This is a guest post from the Planetary Health Network of Young Professionals, written by Katharine Palmer, MPH. KP has studied Psychology and Public Health, and is currently working as a Research Assistant.The article has been edited by Janice N. Averilla. For more posts on managing your mental health during the ongoing COVID-19 pandemic, see our resource pack.
A potential mental health crisis has been predicted in the aftermath of the COVID-19 pandemic. However, numerous people worldwide have already experienced or are currently experiencing anxiety, stress, or grief caused by the uncertainty, fear, or loss from a disease that has assaulted our plans and lifestyles. For some, the changes have been considerably minor, but for others they have been enormous and devastating. In countries where isolation in the household is strictly imposed, increasing concerns about the possible negative impact of this extended isolation on mental health have emerged. In a recent study conducted in China, those aged under 35 and those who consume three or more hours of COVID-19 related news per day report more anxiety and depressive symptoms, and medical professionals report getting less sleep due to long working hours.
Post-traumatic stress disorder (PTSD) is often identified as one possible mental health consequence of COVID-19. Research from the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in Toronto suggests that strict quarantine measures could cause an increase in PTSD symptoms and depressive symptoms for those in quarantine, particularly if they are lower income households. However, this study only investigated PTSD symptoms in quarantined individuals roughly two months after quarantine. How long symptoms will last, and if they will develop into a PTSD diagnosis, is still unknown. Identifying key factors, such as low income, that predispose people to more severe mental health outcomes can be useful to extend help to those most at risk. The Pan-America Health Organization has identified other essential factors including being part of a minority group, having a history of mental illness or chronic disease, or working with large numbers of patients. But, as so much of the world’s population has been affected by the pandemic, reducing the mental health burden for individuals with one or multiple risk factors appears challenging.
Improving mental health after a disaster takes a broad approach, and frequently focuses on solving practical problems to alleviate stress from a lack of food or shelter. By relieving the excess stress caused by a disaster, basic emotional needs can be met, reducing the risk of mental health disorders. In an ideal scenario, we imagine one-on-one or group therapy with a professional as a means of improving one’s mental health. On the contrary, and in the context of COVID-19, we face the reality that providing rapid mental health services to all who are in need is rather problematic, especially in many countries where these services have been limited even before the onset of the current pandemic. Thus, different approaches need to be undertaken to ensure the effectivity and sustainability of treatments.
One challenge unique to this pandemic is the lack of social contact, restraining social support amongst friends and families. With work and school taking place at home, many public mental health interventions that would typically occur in schools or offices are not permissible, although they may be useful in the later stages of the pandemic. Recently, there has been a call for online mental health help, such as counselling through WeChat, hotlines, or apps. Variousorganizations have also come up with helpful tips for handling coronavirus stress such as only looking at information from reliable sources, consuming less news, connecting with others, and accessing further help if they are in need. However, it is difficult to know where to access accurate information especially for those who do not have access to the internet as all online mental health resources rely on an internet connection. Finally, accessing such resources requires knowing that online mental health help is not a futuristic idea, but is currently available. Sharing and promoting these resources is helpful. Below are a few resources we find useful for mental health improvement:
COVID-19 pandemic has affected everyone in diverse ways and there has been an almost population-wide shared experience of lockdown stress. There are also many news stories and personal accounts of increased mental health burdens available online. Hopefully, the increasing attention to mental health will give those who are suffering the courage to speak out and seek help, in the comfort that they are not alone.
The after-effects of the COVID-19 pandemic are going to be felt for years to come. Some of these may be positive – for example global lockdowns have helped to (temporarily) improve air quality in cities. But what impact has restricting people’s movements had on individuals and their health and mental wellbeing? And how much are people getting out and about in nature during this time? Researchers from the University of Sheffield are hoping to find out.
This survey aims to capture data on whether people’s interactions with nature have changed since the onset of the pandemic. It takes roughly 15 minutes to complete and is completely anonymous.
By completing the survey, you can contribute to research on the effects of nature on people’s health and wellbeing in the pandemic. We’ll be talking more about the importance of citizen science and public contributions to research in upcoming articles – keep an eye out for them on the website and our Facebook and Twitter.
With the UK Prime Minister announcing a nation-wide lockdown earlier this week after several days of social distancing, it’s safe to say that the Covid-19 outbreak is having a major impact on everyone’s lives. It’s easy to get overwhelmed – especially as the virus is the only topic on the news right now. We’re all facing the possibility of at least a few weeks staying inside at home, and that’s going to have a knock-on effect on people’s emotional wellbeing.
If you’re reading this, your brain is probably completely saturated with alarming news and statistics about the novel coronavirus. This article isn’t going to add to your stress – instead, we’ll be looking at ways you can improve your emotional wellbeing while on lockdown, and why staying at home is the best possible thing you can do right now. And if you really must look at Covid-19 news, a good place to start is this datapack from Information Is Beautiful.
1. Staying at home keeps you, and everyone around you, safer
Don’t look at this as being forced to stay inside. Reframe your perspective and see the lockdown as a way to avoid exposing yourself and your loved ones to the virus. If you’re home and following proper sanitisation procedures (washing your hands to whatever song floats your boat, regularly disinfecting surfaces and objects like your phone), it’s much less likely you’ll catch the virus or risk spreading it to anyone else outside your household. There’s an end goal in sight – we’re collectively trying to flatten the curve and keep the rate of infection (R0) lower than 1 (i.e., each infected person infects fewer than one other person.
2. Boost your emotional wellbeing by staying social
Loneliness and social isolation can have serious negative impacts on health and emotional wellbeing and many of us get most of our social interaction through the workplace or in school. Even though we may not be physically in the same room, the internet and messaging apps have given us all the tools we need to talk to people. You don’t need to use conferencing apps like Zoom just for work – grab yourself a cup of tea and some biscuits and settle in for a conference-call chat with your friends.
Even if you don’t have the bandwidth to video call people, make sure to check in with friends at least once every day – it’s likely they’re feeling just as stressed out by all of this as you are.
3. Give yourself a break from social media
Yes, we just told you to be more social. But that doesn’t include checking Twitter three hundred times a day. Misinformation about the virus is being shared everywhere, along with a constant stream of news broadcasts telling you things that are guaranteed to stress you out. Turn your social media notifications off, remove the apps from your phone, and put your phone out of reach. If you don’t want to stay away from social media completely, maybe take a look at who you follow and see if you can keep your feed stress-free.
Unless you have somewhere to be (let’s face it: unlikely) or an urgent deadline, try letting your body tell you when to wake up. The caveat is that you should probably try to go to sleep before midnight, otherwise you’ll probably find yourself sleeping well into the next day. Try it – you might be surprised at how quickly your body adapts to a good sleep rhythm.
5. Get a plant to look after
Houseplants are all the rage right now, but they’re not just good for brightening up your Insta feed. Gardening is surprisingly good for your mental health and emotional wellbeing. In fact, the Royal Horticultural Society has made gardening and mental health a key part of it’s science strategy. They’ve created four new Wellbeing Gardens around the National Centre for Horticultural Science. You can visit just as soon as the gardens are reopened. In the meantime why not pick up a houseplant next time you’re in the supermarket stocking up on toilet roll?
6. Pick up a home project you’ve been putting off
It doesn’t have to be a huge task. It can be as simple as emptying out that junk drawer that things disappear into, but never seem to come out of. Doing something that makes your life slightly easier in the long run will make you feel more productive. Plus, it helps stave off any feelings of lethargy that you might experience being inside for long periods without a clear schedule.
7. Get creative with your cooking
It’s easy to start mindlessly snacking when you’re home for long periods of time. This is probably not very good for you for a couple of reasons. One, eating unhealthy food is linked to increased stress, anxiety, and depression ( and you’re likely to consume more of it). Two, although you can go to supermarkets, you need to limit your trips there as much as possible. Social distancing!
Plenty of people are talking about what to do with those random tins you have at the back of the cupboard. A good place to start is Twitter, where chef and food writer Jack Monroe runs #JackMonroesLockdownLarder every night from 5pm.
8. Read a book
Bibliotherapy isn’t a hugely well-studied field, but storytelling has been around for millennia. Reading is an easy way to escape for a little while. With the lockdown in place, now is the time to get through your ‘to-be-read’ list. Services like Kindle, Google Play and Apple Books have ebooks you can buy if you can’t get hold of physical books. But did you know in the UK many libraries offer apps where you can loan free ebooks? You can use this postcode checker to see what services your local library has to offer.
9. Improve your emotional wellbeing by getting outside
Yes, we’re on lockdown. You’re still allowed outside once a day for exercise though – the important thing is to be smart about it. Find the quiet places in your local area. Even if it’s just a walk round the block, countless studies show the importance of getting some exercise every day. Trying to spend a little bit of your day in nature is good for you, too. Sensible precautions apply – if you’re showing symptoms or you’ve come into contact with someone who has, you should stay inside. Even if you can’t get outside every day, opening the windows will get some air moving in your house. It’s a good way to take advantage of the improved air quality in many cities – a result of the lockdown.
This post is by Jennifer Cole PhD, a full-time Research Fellow at Royal Holloway, University of London. She is an Associate Fellow at the Royal United Institute for Defence and Security Studies, a UK-based policy think tank, where she ran the Resilience and Emergency Planning programme until 2018. She has also worked with UK and international government agencies on policy planning around the response to serious infectious disease outbreaks. Find her Reddit AMA on the COVID-19 pandemic here.
When people use the word ‘pandemic’ it tends to incite fear. It conjures up pictures of widespread death and societal collapse, the Hollywood movie version of what would happen and how the world would(n’t) cope with a new, unknown disease. History lessons of the Plague of Athens, the Black Death and, more recently, Spanish Flu bubble to the surface of collective and cultural memory. Millions of deaths. Bodies piling up in the streets. Society breaking down.
But take a deep breath (through an N95 respirator mask if you want to be careful), step back and try not to panic. Even if the worst case prediction of case fatality rates – currently running at around 2% turn out to be true – and it is increasingly looking as if this is a high-end estimate that doesn’t take into account the many cases that go unreported because symptoms are mild – there is no reason to think that this will equate to societal and economic collapse; the 1918-19 influenza outbreak had a similar CFR but didn’t, even in a world already economically depleted by WWI . There are currently 7.6 billion people in the world: even 2% less than that is still a lot more than 7 billion. The world won’t lose all its doctors, or airline pilots, or software developers, or rap artists.
Society did anything but descend into chaos on either occasion: the affected communities came out stronger and more just. Neither is collapse likely with SARS-Cov2, the virus responsible for the COVID-19 outbreak. This isn’t to play down the situation. It isn’t to belittle the virus as ‘just a cold’ or to not care about the people who have died and will still die. But it is a call to keep things in perspective, to guard against panic, and to consider what part everyone has to play in responding to events over the coming weeks.
What is a pandemic, and are all pandemics deadly?
So is SARS-Cov2 a disaster? A death sentence for the world? The end of civilisation as we know it? The evidence is increasingly saying ‘no’. Pandemics have, in the past, been all those things but at the same time, all ‘pandemic’ means in literal terms – ‘pan (all) and demos (people)’ – is ‘everywhere in the world’. It denotes the geographic range of the spread, not severity of the disease, but tends to be interpreted by lay audiences as the latter only. This is precisely why the WHO revised how they used the term following the 2009-10 H1NI ‘Swine Flu’ pandemic: when the virus responsible turned out to cause only mild disease in most cases, they were criticised for over-reacting and of encouraging countries to ramp up unnecessary countermeasures.
The media prefer to hear about PHEICs – Public Health Emergencies of International Concern – because they’re easier to make headlines out of. Emergency! Concern! – even though PHEICs may not be everywhere or much of a threat to most people other than the ones whose job it is to deal with them. Anyone remember the Polio PHIEC of 2014? It didn’t spark sensational headlines because the world has a vaccine. The fact that the vaccination programme had broken down in war-torn Syria, putting thousands of Syrian children at risk – but no-one else – wasn’t a good enough story.
Ebola, which was happening at the same time, got much more attention. There was more of a threat from a disease that didn’t have a vaccine – although, as it turned out, even that threat was reasonably easily mitigated by any quarter-decent healthcare system. A few years before, Swine Flu had made the headlines when people who don’t usually die if they catch influenza thought they might, but everyone then lost interest when they realised that this wasn’t the case. At the same time, the papers forgot that more than 600,000 people die each year from normal seasonal flu – up to 10,000 in the UK alone. This is also pandemic, but no-one really worries too much about it.
So how does all this relate to coronavirus SARS-CoV2? Should we be scared that (a) it’s a PHEIC and (b) that it may or not be ‘officially’ a pandemic depending on whose classification is used and how that classification is made?
A COVID-19 pandemic: should we panic now?
The key to how scared someone should be of a disease is, of course, how likely they are to be affected by it. Primarily, how likely they are to die if they catch it. This, in turn, depends on a number of factors, including, but not limited to:  how susceptible they are to catching the disease,  how able to naturally (without any medical help) fight it off if they are infected,  how much, and what, medical help is available if they can’t fight it off without medical intervention,  how measures including quarantine and vaccination offer protection  and what can be done to avoid catching it, which includes everything from handwashing, using a face mask, to self-isolating and quarantine. PHEICs drive international cooperation. Pandemics encourage rapid research and vaccine development, bring greater and more immediate investment, galvanise the research community to work together and lead to greater understanding of not only the disease itself, but of how best to organise healthcare systems and response. Not all of it is bad news.
So, let’s deal with each of the factors mentioned above in turn:
1. How likely am I to get COVID-19?
In the case of SARS-Cov2, the current planning assumptions are still that everyone is susceptible to catching it. That no-one has any innate immunity (obtained from having caught it once before, when they may have been younger and fitter and more able to fight it off). There may be little genetic immunity (which can exist within a society because people who are less able to fight it off don’t survive to breed) because it hasn’t been around long enough for this selective pressure to come into play.
Equally, however, there may be – some people were naturally immune to Ebola because they carried an allele known as CCR5 Delta-32– which also offers protection against HIV. General virus-fighting biology may be working behind the scenes but it takes a long time for scientists to figure this out – with Ebola, it was deduced from analysing family members who had all been exposed but not all of them became infected – but things have so far been happening very, very quickly with SARS-Cov2; too quickly for such analyses to be made.
The cruise ships are the best microcosm we have to deduce how many people who have clearly been at risk don’t become infected. More time will be needed to develop a clearer picture on this but out of 3711 crew and passengers, only around one in five seems to have contracted the disease.
2. How serious are the symptoms?
A second factor in how badly the virus will affect society is how likely the average person who contracts it will be to require hospital treatment. This is particularly difficult to calculate from early cases as mild and asymptomatic ones will not be recorded. Only the severe cases tend to be diagnosed – possibly only those who go on to need hospitalisation – show up in the figures. It seems that many people either didn’t realise they were infected or had such mild symptoms they didn’t go to a doctor. It was indeed, ‘just a cold’ for them. Here, again, the cruise ships will provide some of the most accurate numbers available, as will contact-tracing relatives of known cases and people who are known to be at risk of exposure.
Normally, healthy people aren’t tested for cold or flu viruses or recorded in medical records, and thus severity and case fatality rates tend to be overestimated at first, and drop as more figures become available. Now that significant numbers of people are being tested – whether they’re ill or not, and whether they’re mildly or significantly ill – the real picture will become clearer, as will info on what types of people are more likely to be severely ill than mildly ill: the very elderly, those with underlying health conditions, heavy smokers etc. Once demographics have been established, people outside of those categories can worry a bit less. Early indications so far suggest that the risk of dying if one contracts the virus is around 14% for people over 80, but only 0.2% for those under 40.
3. Can we treat COVID-19?
Medical help is available, and paints a reasonably optimistic picture. Dealing severe respiratory conditions is a staple of hospital operations: there’s lots of equipment and trained nurses and doctors. If you end up in hospital, they know what to do. The real challenge with SARS-Cov2 is that there will be more people than usual in hospital at the same time. Mostly old, already ill with other conditions, or immunocompromised people – but still more. Remember the accusations that Swine Flu was a bit of crying wolf? The NHS doesn’t – the UK’s healthcare sector only barely coped. Still, it did – due to years of planning, exercising and preparation. People died, but not that many more than in an average flu season.
The biggest concern with SARS-Cov2 is that high numbers of severe cases – quantity rather than quality of disease – will result in not enough of this medical help to go round. This is probably the biggest real concern in the current situation. It’s why one of China’s first actions was to build the massive temporary hospitals, why the US’s FEMA is sending out letters requisitioning hotel beds, and why in most countries, emergency plans will be kicking in to do the same and to see what other things hospital beds are used for – such as routine hip replacements, for example – can be postponed for a few months.
In the meantime, quarantines, social distancing and encouraged self-isolation will help to protect these elderly and vulnerable members of the population, as well as those who could probably fight it off alone. This doesn’t mean that quarantines, lockdowns and self-isolation is an over- or knee-jerk reaction – but rather than only benefitting the quarantined individual, they buy time: to understand the virus better, to learn how to deal with it, to calculate more accurate figures for how infectious it is and the case fatality rate it causes, and how to prevent it.
4. Can we vaccinate against COVID-19?
One main advantage of quarantines, lockdowns and curfews is that they buy time: for healthcare professionals and scientists to figure out how best to deal with the disease and, ideally, they buy time in which vaccines can be developed and trialled. Even if and when it’s completely understood that containment measures cannot keep a disease from spreading and becoming pandemic for ever, it is still worth slowing that spread down – as much as possible, for as long as possible. This is the best response for society at a mass level – but has to be weighed against the damage quarantines may cause, such as panicking people, and damaging the economy.
The alternative is to let the virus run and take the consequences – potentially sacrificing the elderly and vulnerable for whom there may not be enough healthcare. It would take a very, very brave politician to make that call. The politically safer (and more human) option is to keep plugging away with the quarantines even when you know they will ultimately fail to contain the spread.
5. How do I avoid catching it in a pandemic?
At a societal level, however, there is still much we can do. Human behaviour is an important factor in disease spread as the characteristics of the pathogen itself and everything from basic handwashing, not coughing on your neighbours, working from home if possible and shopping online for groceries, will have a significant impact on whether you personally catch the disease and whether the chains of infection across the world can be broken. Emergency planning scenarios tend not to like to focus so much on human factors, as they’re harder to control, but once factored in, they make the whole situation much, much less scary.
The vast majority of these plans have been publicly available for years but the irony is, the public mostly ignores them and even sneers at them until the crisis hits. But they’re there, and people are working behind the scenes right now – just as they always are – to make sure that they hold up as well as possible under very trying circumstances. A massive help to how well they can operate is making sure the public doesn’t panic – that people take avoidance measures where necessary but don’t get overly worried about what they can’t change. Society will only break down if society allows it to.
So we’ll get through this pandemic?
It is important to keep things in perspective. ‘Pandemic’ refers to the number of cases and the number of countries a disease is spreading freely in, not its severity. If and when SARS-Cov2 becomes pandemic, this doesn’t mean it’s more or less infectious/serious/scary than it was last week. It means that countries and their healthcare sectors are more alert to it, more likely to reach for, assess and amend where necessary their own emergency plans to deal with it. This includes how they will cope with more hospitalizations, what additional supplies they need to start drawing in and how they reorganise to manage something beyond business as usual. Swine flu is recent enough that plans have been tested within living memory, and they did hold up.
Pandemics have the greatest effect at a societal level
For those still feeling that the best response is to panic: keep in perspective the difference between risks to individuals and risks to society. The longer outbreaks go on, the more information emerges about them. The more SARS-Cov2 cases are understood, and the more information and understanding is gained about asymptomatic or very mildly symptomatic cases, the more it looks as if, on an individual level, the virus may not be too much worse than a typical seasonal flu season for the majority of people under 80.
At population level, this is still a significant challenge because – unlike the viruses that circulate during a typical flu season – no one has any immunity to SARS-Cov2, so overall there will be many more cases. The people least likely to be able to fight it off – the elderly – won’t be protected by residual immunity from other viruses that were similar enough to the current one to help. In the 2009 Swine Flu epidemic, residual immunity to the Asian flu(s) of the late 50s and 60s meant that the elderly had some protection. That’s not there this time. But, if you aren’t elderly, don’t have an underlying immune condition and seek treatment early, it is looking increasingly as though you are likely to survive infection, without needing hospital treatment..
The picture is somewhat different for those who work in the health system, who are likely to face significantly increased workloads. But preparedness plans (all publicly available online) are in place and the doctors who know about them tend to be playing down the dangers.
Quarantines are a good thing
It’s also important to acknowledge that the quarantines and lockdowns in place across the world look dramatic on TV but are there primarily to slow down the spread of virus, which has two main advantages:
1. If the spread is slower, an outbreak in one area might be more or less over before another one starts. Resources can be moved around and go further if the entire world doesn’t have to deal with all cases there will ever be at once. In particular, once an outbreak has passed through one region, it tends to leave behind recovered and immune survivors who can help those who come after them.
2. Secondly, the slower the spread goes, the more time there is for vaccine development, to protect those in regions not yet affected. The world’s vaccine developers are working round the clock to make sure this happens: a vaccine may be ready for early human trials in April .
The scenario presented above isn’t the sensationalised doom-mongering that makes the best tabloid headines. Nor is it looking at the challenge through rose-tinted glasses. Panic never solved anything; the best approach to any crisis is to be well-informed, well-prepared and ready to meet it head on. The young(ish) and generally healthy will mostly survive. By doing what we can to avoid catching the virus and passing it on, everyone can help to protect those who are older and less generally healthy. By aiming to be part of the solution, not the problem, we all have has a part to play in keeping society in the best health possible over the coming weeks.