Spotlight Series: Dr. Mike Witte

COVID-19: Challenges and Opportunities for Building Resilience

Dr. Mike Witte, Chief Medical Officer for the California Primary Care Association, discusses the dual infections facing the nation – COVID-19 and structural racism – and how health care providers have an opportunity to respond with trauma-informed care.

Given the impacts of the COVID-19 emergency, health care providers are having to fundamentally change the way they respond to the increasing and complex needs of their patients. Amid this COVID-19 emergency, the country is also beginning to grapple with longstanding issues of structural racism. I cannot help but connect these two tragic crises. They both clearly point to deep disparities endemic in the United States. Communities of color have a much higher burden of COVID infections. Data out of Oakland highlights Latinos having as much as a 20 percent positive COVID-19 testing rate, while the overall positive testing rate there is about 4 percent. Why? What social disparities lend themselves to these egregious numbers?

Meanwhile, racism is creating both protest and chaos in cities across the country. The senseless brutalizing and killing of a black man in Minnesota is breaking hearts across this pandemic-infected world. We must collectively work to cure these terrible infections; they both challenge our best selves to do better.

In the face of these crises, providers are being forced to adapt to new ways of working and, often, new technology; they lack the day-to-day support of peers in their usual health care work environments; and they likely face additional stressors at home. And because of social distancing measures, they are frustrated because they can’t place a comforting hand on a patient’s shoulder when they’re struggling or give them a well-earned pat on the back for achieving a health goal. They have lost important connections with patients – and in many cases, the ability to prevent illness or readily manage a chronic disease.

While we work to adjust to the new normal in patient care and provider self-care over the next many months, our focus on addressing the impacts of stress and adversity both within our care organizations and in our patient communities can help build resiliency.

The pandemic and the protests have profoundly affected the well-being of many Californians. Beyond the many lives lost to the virus, the impact of COVID-19 on job security, family relationships, educational opportunities, and mental and physical health amounts to trauma. And we are all again recognizing the trauma imposed on so many of our brothers and sisters by the burden of racism. This trauma requires a trauma-informed approach to care.

In many of the communities we serve, COVID-19-related trauma is occurring in environments already struggling with racial inequities, economic distress, as well as housing, employment, food, and health instability. This trauma is leading to increases in sleep disorders, exacerbation of mental health crises or even suicide, as well as worsening of untreated chronic illnesses like diabetes, heart disease, and asthma.

Screening children and adults for Adverse Childhood Experiences (ACEs) and trauma and responding with trauma-informed care has never been more important. At the California Primary Care Association, we strive to build integrated care teams, joining primary care providers, including physicians, physician assistants, family nurse practitioners, licensed vocational, and registered nurses, with allied professionals, such as patient navigators, social workers, and clinical psychologists. This coherent, coordinated, and integrated approach allows us to better deliver trauma-informed care to support our patients and one another.

Trauma-informed care, even when delivered through telehealth technology, allows providers to recognize the signs and symptoms of trauma exposure on a patient’s physical and mental health. Providers can then supplement treatment with patient education about how to recognize and respond to the role that stressors – experienced both in the past and present – play in their health.

Evidence demonstrates that we can help patients experiencing what we call a “toxic stress response” with interventions that include enhancing supportive relationships, regular physical activity, balanced nutrition, sufficient sleep, mindfulness, mental health care, and substance use disorder treatment, if needed.

In practice, we can provide this kind of support over the phone or during a video visit. The key, I believe, is bringing patients into the process to arrive at mutually agreed upon goals. By being active listeners, providers can promote resiliency. Ask patients what is really important to them. Ask them what they need or how you can help. Then ask how they are sleeping, how they are eating, how their children are doing, whether they’re able to take walks every day or take their kids to the playground.

These conversations are useful for providers, too, who are facing stressors that can impact their own health. The COVID-19 crisis is an opportunity for us to practice and embody compassionate resilience ourselves. This is key to allowing us to help our patients overcome trauma and become resilient. ACEs Aware offers a range of resources for provider self-care, trauma-informed care, and specific tools to address anxiety and stress for patients as well as providers.

The trauma induced by the COVID-19 pandemic and the disruptions it has caused in our lives are both real. But our common experience can become our strength as we move through the trauma toward healing together.

Visit the California Primary Care Association website for more resources, including webinars, to support self, collective, and patient care during the COVID-19 emergency.

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Watch the video below to hear more from Dr. Mike Witte.

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