The other pandemic that COVID-19 has brought with it

While the coronavirus pandemic is the main course, it has spawned a parallel fear psychosis of epic proportions that has affected virtually everyone – an unprecedented challenge for mental health services.

A recent insightful report by the psychiatry department of NIMHANS, Bangalore, titled Mental Health in the times of COVID-19 Pandemic, has drawn up a picture of a malaise whose impact now, appears surreal, both for the medics handling the virus and the populace at large.

"With almost all affected, mental health service delivery to address the psychological consequences at an individual level has become near impossible,” says the study, admitting that the existing health services is at its breaking point to control the spread and reduce mortality of COVID.

"Front-line personnel, including medical professionals, however, face the daunting task of dealing with the distress and trauma of individuals, families and communities daily. In addition, most must deal with their own emotions and anxieties,” reveals the 177-page study.

In India, the first and foremost responses to the pandemic have been fear and a sense of clear and imminent danger. Fears have ranged from those based on facts to unfounded fears based on information/misinformation circulating in the media, particularly social media.

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The fear of contracting the illness is also frequent and has ranged from misinterpreting every fever or cough as a COVID-19 infection, wanting a test done for reassurance even though there are strict guidelines for testing, to hoarding medications despite there not being indications for their generalised use.

Apart from the advisories regarding handwashing, doubts about whether to use a mask, what type of mask, how much distance to maintain, what surfaces need disinfection with what - are some of the common queries, that have turned into distress.

There are also real and imagined worries of job losses, steep salary cuts and economic slowdown during and following the pandemic. The list is endless and leads to a cycle of concern, worry and distress.

Equally important has been the impact of social distancing and lockdown, which have led to several changes in day-to-day activities, redistribution of home chores, extensive working from home and greater time spent with those living together.

Notwithstanding the importance of social distancing (or what some term as physical distancing), such a requirement has meant long separation from families for those working away from their hometowns, financial stress and interpersonal strain.

“Reactions can range from boredom and moodiness to anger, irritation, and frustration. Another maladaptive coping is using mind-altering substances. Uncertainty and a sense of loss of control are undoubtedly the pathogenic agents for anxiety, panic, and depression,” notes the NIMHANS Study.

Naturally, different people have reacted differently to the new situation, which has no precedent. Dr Amit Dias, Head School for Mental Studies and Social Medicine, Goa Medical Department, believes that every individual’s reaction is different. "It is like going to war. Some people can cope with it, others cannot,” he told this writer.

Stress and strain of the virus

Calling the current situation 'extremely stressful', Dr Dias points out that doctors, nurses and other health care professionals are operating under very difficult conditions. As the pandemic progresses, they have become more and more engaged in COVID-19 care. Worries about caring for such patients, adequacy of protection, taking infections to their families, long working hours, inadequate access to food, liquids and rest, and separation from families can lead to severe psychological distress among health professionals.

"They are working round the clock, cannot go back home and are open to infection anytime. Traumatic stress disorders are on the rise. We are in the process of formulating data about Goa, which is among the lesser affected states,” Dr Dias points out.

It is anyone’s guess about the situation in those parts of the country where typically, testing is low, health infrastructure is grossly inadequate and there is a long list of positive patients who come from the lowest strata of society. While a Delhi, Mumbai or Goa can examine mental health issues, it is doubtful whether overpopulated states like UP, Bihar or Assam are equipped for such kind of care.

Under the circumstances, it is important to consider the impact of the various phases of the pandemic on children, the elderly and pregnant women. The worries of adults can be transmitted to children and make them anxious and fearful. Medics say they can become very easily bored, angry and frustrated. Without an opportunity for outdoor play and socialisation, children have become engrossed in social media and online entertainment, making them even more socially isolated when they emerge out of this situation.

Parents need to know the means of keeping their children engaged, providing an opportunity to learn new skills at home, as well as encourage them to participate in activities, get them engaged in 'edutainment' and hone their extra-curricular skills. Children with special needs may need innovative approaches to engagement, keeping them active at home.

The elderly, under real threat of infection, can feel further isolated and neglected, become more worried about their families, and increasingly troubled about their health. They may not have the support systems to care for them, particularly in terms of their medical needs. This can aggravate into anxiety and depression.

A plethora of worries

Pregnant mothers have a host of concerns: from worries about whether to go for ante-natal examinations, about risks to the unborn child, stressed about their contracting the infection and concerns about the future. Gender perspectives also need attention, as times like this can amplify an abusive relationship and increase intimate partner violence.

Psychiatrists believe that the stigma that might accompany Covid-19 can be no less of a tragedy. There are several instances of people at risk, particularly health professionals being evicted from their premises by anxious landlords, people in quarantine being isolated from society, and apathetic societal responses to people diagnosed with Covid-19, leading to some of them not disclosing symptoms or seeking appropriate medical help.

In such circumstances, could things get suicidal? For a country with the highest number of poor and malnourished, and individuals with depression and anxiety, some experts believe that India should expect the worse. ``India reported 1,34,516 suicides in 2018. Most independent estimates are far more. The World Health Organization (WHO) pegged 2016 suicides at 215,872, with a suicide rate of 16.5 suicides, against the global suicide rate of 10.5. History tells us that India should prepare for a large number of suicides, even in the thousands,” predicted Nelson Vinod Moses, founder, Suicide Prevention India Foundation, and an independent journalist, writing in the Hindustan Times. Clearly, these are trying times where mental health is nearly as important as the actual pandemic, coupled with the unhappy proviso that knowledge about it is rather limited.

Ranjit Bhushan is a senior journalist based in Delhi.