Hypervigilance. Difficulty experiencing positive emotions. Self-blame. Negative thoughts. Aggression. Flashbacks. Nightmares. According to the 5th Edition of the Diagnostic and Statistical Manual for Mental Disorders, each of these are symptoms of Post-Traumatic Stress Disorder.

What are often thought to be symptoms that present in combat veterans and survivors of terrorist attacks are now increasing among medical professionals.

For over a year now, many Oklahoma healthcare professionals have been faced with daily trauma. Research suggests that infectious disease outbreaks are associated with post-traumatic stress symptoms in medical professionals.

Since the advent of the COVID-19 outbreak, many frontline medical workers across the state have been exposed to an increase in traumatic events, such as patient deaths and vicarious traumatization, due to the surges in hospitalizations of COVID-19 patients over the last year.

Few could have predicted the novel coronavirus and the pain it would inflict on Oklahoma. However, it is not difficult to foresee that a precedent of making cuts to vital infrastructure in the state would lead to a lack access to medical care for many rural Oklahomans and a predisposition to develop symptoms of burnout and trauma in frontline medical professionals. 

Last summer, Oklahoma was the 37th state to approve the Medicaid expansion, ten years after the Affordable Care Act was put into effect. For a state with the second highest uninsured rate in the country, the approval of Medicaid expansion may mean that hospitals remain open and more Oklahomans stay alive.

However, in that decade that Oklahoma failed to expand Medicaid, at least eight rural Oklahoma hospitals were forced to close their doors. Along with reducing rural Oklahomans’ already limited medical resources, it also put more strain on our state’s medical workers. 

As COVID-19 cases rose, eventually so did hospitalization rates. Fewer rural hospitals meant that Oklahomans from across the state had to be served by urban facilities. Entire cities’ worth of hospitals began to run out of beds. Yet the numbers of COVID-19 cases kept growing; along with the stress on some of the most important Oklahomans.

On top of experiencing symptoms of trauma, Oklahoma medical professionals are also susceptible to burnout. Research suggests that sustained stress at work can lead to symptoms of burnout. In physicians, the emotional exhaustion associated with burnout can lead to substance abuse and depressive symptoms, including suicidal ideation. Research suggests that reducing stress can aid in reducing burnout symptoms. Yet our state’s leadership prioritized “personal responsibility” over preventing psychological stress in our frontline workers. 

It’s not a mystery why Oklahoma healthcare providers experienced so much psychological distress; their hospitals were at capacity, they didn’t have the necessary personal protective equipment to safely perform their job, and no statewide mask mandate was in place to slow the spread of cases. Our state has been managed like a failing business rather than a governing body.

Former Oklahoma Commissioner of Health Gary Cox, who was appointed by Governor Kevin Stitt, claims he was striving for frugality when he requested a $4.5 million cut in County Health Department budgets less than four months before the first case of COVID-19 was confirmed in Oklahoma. Then the same day of the first COVID-19 related death in Oklahoma, Governor Stitt abruptly removed then-State Epidemiologist Laurence Burnsed from office. 

What followed was the creation and implementation of Governor Stitt’s Open Up and Recover Safely (OURS) Plan, which appeared to prioritize the economy over the safety of Oklahomans. Despite cases increasing exponentially through the end of 2020, Governor Stitt never rolled back restrictions set in the OURS Plan or implemented a statewide mask mandate.

On top of likely contributing to the growth of COVID-19 in Oklahoma by refusing to set a mask mandate, Governor Stitt also put strain on healthcare providers by pressuring medical professionals and hospitals to refrain from speaking out about dwindling hospital capacity

A nurse who works primarily with COVID-19 patients in metro hospital spoke anonymously about her own struggle with stress, trauma symptoms, and frustration over Governor Stitt’s leadership, saying, 

“Many of us feel exhausted from the roller coaster that this past year has been. It has been physically and more importantly emotionally challenging. I have never experienced so much grief and death as when COVID was at its peak. It was hard making phone calls to families to tell them that their loved one was not improving or even worse that they needed to be intubated. COVID brought me and my coworkers a lot closer to each other and to the physicians.

Our teamwork was stronger than ever. But now we just feel fatigued. I don’t know if I can pinpoint any emotions. Sometimes I still tear up when I think about the people we lost that we fought so hard to save. I don’t even know I’m doing it, until I’m already tearful and I feel a wrenching in my gut. 

The biggest frustration I felt was when Governor Stitt publicly announced that we had plenty of beds for the people of our state. Where were these beds? My unit was always full and overflowing into other units in the hospital. My hospital was so full that we were having to use ER beds and PACU beds for ICU and acute care patients. We were in crisis mode.”

The COVID-19 pandemic has been taxing for healthcare providers nationwide. However, a lack of investment in medical infrastructure combined with poor leadership at the state level have left hundreds of Oklahoma medical professionals at risk for emotional distress, burnout, and trauma.

This problem won’t be solved by our governor holding misleading press conferences and preaching “personal responsibility” without taking it himself. It will only be solved by continuing to support the Medicaid expansion and voting an actual leader into the Office of the Governor next November.