; flaring anger; and panic at the sound of medical alarms. Those whose symptoms last longer than one month and are severe enough to interfere with daily life can be diagnosed with PTSD.

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The surging Delta variant is heaping on fresh trauma as the United States and other nations begin to study PTSD in health workers. Data already showed that U.S. health workers were in crisis before COVID-19.

While PTSD is associated with combat, it can arise among civilians after natural disasters, abuse or other trauma. Health workers can be reluctant to equate their experience with that of returning soldiers.

"I feel like a schmuck calling it PTSD," Prott said. "It took me a long time to be able to talk to somebody because I see guys with real PTSD. What I've got going on, it's nothing in comparison, so you feel guilty for thinking that."

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Psychiatrist Dr. Bessel van der Kolk knows better.

"On the surface, a nurse at your local hospital will not look like a guy coming back from Afghanistan," said the author of "The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma." "But underneath it all, we have these core neurobiology-determined functions that are the same."

Pre-pandemic studies showed that rates of PTSD in front-line health workers varied from 10% to 50%. The suicide rate among doctors was more than twice that of the general public.

The American Medical Association (AMA) has tapped a military psychologist and the Department of Veterans Affairs' (VA) National Center for PTSD to help it measure the pandemic's impact.

Texas Tech University Health Science Center psychiatry resident Dr. Huseyin Bayazit and researchers in his native Turkey surveyed 1,833 Turkish health workers last autumn. The results, presented in May at an American Psychiatric Association meeting, showed a PTSD rate of 49.5% among nonphysicians and 36% for doctors. Rates of suicidal thoughts increased as workers spent more time on COVID-19 units.

Unions want to mitigate trauma by setting national rules for the number of patients under each nurse’s care. Workers say they should not have to pay for therapy, medication, and other interventions.

The AMA and other groups want more confidentiality for doctors who seek mental health services. Most ICU staff who discussed PTSD with Reuters requested anonymity for fear of repercussions at work.

New York's Mount Sinai Health System and Chicago's Rush University System for Health provide free, confidential mental health services.

Mount Sinai's new Center for Stress, Resilience, and Personal Growth offers a military-inspired "Battle Buddies" peer-support program for nurses. A  chaplain  from Rush's "Road Home" program for veterans runs a "post-traumatic growth" bereavement support group for ICU nurses.

The VA system provides no-cost, short-term mental health counseling through its employee assistance program. Many local VA facilities supplement those with spiritual counseling and crisis incident response teams, a spokesperson said.

Around 5,000 U.S. physicians quit every two years due to burnout, said Dr. Christine Sinsky, an AMA vice president. The annual cost is about $4.6 billion - including lost revenue from vacancies and recruitment expenses, she said.

Hospital survey results in March led the Department of Health and Human Services to warn "staffing shortages have affected patient care, and that exhaustion and trauma have taken a toll on staff's mental health."

Trauma surgeon Dr. Kari Jerge volunteered to work in a Phoenix COVID-19 ward during last winter's surge. She turned down substantially more pay to return to the ICU after the Delta variant surge.

Jerge encourages others to prioritize "self-preservation," but worries about the loss of expertise. "There is infinite value in a nurse who's been working in the ICU for 20 years and just has a gut feeling when something's going wrong with a patient," she said.

Nurse Pascaline Muhindura, 40, who cares for COVID-19 patients in Kansas City, Missouri, has advocated for health worker safety since losing a co-worker to the disease early in the pandemic.

"It keeps getting worse and worse. We are heading back to that place - that woke up those emotions again," said Muhindura, who added that many employers do not offer adequate insurance coverage for therapy.

An ICU fosters the kind of camaraderie forged in battle. A group of Southern California COVID-19 nurses got matching tattoos. Health workers commiserate over crying their way home after tough shifts, support each other on social media, and push colleagues to seek help.

"There is nothing wrong with feeling this way," said VA nurse Prott. "You have to deal with it though."

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US-EU agenda for beating the global pandemic: Vaccinating the world, saving lives now, and building back better health security

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Vaccination is the most effective response to the COVID pandemic. The United States and the EU are technological leaders in advanced vaccine platforms, given decades of investments in research and development.

It is vital that we aggressively pursue an agenda to vaccinate the world. Co-ordinated US and EU leadership will help expand supply, deliver in a more coordinated and efficient manner, and manage constraints to supply chains. This will showcase the force of a Transatlantic partnership in facilitating global vaccination while enabling more progress by multilateral and regional initiatives.

Building on the outcome of the May 2021 G20 Global Health Summit, the G7 and US-EU Summits in June, and on the upcoming G20 Summit, the US and the EU will expand cooperation for global action toward vaccinating the world, saving lives now, and building better health security.  

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Pillar I: A Joint EU/US Vaccine Sharing Commitment: the United States and the EU will share doses globally to enhance vaccination rates, with a priority on sharing through COVAX and improving vaccination rates urgently in low and lower-middle income countries. The United States is donating over 1.1 billion doses, and the EU will donate over 500 million doses. This is in addition to the doses we have financed through COVAX.

We call for nations that are able to vaccinate their populations to double their dose-sharing commitments or to make meaningful contributions to vaccine readiness. They will place a premium on predictable and effective dose-sharing to maximize sustainability and minimize waste.

Pillar II: A Joint EU/US Commitment to Vaccine Readiness: the United States and the EU will both support and coordinate with relevant organisations for vaccine delivery, cold chain, logistics, and immunization programs to translate doses in vials into shots in arms. They will share lessons learned from dose sharing, including delivery via COVAX, and promote equitable distribution of vaccines.

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Pillar III: A Joint EU/US partnership on bolstering global vaccine supply and therapeutics: the EU and the United States will leverage their newly launched Joint COVID-19 Manufacturing and Supply Chain Taskforce to support vaccine and therapeutic manufacturing and distribution and overcome supply chain challenges. Collaborative efforts, outlined below, will include monitoring global supply chains, assessing global demand against the supply of ingredients and production materials, and identifying and addressing in real time bottlenecks and other disruptive factors for global vaccine and therapeutics production, as well as coordinating potential solutions and initiatives to boost global production of vaccines, critical inputs, and ancillary supplies.

Pillar IV: A Joint EU/US Proposal to achieve Global Health Security. The United States and the EU will support the establishment of a Financial Intermediary Fund (FIF) by the end of 2021 and will support its sustainable capitalization.  The EU and United States will also support global pandemic surveillance, including the concept of a global pandemic radar. The EU and the United States, through HERA and the Department of Health and Human Services Biomedical Advanced Research and Development Authority, respectively, will cooperate in line with our G7 commitment to expedite the development of new vaccines and make recommendations on enhancing the world's capacity to deliver these vaccines in real time. 

We call on partners to join in establishing and financing the FIF to support to prepare countries for COVID-19 and future biological threats.

Pillar V: A Joint EU/US/Partners Roadmap for regional vaccine production. The EU and the United States will coordinate investments in regional manufacturing capacity with low and lower-middle income countries, as well as targeted efforts to enhance capacity for medical countermeasures under the Build Back and Better World infrastructure and the newly established Global Gateway partnership. The EU and the United States will align efforts to bolster local vaccine manufacturing capacity in Africa and forge ahead on discussions on expanding the production of COVID-19 vaccines and treatments and ensure their equitable access.

We call on partners to join in supporting coordinated investments to expand global and regional manufacturing, including for mRNA, viral vector, and/or protein subunit COVID-19 vaccines.

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Joint statement on the launch of the joint COVID-19 Manufacturing and Supply Chain Taskforce

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Coronavirus: 200th EU disinfection robot delivered to European hospital, a further 100 confirmed

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On 21 September, the Commission delivered the 200th disinfection robot – to Consorci Corporació Sanitària Parc Taulí hospital in Barcelona. The robots, donated by the Commission, help sanitize COVID-19 patient rooms and are part of the Commission's action to supply hospitals across the EU to help them cope with the effects of the coronavirus pandemic. Further to these initial 200 robots announced in November last year, the Commission secured the purchase an additional 100, bringing the total donations to 300.

A Europe fit for the Digital Age Executive Vice President for Margrethe Vestager, said: “Assisting member states overcome the challenges of the pandemic continues to be a number one priority and these donations – a very tangible form of support – are a prime example of what can be achieved. This is European solidarity in action and I am pleased to see the Commission can go the extra mile in donating an additional 100 disinfection robots to hospitals in need.”

Twenty-five disinfection robots have already been working night and day across Spain since February to help tackle the spread of the coronavirus. Nearly every EU Member State has now received at least one disinfection robot, which disinfects a standard patient room in under 15 minutes, alleviating hospital staff and offering them and their patients greater protection against potential infection. This action is made possible through the Emergency Support Instrument and the devices are supplied by Danish company UVD robots, which won an emergency procurement tender.

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Coronavirus: Commission signs contract for the supply of a monoclonal antibody treatment

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The Commission has signed a joint procurement framework contract with the pharmaceutical company Eli Lilly for the supply of a monoclonal antibody treatment for coronavirus patients. This marks the latest development in this first portfolio of five promising therapeutics announced by the Commission under the EU COVID-19 Therapeutics Strategy in June 2021. The medicine is currently under rolling review by the European Medicines Agency. 18 member states have signed up to the joint procurement for the purchase of up to 220,000 treatments.

Health and Food Safety Commissioner Stella Kyriakides said: “Over 73% of the EU adult population is now fully vaccinated, and this rate will still increase. But vaccines cannot be our only response to COVID-19. People still continue to be infected and fall ill. We need to continue our work to prevent illness with vaccines and at the same time ensure that we can treat it with therapeutics. With today's signature, we conclude our third procurement and deliver on our commitment under the EU Therapeutics Strategy to facilitate access to state-of-the-art medicines for COVID-19 patients.”

While vaccination remains the strongest asset both against the virus and its variants, therapeutics play a critical role in the COVID-19 response. They help to save lives, speed up recovery time, reduce the length of hospitalisation and ultimately ease the burden of health care systems.

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The product from Eli Lilly is a combination of two monoclonal antibodies (bamlanivimab and etesevimab) for the treatment of coronavirus patients who do not require oxygen but are at high risk of severe COVID-19. Monoclonal antibodies are proteins conceived in the laboratory that mimic the immune system's ability to fight the coronavirus. They fuse to the spike protein and thus block the virus's attachment to the human cells.

Under the EU Joint Procurement Agreement, the European Commission has concluded until now nearly 200 contracts for different medical countermeasures with a cumulative value of over €12 billion. Under the joint procurement framework contract concluded with Eli Lilly, member states can purchase the combination product bamlanivimab and etesevimab if and when needed, once it has received either a conditional marketing authorisation at EU level from the European Medicines Agency or an emergency use authorisation in the member state concerned.

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Today's joint procurement contract follows the contract signed with Roche for the product REGN-COV2, a combination of Casirivimab and Imdevimab, on 31 March 2021 and the contract with Glaxo Smith Kline on 27 July 2021 for the supply of sotrovimab (VIR-7831), developed in collaboration with VIR biotechnology.

The EU Strategy on COVID-19 Therapeutics, adopted on 6 May 2021, aims to build a broad portfolio of COVID-19 therapeutics with the goal of having three new therapeutics available by October 2021 and possibly two more by the end of the year. It covers the full lifecycle of medicines from research, development, selection of promising candidates, fast regulatory approval, manufacturing and deployment to final use. It will also coordinate, scale-up and ensure that the EU acts together in ensuring access to therapeutics via joint procurements.

The Strategy forms part of a strong European Health Union, using a coordinated EU approach to better protect the health of our citizens, equip the EU and its Member States to better prevent and address future pandemics, and improve resilience of Europe's health systems. Focusing on the treatment of patients with COVID-19, the Strategy works alongside the successful EU Vaccines Strategy, through which safe and effective vaccines against COVID-19 have been authorised for use in the EU to prevent and reduce transmission of cases, as well as hospitalisation rates and deaths caused by the disease.

On 29 June 2021, the strategy delivered its first outcome, with the announcement of five candidate therapeutics that could soon be available to treat patients across the EU. The five products are in an advanced stage of development and have a high potential to be among the three new COVID-19 therapeutics to receive authorization by October 2021, the target set under the strategy, provided the final data demonstrate their safety, quality and efficacy.

Global co-operation on therapeutics is crucial and a key component of our strategy. The Commission is committed to working together with international partners on COVID-19 therapeutics and make them available globally. The Commission is also exploring how to support the enabling environment for manufacturing health products, while strengthening research capacity in partner countries around the globe.

More information

EU Therapeutics Strategy

Coronavirus response

Safe COVID-19 vaccines for Europeans

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