Dr. David Marcozzi, a top medical adviser to Maryland Gov. Larry Hogan on COVID-19, had rehearsed his remarks multiple times before standing in front of the cameras earlier this month for a semiregular pandemic news conference at the State House in Annapolis.
The 51-year-old emergency doctor has become something of a fixture in the media this year, and he knew his words mattered more during unsettling and isolating times.
But these words were more important and more personal. He’d lost a childhood friend to suicide in September and wanted to tell people in the strongest way possible to take care of themselves and check on others.
“I’d never had a problem delivering the remarks,” Marcozzi said. “When I realized the gravity of what I was saying in a room full of people I didn’t know, it gave me pause to reflect on my friend. It overwhelmed me for a moment.”
The audience in the room and at home saw Marcozzi briefly overcome with emotion, creating a moment of silence that perhaps amplified his point far more than he planned. It was unexpected for the seasoned doctor, soldier and first responder who says in his gravelly voice that he doesn’t consider himself "that introspective.”
Many people are feeling anxiety, stress and depression months into a pandemic that is again intensifying. Cases, hospitalizations and deaths are rising in the state and country. There already have been more than 150,000 cases in Maryland and more than 4,000 deaths.
Children still can’t go to school and adults can’t go to work. Businesses have closed and many are suffering economic hardship.
This summer, a survey from the U.S. Centers for Disease Control and Prevention found close to a third of Marylanders had symptoms of depression.
The call volume during the pandemic has been two to three times the norm at 211 Maryland, a nonprofit group that offers mental health and crisis counseling and directs people to other services. Each day, that’s about 5,000 calls for mental health services and about 3,600 calls from people with thoughts of suicide.
“We are encouraging folks to call us if they have anxiety or just want to talk," said Quinton Askew, president and CEO of 211 Maryland. “We’re answering 24 hours a day, seven days a week. ... Or call someone, your friend, your church. Our message is you’re not alone.”
Those in the mental health community say more people do feel emotionally alone because of the physical distancing required during the pandemic. They hope Marcozzi’s message resonates with those who have not asked for help or rely on others to recognize their need.
“Our heart goes out to Dr. Marcozzi on the loss of his friend. We are grateful he had the courage to share his pain and the importance of talking to a mental health professional,” said Shannon Hall, executive director of the Community Behavioral Health Association of Maryland, which represents 85 mental health and addiction treatment programs in Maryland.
“We’ve all seen the stories of the pandemic’s rising toll on mental health, but in many cases Maryland providers are seeing referrals decline dramatically, particularly for children,” she said. “With schools and pediatricians making fewer referrals to mental health professionals, Dr. Marcozzi is right to call on us as a community to be the bridge. We must reach out, check in, and be present.”
During the pandemic, Hall said, people can get professional help via phone or video. But she said the community needs to be more “creative and aggressive” in getting people to care.
Marcozzi, the COVID-19 incident commander for the 13-hospital University of Maryland Medical System, said he’s normally one to “compartmentalize” during times of stress so he can push on.
He did that through two tours in Iraq and one in Afghanistan as a colonel in the U.S. Army Reserves, while responding after the terrorist attacks of September 11, 2001, and in his own emergency department.
But the pandemic, on top of the racial and political strife that has divided the nation, is somehow different.
He said he became more aware of the toll specifically on medical providers after one of his own colleagues became gravely ill. He visited the man in a special COVID-19 intensive care unit at Upper Chesapeake Medical Center in Bel Air. When he asked a nurse what she needed, she got tearful.
There had not been enough protective gear to spare for family or friends to visit, so the nurses were stepping in.
"She said, ‘I’m tired. I’m a wife, a daughter, a clergyman for these patients,’” he said. “That really resonated with me. There is so much stress.”
And then came his friend’s suicide.
It was September when Marcozzi heard of the death. They had known each other since they were young children and often saw each other during summers. But like so many other plans during the pandemic, that didn’t happen this year.
“He was one of the kindest people I’ve ever known in my life, and we still got to see each other a couple of times a year,” he said. “He lived in Philadelphia, but we kept in touch. But this summer we didn’t. … When something like this happens, you got to ask yourself whether that would have changed the outcome.”
He said he still wondered that during the news conference.
“I had to take a knee,” he said.
It will serve as a reminder, Marcozzi said, to make phone calls or figure safe ways to see friends and family or just let them know you are thinking of them.
It’s also a reminder to seek help, he and others say. Those needing help for themselves or others can call National Suicide Prevention Lifeline at 1-800-273-8255. In Maryland, people can also dial the 211 helpline or text #MDMINDHEALTH TO 898-211 to receive regular caring messages.
On Nov. 12, the University of Maryland Medical System is holding a free virtual event with a focus on “understanding grief, loss and building hope during the COVID-19 pandemic.” More information can be found at umms.org/notallwounds.
There are other steps people can take even when they don’t believe they need professional help, said Connie Noll, a psychiatric nurse practitioner at Upper Chesapeake Health.
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She said staying in touch with family and friends is crucial even when you can’t be in the same room.
But she also said to take personal steps such as eating well, sleeping enough and limiting alcohol, caffeine and other drugs. Noll said do something enjoyable, like take a long, hot shower or walk in the woods or try something that you have always thought about like painting.
Also, make a bucket list of the things you’d like to do when the pandemic ends.
“This constant stress affects people in different ways,” she said. “Some people are experiencing catastrophic loss of life or catastrophic loss of livelihood. Many of us have not had those kinds of things happen, but there is a sense of small grief for the way life used to be nine months ago.”
Give yourself a break, she advises. Give others a break. And, as Marcozzi said, check on others.
He’s asking for a friend.
Those needing help for themselves or others can call National Suicide Prevention Lifeline at 1-800-273-8255. In Maryland, people can also dial the 211 helpline or text #MDMINDHEALTH TO 898-211 to receive regular caring messages.