While I was working on my research article, Dawn news popped up on my Facebook timeline with heading -“14 deaths were reported of coronavirus across Pakistan today, the highest daily death count so far”. On the other side, New Zealand is preparing to end the lockdown after success in coronavirus battle. Social distancing is one of the significant contributors in success in coronavirus battle. Pakistan, by Saturday morning (11th April 2020), reported a total number of 5011 confirmed Covid-19 cases, out of which 50 have been critical.
It stopped me a while and made me to share some points regarding impact of this pandemic on us – on me, your and even your family members. Perhaps many of you are thinking what the hell is going around? how long will this last? how long I have to stay inside? how long I or my family has to be isolated? and last but not least, how many of us are impatient to get back to normal life. Most importantly, let us go out and take snaps of roads during this lockdown – shows our insensitive attitude. Are we actually following the govt. directives / instructions?
This is one of the biggest challenging time of our lives – the challenge is to how to control over selves, the challenge is to stay inside, the challenge is to how to think and act during this pandemic, the challenge is to when we come out of this self-isolation or social distancing, the challenge is to support others or not, and yes, the challenge is to how to react when we come out of this isolation.
Coronavirus pandemic is declared as a public health emergency globally and Pakistan is not alone battling in this global threat – an invisible threat. Why invisible threat? because we do not know who is infected and how. Anyone could infect us. We, honestly, do not know how bad it will get. We do not know even how long it will last. Pakistan is also battling with coronavirus pandemic along with all other countries and the government is making all efforts to keep its citizens stay at home, stay safe, and vies to enhance testing capacity despite of numerous healthcare limitations. Besides govt. efforts, as a citizen and an individual what can you do at your part?, for your family, for your community, for your society and for your country.
Initially, coronavirus raised fear, real and perceived threats, panic and anxiousness in 27 countries when this viral infection was detected in December 2019. Govts. of these countries got worried as they do not know how to manage this situation. The absence of a definitive and exact treatment or cure for coronavirus exhibited anxiety and uncertainty. Individuals respond differently to global events. As more cases are confirmed positive, we see a variety of reactions. People become anxious about the situation, resulted in disruptions, fear and stress. Some people turn to humor, cracking jokes or posting images / memes. Some become so much panic that they start hoarding food items, masks, hand sanitizers, soaps, toilet papers, and medical supplies. Some companies cash in and raise their prices. Some shopkeepers stockpile the necessity items. Low income countries or people of low social status are not facing fear of contacting the virus and its impact on health, but the fallout on their business and economic situation. However, due to stigmatization and xenophobia, people isolated themselves at their homes and avoided medical doctors but some started wandering in streets and public places and affected much more people.
Lack of knowledge and ignorance about epidemics, increased the likelihood of infection of corona virus globally. The effect of the coronavirus on mental health have not been systematically studied, it cannot be anticipated that what kind of impact this COVID-19 will have on the mental health of humans.
The most common symptoms of coronavirus are fever, cough, and difficulty breathing. Many diagnosed cases showed vomiting and diarrhea as indicators of coronavirus. It means this coronavirus is not just a flu, but it is also infected the digestive and respiratory systems in humans.
However, there are some mysterious cases, reported no symptoms at all. No symptoms mean silence spreaders of the virus. Even victims / patients did not even know that they had coronavirus and felt nothing at all. Some reported loss of the sense of smell but lack of the symptoms of flu. whereas some reported mild cold, flu along with fatigue.
Is this coronavirus affecting the brain too? It is not yet clear how it can be and to what extent affecting the brain. Usually patient having flu report confusion, headaches, and other symptoms. Rarely, some may be caused by inflammation of the brain. Anyhow, one point is very clear that this coronavirus is disrupting the respiratory system of the human body – the oxygen. In some cases, it is observed that if patient received the small amount of oxygen by putting on ventilator first, controls the situation of the patient. Heart-lung support system gets serious if no ventilation. However, lack of oxygen can damage the central nervous system including neurological disorders. The exact neurological disorders are not identified yet. It is understandable that the brain processing and functioning will be deteriorated if there is no supply of oxygen to the brain. Breathing problems are reported in severe cases.
Recently, a woman in her late fifties who had experienced three days of cough, fever, and “altered mental status” was tested for flu, which she did not have. Turns out she had Covid-19. Brain scans showed unusual swelling, and physicians diagnosed it as acute necrotizing hemorrhagic encephalopathy, which is “a rare central nervous system complication secondary to influenza or other viral infections which is characterized by altered mental status and seizures, and often this further leads to profound disability or death.” “This is the first reported case of Covid-19-associated acute necrotizing hemorrhagic encephalopathy,” the physicians, from the Henry Ford Health System in Detroit, concluded on March 31 in the journal Radiology. “As the number of patients with Covid-19 increases worldwide, clinicians and radiologists should be watching for this presentation among patients presenting with Covid-19 and altered mental status.” After this first reported case, initially it was assumed that elderly is more prone towards having the coronavirus due age, loss of speech, and deteriorating of mental functioning. Sudden inability to speak in a 74-year-old man with preexisting neurological conditions affirmed this assumption. Medical doctors are following cases to assess if any neurological conditions do occur because of coronavirus.
Individuals with mental illness may be particularly vulnerable to the effects of widespread panic and threat. Although the effects of the coronavirus on mental health have not been systematically studied, it is anticipated that COVID-19 would have negative effects, especially based on current public reactions. Acknowledging, recognizing, and acting on mental distress in this pandemic situation is a key to lessening the impact. Anxiety is our natural response to the unknown. It helps us to understand the situation and how to sort out the solution.
We all must do social distancing in this situation as it is considered as critical to slowing the spread of the coronavirus. It means no face-to-face interaction, no gatherings, no crowds, no meetings, or conferences and even no hanging out or shopping – the hardest time for the extroverts. May be many of you are uncertain how long you will maintain this social distancing or self-imposed quarantine. This kind of thinking provokes anxiety, stress, or frustration among us. Sometimes it provokes aggression too. Individuals who are very social can lead towards the loneliness. This loneliness can trigger fear of catching or dying with the virus, anxiety, and stress.
There is a chance in this situation to become obsessive about disease prevention – unwanted, sticky thinking that I am dirty and I have to wash, clean or sterilize myself again and again. Overuse of sanitizers, soaps or any toxic cleaning supplies can lead to inhalational injuries or skin rashes. Further, fear of acquiring a new disease may trigger the negative behaviors or thoughts.
Those individuals / families are more vulnerable to this situation who have related traumas in their lives before. Some researchers suggest that domestic violence is increased in this lockdown / quarantine period. This lockdown / quarantine period made the authority figures or husbands more aggressive or frustrated as they must stay home for uncertain period. This resulted in fear, insecurity, and panic among vulnerable persons like wife, children, or weaker persons at home. Research reported that as time goes on and people develop even more severe anxiety or depression as it relates to economic uncertainty or as a side effect of isolation.
It is assumed that individuals can experience sleep (more or less sleep) and appetite issues (eating all the time or no appetite at all), and overall lower perceived state of health, if stay at home for a long uncertain time.
Looking after your mental health during the Coronavirus outbreak
Majority of us have to spend a very long time at home, generate new activities at home, and even work from home rather than work places, except armed forces, police, medical professionals, bankers and /or other workers who are still on job. Even students are engaged in interactive sessions online either belong to schools, colleges, or universities. In this situation, there are some who are spending their time positively and enjoying with their families. It is up to you how will you look after your mental health while you are staying at home.
A. Create a new daily routine that prioritizes looking after yourself and your family. Engage yourself in healthy activities besides your online office work.
B. Stay calm! Do not get panic and stay calm as much as you can. Breathing is the most fantastic way to relax and stay calm. For breathing, take five deep breaths in and out (inhale from your nose and exhale from your mouth. Do not forget your belly in breathing and imagine all that stress leaving your body with each exhale. Feel free to repeat the above steps whenever you want. Smile is the best way to stay calm. Fake your smile if you must.
C. Make A Gratitude List. You can make daily gratitude list by focusing on what you value and what you are grateful for. You can focus on good things in your daily life.
D. Do not overload your brain – Gossip and rumors spread false information. Some people obsess about each news that can result in mental exhaustion. This can affect daily functioning and sleep. Listen to the morning or evening news, and that is it!
E. Reliable sources – Get the facts and stick to it. Having access to good quality information about the virus can help you feel more in control. Obtain your information from reliable sources.
F. Follow hygiene advice such as washing your hands more often than usual, for 20 seconds with soap and hot water. Be careful, do not wastewater in these 20 seconds. (you can sing ‘happy birthday’ or any song if you want to yourself twice to make sure you do this for 20 seconds). You should do this whenever you get home or into work, blow your nose, sneeze, or cough, eat or handle food. If you cannot wash your hands straightaway, use hand sanitizer and then wash them at the next opportunity. You should also use tissues or wipes if you sneeze and make sure you dispose of them quickly; and stay at home if you are feeling unwell.
G. Social distancing – The most hardest time for the extroverts. Minimize your exposure to large groups. Stand at the distance of 2 meters or six feet at public places, for example, banks, stores, or marts. Walk away if you find any public place crowdy or noisy
H. Stay in touch with far-flung family members or friends on social media but try not to sensationalize things. If you are sharing content, use this from trusted sources, and remember that your far-flung family members or friends might be worried too.
I. Balanced diet – Cook simple food. No junk food. Chew slowly! Use green vegetables and fresh fruits in your diet. Do not shovel your food. Be a mindful eater, pay attention to your food – taste, texture, and aroma of every dish while eating. If you shovel your food down as fast as you can, you will get a bellyache, digesting issue and sleeping difficulty too. Well, chewing slowly will also reduce those dreadful late-night cravings that sneak up on you after work.
J. Stress Management – It is OK to feel vulnerable and overwhelmed in the present situation. If you have experienced trauma or a mental health problem in the past, or if you have a long-term physical health condition, it makes you more vulnerable to the effects of the coronavirus. you can relax by following different stress management techniques. There are so many even available on internet. If possible, download the distressing app like Calm or Headspace. you can listen to sounds of birds chirping, seashores, raining or showering, campfire. Such sounds help you in relieving stress and anxiety. The best technique is to take a 10-15-minute walk. Walk it will help in increasing endorphins and decreasing in stress. Endorphins make you happy.)
K. Keep Active – Engage yourself in self-care routines and healthy habits. Get fresh air, adequate rest and take care of your immune system. As Ramzan, a holy month, is approaching, you can read Quran Pak, different surahs, wazaifs, and so on. You can do exercise at home, either in your room, on the roof or balcony – entirely up to you. Engage in healthy distractions such as reading a book or watching a funny movie, going for a walk in the fresh air or learning a new language or skill.
L. We need to watch our language to avoid panic state, dramatics, and hysteria. Do not pollute your home environment. We need to be mindful of how we talk in front of children as our behavior leave deep impact on their minds. Remember action matters than words.
M. Talk to your children (if you are married) – To get involve our family and children in our discussions, plans, or making any decision is essential for healthy home environment. We need be alert to and ask children what they have heard about this pandemic without causing them alarm or panic. Explain facts to your family and children. We need to minimize the negative impact it has on our children. Discuss the news with them but try and avoid over-exposure to coverage of the virus. Be as truthful as possible but in an appropriate way. You can read a story to them or engage them in healthy activities like gardening, birds feeding, or learning any new skill.
N. Show empathy, care and support – be concerned about your neighborhood and try to help them financially or share their burden by sharing food or needy items with them. Check in with people who you know are living alone.
O. Also remember to regularly review your social media activity. Tune in with yourself and ask if they need to be adjusted. Mute those friends or members in your list if they are increasing your worries, stress, or anxiety. You can unfollow accounts or hashtags that cause you to feel anxious.
Just remember – we all are humans and interconnected. We are NOT individuals only, but we ARE Family and community. We must support each other in this pandemic crisis.
Be Assertive, Be Constructive, & Play your part!