Ahmad Gamal Saad-Eddin

Over time, Amr Abdullah, an Egyptian cardiologist, grows to notice his anxiety pattern. While being occupied in his daily routine at the hospital, he senses a feeling of mild stress, reflected in the strict implementation of prevention instructions and following up on cases with keen attention. This feeling reaches a breaking point on his way home, terrified of transmitting a possible viral infection to his family; the peak of his anxiety hits once he’s back from work, precisely at the exact moment he enters his home.

“Anxiety doubles if I had already dealt with Covid-19 cases,” Abdullah says. He adds that he suffered from insomnia for almost two weeks after directly handling some infected cases, particularly when he began his shifts at the hospital reception to sort the suspected Coronavirus cases out of the normal patients, to detect later that some of them tested positive.

Since the end of 2019, people are experiencing huge changes in their lives with the onset of the SARS-CoV-2 virus, the cause of the COVID-19 pandemic; the most hazardous health threat the world has seen since the end of the Spanish Flu Pandemic in 1919. One essential side, where all observations and reactions interfere, is the mental health of individuals, namely the ones who work in healthcare sectors during the pandemic outbreak in the world.

Chaos isn’t new in similar situations, considering the difficulties the pandemic brings to the table in monitoring and evaluating the mental states, also the way the outbreak of the virus might influence data collection methods. Often, the viral extensive spread hinders the efforts of mental health researchers in terms of data collection. So the obvious result is to postpone all of it until quieter saner times, which negatively impacts the outcome when it comes to methods of dealing with mental disorders at similar times.

To approach these kinds of problems, a recent study, published in the Asian Journal of Psychiatry, attempted to create a conceptual framework that guides policymakers, researchers, and physicians to cope with this status quo. The study relied on the insights of several early-career psychiatrists, from sixteen different countries that include all the places the World Health Organization supervises, which provide a space to create a closer visualization and to develop a methodology to tackle mental disorders, particularly in times we lack to clear treatment plans, based on medical manuals.

According to Marwa Nofal, one of the participating psychiatrists in the study, “most of the previous studies were limited to a specific region or a certain phase of the pandemic, therefore it’s hard to build a work plan based on them,” and this is exactly what the recent study hoped to expand through shedding light on mental health during pandemic preparedness and the earliest phases in sixteen countries.

Mutual Conceptual Framework

Researchers succeeded in creating a general conceptual framework through questionnaires to the psychiatrists, their answers could form a comprehensive point of view on the mental health current situation in their countries. This was along with the false information circulated about the virus that Nofal believes is strongly related to the aggressive mental impacts, such as the dreadful fear of catching the virus or the complete denial of it, resulting in the invention of non-scientific misleading myths about the virus origin and the way it spreads.

The preliminary conceptual framework developed by the psychiatrists, which includes solutions and accessible care approaches, is essentially built on information previously collected about the mental health of individuals when similar diseases spread, like SARS and MERS, and many other diseases that broke out across large parts of the world. This framework also relies on the direct views of the psychiatrists, enhanced by the fact that they are still in their early careers which allows them to communicate more with their patients.

Study authors propose the idea of the “emotional epidemic curve”, which is separate from the epidemic curve itself and the spread curve. The emotional curve contains two peaks of mental problems; the first one includes symptoms like anxiety, distress, depression, and sleep disorders. This peak, as the study states, is caused by the policies of social and physical distancing, ignorance of the disease, fear of the unknown, and other emotions related to facing a unique situation for the first time. The second peak would be harder, represented in post-traumatic stress disorder and other types of depression, but all are a result of the pandemic’s social and economic consequences or the death of loved ones because of the virus. The study describes the second peak as unpredicted and complex.”

At the same time, Nofal stresses that this framework isn’t 100% accurate, even if it plays a role in mapping out a way for the researchers and policymakers; it’s a starting point to tackle acute mental symptoms, especially given the multiple uncertainties surrounding the pandemic that treating physicians have to deal with in these unprecedented times.

Serious Repercussions

In 2015, Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, published an analysis of seventy studies, conducted on nearly 3,4 million people, to examine the impacts of loneliness and social isolation. It was found, among other results, that loneliness increased premature death rates by 26% of the sample, also social isolation led to increasing deaths by 20%, regardless of gender, region, or intellectuality.

These findings seem relevant in current times while governments impose many measures to keep people away from each other to reduce the risk of infections as much as possible. For that reason, Dévora Kestel, director of the department of mental health and substance abuse at the World Health Organization, warned that we may face a serious crisis with people’s mental health; therefore, it won’t be a minor issue but a fundamental factor in the present circumstances.

On another side, Muhammad Al-Sheikh, a medical and psychotherapist specialist at the Charité – Universitätsmedizin Berlin, wasn’t part of the research, sees that the study results are just preliminary findings, given the nature of the used methodology and the need for actual applications to test these findings, if reliable or not, and if the study has concrete indications of the necessity to make mental health procedures included in pandemic preparedness.

Measuring the impacts of pandemics and other disasters on mental health has another difficulty, as Al-Sheikh adds, “we still don’t acquire the right tools to measure this, no matter what the disaster is. Also, there is no evident scientific tool to define a causal connection between this kind of catastrophe and mental issues with its medical implications, even if disasters undoubtedly are a catalyst. But we will have to wait until the end of all of this so we can evaluate the repercussions.”

Marwa Nofal emphasizes that the framework the study provides could be divided per the pandemic phases since it only strives to work within available means. In the early phase, the study suggests firmly preparing the infrastructure to cope with any upcoming conditions, such as remote mental health counseling, workers’ training, etc. As for later phases, using technology to offer psychological support and care is a necessity, like exclusive hotlines and platforms of mental health specialists. Setting up virtual support groups in apps like WhatsApp or Telegram and others may facilitate access to those in need.

Not Just the Virus

The negative repercussions don’t stop there but stretch to medical personnel; in a study published at the beginning of February 2020 about the serious mental problems that medical staff was suffering from in China. The authors clarified that the exceptional situation the medics live in daily affects their mental health enormously. They also reported frequent cases showing obvious symptoms like stress, anxiety, and depression, sometimes it gets worse with sleep disorders, temper tantrums, and panic attacks. These issues, understandably, influence the medics’ capability to function, leading to negative impacts on the cases they are responsible for treating, which only adds up to the heavy burden of COVID-19 disease on all fronts.

“It’s essential to focus on the medical service providers’ mental health as they are the cornerstone of the system. This is the reason they deal with a lot of pressure and have to cope with it,” Nofal remarks. She adds that WHO unfortunately failed to mention mental health preparedness as the main component of the comprehensive action plan to meet Coronavirus challenges. Nofal continues, “The entire attention of the WHO was centered on physical health even though many mental disorders, such as anxiety, weaken immunity and thus increase the chances of being unwell.” She also notes that the infrastructure of psychiatry is already fractured in many countries, having caused disruption to plan suitable ways to manage the mental crisis after the outbreak of the pandemic.

This was the fundamental attempt of the study, in Al-Sheikh’s opinion. Moreover, he stressed that the study aimed to shed light on the central essential role of mental health in resisting the current pandemic and the necessity to include similar work plans during preparations so the difficulties wouldn’t exacerbate with time. Nofal agrees with him, indicating that we must pay a great deal of attention to the second peak of mental issues and prepare for it in every single way possible whether by training the medical workers or funding a comprehensive plan to tackle the crisis on all sides, including medical personnel.

As for Amr, nowadays he experiences a continuous feeling of being trapped, he says, “Usually, I don’t check my phone a lot but these days I don’t put it down!” He reads every single thing he finds about the pandemic, looks for new treatment protocols, recently published research, or even a comment on another one, describing it as a constant, persistent feeling of grave danger surrounding him in all directions.