Health: Post Covid fear of going out
UNTIL last summer, Sunita Hind was a happy-golucky person who enjoyed weekly shopping trips in town with her girlfriends. But today, even a visit to her local hairdresser feels terrifying.
‘I am living in a constant state of fear,’ says the 38-year-old writer.
‘The thought of coming into contact with other people makes me terrified. I thought I’d be jumping for joy at the idea of going to get my hair done. But all I can think of is the people who might come too close to me.’
Sunita was diagnosed with anxiety by her GP last summer. She rarely ventures out – despite having had both her Covid jabs. Two weeks ago, she suffered a panic attack in her local supermarket. ‘It was all the people swarming around me. Having spent so long in my little bubble at home, where I felt safe, it was way too much.’
Sunita began to feel anxious following a hysterectomy last June, months after doctors found a cancerous cyst on her ovaries. ‘I was alone surrounded by a load of doctors in hazmat suits,’ she says. ‘The memory haunts me.’
Her anxiety is rooted in a fear of what would happen if she caught Covid.
‘Because of the cancer, I’m convinced I will die,’ she says. ‘I remember reading the reports about women of colour being more likely to be put on a ventilator and I thought, well, that will happen to me.’
Sunita has been left wondering whether life will ever be the same again. And she is far from alone.
You might say, given the circumstances of the past 15 months, this situation is not altogether surprising. Millions of those at highest risk from Covid spent months cocooning. Covid has claimed the lives of more than 4,900 – in many cases leaving behind fearful loved ones.
Last year a report from HSE specialists spoke of the increased demand for mental health services and warned that a ‘tsunami of mental health need will persist for months to years afterwards and will be compounded by the economic impact of the pandemic’.
One of the report’s co-authors, Dr Karen O’Connor, said: ‘I don’t want to overstate it but it’s based on the numbers that we’re getting out of our early intervention and psychosocial services.’
Dr David Crepaz-Keay, head of social issues at the UK’s Mental Health Foundation adds: ‘Research from past pandemics shows a delay in people coming forward for help. The event itself offers a distraction, they are focused on simply getting through the day-to-day. But as soon as normality begins to return, the serious mental health issues come to the fore. Some will already have a diagnosis and will suffer a relapse, while others will be experiencing something for the first time. These conditions may well continue for years beyond the end of the pandemic.’
Studies have shown the SARS global outbreak in 2003 was directly linked to a 30 per cent increase in suicides in people aged over 65 in the years following the crisis. A study of the after effects of the Chernobyl disaster in Ukraine found that, two decades later, those directly involved with the event were more likely to be depressed than those unaffected.
Dr Adrian James, president of the Royal College of Psychiatrists, says that referrals are already beginning to creep up.
‘GPs and colleagues in emergency departments say, right now, they are seeing unprecedented numbers of people presenting with mental illness,’ he adds. ‘It’s to be expected, given the job losses, grief and social isolation millions have been through.’
One of the most common problems is somewhat obvious: anxiety about health, disease and contamination. Occasional anxiety – racing heart, sweaty palms and intrusive thoughts – is normal.
But it becomes a medical problem when it happens regularly enough to interfere with daily life, and cause significant distress.
Experts say many people’s normal, manageable anxiety has been ‘tipped over the edge’ by the pandemic.
And some are fearful of returning to their workplaces.
Researchers at the London South Bank University have termed this ‘Covid-19 anxiety syndrome’ – an unnecessary con
cern about mixing with others, touching objects and using public transport, for fear of contracting the virus.
They say people who suffer this will struggle to ‘disengage’ with the threat of the virus which ‘may make return to normal living harder’.
Dr Ahmed Hankir, a psychiatrist working in emergency care in London, says: ‘We’ve had a definite rise in people reaching crisis point with their anxiety, some ending up in need of a hospital admission due to uncontrollable panic or self-harm.’
He warns he’s noticed an increase in exacerbations of obsessive compulsive disorders in patients, a mental health condition characterised by unwelcome thoughts, urges, worries and doubts, and compulsions to carry out repetitive activities linked to those worries – such as constant hand-washing.
‘We think it’s been sparked by worries about catching the virus,’ adds Dr Hankir. ‘A lot of the anxiety we see is steeped in a fear of contamination or extreme worries about their health. Once these thought patterns have taken hold, it is very difficult to reverse them.’
And it’s not only the fear of illness that’s causing anxiety. The constantly changing regulations about what we can and can’t do is also a factor. ‘The brain does not cope well with question marks, or feeling like something is beyond our control,’ says Dr Hankir.
‘We ruminate about what could happen. Obsessive behaviours can serve as a distraction, making us feel we’re in control.’
Experts say as the country opens up, more of these patients will reach crisis point. ‘For the past six months, patients have had a justification for their health anxieties, because there was a legitimate threat,’ says Dr Crepaz-Keay.
‘But now, they will suddenly be forced into a world full of the crowds they are scared of. Seeing everyone being together makes patients’ mood dip further, because they think why aren’t I feeling as happy? This can often spiral into depression.’
Dr James says: ‘Exposure to a situation someone finds frightening has to be done in baby steps. There’s a risk that the patient becomes overwhelmed and acutely anxious. ‘This heightens the fear of exposing themselves to the situation again, so they may avoid it, leading to a vicious cycle.’
Then there are the effects of prolonged isolation. A recent survey by care company Elder found that, during the three lockdowns, 40 per cent of over-70s didn’t leave their homes. One in five said they had contact with another person once every fortnight.
Studies after the 2003 SARS epidemic found that quarantine was linked to the development of long-term depressive symptoms, and alcohol abuse.
‘Last week I was called to the bedside of an older woman who had been on her own pretty much since the start of the pandemic,’ says Dr Hankir.
‘She’d become so lonely she’d developed psychotic depression and hallucinations.
‘We needed to admit her to hospital but there weren’t enough psychiatric beds.’
Worryingly, Dr Hankir says these cases of acute mental illness are becoming increasingly common. ‘I’ve been most struck by the rise in psychosis in people who’ve never struggled before,’ he says. ‘People wanting to harm themselves or self-harming, because a voice in their head is telling them to. More often than not the situation has arisen because of the pandemic. Either they’ve become unemployed, cut off from people they love, or have been selfmedicating with narcotics to distract from the isolation.’
Early Chinese studies identified an unexpected rise in patients developing schizophrenia since the start of the pandemic. And for these very sick patients, there is no quick fix. Many will require hospital treatment and several courses of talking therapy – for which the waiting lists are already lengthy.
Only one in seven schizophrenia patients are fully recovered two years after the onset of their illness, according to a review by medics from Oulu University Hospital in Finland.
There’s even been suggestion that Covid infection itself could trigger mental health problems. In November, researchers from the University of Oxford analysed the medical records of 62,000 Covid patients and found one in five received a psychiatric diagnosis of either anxiety, insomnia or depression three months after testing positive. Covid sufferers when compared with a group of flu patients were 50 per cent more likely to become mentally ill. Medics suggest that inflammatory proteins released by the immune system as part of its attack on the virus can cross the blood-brain barrier, damaging neurological pathways. But the exact reason remains unclear. ‘We think people become mentally ill because of the psychological and social effects of being unwell with Covid, rather than how it affects the brain,’ says Professor Paul Harrison, associate head of psychiatry at the University of Oxford and a lead researcher in this area. ‘Patients are worried they might die, or are lonely and stressed about losing finances when they have to self-isolate.’
Studies have also shown that social comparison – taking cues on how to behave from peers – is crucial for helping young people develop a healthy sense of who they are, and how to interact with others. Without this, children are bound by unrealistic ideas about how they should behave or what they must look like, usually thanks to social media, and become selfconscious in social situations.
Dr James says: ‘For many children, unrealistic content online will be their only interaction with other people – and they aren’t able to see their friends to help them understand what’s real and what isn’t. Added to this, thousands of children will have been trapped in a home they aren’t happy or comfortable in, cut off from other support.’
Today, Sunita takes a daily anti-anxiety pill and has fortnightly cognitive behavioural therapy, over the telephone. Her scans show no signs of cancer and she received her second Covid jab last month. ‘I might see my family – but only because it’s only a few, familiar people,’ she says. When will Sunita to go back to normal, properly?
‘I don’t know. But now is definitely not the right time.’