The Covid-19 pandemic has affected almost all countries of the world. Some like
India, United States, Brazil, and Russia are going through a rapid rise in the number of cases. Other countries have already peaked but are struggling with the aftermath. The struggle with the pandemic has not just a physical, but also a psychological impact and people both with and without the disease are impacted by it. The most common impacts of such an outbreak or epidemic are
Anxiety
Panic behaviour
Disturbed sleep
Disrupted daily biological rhythms
Anger
Fear, which can manifest itself in multiple ways
Fear of becoming infected
Fear of financial insecurity
Fear of quarantine/social isolation
The extent of these are related to the prevalence of infectiousness and mortality but the most common factors for such stress are
The lack of regular routines.
The additional stress of being careful once you step out.
The inability to connect to family and friends as before, leading to social isolation.
Fear of being required to isolate / quarantine.
Keeping up with changing government guidelines is challenging.
The financial impact and insecurity because of the pandemic can be stressful and the expense incurred in case of illness, can be also be a cause of concern.
The quest to know more about the disease and its spread makes people look for information on the internet. There is Information Overload on social media too. This Cyberchondria and information overload leads to decreased ability to process and assimilate the information. Fake information on social media makes things worse. All of this leads to Health Anxiety, which in normal circumstances can be protective, leading to timely action for health issues. But during the pandemic it may lead to repeated medical consultations or an aversion to taking medical advice in case of sickness.
Although mental health issues arising due to the pandemic can impact anyone, the most vulnerable groups are
People with existing mental health issues
The elderly
People with co-morbidities (diabetes, obesity, heart disease)
Pregnant women
Children and adolescents
Healthcare professionals, especially frontline workers
Parents struggling to keep their children engaged
Those vulnerable to domestic abuse or substance abuse
People without a history of mental illness are also prone to anxiety. Those who have suffered from Covid-19 are prone to depression and post-traumatic stress disorder which can be caused by
Isolation
Stigmatisation
Concern for the well-being of loved ones
Anxiety about the course of the disease
Availability of hospital beds if required
It is also traumatic for the family. Keeping a positive outlook and being connected to family and friends virtually is very reassuring and helpful.
But all is not grim. Incorporating a few small steps routinely can help decrease anxiety. Managing the current problems efficiently and asking for professional help in a timely manner can go a long way to alleviate the long term mental health consequences of the pandemic, which can be as disastrous as the pandemic itself.
The most important thing to do is to accept the situation. We cannot wish the pandemic away; it is here to stay. Take all the preventive steps like washing hands, wearing masks properly, avoiding touching eyes and face, social distancing and sanitizing wherever necessary. Make sure all the family members are doing the same, make collective decisions.
See things in the right perspective.
Be informed, but from the right sources. Incorrect information puts us at risk and makes us vulnerable. Media and social media can bring in lot of information, maybe more than is necessary. Limit your exposure to them, relying on experts or government sources to give authentic information. Block the sources if they are giving wrong information or spreading negativity.
Understand the current situation in your locality and city. It is natural to worry and have fears. For some “a worry list” and “an action list” can be helpful. Have a worry list and assess if your worry is realistic. Focus on things which can be managed and have an actionable plan. Keep a list of the resources and support system just in case there is a need. Focusing on what you can control can help a long way to decrease anxiety. Have confidence in your capability to deal with the current situation. It is natural for human mind to think of negative outcomes. Putting things in the right perspective, visiting your past experiences when you have managed tough situations can give you the confidence to plan or look for solutions. The pandemic is not in your control, your actions are. Share with others who may be going through the same issues and find solutions.
Distance physically but not socially. Man is a social animal indeed. That is why being confined to our homes and being unable to meet friends and family is taking its toll. The coronavirus spreads by aerosol generation and fomites. To reduce the chances of getting infected masks and keeping 6 feet from others is advised. This does not mean that we should not connect with friend and family virtually. Dedicate time for connecting, discuss with family and friends and set aside a day / time to connect individually or in groups, and party virtually! If you must meet in person meet people who stick to a social bubble. A social bubble implies meeting a very limited number of people who you are certain are taking the same precautions as you are. Meet only for a short while and not too often, preferably outdoors and wear masks.
Connect with positive people. While it is important to discuss and learn from others, stay away from people who have negative inputs about the pandemic or about you personally. Do not let Coronavirus dominate the conversation. Sharing about your fears and anxiety can help you to find solutions - remember that others are also going through the same. Together you may come up with solutions which can be helpful to all.
Look after yourself and your family. It is evident from the past few months that people with good immunity do better after getting infected. In case we get infected despite adequate precautions, this is our defence. Older people and people with comorbidities are prone to get severe disease. To enhance immunity, we can do the following
Eat healthy. Plenty of vegetables/fruits and a balanced diet helps to build your immune system. Research has shown that a few nutrients like Vitamin C and D, Zinc, Selenium help to fight viral infections so include foods rich in these in diet daily.
Exercise regularly. It will increase your innate immunity against the virus. It also releases serotonin and endorphins - transmitters which elevate our mood and help fight anxiety and depression. Breathing or Pranayam will increase the parasympathetic drive and decrease the stress response. Set aside a time of the day, make a buddy system with others to ensure regularity.
Have a good night’s sleep. The simple act of sleeping 7-8 hours builds up immunity, makes you less irritable and helps to be mentally agile. Do not compromise on sleep, follow and the day/night cycle. Watching your favourite show till late in the night can make you vulnerable in many ways. So, avoid screens before bedtime, read a book, relax, or meditate. Caffeine and alcohol in the evening also interfere with restful sleep.
Managing stress requires active effort. Make a routine and structure the day to help to manage time. Dedicate time for relaxation, meditation, mindfulness - any activity which calms the mind. If you have not tried it before, there are many apps which help you to do this, and also individual and group stress management programs. If anxiety and feeling of helplessness persist, look for professional help. There are many helplines for this. Do not hesitate to ask for help.
Above all, be kind to yourself and to others. Do something you enjoy, like an old hobby you never found time for. Set aside a me time. Dedicate a time for doing what you like - any hobby - music, reading or even learning a new skill that you always wanted to. There is a time to worry and a time to enjoy and be constructive. First look after yourself - physically and emotionally before you help others. Share what you do with family and friends, you will be happy to support them and be supported.
It can be challenging to manage children, especially if parents are working from home. Not meeting friends and the inability to go outdoors or to school can lead to behaviour problems in children. Look for behaviour changes like
Excessive crying / irritation / worrying / sadness
Unhealthy eating
Change in sleep patterns
Avoiding school curriculum
Difficulty concentrating / paying attention
Avoiding things / activities they enjoyed earlier
Unexplained physical symptoms
Be supportive, talk to them. Give them information about the pandemic that they can understand. Leave out details like mortality rates which may add to anxiety. Answer their questions. Explain the precautions to be taken and reassure their safety. Limit news and screen time for them. Sit with them and make schedules routinely, keep them engaged in constructive activities. Be firm about not being disturbed during your work schedule. A routine according to school hours helps children to stay focused. Spend quality time with them, like reading, exercising, and playing board games. Be a role model.
Elders, especially those with comorbidities need to be more careful and this can add to anxiety and isolation. Help them to make routines and to do things they enjoy. Encourage them to connect virtually to avoid isolation and boredom.
For Covid 19 patients - both during and after recovery - coping with isolation and fear, discomfort in breathing and other complications requires psychological support. New analysis from various countries is revealing that there may be long term consequences of Covid-19 which may require monitoring for 3-4 months. The incidence of these and post-traumatic stress disorder and their consequences remain to be assessed in future.
Together let us beat the pandemic, by winning the war on mental health collectively, while the Medical profession takes care of the illness!