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Shreya Dhital
The effects of COVID-19 are far more outlasting than the millions of infections we know of today. The present scenario has spread not only geographically through respiratory droplets, but also through media deep into our thoughts and actions. No two people in the world today are experiencing the pandemic in the exact same way. Here is how the pandemic is not merely affecting our lungs, but also our minds.
Health care workers are completely stressed and overwhelmed. Doctors in India have been reported working for 6-7 hour shifts with the influx of COVID patients and this remains a single example in a world stricken by this disease. In essence, doctors everywhere are on the frontlines of a war zone. They are wearing Personal Protective Equipment (PPE) every day, which unto itself is highly uncomfortable and distressing. These gears often result in overheating and dehydration which may further lead to heat rashes and heat stroke. Gloves and other forms of PPE may cause irritant contact dermatitis when they rub on the skin. Some health workers even develop hypersensitivity reactions to specific materials or chemicals used to make PPE. Facial ulcers and acne have been reported in those who wear goggles or a mask for a long period due to pressure effects.
Due to the scarcity of PPE products and the fact that one suit can only be used for one shift, doctors are having to make the most of each set of equipment they are handed. This means that doctors are being forced, by circumstances, to wear the equipment for the longest time possible and wearing the suits for the entirety of their lengthened 6-7 hour shifts. Doctors also report forgetting bodily requirements like food, water and etc as removing the equipment is a lengthy 30 min long process after which the equipment is unsafe to use.
Besides the physical distress, the situation also takes a toll on their mental health. On top of seeing people die every day, they’re being called upon to perform in ways that they’ve never had to face before. 46% of US Physicians have reported feeling “burnt out” and it’s speculated that those numbers may even be higher. A recent study found that frontline workers from 34 different hospitals tending COVID patients have experienced symptoms of depression, anxiety, insomnia, and distress. These reports represent only a small portion of the millions of stories of healthcare workers all around the world.
Mental wellbeing has been a struggle for people who are personally affected by the pandemic.People who may have a friend or a family member who has died or has been severely ill from the disease suffer trauma and stress. Survivors are often overlooked but the fact is that “Given the very frightening and invasive nature of the Covid-19 critical care experience, the high risk of death and the potential for long-term medical complications, those most severely affected by Covid-19 are likely to be at very high risk of developing trauma and stress-related mental health difficulties.”
Even during normal times, 40% of patients discharged from the ICU report anxiety due to the experience and 30% have depression and 20% have signs of PTSD. It is also known that during the first SARS-COV outbreak, 60% of recovered patients had diagnosable mental health issues even after a year of recovery. These numbers are characteristic of infectious diseases as patients, aside from the difficulties posed by the diseases medically, are usually isolated from family, friends and basic human contact. If one is not able to deal with such isolation, it can lead to long term damage. It has also been reported that delirium seems to be a rising problem in the ICU as well. 50-70% of critically ill patients have been reported to develop delirium. If left unattended, delirium leads to encephalopathy (brain damage). Fighting COVID , it seems, is only half of the battle posed by the virus.
Moreover, some haven’t been able to pay proper respects to the dead and perform the rituals of burial. Considering the previous lessons learned from the Ebola outbreak while also taking into consideration the local values and burial procedures, the WHO recommends “safe and dignified burials”. Although we try to achieve this goal, most of the time, it proves to be unfeasible.
Christian funeral homes ended all chapel memorials and will only offer graveside services. They won’t pick families up in limousines, and private goodbyes the night before burial have been outlawed. Mourners must now use their hands to throw dirt on top of the coffin, a Jewish tradition usually carried out with a shovel. Prayers are read off smartphones, instead of from communal books, and yarmulkes are no longer available to borrow, so bare heads abound. In Italy, priests even stopped reading the last rites. Hugging and handshaking are discouraged.
According to Islam tradition, the burial of the deceased is a collective obligation by the Muslim community. The obligation includes washing of the bodies and dressing it. Although such procedures cannot be fulfilled, there is a silver lining. All mourners avoid unnecessary touching of the body as it is considered impure. Besides, the first of the five ultimate objectives of Islamic law is the protection of life. As this overrules other obligations, it is easier for mourners to undergo safe burials.
Some are finding alternatives to the traditional funeral with new practices. Churches in the United States have drive-in funerals where people can listen to services broadcast on their car radios and watch them projected on a screen in parking lots.
In Nepal, the government has declared that all who die from the coronavirus will be cremated at the electric crematorium in Pashupati to avoid a high risk of transmission. This procedure takes only 45 minutes, compared to the four hours with firewood. The crematorium allows only two family members to perform the last rites with proper precautions and is also not charging its usual fee.
Hindu rituals require family members to maintain physical distance, wear new clothes, and eat food untouched by others for 13 days. These practices are similar to the practices of quarantine, isolation, and social distancing. The government’s COVID-19 guidelines have uncanny similarities to the previously existing cultural practices. A cultural historian claims that we have been practicing traditional social distancing for centuries, and the reason we do it for 13 days is to prevent transmission of infectious diseases during a funeral. Even so, there is only one electric crematorium in all of Nepal, which poses a risk to the people living outside the capital.
Scholars who study funeral rituals worldwide affirm that grieving practices are crucial for an individual’s mental and spiritual health. The rituals serve as a process of learning to handle the grief. Due to the required precautions imposed by the virus, many have been denied these rituals and are unable to handle the grief.
On the other end of the spectrum, some people have nothing to do with healthcare and don’t know anybody who has ever had coronavirus. Even their lives are upended as they are trying to figure things out by working from home and taking care of the kids who are out of school. Their routine has been utterly disrupted. Although the lack of structure may sound trivial, they are important as people rely on routine to get any work done. Its absence has created a stressful environment, causing people to struggle.
Although social distance is an important weapon to fight this disease, it is an aversive thing to do. A lot of people are experiencing social distancing like solitary confinement, which is a punishment to prisoners who misbehave where they are placed in a single cell with no to little human contact.
On top of that, there are threats to our society and our way of life. We’ve had innumerable losses. People have lost money in their savings account. They’ve lost their jobs. We have lost a lot of routine pleasures of life – parties, weddings, school, conferences, vacations, sporting events, and simply going out.
The unemployment rate is worse today than at any time since the Great Depression of the 1930s. In the US alone, about 30 million people are unemployed. Job openings are at their lowest level in years whereas there has been a sharp increase in numbers of people requesting emergency loans to cover job losses and wage cuts. There are a lot of jobless people who are bored and restless. Most are worried about their financial circumstances and are beginning to feel hopeless.
Loss of job and money leads to fear, anxiety, stress, uncertainty, and exhaustion. A lot of people are getting angry instead of beaten down. People are experiencing these stressful, life-threatening circumstances over and over. When they learn that there is nothing they can do about it, they start feeling helpless. People in this state of learned helplessness, get into all sorts of mental health problems. Quality of life is degrading since the virus is affecting the health, education, and income of families.
Reviewed mental health professionals are anticipating another pandemic – the pandemic of mental health disorders as a result of the coronavirus. Skyrocketing rates of depression, anxiety, insomnia, and post-traumatic stress disorder are expected. We also know that when rates of unemployment hike, cases of domestic violence, alcohol, and drug abuse go up.
The UN has described the worldwide increase in domestic abuse as a “shadow pandemic” alongside COVID-19. It’s thought that cases have increased by 20% during the lockdown as many people are trapped at home with their abuser. Data show a decreased rate of child abuse, but experts believe that is not the case since people who report child abuse are usually pediatricians and teachers. Due to the lockdown, children have had no contact with authorities to report abuse which could explain the decreased rate of child abuse. Around 90% of the causes of violence in the present are related to the pandemic.
There have also been reports of a spike in alcohol sales that suggest that many are coping with the stress of the pandemic with booze. In the UK, sales were up by 30% in March and the US has seen a rise of 55% compared to the same period last year.
The coronavirus also ends up shortening life spans from heart attacks and strokes as patients fear to enter hospitals and other healthcare facilities . Even when the situation improves and social distancing rules are uplifted, the fear will persist. The majority of hospital staff reported a drop in the number of patients with severe heart attacks coming to the hospital. On average, it is a 50% decrease. Additionally, among those patients who did go to the hospital, 48% arrived later than usual and beyond the optimal window for urgent treatment. The nationwide data in the US shows that from the “excess deaths”, which refers to more deaths than would be expected, only two-thirds of it were attributed to COVID-19.
Whether some realize it or not, the world has already faced epidemics of mental health issues. We are already seeing increasing rates of stress, burnout, loneliness, anxiety, and suicide in the last couple of decades. People already struggling with mental health disorders have lost access to their therapists due to the lockdown. During the first 74 days of the lockdown in Nepal, 1227 people across the country committed suicide.
The most recent example of the mental health effects of COVID-19 is that of Hurricane Katrina. This was an isolated event that primarily affected New Orleans. Similar to this pandemic, thousands of people lost their lives and jobs. In New Orleans, 8 months after the hurricane, a whopping 36% of the population who had no mental health problems before the hurricane had some kind of mental health disorders. Before the disaster, 17% of the population already had mental health issues. Thus, after the hurricane, more than 50% of the population was suffering from some kind of mental health problem.
Mental illnesses are often stigmatized and people don’t take them seriously. However, everyone needs to realize its importance and be aware of the repercussions of the COVID-19. This isn’t just a virus that makes one ill or takes a life, but it is a disease capable of initiating a domino effect.
References:
COVID-19 Resources for Providers. (n.d.). Retrieved from https://postgraduateeducation.hms.harvard.edu/continuing-education/covid-19-resources-providers
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Sijapati, A. (2020, May 20). With 2nd COVID-19 fatality, Nepal issues funeral guideline. Retrieved from https://www.nepalitimes.com/latest/with-3rd-covid-19-fatality-nepal-issues-funeral-guideline/
COVID-19 crisis: Ordeal faced by doctors working 6-7 hours shift in Hazmat suits. (2020, April 26). Retrieved from https://www.dnaindia.com/india/report-covid-19-crisis-ordeal-faced-by-doctors-working-6-7-hours-shift-in-hazmat-suits-2822605
Kumar, S. (2016, June 30). Burnout and Doctors: Prevalence, Prevention and Intervention. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041038/
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COVID-19: ICU delirium management during SARS-CoV-2 pandemic
Campbell, D. (2020, June 28). Screen survivors of Covid-19 for PTSD, say mental health experts. Retrieved from https://www.theguardian.com/world/2020/jun/28/screen-survivors-of-covid-19-for-ptsd-say-mental-health-experts
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