The media is dominated by the growing coronavirus (covid-19) crisis that is rapidly escalating on a daily basis. The online Johns Hopkins Coronavirus Resource Center is a good source of up to date information and has a map detailing confirmed cases by country.  With growing anxiety, fear, and even panic, coupled with the various secondary effects on the global economy and stock markets, covid-19 is causing havoc on a scale that has not occurred for a generation.
It is not surprising that the general public is becoming increasingly concerned with developments around the world, and many are stockpiling various non-perishable household goods such as toilet paper and kitchen roll for fear of running out themselves.  The perceived need to secure supplies has even resulted in hostility and fighting between shoppers.  It is not just supermarkets that are experiencing this sort of behaviour. There are many reports of bulk quantities of facemasks and hand sanitisers being stolen from hospitals around the world, potentially putting healthcare staff and patients at risk.  It would be naïve to think that the public are not the only ones taking these items for their friends and families, but such actions show selfishness and a lack of respect for others.
No one is immune from the physical effects of covid-19 infection. However, we should also be aware of the potential and perhaps underestimated psychological implications that this crisis could cause, with added stress and anxiety at work and at home, and the possible effects on our own wellbeing.  Proactive staff counselling and support may be required during an outbreak and effective leadership is always important. 
As doctors, we are usually “in control” for the majority of our day-to-day practice. Coronavirus is already disrupting this at multiple levels. This includes stopping some elective surgery, cancellation and alterations to outpatient clinics, other changes to “normal” working practice and on call arrangements (including the possibility of working outside of ones normal clinical “comfort zone”), together with staff absences (for example due to sickness, childcare provision, bereavement or isolation measures) and a potentially diminished workforce able to provide care to our patients.
When working under these stressful situations, tensions can rapidly escalate with potential to lead to shouting at other team members, bullying, or even outbursts of anger. Such behaviour results in a loss of respect, which can be difficult or impossible to regain and in extreme circumstances results in a complete breakdown in team working with the possible knock on adverse effects on patient safety. 
In busy and demanding working environments such as the intensive care unit, emergency medicine, and operating theatres, regular short breaks are recommended (even if these are for only a few minutes) every 2-3 hours. This is particularly important during the current crisis. When a stressful situation begins to escalate, stopping and walking away (if safe to do so), can diffuse potential conflict with others, allows reassessment of the situation and regrouping of the team. Use of words such as “I’m sorry please can you give me a few minutes to think about this?” usually has a much better outcome than a raised voice or outburst.
Doctors who behave in a civil way to other team members are usually seen as warm and competent, are much more likely to be asked for advice and are regarded as good leaders.  In contrast, most healthcare professionals regret their incivility to others after an event. Not only might this damage present and future working relationships, but when it happens on a regular basis incivility can raise the risk of burnout for the perpetrator.  Furthermore, a lack of civility raises a risk that people won’t speak up either if they have a concern.
We should be looking out for each other, providing emotional support where needed, and actively empowering all team members to be able to speak up without fear of retribution if they have any concerns about patient safety.  This includes flattening hierarchies so that team members can express concern for the health of all their colleagues regardless of seniority. It is definitely not the time for misplaced stoicism or for working under the misapprehension that “the team cannot function without me.”
The course of the covid-19 outbreak over the next few weeks and months is unknown and levels of stress, anxiety and fear are evolving on a daily basis. In this unprecedented situation we each have a professional responsibility to be civil and show respect and kindness for others at all times.
Rachel S Oeppen, Consultant Radiologist, University Hospitals Southampton, Southampton SO16 6YD
Justin Davies, Deputy Medical Director, Consultant Colorectal Surgeon, Addenbrooke’s Hospital, Cambridge CB2 0QQ
Graham Shaw, Captain, Boeing 777, Heathrow Airport, London UB7 0GA
Peter A Brennan, Consultant Maxillofacial Surgeon, Honorary Professor of Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
Competing interests: None declared.
- Johns Hopkins coronavirus resource centre. Available online at: https://coronavirus.jhu.edu
- Coronavirus: can you stop people stockpiling. BBC News 9 March 2020. Available at: https://www.bbc.co.uk/news/business-51737030 (accessed 16 March 2020)
- Coronavirus: Tussle over toilet paper prompts Australia police to call for calm. Available at: https://www.scmp.com/news/asia/australasia/article/3074070/coronavirus-tussle-over-toilet-paper-prompts-australia-police (accessed 16 March 2020)
- Jiang X, Deng L, Zhu Y, et al. Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai. Psychiatry Res. 2020;286:112903.
- Al Knawy BA, Al-Kadri HMF, Elbarbary M, et al. Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open. 2019;9:e017476.
- Oeppen RS, Brennan PA, Taggart I, et al. Human factors in medicine: the art of common sense at work. Br J Hosp Med (Lond). 2019;80:424-425.
- Porath CL, Gerbasi A, Schorch SL. The effects of civility on advice, leadership, and performance. J Appl Psychol. 2015;100:1527-41.
- Petitta L, Jiang L. Burning out? Watch your own incivility and the emotions you spread. Work. 2019;64:671-683.
- Brennan PA, Davidson M. Improving patient safety: we need to reduce hierarchy and empower junior doctors to speak up. BMJ. 2019;366:l4461.