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INVITED VIEWPOINT
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 19-23

COVID-19 pandemic: Some observations and a few recommendations


Rajendra Vihar, Lane, Newada, Sunderpur, Varanasi, Uttar Pradesh, India

Date of Submission19-Jul-2020
Date of Acceptance21-Jul-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Prof. Indira Sharma
Rajendra Vihar, Lane 6A, Newada, Sunderpur, Varanasi, Uttar Pradesh-221005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_220_20

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  Abstract 


The COVID-19 pandemic has emerged as a major challenge for India. There has been a widespread response from different sectors. This article seeks to make pertinent observations on the responses to the pandemic in light of implications for the mental health of the community and give concrete suggestions regarding the same. The main observations include: a “global COVID mass hysteria” is fast spreading, an unbalanced presentation of the pandemic highlighting the negative more than the positive aspects; COVID stress is accounted for by other factors as well; cultural aspect of COVID, the nothing to do syndrome; limitations of webinars/online classes; need for simple coping strategies; causes of domestic violence during COVID lockdown; right to privacy of being COVID positive is not absolute, has to be balanced; emergence of morbidities during lockdown, new and old, physical and mental; attention to COVID-19 is resulting in less attention to non-COVID cases; and the major problems of persons with mental illness, especially those with severe mental illness and substance use disorders. The recommendations are balanced education on COVID-19; a pragmatic model of coping, which includes a healthy lifestyle, positive cognitions, and instrumental help to the needy; periodic review of strategies; early detection and treatment of mental illness; re-calibration of health services; continuous supply of medication to persons with mental illness on maintenance therapy; and simple home-based de-addiction.

Keywords: Coping, COVID-19 pandemic, culture, global mass hysteria


How to cite this article:
Sharma I. COVID-19 pandemic: Some observations and a few recommendations. Indian J Soc Psychiatry 2020;36, Suppl S1:19-23

How to cite this URL:
Sharma I. COVID-19 pandemic: Some observations and a few recommendations. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 26];36, Suppl S1:19-23. Available from: https://www.indjsp.org/text.asp?2020/36/5/19/297135




  Introduction Top


The COVID-19 pandemic is affecting 213 countries and territories around the world. India ranks number 3 in the number of COVID-positive cases. People from all corners of the world are working tirelessly to meet the great challenge.


  Observations Top


Global COVID-19 mass hysteria

There is an imminent threat of the spread of COVID-19 infection which deserves attention and appropriate action in the form of social distancing (better called body distancing), sanitization, and for other measures. However, an exaggerated fear of getting infected; prolonged isolation by many, even after the closure of 50 days of lockdown;[1] a family not taking a 93-year-old woman home even after she recovered from the novel coronavirus, who was declared fit by the hospital;[2] excessive care and avoidance behavior, to the extent of stigmatizing COVID victims, akin to a fear psychosis, is fast spreading, among many and involving all sections of the society; and developing into a Global COVID Mass Hysteria. The negative effects of this aberrant behavior on mental health are increasing the burden of the COVID-19 pandemic.

Gloomy picture of COVID-19

A rather gloomy picture of the COVID-19 pandemic is being projected by the media. The COVID-19 pandemic is being perceived as a serious threat in the immediate as well as in the distant future. The hype has seemingly been because of opportunism by many sectors because the pandemic has provided for an alternate economy and other reasons. For example, the companies making sanitizers, personal protection equipment, medicines for treatment of corona infection, and vaccines; and many private hospitals perceive the pandemic as a God-given opportunity to work and prosper. The mortality rates of COVID infection are being inflated. It is now clear that 70% of the deaths are not due to COVID per se, but rather due to the comorbidities.[3] The negative portrayal of the pandemic is taking a toll on the people by the way of enhancing the magnitude of perceived stress.

COVID-19 pandemic The silver lining

Some positive aspects of COVID-19 lockdown are:

  1. COVID cases have risen globally, but deaths have gone sharply down.[4] Only 1% of the COVID cases are critical.[4]
  2. The current scenario in India is compared with that of other countries [4] and is depicted in [Table 1].


  3. The figures are much lower for India. Besides, from April 3, 2020, onwards, while the death rate (30.94%) has been decreasing and from April 4, the recovery rate (69.82%) has been steadily increasing.[4] In many countries (Peru, Columbia, Argentina, Panama, Bahrain, Nigeria, Ghana, Japan, Bhutan, etc.), no new cases are reported. The same may be predicted for India

  4. New Zealand and Kerala have successfully controlled the pandemic to a very great extent.[4]
  5. Eighteen states in India have more COVID-19 recoveries than active cases [5]
  6. It has been clarified at a recent WHO meeting that infection from asymptomatic COVID-positive cases is extremely rare. Research has shown that infected cases bearing a high viral load spread the infection at a rate almost eight times higher than cases with a low viral load.[6] It follows that simply touching the infected surfaces would have negligible risk. The airborne theory of corona spread is still debatable. The WHO noted that “Airborne spread particularly in specific indoor locations, such as crowded and inadequately ventilated spaces, over a prolonged period of time, with infected persons, cannot be ruled out.”[7] This statement was made when scientists from a few countries cornered the WHO.
  7. A recent research has found that abnormal blood clotting occurring in coronavirus patients with severe COVID-19 infection leads to microclots within the lungs that contribute to the death of some patients.[8] Thus, the treatment protocol has been revised with better outcomes. Similarly, the role of dexamethasone, based on clinical trial data, in COVID management has been accepted.[9]
  8. Two vaccines, one developed by Bharat Biotech International Ltd in collaboration with the ICMR and another by Zydus Cadila Health Care Ltd, have been permitted by the Drug Controller General of India to go in for Phase 1 and Phase 2 human clinical trials.[10] By 6–9 months, the vaccine should be available for use.[10]
  9. The COVID-19 pandemic is not permanent. Herd immunity would develop, leading to decrease in morbidity.
  10. The nationwide lockdown due to the pandemic has led to a drastic decline of NO2 emissions and reduced air pollution levels by over 50% in some areas.[11]
  11. Coronary disease is the major killer, with 3 million deaths/year in India. Anecdotal evidence suggests that there has been a substantial reduction in patients with acute coronary syndrome attending emergency departments, although it is not confirmed that this reflects the actual reduction in morbidity.[12]
  12. Psychological benefits:
Table 1: Current scenario in India compared with that of other countries

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Many people in government and private sectors, who were overburdened with work, because of restricted leaves, got leave from work because of the COVID lockdown.

NEET and other competitive exams have been postponed, giving students more time to prepare and succeed. Men are learning to stay indoors and giving time to their family. Many people have been utilizing the time for completing pending work. Others are using the time to develop new pastimes. This lockdown “may be a blessing in disguise for some people who may utilize the opportunity to quit drinking altogether.”[13]

COVID-19 pandemic stress

Only a small fraction of the stress is due to fear of getting infected with COVID-19. A large of it is due to other factors such as lockdown, quarantine, isolation, treatment in intensive care unit, expenditure on treatment, loss of job (income), migration, not able to get essentials (food and medicines), not able to meet/help near and dear ones, and “nothing to do.”

Cultural aspects of the COVID lockdown – “nothing to do syndrome”

In India, gender roles are more or less clearly delineated. Women manage the home, while men look after external affairs. At home, men hardly do any work because they have “nothing to do.” In recent times, as more women are working and adopting the conventional lifestyle(s) of men, they are also being afflicted with nothing to do syndrome (NTDS). In addition, because many have NTDS, so they cling on to the mobile. For many, the only pastime is mobile use.

Webinars on COVID and online classes

Only educated persons having access to digital media and having digital skills can attend webinars/online classes and benefit from them. It is ironical that even though CBSE issued a circular on July 29, 2009, banning mobile phones in school campus,[14] after the COVID-19 lockdown, many schools are conducting regular online classes for children including tiny tots, 2½ year olds, in preschools.[15] The ill effects of excessive screen time, especially in children, are widely reported.

Many students do not have access to phone, TV, or radio. A recent study from Maharashtra reported [16] that 26.1% of the students do not own a phone. Nearly 57.7% of the students do not have WhatsApp and 69.8% do not have SMS facility. Considering this, the Government of Maharashtra proposed to disseminate information by TV and radio, but 35% of the students do not have a TV set at home and only 11% have a radio at home.

Coping strategies

A wide range of strategies ranging from involvement in activities to professional treatments such as cognitive behavioral therapy have been advocated. In India, a developing country with a vast population, a simple, easy-to-comprehend (point wise), inexpensive method, consistent with the culture, is needed.

Coronavirus and domestic violence

Soon after witnessing a rise in domestic violence (DV) complaints during the coronavirus lockdown in India, the National Commission for Women launched a WhatsApp number on April 3, 2020, to report cases of DV.[17] Between March 25 and May 31, 2020, 1477 complaints of DV were made by women. This 68-day period recorded more complaints than those received between March and May in the previous 10 years.[17] The alarming increase in DV can be attributed only partly to the availability of easy reporting via WhatsApp. The increase in DV in the country can be accounted largely by factors such as NTDS, substance abuse disorders, psychiatric morbidity in victims and/the perpetrators, and nonavailability of medication, leading to noncompliance and relapse.

Right to privacy

The Odisha government was criticized for disclosing the name and address of one out of the forty persons positive for COVID-19 as he did not have a travel history and all attempts to trace his contacts proved unsuccessful. The disclosure was necessary to save many other lives.[18] It is pertinent to mention that the disclosure of names of corona-positive persons, with the aim to trace contacts and stop the spread of the virus in such exceptional circumstances, is a proportionate and necessary limitation to the person's right to privacy and is in accordance with the Supreme Court judgment in the landmark case, Justice KS Puttaswamy v. Union of India 2017.[18]

COVID-19 and psychiatric morbidity

The COVID-19 pandemic, a stress of unprecedented proportion, has resulted in increased morbidity by way of relapses and new morbidities, both mental and physical. The major focus of psychiatrists has been on coping with “COVID stress,” which is justified, but less on the early detection of mental illness. There are several reasons for focusing on the latter, especially severe mental illness, during the COVID pandemic/lockdown. Patients with severe mental illness and those with substance use disorders are not likely to adhere to the dictate of body distancing, sanitization, wearing a mask, etc., so may spread the virus. Sudden withdrawal of antiepileptics, benzodiazepines, and antidepressants can lead to withdrawal symptoms and serious complications. Many patients with severe mental illness have relapsed because of nonavailability of medication. Although the Ministry of Health and Family Welfare has permitted telepsychiatry, it has limitations and cannot replace “real-world” psychiatric practice.

COVID-19 and alcohol use disorder

Rather than ensuring continuity of de-addiction services during the lockdown, the Kerala government allowed home delivery of liquor by bringing alcohol into the category of essential goods. Three liters per week was permitted to those showing withdrawal symptoms. Leading medical organizations strongly condemned the move and conveyed that their doctors would not prescribe alcohol for withdrawal symptoms and indulge in unethical practice.[19]

COVID-19 versus non-COVID-19 morbidity

Priority to containing COVID and treating COVID-19 cases has led to neglect of non-COVID cases.


  Suggestions Top


Education on COVID

Perception of stress is an important determinant of the magnitude of stress. Thus, balanced information should be provided. Unrealistic fears can be corrected by evidence-based intensive educational programs. The barriers to accessing information such as language, technology, education, and disability should be taken care of. Print media (pamphlets, booklets, posters, and daily newspaper) and TV, which are the popular modes of communication, should be utilized to disseminate information related to COVID-19.

Coping with COVID

The routine should have provision for 8 hours of sleep; daily bathing, toileting and other self help skills; prayer for 5-10 minutes and reading daily newspaper; aerobic exercise, 40 minutes per day; feeding 4 times a day, 5 times a day if diabetic; work for 8 hours (with adjustments for age); viewing TV news channel for 15 to 30 minutes; recreation and / talent promotion; and other activities as per choice and need. It should the responsibility of parents to chalk-out routines for all family members and see that the same are implemented.

Promotion of positive cognitions to facilitate coping is suggested. For example:

Take life as it is, not as it should be; stress is an inseparable part of life, so learn to cope with it; health and ill-health are part of the life package; submit yourself to God's will (God has brought COVID, God will contain it); every problem has a solution; look at the silver lining: God has given you an opportunity to complete your pending work, spend time with your family, tutor your children, promote your talent, prepare for competitive exam, quit alcohol, etc.

Mechanisms for providing instrumental help, for example, transport, monetary assistance, and medication should be re-energized so that help reaches the needy.

Periodic review

Strategies on managing COVID need periodic review so that mistakes are not repeated. For example, total closure of many private sector units, leading to bankruptcy and exodus of migrant workers, was probably not justified. Working with body distancing in three shifts a day, with other protective measures, could have been a better option.

Early detection and treatment of mental illness

Educating people about identifying new mental illness in families and taking prompt treatment from mental health professionals must receive priority.

Re-calibration of health services

To meet the needs of psychiatric patients during the pandemic, re-calibration of health services, as suggested by the National Institute of Mental Health and Neurosciences, Bengaluru,[20] is recommended.

Preventing relapse

A government order permitting psychiatric patients to get medication as per previous medication, from local retailer/through the Internet during the period of lockdown, would prevent relapse.

De-addiction

Simple home-based strategies may be employed for de-addiction, for example, by weekly reduction of alcohol over a period of 10 weeks (from 10% to 20% to 5%).

Last but not the least, the message is:

COVID is not the real problem, it is you. Identify your strengths, enhance them, handle COVID the right way, God will help you in your journey to overcome COVID.

Acknowledgment

I would like to put on record my appreciation and thanks to Prof. Nitin Gupta, Editor, IJSP, for his vision and zeal on COVID-19 and for giving me an opportunity to share my experience and wisdom on this very important topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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