By Sue Coyle, MSW
As the world nears the end of the third year of the COVID-19 pandemic, the United States is both transitioning back toward pre-pandemic life and settling into a new normal. It’s a delicate balance that continues to evolve, as does the virus.
Cases of the coronavirus have not disappeared. In mid-September, two and a half years after the pandemic began in the U.S., there were 471,611 reported weekly cases in the country and 3,230 deaths.
However, vaccines and proven treatments have allowed for a somewhat more relaxed, though still cautious, relationship with the virus. For example, the Centers for Disease Control and Prevention no longer advises fully vaccinated and boosted individuals to quarantine after exposure, and the World Health Organization stated in September that the end of the pandemic was in sight.
For social workers and their clients, the pandemic may not be as front of mind as it once was, but it remains a factor and adds another layer to already challenging situations.
“It’s stressful personally,” says Danielle Wagner, MSSW, LCSW, staff therapist at a Pennsylvania college who also sees patients in private practice. “In the sense that it’s just one more thing to check in about, and then systemically, it’s stressful in that it’s a strain on our very strained resources.”
For social workers and their clients, the changes in how COVID-19 is managed may be most visible now in an organization’s or facility’s policies. This is, after all, where many individuals first encountered COVID-19 restrictions.
“During the height of the pandemic, we were limited to how many people could be present in a room at one time, we had to wear masks and wipe every surface down that we touched, and we were required to work remotely or quarantine if we felt sick or came in contact with COVID-19 in any way,” describes Megan Macareno, MSW, Housing and Street Outreach program supervisor at Valley Youth House in Pennsylvania. Macareno works primarily with young adults aged 18 to 24, many of whom are experiencing homelessness.
These restrictions were not uncommon for social workers on the front line, and some remain in place today. For example, both Jeffery Jin, DSW, an oncology social worker in New Jersey, and Jordan Levy, LCSW, a social worker for an inpatient psychiatric unit in Philadelphia, note that masks are still worn by employees and likely will be for the foreseeable future in medical facilities. “I personally do not ever plan to work in the hospital without wearing a mask/PPE (personal protective equipment),” says Levy.
Outside of medical facilities, wearing a mask has become largely optional, leaving social workers and their clients to decide how to proceed. For Wagner, that means doing daily check-ins with herself, the students and the area. When cases are high on campus or in the county, she’s more likely to wear a mask.
“It’s tough. I have a lot of co-workers that wear masks in session. I do my due diligence in asking students if they feel sick. If I’ve been traveling or if they feel sick, (I wear a mask),” she says. However, she adds that at this point in the pandemic, “I don’t think about it in the moment. I’m more interested in connecting with my clients.”
Wagner finds that connection more easily made in person. At the height of the pandemic, she conducted teletherapy—like many social workers did. The 2020-2021 school year was completely virtual, she says. This year, they have teletherapy options, but Wagner finds that 95% of her clients prefer to meet in person.
It is likely that teletherapy will remain an option after the pandemic. However, the return to in-person sessions is increasing across the profession. What remains virtual for many social workers are administrative meetings. Staff meetings, supervisions and other calls are completed on a platform such as Zoom when able or necessary. Some would like that to continue.
“Virtual meetings do not bother me, because rather than spending a lot of time out on the road driving [to meetings], I am able to accomplish more in my day and see more staff or clients than I had been before,” says Macareno.
Company policies are, of course, not the only changes or reminders of the pandemic social workers and their clients are seeing in year three of COVID-19. One thing that is not shifting back to “normal” for clients are resources. There is a definitive lack of availability, affordability and accessibility.
“The cost of rent in the area we serve has increased dramatically since the pandemic started,” says Macareno, “which for most of the youth we serve puts safe, affordable housing out of their reach. A lot of mental health treatment shifted to telehealth during the pandemic, which can be positive for some or negative … but we have also found that wait lists are long for some providers, which puts off treatment for some young people.”
Levy agrees, noting that “we continue to have difficulty finding resources for patients in the community because there aren’t enough providers and most outpatient providers have very long wait lists.”
Some things have improved for clients, however. Top of mind for both Levy and Jin is isolation. At the height of the pandemic, isolation, inactivity, grief and stress from the pandemic were catalysts for admission to the hospital, says Levy, whereas Jin saw the isolation play out in treatment.
“We’ve had patients coming in-person for chemotherapy and radiation throughout the pandemic. As our patients are immunocompromised, there was a great deal of fear and apprehension; We had to take many steps to try to ensure their safety. We had to restrict visitors, which was extremely difficult for our new chemotherapy patients to be alone. Our staff stepped up to the plate as best we could to help decrease isolation. My patients and families are always inspiring and the extra bravery to deal with this pandemic has been so heartwarming,” Jin says.
That level of isolation has decreased as the world shifts back toward pre-pandemic socializing and facilities are able to allow individuals the type of in-person support they need. But, says Wagner, improvement does not mean that it has gone away completely. Yes, isolation is less of a concern than it was, but it also has become a habit for some as they spend more time alone and/or on screens than with peers.
Wagner adds that she is seeing more clients struggling with stress tolerance. “There’s some lingering isolation in the class years who started during COVID, but now I feel like I’m seeing more stress tolerance-related concerns—managing the stress load of college. There’s nobody in college, in a four-year institution, that has not been there in COVID,” she says. “I feel like the emotional development is delayed two years in general. Where somebody is a senior, really they’re still socially and emotionally closer to a sophomore.”
Social Workers, Burnout and Self-Care
Clients are not the only ones who are still feeling the impact of the pandemic.
“Burnout is real,” says Macareno. “For a while, it seemed like everyone was operating on autopilot.
People seemed tired and depressed. I know I was.”
Some of that burnout has stemmed from staffing shortages, which continue today, and that has sometimes led to a delay in services as well as more pressure on the remaining professionals.
“With our social work team and colleagues in our collaborating professions, I feel that we’ve had to pull together even more,” says Jin.
Levy says of her team, “There were times when the only people we’d see were each other. There was solidarity and comfort in having each other.” However, there was also a need to create boundaries. The shift toward virtual work, when possible, means that social workers are now technically available 24/7, not just during their working hours.
“I have had to get very diligent about creating boundaries for myself,” Levy says. “I think the difficulty in maintaining a work-life balance has created more irritability in my co-workers as well.”
Social workers have found that successful boundaries extend beyond putting away the work phone and laptop at night. They need to make a conscious decision to think and talk about other topics. Both Wagner and her partner are therapists. “We ended up coming up with some ground rules about when and where we talk about work: Here’s when we’re not going to talk about work and here’s when we are.”
Similarly, Levy and her partner took the time to focus on each other and their relationship. “On a personal level, the pandemic brought my partner and I closer, as we were able to prioritize our time and even meals together when before there were always other things going on.”
Developing a self-care routine has also enabled social workers to continue working through an ever-changing pandemic and cope with the burnout and trauma they’ve both experienced and witnessed for the past three years. For example, Jin says, “I started working out every day at the beginning of the pandemic, and now I am in the best physical shape I’ve been in in over 20 years.”
Unfortunately for some social workers, however, the pandemic meant a step away from the profession—a step that hasn’t always been taken back. Cho Win, MSW, a social worker with experience in advocacy work—specifically program management and union organizing—stopped working shortly before COVID-19 to prepare for the birth of her second child. Win’s partner is an emergency department doctor, and when the pandemic began, his schedule and own staffing shortages meant that Win was the primary caregiver nearly all of the time. In the years since, Win has considered returning to work. However, the realities of year three of COVID-19, as well as social work, hold her back.
“We are truly blessed that [financially] I don’t have to work. It’s been a savior,” says Win, thinking about the lack of child care, quarantine requirements for her school-age daughter, and the unpredictability of her partner’s schedule. “His job hasn’t slowed down. He’s working extra hours. There’s a pediatrician shortage at the hospital. He can’t do child-care pickup. I’ve been looking at full-time jobs, but in social work it’s full-time plus. I’ve been looking at part-time jobs, but they’re part-time plus,” she says.
Win explains that in her experience with advocacy work, social workers have to be available to go to events and meet the community when and where they are. (This is also true for social workers meeting one-on-one with clients.) That’s not yet possible for her or her family. The boundary she has had to create is to remain at home.
While it may seem that the pandemic has taken, and continues to take, a toll on both social workers and their clients, there are some positives emerging. For example, Macareno appreciates the acceptance of remote work—something that was not promoted by her or her organization before the pandemic.
“At first, I thought it might be difficult to reach clients as a social worker remotely, but I have found that a lot of our clients actually prefer that method,” she says.
“I think my team and colleagues have learned that we will not stop providing the best care we can for our clients just because we may not be able to meet in person and that we are constantly finding ways to meet their needs virtually.”
Wagner has found a new level of confidence in her skills as a therapist as well. “I definitely feel like I’ve taken another step in terms of rapport-building,” she says. “Throughout COVID there were challenging cases that I was able to connect with.”
She also feels more genuine and comfortable as a therapist. “When you start as a therapist, it’s very much ‘I have to be this and do this and say this,’ she says, referencing impostor syndrome. “But even more so now, post-COVID, these clients [when virtual] are in my home with me. I have to be me. I have to self-disclose and tell you that we’re having construction done, for instance. We’re going through the pandemic as well, all at the same time. This is brand new to every single one of us.”
Overall, Levy and Jin have noticed a new or at least improved appreciation for social workers and others in general. “I feel like people seem to be more sensitive with each other, maybe because everyone assumes everyone else is going through a hard time. I’ve experienced people being more accommodating, supportive, flexible and creative in finding new ways
to accomplish necessary tasks,” says Levy.
Jin remembers a moment at the height of the pandemic. “One morning as I left the train station to walk to our clinic, I saw an older gentleman sweeping the street. Seeing me in a lab coat, he put his broom down and applauded me. Honestly, I get teary-eyed just thinking about this. I never felt professional appreciation like this, and it reminded me just how valuable working in health care is.”
Three years in, that memory stays with Jin and reinforces the work he does day in and day out, balancing the challenges he and other social workers continue to face through a near-ending but still ongoing pandemic.