The madness of the pandemic
MENTAL HEALTH: TIME IS RUNNING OUT AS SUICIDES SPIKE BECAUSE OF COVID-19
‘Next tsunami’ is the psychological scarring that will stay.
It’s been eight months of madness since the Covid-19 pandemic gripped the country – and, as a psychiatrist, I stand by helpless as I see the virus mowing down my nearly 1 200 patients.
Donned in my usual full Hazmat suit – hat and all – I was laughing with one psychotic woman a week ago. Two days later, I heard she was dead. And the suicides are spiking around me…
Never in recent history has the world been engulfed in such a sudden crisis as the outbreak of Covid-19. In January, the World Health Organisation (WHO) declared the outbreak of the coronavirus a public health emergency of international concern – and I knew my world, as I knew it, had changed forever.
The virus quickly spread to most countries and in March, the WHO called it a pandemic.
Public health authorities worldwide jumped into action to contain the outbreak, initially from a physical and life-saving point of view. But as the weeks progressed, the psychological consequences became obvious: people were scarred by the pandemic and its associated rules and regulations – especially those relating to social contact.
Mental health workers – me included – kick-started studies; held online discussions. The concern was that long after the virus has been contained, hopefully mostly “eradicated”, the psychological scarring and effects will remain. In the medical press this was described as the “next tsunami” of consequences.
There is no doubt that every person will be affected and subjected to increased stress because of the outbreak. Most healthcare workers will confirm this.
Patients describe multiple factors that contribute to their stress, including the prolonged lockdown, social isolation, lack of emotional and psychological support, unemployment, financial insecurity, and the unknown “when and how this will all end”.
Due to the prolonged stress, patients reported that the pandemic has definitely affected their mental health to some degree: they were scared (had an increased sense of fear), anxious, depressed, were struggling to sleep and were just being on edge all the time.
In practice, many more patients are being diagnosed with anxiety disorders and depression that now needs medication and psychological intervention.
Patients who have already been diagnosed with these conditions report an exacerbation in their symptoms that requires an adjustment in their medication.
The feelings of despair because of the consequences of the pandemic also have far-reaching psychological effects. The most important is that of increased substance abuse and suicide to cope with emotions. We need to identify someone with a substance abuse problem early and arrange a comprehensive treatment programme.
The South African Depression and Anxiety Group reports at least a doubling in its daily call rates on the helplines.
Many of the callers have suicidal thoughts and even plans.
As the pandemic spreads and affects especially vulnerable groups and the economy, so will suicide increase. We need to save mental lives during this pandemic, too. Managing and preventing suicide therefore needs urgent attention.
Several psychological factors among individuals who had Covid-19 may be related to suicidal tendencies. These factors include when patients learned about their diagnosis, especially in low-resilient individuals: it increased anxiety, the distress related to severity of symptoms of the disease and stress related to hospitalisation and hospital treatment spiked.
Not knowing what course the disease will take in an individual also adds significant distress. Social isolation, quarantine and fear of infecting other people lead to a serious psychological trauma.
From the current statistics we know that most Covid-19 patients should recover without experiencing any physical symptoms.
From experience we know that survivors of critical illness are at risk of persistent psychiatric impairment after discharge from hospital.
But maybe not often recognised is that of post-traumatic stress disorder (PTSD).
The key feature of severe Covid-19 illness is severe acute respiratory distress syndrome, admission to an ICU and ventilation. This pandemic must be regarded as the most severe since Spanish Influenza and therefore highly likely to promote PTSD. Furthermore, psychiatric research has shown that PTSD individuals are more at-risk of suicidal thoughts and a possible suicide attempt.
The pandemic stigma has become an important theme, too.
People who have been quarantined (especially in centres away from home) reported more stigmatisation and rejection from people in their neighbourhoods.
They are being treated differently and avoided, social invitations are withdrawn, they are viewed with fear and suspicion, and subjected to critical comments.
It is known that pandemics can produce contagion stigma in which specific ethnic, national, racial, or religious groups are targeted with blame. Such targeted populations can be subjected to stereotyping, prejudice, discrimination, and social exclusion, as we have learnt from the HIV/Aids disease over the years.
Finally, we need to remember those around the Covid-19 patient. When an individual is affected, this can also influence their caretakers, friends and family. They may be subjected to similar stigma and shame, as well as develop depression, increased stress, PTSD and anxiety – and they may even develop suicidal thoughts.
Covid-19 has now been around for several months with rapid research in the nature of the disease and its management.
There is a scramble in the medical world to find an effective vaccine. Let us scramble to find the answers to the mental health aspects of the disease.
We need to tackle these with the same vigour and determination. Time is running out...
Dr Korb, board chair of the South African Depression and Anxiety Group, is in full-time private practice as a psychiatrist and clinical psychologist in Sandton.
I stand by helpless as I see the virus mowing down my patients