The hidden cost of COVID-19
Pandemic’s impact on physical health is well documented but it also exacts a heavy mental toll, Wang Qian reports.
It has been a year since Zhang Xiangyang, a frontline doctor in Wuhan, Hubei province, tested positive for COVID-19. She returned to work after recovery, but Zhang has found that “back to normal psychologically” is not as easy or the same as being physically capable of work.
“People kept a distance when talking to me. Once I encountered a colleague while walking upstairs, she seemed to freak out. She turned around and walked away immediately. I understood their concerns, but these occasions made me uncomfortable,” she says.
Without telling anyone, Zhang pretended that everything was OK and kept herself busy with her patients. She had an emotional episode on May 20, when she heard that a man in his 50s tried to drink pesticide to commit suicide, because he couldn’t face the lingering stigma after developing the disease.
The doctor telephoned Shi Zhanbiao, a psychologist from the Institute of Psychology at the Chinese Academy of Sciences, about the case, and when Shi asked how she felt, she burst into tears.
“Having been through all the fears, uncertainties and difficulties since the outbreak, it was the first time I felt that someone cared about me,” Zhang says. Virus-related discrimination and stigma has always been there, which brings more pain than the virus, she adds.
Shi is in charge of a mental health support program targeting infected medical workers and their families. Launched in May, it aims to provide free and consistent emotional support to the group for a year. Initiated by internet company ByteDance, the program was jointly established by the Institute of Psychology of the Chinese Academy of Sciences and Chinese Psychological Society.
In hospitals around Wuhan, once the hardest-hit city in China, doctors, nurses and other healthcare workers like Zhang have fought valiantly against the coronavirus, which has taken a mental toll on many of those who survived it.
Data from the National Health Commission showed that by Feb 11 last year, there were a total of 1,716 confirmed COVID-19 cases among medical professionals across the country.
As of Jan 25, the program has provided 304 occasions of one-to-one mental health counseling to 225 infected doctors and nurses, according to ByteDance.
“For some medical workers, it may take one or two years to really get over the mental trauma caused by the pandemic,” Shi says, adding that his team will keep tracking the high risk group until people return to normal life.
Psychological challenge
Three days after Wuhan lifted its 76-day lockdown on April 8, as the COVID-19 outbreak waned, Shi and his team arrived at the city’s Wuchang Railway Station. Before that, Shi had talked to some of the medical workers about their worries and concerns over the phone or online.
With a population of 11 million, the city was the worst-hit in China, with more than 50,000 cases and at least 3,800 deaths.
Their first stop was Jinyintan Hospital, which specialized in infectious diseases and was designated for treatment for the initial cases in Wuhan. Dedicated nurses and doctors battled to save thousands at the start of the pandemic.
“According to our mental health evaluation survey after arrival, the pandemic caused a high prevalence of anxiety and depression among the medical workers in the early stages,” Shi says. Some even had post-traumatic stress disorder, which is caused by stressful, frightening or distressing events, with symptoms including repeated nightmares and flashbacks, he adds.
A study published in The Lancet in March last year echoes that up to one-sixth of the Chinese frontline health workers surveyed between Feb 17 and 24 reported mental health challenges. The prevalence of psychological distress, anxiety and depressive symptoms were 15.9 percent, 16 percent and 34.6 percent respectively. A total of 4,679 doctors and nurses from 348 hospitals across the country took part in the survey conducted by Peking University and Capital Medical University.
In a viral interview with China Central Television in January last year, after hearing that one of his colleagues was dying due to the virus, doctor Hu Ming couldn’t stop crying in front of the camera.
“Medical workers are humans first, who have their limits. It must be terrifying and saddening to see patients pass away within days. With no time to process, it means trauma after trauma for frontline healthcare providers, who need the right support to cope with the stress,” Shi says.
Shi had a doctor who blamed herself for her parents’ and child’s contamination. After testing positive, she sent her child to her parents’ home and later they got sick. She kept saying that it was her fault. Although they all recovered, she could not forgive herself and dared not meet her child.
Shi has talked with the doctor many times to ask her to reunite with her family.
But not all people are willing to open up to therapists. Shi finds that many people, especially medical professionals, have difficulties admitting that they suffer from psychological distress, which is sometimes stigmatized as weakness or a personal flaw.
To help these people know themselves better and feel connected with families and society, Shi’s team has organized seminars, training and support groups with various themes, such as how to get on well with colleagues and family members and how to communicate with patients.
Through livestreaming platforms and social-media apps, Shi can talk to people in need anytime, anywhere.
Improving mental care
Besides the diversified channels in mental care support during the pandemic, Shi is happy to see coping with mental health issues has been highlighted by authorities during the early stage of the outbreak.
As early as Feb 4, the National Health Commission set up a psychological assistance expert working group that was sent to Wuhan to formulate plans to help frontline health workers address mental health challenges.
During the height of the COVID19 outbreak, a total of 430 psychiatric and mental health workers were dispatched to Hubei to deliver services. Nationwide, 667 hotlines dedicated to meeting rising demands for mental healthcare were set up, according to the commission.
In March, the Institute of Psychology of the Chinese Academy of Sciences set up a work station in Wuhan to provide psychological support for people in need.
“The operation will last at least two years,” Shi says, adding that besides psychological assistance, they will improve intervention therapies and explore new modes in emergency assistance response on the community level.
As a member of the psychological assistance team during the 2008 Wenchuan earthquake, Shi says public awareness of mental health has been improved in China over the past decade.
“After the Wenchuan earthquake, most people rejected psychological support service. But now people have begun to recognize, accept and even seek mental-support service,” he says, adding that authorities have paid high attention to raise public awareness of mental healthcare.
In 2012, China’s top legislative body adopted the Mental Health Law. The long-awaited national legislation on mental health aims to help improve patients’ access to timely and appropriate treatment and improve public mental health services.
According to the Healthy China 2030 plan, China will step up its efforts to enhance people’s mental health, as the country aims to improve the rate of treatment of depression by 80 percent by 2030.
For some medical workers, it may take one or two years to really get over the mental trauma caused by the pandemic.”
Shi Zhanbiao, professor, Institute of Psychology, Chinese Academy of Sciences