As we are entering level 4 of the lockdown we have come to know our enemy, the coronavirus a bit better. According to Prof. Adam Kucharski, a mathematician at the London School of Hygiene & Tropical Medicine, there is a saying among epidemiologists: “If you’ve seen one pandemic, you’ve seen… one pandemic.” (10) This means that we learn as we get more evidence. There is hope (more on that later), but as we are fighting the fight for survival history reminds us that pandemics always leave psychiatric problems when they say their final goodbyes.
There is still a lot of uncertainty regarding the future and how well South Africa will “do” in the time of the pandemic. However, the ingredients of a massive disaster are present and these include being confronted by a deadly disease, the abrupt change in our lives and routines, the prospect of unemployment, social isolation, etc., where threats will also most definitely cause a trauma response in our psyches. When we are out of the lockdown situation, and even when there is a vaccine, we will still be left with the psychological trauma caused by this disaster.
A virus is defined as a sub-microscopic infectious agent that only replicates inside the living cells of an organism. There are seven other known coronaviruses (which includes those causing SARS and MERS). The coronavirus that causes COVID-19 is an RNA virus. A virus delivers “its DNA or RNA genome into the hostʼs cells so that the genome can be expressed by the host cell.” (1) This means that it is a piece of genetic information, and it needs a host to survive. A virus is the ultimate parasite, it quickly dies if it cannot infect another living thing. It is very small, which makes it possible for viruses to infect bacteria. It is so small that it took scientists until 1939 to take the first photo of a virus. This first photo was of the tobacco mosaic virus that infects the leaves of the tobacco plant. (If viruses like tobacco I wonder if this is why we cannot buy cigarettes during the lockdown?!)
There is no evidence that the coronavirus causing COVID-19 was engineered in a lab. There are reasons scientists know this for sure, but most tellingly the coronavirus closely resembles the viruses found in bats and pangolins, and these have never been known to cause harm to humans (2). Using it as a model for replication is therefore highly unlikely. Another interesting piece of virus information is that the first epidemic was circa 3000 BC – 5 000 years ago, and it also originated in China (3).
Although viruses differ, what can we expect?
- Viruses are highly contagious because they are only concerned with survival and need a host to survive.
- There are certain population groups that are more vulnerable to COVID-19. These include the elderly, the immune compromised and those with underlying cardio and/or respiratory illness.
- Viruses mutate. The quicker and better they mutate the more difficult it is to develop a vaccine, bearing in mind there are other factors that determine how easy it is to develop a vaccine.
- Viruses penetrate the central nervous system.
- Herd immunity could develop which means enough people become immune to stop the virus transmission, where contrary to the popular belief, not everybody is infected in the end.
The economic consequences are arguably just as serious and life threating as the medical consequences. People do not only lose their lives due to becoming infected by the virus, but also due to poverty, violence and suicide that comes in its wake.
This brings us to the mental health issues during and after a pandemic. Patients with mental health disorders are vulnerable because they have less resilience and less support. The current pandemic has consequences which affect our mental health, such as the following:
- According to Dr Roger Mclntyre, a professor of Psychiatry and Pharmacology at the University of Toronto, quarantine and isolation is toxic to the brain. There is also a difference between quarantine and isolation. “Quarantine” is used when we do not know who is infected and everyone is socially isolated, where with “isolation” the people that we know are infected are isolated. I suspect quarantine might be psychologically worse than isolation due to the uncertainty of who is infected. Quarantine is made worse when high levels of fear, frustration, financial insecurity and boredom are involved. We know that people who are isolated under normal circumstances have a shorter lifespan and increased risk for contributing to cardiovascular disease, and therefore these physical conditions will most probably worsen during unusual circumstances and an extended period of isolation.
The return to “normal” might also be difficult for people suffering from depression, because it was easier for them to withdraw and be less active during quarantine or isolation. Many of my patients expressed relief that they did not have to face their boss or mother-in-law because of the lockdown.
- Fear of the virus. If they were not so anxious already, many of my patients with OCD (obsessive compulsive disorder) would have been smug about the fact that they have always been scared of germs, and are already washing their hands for hours every day. The pandemic has worsened this anxiety with the added concern of contracting a deadly disease.
- Economic insecurity brings about more anxiety. Generalised Anxiety Disorder is the most common mental disorder, affecting about 30% of people in their lifetime. This underlying anxiety is made worse by the real threat of economic difficulties.
- We are bombarded by different opinions every day, some contradictory, and this increases the general uncertainty we have to deal with.
- Survivors often suffer from shame and guilt. Some people feel that they have done something wrong to survive a disaster. In South Africa we are reminded daily that the poorest of the poor are busy starving during the lockdown, which can create feelings of hopelessness and guilt.
- Post-Traumatic Stress Disorder is a psychiatric disorder characterised by reliving the trauma, being hypervigilant and being avoidant.
- Increased suicide risk. Being unemployed can be devastating. The link between suicide and unemployment has been well described in research studies. (4) According to Dr Roger McIntyre, there is a 1% rise in suicide for every 1% rise in unemployment. The prediction for job losses in South Africa is between 5 and 14%. (5) Unfortunately, South Africa’s suicide rate is 13,4 per 100 000 people, which is about four times the global rate. (14)
- Paranoia is a symptom of a couple of psychiatric disorders including schizophrenia, delusional disorder and borderline personality disorder. Paranoia in these disorders will increase due to the stress of uncertainty and isolation, and also because of “conspiracy theories” spread in the media (such as that the coronavirus was engineered in China, and it is caused by 5G).
However, in my opinion (and because it is good to consider some positive facts), there is some good news for us in South Africa:
- COVID-19 is quite contagious, but not as contagious as measles or other coronaviruses. An essential metric called R0 (“R naught”), represents the number of people an average person with a virus infects. The coronavirus has an R0 of 2 to 2,5. To end a pandemic the crucial measure needs to drop to below 1. (6) Success stories from countries such as Taiwan, Canada and South Korea show that this is possible.
- A poorer country, such as Vietnam, can fight the pandemic successfully.
- Yet, South Africa has managed a hard lockdown without descending into totalitarianism as in Vietnam and Hungary. (7)
- The coronavirus seems to mutate much slower than seasonal flu (8), which could mean good news for developing a vaccine.
- Most South Africans have been vaccinated against tuberculosis, and it seems that this vaccine may have a positive effect, unrelated to tuberculosis, in slowing the spread of the coronavirus. (9)
So what can we do?
- Get the right information. (12) Find information on credible resources such as the WHO, NICD, or if you want to see a snapshot instead, try these cool infographics at https://www.scmp.com/infographic/
- Spend less time on social media. The time you spend on social media is directly correlated with how depressed you are. People who spend five hours or longer per day on social media are almost guaranteed to be depressed. (11)
- Similarly, do not read the news too often. Remember news is also a business and bad news sells better than good news.
- Pay attention to things that can make you more vulnerable to mental disorders. If you have suffered from anxiety and depression in the past, be on the lookout for a relapse of the symptoms and take extra care of yourself. Do not ignore psychological symptoms, such as a depressed mood or anxiety, that start or worsen. Contact your doctor and/or therapist, take your medication correctly, sleep and eat well. Take care of your physical and mental health and ask for help sooner rather than later.
- Try a bit of CBT (cognitive behavioural therapy) on yourself. CBT says that it is our reactionsto things that determine our moods and behaviour, and not the things themselves. Yes, we are in a pandemic, our freedom is restricted and we are going into a recession, but how we think about it will determine our reaction. According to CBT theory there are “four irrational beliefs”. An irrational belief is a belief that is rigid, dogmatic in nature, inconsistent with reality, illogical and blocks us from achieving our goals. (13)
Test to see if you have thoughts that are in line with the following. If so, be aware that these are your thoughts and interpretations, and that if you can think a bit differently, it will greatly lessen your anxiety levels.
- Demandingness: “I should not have to go through this”, in other words, feeling that it is unfair that I/we should be going through a pandemic.
- Frustration Tolerance: “I cannot stand this” such as that I cannot stand not being able to get my hair done.
- Awfulizing/Catastrophizing: “It is horrible/terrible/awful” such as believing that this pandemic is awful, and we are all going to die.
- Self/Other/Life Rating: “I am hopeless/weak/bad” in that I consider myself a failure for letting my family down by not getting a salary.
If this looks like something that is of interest to you, consider visiting a therapist that is qualified to offer CBT or REBT (rational emotive behaviour therapy).
In closing, remember that an epidemic or a pandemic always ends. As Alexander Dumas said, “All human wisdom is summed up in two words; wait and hope.”
So while we wait and hope, also stay safe in your head.
Dr Melane Van Zyl
Sources:
1. What are viruses? www.livescience.com
2. The coronavirus was not engineered in a lab. Here’s how we know. www.livescience.com
3. 20 of the worst epidemics and pandemics in history. ww.livescience.com
4. The link between unemployment and suicide. Weforum.org
5. COVID-19: SA on right track to mitigate job losses. www.enca.com
6. How contagious is coronavirus? www.businessinsider.com
7. These countries showed us how to stop coronavirus. www.zmescience.com
8. Coronavirus seems to mutate much slower than seasonal flu. www.livescience.com
9. How a 100 year old vaccine for tuberculosis could help fight the novel coronavirus. www.cnn.com
10. The Rules of Contagion, by Adam Kucharski
11. The impact of COVID-19 on patients with Mental Health Disorders. Dr Roger McIntyre, Professor of Psychiatry & Psychopharmacology, University of Toronto, Canada. www.torontosun.com
12. The best COVID-19 resources we have discovered so far. www.visualcapitalist.com
13. REBT. The Albert Ellis Institute
14. South Africa’s suicide rate four times global rate. www.citizen.co.za