A recent survey in the Journal of the American Medical Association of 1,275 healthcare workers on the frontlines of China’s COVID-19 response finds significant symptoms of “depression, anxiety, insomnia, and distress” among respondents. What’s more, the authors suggest the closer to the epicenter of the virus, the more acute the symptoms tend to be. As someone who has worked with American first responders for nearly 15 years, this doesn’t surprise me. Stress and trauma are occupational hazards for those called to the front lines, even in the best of times.
There’s no question about it: COVID-19 has added a layer of complexity and concern to the work of America’s first responders as well. A recent survey by the Conference of Mayors finds that 92% of cities have inadequate personal protective equipment (PPE) for first responders. A similar percentage of cities, they find, are lacking test kits. The result is policy that often changes daily, sometimes more, depending on current availability of supplies to fire, emergency medical services and law enforcement. “It seems right now that the people at the top issuing decrees are more concerned with conserving PPE for than with protecting us out on the street,” a firefighter at a major metropolitan station told me.
Concern for Family
Uncertainty, a lack of support, fear—all feelings that contribute to a first responder’s emotional valence. And the fear is not just for themselves. In fact, a PoliceOne poll found the most common concern (27%) of respondents is “being away from/infecting my family.”
“It’s critical for first responders to take care of themselves during the COVID-19 crisis,” says Dr. David Black.
Families are feeling it too. “I fear for the physical safety of our first responders,” says Dianne Bernhard, executive director of Concerns of Police Survivors. “But for the people at home, especially those who have lost a family member or colleague in the line of duty, who find themselves quarantined with nothing to do but watch cable news and check the internet—this is devastating from a mental health perspective. And we know the families of our law enforcement and first responders are their first line of defense when it comes to mental and emotional health.”
What are our first responders to do?
The Importance of Self-Care
“It’s critical for first responders to take care of themselves during the COVID-19 crisis,” says Dr. David Black, CEO of Cordico and a clinical psychologist who works with first responders. “Our heroes on the front lines are always seeking to help others, but it’s more important than ever that they also prioritize taking care of themselves during this very demanding time.”
Dr. Black makes some concrete suggestions to alleviate stress among first responders and their families:
- Follow COVID-19 safety best practices.
- Maintain healthy routines: Get exercise, eat well and prioritize sleep.
- Maintain supportive social relationships—distance physically rather than socially.
- Prioritize taking care of your family and ensuring their cohesion, health, wellness and safety.
- Avoid falling into negative patterns of behavior, such as drinking too much alcohol, overeating, skipping out on sleep or obsessively consuming news.
- Be proactive and purposeful so that your habits and routines embody your core values and ideals (e.g., family, health and wellness, faith, safety, service), rather than reactive responses to stressful circumstances (i.e., alcohol, junk food, excessive screen-time, social isolation).
- Now is a great time to emphasize your mindfulness practice or to create one if you don’t already.
Bernhard concurs with Dr. Black’s advice. “Stay healthy. Have purpose,” she says. “Another thing we really recommend here at COPS is deep breathing. When you feel stress coming on or anxiety or feel overwhelmed, it’s a good idea, we’ve found, to take some nice, deep breaths and let those feelings pass. I find that, generally speaking, breathing deeply is calming.”
As I discuss in my book, breathing is an excellent entry point into a meditative practice as well—for you and your family.
Here’s how. Find a quiet and peaceful place to sit comfortably but with proper posture (your personal vehicle, before or after shift, might work). Let your eyes rest and settle unfocused, but open. Have a few good, deep breaths as you settle into yourself and transition from “doing” into “being.” If this doesn’t work for you, maybe go for a quiet walk—whatever it is that brings you personal equanimity and peace. This is a time to tap into the vast reserves of strength and understanding within yourself and the world around you. It’s still there, as always, despite coronavirus.
 Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
 Citron, F.M., Gray, M.A., Critchley, H.D., Weekes, B.S., & Ferstl, E.C. (2014). Emotional valence and arousal affect reading in an interactive way: Neuroimaging evidence for an approach-withdrawal framework. Neuropsychologia.