By Megan Thielking

Thousands of health care workers, largely in China, have been infected amid the ongoing coronavirus outbreak, a sign of the immensely difficult working conditions for medical staffers, who should be among those best protected against infection.

The infections, along with the deaths of several doctors in China, underscore the deeply challenging, chaotic environment that health care workers confront when toiling on the front lines of a major outbreak. They face long hours, changing protocols, potential medical supply shortages, and risks to their own personal health and that of their loved ones.

“You are expected to be there and stay there and take care of those people, but know that you are at risk and know that you have a family to go home to,” said Salah Qutaishat, an infection prevention epidemiologist who worked for the Marshfield, Wis., health system that identified the first U.S. case of monkeypox in a 2003 outbreak, and who also volunteered in a Toronto-area hospital during the SARS outbreak the same year.

Those fears are compounded when health care workers are working around the clock to combat a virus that isn’t well-understood, as is the case with the novel coronavirus. That uncertainty can create a stressful, unsettling, and, at times, frightening work environment for those on the front lines.

“As a nurse, I have a duty to care [for my patients]. I also have a duty to myself, my family, everybody who has a stake in my wellbeing,” said Cheedy Jaja, a nurse and nursing professor at University of South Carolina who cared for patients with Ebola in Sierra Leone during the 2014-2015 outbreak.

Jaja did two stints in Sierra Leone, his home country, as a volunteer with the nonprofit Partners in Health. He worked long days, stopping only to sleep or eat. While he worked, Jaja was frequently afraid he had contracted Ebola. Every sensation that felt a little out of the ordinary fueled panic.

“It was a heightened sense of alertness, a constant fear,” he said. While Jaja remained healthy, colleagues he worked with were among the hundreds of medical staffers infected during the outbreak. A 2015 WHO report found that, depending on their role, health workers were up to 32 times more likely to be infected with Ebola than adults in the general population.

Many infections in health care workers can be prevented with the right planning, training, and protective equipment. But in China and elsewhere around the globe, the coronavirus outbreak has put a strain on medical supplies. Those shortages fuel stress among health care workers and employees who need to protect themselves from exposure — not just for their own health, but to stem the spread of a pathogen. Equipment used to protect health care workers from infection is in short supply as demand — and prices — for personal protective equipment, or PPE, has soared.

Last week, the Canadian Federation of Nurses Unions released a statement demanding that all frontline health care workers who might be exposed to the virus be protected, at a minimum, with a N-95 respirator, a hard, domed mask used to protect against the spread of respiratory pathogens in hospitals.

Using those respirators and other PPE, too, presents a source of stress for hospital staff, some of whom have to learn how to wear gear they’ve never used before. During the SARS outbreak, Mount Sinai Hospital in Toronto had to train staffers without any clinical expertise in how to take temperatures and screen people entering the hospital for symptoms, said Lynn Nagle, who supervised the SARS response as the hospital’s chief information officer. The hospital had to teach those individuals how to properly don a gown, gloves, and a mask.

Staff must also follow protocols that can quickly change as an outbreak evolves. Nagle said new recommendations from health officials — whether about PPE use or screening questions — “came down fast and furious” during the SARS outbreak. They had to constantly update the staff about new information — and acknowledge what still wasn’t known.

“The biggest challenge for them, and for all of us trying to protect them, was the uncertainty as this thing unfolded,” said Nagle, who is also a professor of nursing at the University of Toronto.

Even health care workers who aren’t on the front lines feel the impact of an outbreak. In 2014, Amy McCarthy was a nurse in the mother and baby unit at Texas Health Presbyterian Hospital in Dallas, Texas, where the first patient diagnosed with Ebola in the U.S. was being treated. Two nurses who cared for the patient contracted Ebola, one of whom later alleged in a lawsuit that the hospital had offered no formal guidance or training in what type of personal protective equipment to wear.

At the time, McCarthy’s unit wasn’t directly affected. But her patients and their families peppered her with questions. Some came in wearing paper masks, fearful of being exposed, but not fully understanding how the virus was actually transmitted.

“It was a time of real anxiety for everyone involved,” she said. “We had to do a lot of comforting and education about Ebola.”

For those on the front lines of an outbreak, the experience can take a significant emotional toll, even years later. Jaja was quarantined after returning to the U.S. after his first tour in Sierra Leone. It was a hard pivot, from a high-stress situation to being stuck at home with nothing to do.

“That’s when the mind starts playing tricks on you. That’s when you start reflecting. That’s when, out of left field, the psychological trauma kicks in,” he said.

Jaja realized he wasn’t the only person in the cohort he traveled with feeling that way. Soon, he and about a dozen other colleagues, all across the country, started video-chatting every day. They talked about what they saw and experienced, and how, during that quarantine, they felt a complicated mix of anger, sadness, and relief.

“It was that sense of, we all went to battle together, that helped us pull through the trauma,” he said.