|Year : 2020 | Volume
| Issue : 5 | Page : 43-45
Battling COVID-19: The unbound mutant
Former Dean and Professor and Head, Department of Psychiatry, PGIMER, Chandigarh; Currently Senior Consultant, Fortis Hospital, Mohali, Punjab, India
|Date of Submission||10-Aug-2020|
|Date of Acceptance||10-Aug-2020|
|Date of Web Publication||02-Oct-2020|
Dr. Savita Malhotra
Senior Consultant Psychiatrist, Fortis Hospital, Mohali, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Malhotra S. Battling COVID-19: The unbound mutant. Indian J Soc Psychiatry 2020;36, Suppl S1:43-5
COVID-19 is a new virus belonging to the family of coronaviruses, and very little is known about the pathogenesis, treatment, course, and outcome of the disease process it has unleashed on the humanity.
COVID-19 crisis is different from the other disasters or calamities that have been referred to in the paper by Murthy. While the scale of problem in other disasters such as Bhopal Gas tragedy or Latur earthquake was geographically localized affecting people in a circumscribed area, COVID-19 is almost universal. Second, the disaster was clearly visible and time limited, i.e., it happened and finished. People, thereafter, had to come to terms with the loss and focus on rebuilding their lives. In COVID-19, the sheer scale is enormous and the threat is not over, it is ongoing with continued uncertainty, due to which people remain at the first stage of fear and anticipation and cannot move onto planning or rebuilding their lives.
Murthy  describes the impact of COVID-19 on emotional health from a social psychiatry perspective; a reasonably detailed review of the earlier disasters such as Bhopal Gas tragedy, Orissa cyclone, etc., is discussed and a parallel is drawn between these events and COVID-19 pandemic, thus, primarily building on the learning from the earlier disasters. However, challenges faced in the onslaught of COVID-19 pandemic are very different as compared to those during earlier disasters.
| Initial Impact and Denial|| |
The COVID-19 pandemic developed suddenly, with the first case reported on December 31, 2019, from Wuhan, China; the WHO declaring it a pandemic on March 13, 2020. The initial response of many countries was that of denial of its seriousness when they thought that they may not be as badly affected as some others, or that they are better placed to deal with the virus. Both the assumptions were proved wrong.
The impact and response of particularly those in the western developed world were different from those in India or other countries similarly placed on the socio-economic ladder. In the Western developed world, the pandemic presented with the problems of insufficient health infrastructure to meet the requirements of treating a large number of people getting sick at the same time, higher percentage of population in the elderly age group contributing to high morbidity and mortality, escalation of risk due to already existing social isolation and lack of family support for many, especially in the older age group, loss of employment or businesses, and curtailment of social freedom, freedom of physical movement, recreational, educational, or other such activities. Lack of preparedness for handling an infectious disease was evident as against the increasing focus on health infrastructure and research on noncommunicable diseases in recent years. The situation emerged suddenly, as if a smooth sailing boat began to rock and sink without the necessary safeguards or protective equipment. In India, the socioeconomic realities and even the population's gene pool are very different. It is yet to be seen whether the people in India will follow the same course and outcome as in the West. People's response to the emerging epidemic was also different in India. Certain groups of people thought that their religion and faith are sufficient antidote for any infection, and that they will be protected by the mercy of their “God” and even if they died of the disease it will be in the service of “God.” Some of them hid themselves and obstructed medical intervention putting their and others health at risk. Ignorance, lack of faith in medical science, stigma, and an all-encompassing faith in “God” were one of the challenges that had to be tackled initially.
| Realization and Containment|| |
India realized its seriousness very early and took measures to contain the spread. Lockdown as a strategy to contain and prevent spread had its own contribution to the crisis. Thus, there is risk from two sources: One is the virus or the pathogen, and the other is the lockdown as a method of containment of the disease.
There is no doubt that the virus or the pathogen was highly infectious and could paralyze the health services by the sheer number of cases falling ill all at once. This happened in the many countries such as the US, Italy, and Spain. On the other hand, the level of morbidity caused by this virus was not so grave. Most people, i.e., about 80%–85% infected with virus were either asymptomatic or suffered a mild illness, who recovered by themselves without any specific treatment. Only 15% or so would get moderate-to-severe symptoms, of which only about 5% suffered severe illness needing intensive care in the hospitals.
Two main strategies were needed for handling this pandemic: One was containment to stop the spread; and the second was mitigation and treatment. Containment required people to socially isolate themselves curtailing their movement, undertaking measures to sanitize themselves and their environment. Moreover, India and many other countries would have needed time to prepare for tackling the numbers of people falling ill due to infection by bolstering the health infrastructure and creating systems for effective identification, contact tracing, quarantine, testing, and treatment. Sudden and strict lockdown as enforced in India derailed the lives of people, particularly those who were migrant laborers, daily wage earners, homeless or those who were travelling and were away from their homes such as students and employees. The psychosocial impact was different for the different groups of people.
People who were already vulnerable to the mental health problems were the worst hit as also the poor, the migrants, and the daily wage laborers and their families. They lost their livelihood and could not even travel to their hometowns due to the suspension of all transport facilities. This became a major crisis of survival for millions. Most efforts by the respective state governments and the nongovernmental organizations (NGOs) to provide them with food and shelter, etc., proved insufficient. Scenes of a sea of humanity walking on the foot for thousands of miles were shocking and hurtful. Many lives were lost to starvation, exhaustion, accidents, and so on. Their psychosocial struggle and concerns very different from what the middle or upper socioeconomic class experienced.
The COVID-19 pandemic triggered a severe medico-social-psychological emergency. People were required to understand and cope with the nature of the disease, the degree of risk to them and their families and society.
It is the suddenness of the trauma that produces maximal turmoil in the initial phases. As the time goes by, most people begin to understand the scope and limits of the problem as well as the best strategy they can employ to stay well. This time frame is needed for activating the coping and resilience in an individual or society, and though variable, but can certainly be strengthened. That is where the mental health professional will have a role.
There are several levels at which the mental health professionals can have a role.
- Taking care of the panic, fear due to the sudden outbreak of the epidemic. This can be done by providing adequate and reliable information so that the people can gauge for themselves the degree of risk and probability of getting the infection and take suitable and timely measures to protect themselves
- Prepare them psychologically for a protracted fight with the disease and inculcate changes in their lifestyle, habit patterns, etc., over a longer period of time, which is again a step toward building resilience
- Tackling the consequences of social isolation, absence of employment, lack of care, etc., This can be done by online or telephonic helplines, counseling services as well as fulfilment of their daily needs
- Build community resources by mobilizing groups, volunteers, NGO's, to undertake the relief, and rebuilding work
- There are many individuals who would exhibit mental decompensation with new mental disorders or aggravation of preexisting mental disorders. Setting up mental health-care services for them would be of paramount importance
- Setting up of mental health-care services at the patient's doorstep, mostly through telecommunication or videoconferencing, would be absolutely essential
- Tackling stigma and social consequences of contacting the disease are necessary as there have been many examples of people and communities not letting the recovered patients to stay in their neighborhood due to the fear of contacting the disease. In some instances, the local people did not allow even the cremation of the individual who died of COVID-19
- Psychosocial consequences of quarantine by itself had been a major cause of anxiety, depression, loneliness, etc., These people need mental health care.
| Caring for the Carers|| |
Care of the carers, i.e., the doctors, nurses, paramedics, sanitation workers, police and all those who are in the front line of treatment and providing care to the patients infected with the COVID-19 virus are at a huge risk of not only contracting the disease themselves, but also suffering emotional turmoil. They have been working under extremely testing situations of having to manage a large number of severely sick patients without sufficient number of beds, medical supplies, equipment, personnel, and protective gear for themselves. They are in the front line to deal with the death and disease, emotional trauma of the sick and dying patients and their families. A sense of helplessness and hopelessness in fighting a losing battle takes its own toll on their mental health. They have also to deal with the sickness and death, due to COVID-19, of their own colleagues and co-workers. They are themselves quarantined or separated from their own families for weeks while on COVID-19 duty which takes a toll on their and the family's mental health.
There is an atmosphere of fear and hopelessness more so because very little is known about the virus, the pathogenic mechanisms, course, outcome, treatment, etc., In such a situation, people are unable to think and plan their lives in near future or in the long term. They are perhaps required to live with the possibility of the infectious disease persisting for a long time and learn newer ways handling, coping, or behaving. It would, therefore, contribute to continued stress and a sense of anxiety, fear, and hopelessness.
| Effective Coping and Rebuilding Lives|| |
The government can take policy decisions, frame guidelines, mobilize resources and infrastructure, but in reality, it is the people who have to put it into action on the ground zero. Hence, people's involvement is a must and the most essential part of fight against COVID-19. In such a situation, most important psychosocial intervention is aimed at:
- Keeping the people calm, motivated, hopeful, and willing to work themselves toward betterment of their conditions
- Keep the levels of psychiatric morbidity low by fostering coping and resilience
- Seek engagement and co-operation of people in the fight against COVID-19. One should never underestimate the psychological strength and ingenuity of people. They can come up with wonderful innovative ideas for the benefit of individuals as well as the society
- Develop mechanisms and systems to reach patients who have mental disorders with the aim to provide treatment, continued care, medications as required
- Pay attention to special and vulnerable groups such as children, adolescents, elderly, pregnant women, institutionalized, the poor, migrant, or the homeless.
Life, so to say, is held in abeyance for uncertain length of time. Such a circumstance would and is likely to increase anxiety, fear, sadness, hopelessness, insomnia, irritability, somatization, and stress. It may require long-term changes in their life style and life's decisions such as reducing in-person socialization; curtailing social and recreational activities; changes in work habits; changes in personal plans like job, marriage etc., changes in world view and so on. All this would call for a substantial level of psychosocial readjustment for which everybody is not sufficiently adept or prepared. Individual vulnerabilities and predilections would surface and channel the course of adaptations or otherwise.
The COVID-19 crisis is likely to produce more systemic and deep-rooted impact and alterations in the mind and lives of people. Mental health professionals will have to re-strategize their approaches for mental health care focusing on re-learning ways of thinking, behaving, expecting, and living with the newer realities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Murthy RS. COVID-19 pandemic and emotional health-social psychiatry perspective. Indian J Soc Psychiatry 2020:36 (Suppl);S24-42.