Mental Health Issues in aPost-Covid-19 Pandemic World

Introduction:

The word Corona means “crown” in Latin. Coronavirus got their name from the way that they look under a microscope. The virus contains a core of genetic material surrounded by a cover with protein spikes. This gives it the appearance of a crown.

Coronavirus is zoonotic, meaning that the virus is transmitted between animals and humans. Coronavirus cause illnesses such as respiratory diseases or gastrointestinal diseases. Respiratory diseases can range from the common cold to more severe diseases e.g. 

• Middle East Respiratory Syndrome (MERS-CoV).
• Severe Acute Respiratory Syndrome (SARS-CoV).

The coronavirus disease (COVID-19), first identified in December 2019, in Wuhan, Hubei Province, China, has resulted in a global pandemic which continues to impact people in many ways. It has changed the social life of people across the world and has added new isolation measures and quarantine to their life. This isolation is known to affect their mental health due to the loss of a true human connection and surging feelings of stress and anxiety during times of uncertainty. The public health event it caused has led to delays in starting schools and universities and a switch to online modes of teaching. 

Coronavirus Disease 2019 (COVID-19) and the spread of severe acute respiratory syndrome coronavirus became a global pandemic, with more than 150 million cases confirmed, and 3.2 million lives lost in more than 200 countries by the end of April 2021. Although considered as a respiratory disease, COVID-19 has become increasing recognized as neurotropic since patients might experience mild to severe neurological symptoms. Using magnetic resonance imaging (MRI), previous studies reported that half of the COVID-19 patients have brain structural abnormalities, including white matter hyper intensities and frontal-temporal gray matter volume abnormalities.

While the control of widespread and care of patients are the most crucial tasks, new research is now suggesting that there may be long-term consequences, in those 60 million people who recovered from COVID-19 infections. Such as 

• Fatigue  
• Muscle weakness, 
• Sleep difficulties, 
• Anxiety and
• Depression

 Crucially, COVID-19 survivors who experienced fear for survival, are vulnerable to develop post-traumatic stress symptoms (PTSS). A recent study found that COVID-19 survivors in Italy suffered severe PTSS shortly after they were discharged (e.g., within 1 month) from the hospital. However, it is still unknown whether COVID-19 survivors suffer longer-term PTSS (e.g., about 3 months to 6 months), and whether their PTSS are associated with apparent brain abnormalities.

The number of cases has continued to rise, with cases and deaths continuing to rise in many countries, while the impact of social distancing and quarantine measures has had a measurable impact on the economy. 

    The World Health Organization (WHO) has stated the coronavirus disease 2019 (COVID-19) a pandemic. A pandemic is defined as “occurring over a wide geographic area and affecting an exceptionally high proportion of the population.” In March 2020, the outbreak of the coronavirus disease 2019 (COVID-19) reached all countries of the Western world. To reduce the speed of its spread, many countries slowed down their economies and enforced pronounced restrictions on public life.

CLINICAL PRESENTATION:

    Typically Coronavirus present with respiratory symptoms. Among those who will become infected, some will show no symptoms. Those who do develop symptoms may have a mild to moderate, but self-limiting disease with symptoms similar to the seasonal flu. Symptoms may include: 

• Respiratory symptoms
• Fever
• Cough
• Fatigue
• Sore throat
• Shortness of breath or difficulty breathing.
• Muscle or body aches.
• Headaches.
• New loss of taste or smell.
• Congestion or runny nose.
• Nausea or vomiting.
• Diarrhea.

A minority group of people will present with more severe symptoms and will need to be hospitalized, most often with pneumonia, and in some instances, the illness can include ARDS, sepsis and septic shock. Emergency warning signs where immediate medical attention should be sought include:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

HIGH RISK POPULATION:

The virus that causes COVID-19 infects people of all ages. However, evidence to date suggests that three groups of people are at a higher risk of getting severe COVID-19 diseases.

• Older people (people over 70 years of age)
• People with serious chronic illnesses such as:
  • Diabetes
  • Cardiovascular disease
  • Chronic respiratory  disease
  • Cancer
  • Hypertension
  • Chronic liver disease
  • People who are Physically Inactive

The WHO has issued and published advice for high-risk groups (older people and people with serious chronic illness) and community support. This is to ensure that these high-risk populations are protected from COVID-19 without being isolated, stigmatized, left in positions of increased vulnerability or unable to have access to basic provisions and social care.

Pandemics can be stressful: 

The coronavirus disease 2019 (COVID-19) pandemic may be stressful for people. The impact of COVID-19 worldwide includes not only increased death rates but also a wide spread of psychological and economic impacts that are now coming to light. The mass fear of COVID-19, termed “Corona phobia,” along with the forced quarantine, has increased levels of anxiety, hoarding behaviors, and PTSD among the general population.

The first association between viral epidemics and psychological distress was made over a 100 years ago during the 1918 Spanish flu pandemic that yielded psychiatric complications.

In recent times, COVID-19 has been recognized as a public health emergency and thus far, most papers published on it are focused only on the clinical characteristics of infected patients. However, this pandemic has also demanded people to show phenomenal emotional resilience in the solitude of their homes which can take a toll on their mental health.

Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. 

Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19.

 Coping with stress in a healthy way will make you, the people you care about, and your community stronger.

Stress during an infectious disease outbreak can sometimes cause the following:

• Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on.
• Changes in sleep or eating patterns.
• Difficulty sleeping or concentrating.
• Worsening of chronic health problems.
• Worsening of mental health conditions.
• Increased use of tobacco, and/or alcohol and other substances.

Another indicator of an increase in mental health issues is the immediate increase in medications to treat anxiety, depression, and insomnia.

According to a World Health Organization survey performed in October 2020:

“The COVID-19 pandemic has disrupted or stopped critical mental health services in 93% of countries worldwide while the demand for mental health is increasing”.

COVID-19 Virus Pandemic Psychological Stress Management

General Coping Skills:

Biological 

• 7-8 hours of sleep each night.
• Eating 3 healthy meals per day.
• Exercise 3 days per week for 30 minutes where your heartrate is over 120 BPM.

Emotional 

• Expressing yourself and talking with co-workers. 
• Validating and supporting others.
• Monitoring your feelings throughout the day. 
• Engaging in self-compassion and setting limits.
• Connecting with those we love each day.

Cognitive:

• Recognizing when your thinking is being influenced by your emotional state. 
• Avoiding black and white thinking.
• Not giving into “automatic thoughts” that elicit negative emotions. 
• Recognizing when our behavior is contributing to negative emotional states.

Environmental:

• Keep a clean and organized environment. 
• Identify factors in our environment that are contributing to our stress and eliminate them if possible. 
• Change your environment if feeling too stressed out.

Social distancing

Concerns:

• Maintaining social distancing can be a very isolating and difficult situation.
• This may raise tensions at home, create loneliness, feeling constrained.
• You may feel more isolated from your co-workers as well due to social distancing rules.

Coping Skills

• Find ways to get outdoors/get out of the house that are still safe. 
• Start a project in your yard or around your apartment. 
• Connect with friends online as others may feel isolated as well. 
• Increase virtual communication with co-workers. Leave them fun digital notes/memes.

Loss of Routine 

Concerns 

• Most people have felt a disruption in their day to day routine as a result of the virus. 
• Both in terms of their job and home life. 
• Extra precautions. 
• Not being able to get resources.

Coping Skills 

• Creating a new routine. 
• Taking initiative to set up routines with co-workers. 
• Accepting the idea that some things won’t get done (plates will drop). 
• Talking with boss about expectations and priorities. 

Loss of Self-Care Activities/Routines

 Concerns 

• Normally we do all kinds of things to take care of ourselves. 
• Unfortunately, many of these activities involve being around others and have been cancelled.

Coping Skills 

• Get CREATIVE! 
• Use YouTube to do exercise, meditation, and mindfulness at home. 
• Get a video game that involves exercise. 
• Read those books you have wanted to read. 
• Go for a walk. 
• Talk to friends online and connect.
• Start a project.

Talking to Kids about Corona Virus

 Concerns 

• Children may be struggling to understand what is happening (just like we are), except they have less agency to manage their lives. 
• Being out of school and out of their routine can be difficult for many kids.

Coping Skills

• Talk with your children about the topic.
• Focus on things that are going to stay the same (being together, being loved, supporting each other). 
• Come up with daily routines and rituals for your children.
• Recognize how your own anxiety may be effecting your children.

Having Special Events Cancelled

Concerns 

• In the wake of social distancing many events have been cancelled or postponed.
• This includes sports, conferences, vacations, and even weddings. 
• This can produce a sense of grief or loss that feels unfair.
• Coping Skills 
• You are not alone in feeling this way! 
• Don’t fall into the trap of feeling like this is a “first world problem” and not allowing yourself to grieve. It’s okay to be disappointed. 
• The process of making changes can bring people together. 
• More time can make some events even better.