(Photo by Luis Galvez on Unsplash)
In the 12,000 years of our history, pandemics have killed about 400 million people. In the middle ages, the plague wiped out 60% of Europeans. Thanks to modern science, COVID-19 has only killed about a million people this past year. If the rising death toll weren't enough, the pandemic has triggered serious emotional, physical, and economic problems worldwide.
We are seeing more people suffering a non-coronavirus affliction during the pandemic. People from all walks of life are suffering panic attacks. Those who once supervised people and held jobs of importance are steadily becoming victims.
Many people in Johnson City, Kingsport, and Bristol are having issues. It becomes a mental barrier that we dare not cross. How do we go out in public and get groceries or run to the store when we have been conditioned to STAY INSIDE!
I wear my mask and take my dog out for a walk. The mail carrier drops my mail in the box... and a neighbor is suddenly overcome with anxiety because she was within six feet! Our mental conditioning is going awry.
Studies have begun to measure the traumatic stressors related to COVID-19 and other stress elements. COVID-19 leads to mental health problems. Anxiety, depression, PTSD, and similar disorders are occurring due to COVID. Patients who have suffered serious effects of COVID (and nearly died), or family members and health care workers, who've witnessed death and serious effects are all impacted. Those with extreme exposure to the fallout from COVID, such as first responders, medical examiners, and hospital personnel are also being studied.
Studies have looked at the stressors that add to our emotional burdens. Social isolation, economic loss, and working from home (with children other others who must receive care) are impacting our health. With healthcare workers, the lack of personal protective equipment (PPE), fear of being exposed, burnout, patient deaths, and triaging limited resources are seriously impacting their health. A few studies even examined posttraumatic stress symptoms, anxiety, depression, and substance abuse in the general population during the pandemic.
Time is needed to conduct investigations on mental health and diagnoses. Studies conducted through the internet use varying rating scales that do not lead to conclusions.
Treatments must be based on the latest research.
Highly Exposed Individuals
A study of nurses exposed to COVID-19 in China found a PTSD incidence of 16.8%, with the highest scores in avoidance symptoms. Job satisfaction was associated with lower PTSD symptom scores. A cross-sectional survey of over 7,000 Chinese (February 2020) found that healthcare workers had the highest rate of poor sleep. Those 35 and younger had more mood and anxiety symptoms. Overall, 35% of respondents reported anxiety symptoms, 20% depression symptoms, and 18% poor sleep quality.
Exposure to Nontraumatic Stress
Mental health advocates believe the population may suffer from levels of traumatization. In August 2020 the CDC published results of a large US survey of over 5000 adults. Of those surveyed, over 40% identified with at least one mental/behavioral health issue in relation to the pandemic. Symptoms of trauma or stress-related disorders were reported by over a quarter of participants, while symptoms of anxiety and depression were exhibited by over 30%. It was not surprising that substance use was reported by over 13% in order to cope.
Nearly 11% of participants were or had been contemplating suicide. Suicidal thoughts were higher for younger respondents (18 to 24 years - 25.5%), minority groups (Hispanic-18.6%; Black-15.1%), unpaid caregivers (30.7%), and essential workers (21.7%). It is clear that caring for others is high risk.
Nursing home residents have been particularly vulnerable to poor health outcomes; early in the COVID-19 pandemic, many facilities adopted strict lockdown policies. Social isolation is detrimental to the elderly, who have an increased risk for depression, anxiety, and worsening dementia. The Centers for Medicare and Medicaid Services (CMS) recommends safe communal activities for locked-down nursing homes.
How do we help
Support healthcare providers and first responders on the front lines during a pandemic. Dealing with burnout and prolonged problems often overlap. They lead to acute stress disorder and PTSD. Practical measures should be implemented in a timely manner. These include:
- providing suitable and adequate PPE
- developing policies that assign at-risk personnel to low-risk sites
- ensuring the safety of family members
- stressing the importance of self-care
- provide access to child care service
- provide adequate breaks
- be excused from less-essential tasks
- provide regular information and feedback sessions
Many hospitals provide telephone hotlines with mental health professions to provide psychological assistance. Many professional organizations offer wellness programs and free, confidential sessions to deal with burnout, adjustment problems, family issues, and other mental health sequelae.
To combat isolation among locked-down nursing home residents, CMS recommends safe communal activities such as book clubs, movies, bingo, and outdoor family visits (on the grounds) with social distancing precautions and PPE. A few nursing homes have provided:
- live music
- therapy animals
- recordings and photos of loved ones
- video chats (Facetime/Skype/WebEx/Zoom)
- physical contact with loved ones through protective barriers
- physical and occupational therapy sessions held outdoors
Mental Health First Aid
Mental Health First Aid is being taught to many school employees, first responders, and healthcare providers through volunteer instructors. Trained personnel may help others as they stress over the COVID-19 pandemic. For individuals with stressors, experts recommend expanding the use of telehealth to identify and treat mental health conditions -including depression, PTSD, and other trauma-related disorders, substance use disorders, and suicidal ideation.
Bristol Tennessee Fire Department has trained all of its personnel in Mental Health First Aid. Assistant Chief Tommy Castle states - "It has really helped us keep an eye on one another. The older guys are used to talking about calls and everything, where the younger people are caught up in their phones and such and don't talk about things as much. It has given us a lot of tools in how to start conversations with people, whether the public or among ourselves. Reaching out to really check on somebody to see how they are doing is easier with the Mental Health First Aid program.
Melissa Taylor, RN, is an instructor and works with Emergency Preparedness at the Northeast Tennessee Regional Health Office in Johnson City. She has been instrumental in teaching the program and training others across the Tri-Cities and Northeast Tennessee region.
It is important to reach out to one another and help ourselves and those around us. Working together for our common good should bring us closer together. We need each other to persevere and thrive once the pandemic is over.
Czeisler MÉ, Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — the United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1049–1057.