Joan Cornet, Director Digital Health Observatory ECHAlliance and Psychologist
We are at a crossroads created by a virus, of which we know little, that is radically disrupting the world we live in. It attacks virtually every country in the world and does not discriminate between the powerful and the humble. All we know is that the world after this pandemic is not going to be the same. Neither I, nor do I believe anyone, can dare to predict what this world will be like. What if I may reflect on the areas in which this pandemic is affecting, and that likely will be key in the reinvention of our societies and our lives.
EFFECTS OF CONFINEMENT
The impact of confinement depends on:
Quarantine duration. Three studies show that the longer duration of quarantine is specifically associated with worse mental health, post-traumatic stress symptoms, (1, 2) and avoidance and anger behaviors. (3)
Fear of infection. Despite the confinement, there is a fear that we may be infected by the virus, either because it was already dormant in our bodies, that a family member with which we share quarantine can contaminate us, or worse when a family member or partner in the same space we inhabit is sick due to the virus. So is the fear that I am the one who might contaminate others. People with a tendency to become obsessive can develop obsessive behaviors, washing their hands, taking the temperature, disinfecting the house, etc. dozens of times during the day. (4)
Frustration and boredom. We are social animals; routine lovers and we do anything not to get bored. Quarantine fills us with frustrations that can be aggressively expressed to people around us. In several countries, domestic violence complaints have increased markedly since the beginning of quarantines.
Inadequate or insufficient supplies. Lack of enough food, the need to have medicines on time, the lack of protective material, etc. can create a sense of panic.
Inadequate information. In pandemics like wars, the first victim is the truth. Receiving conflicting or false news creates uncertainty and mistrust.
Finance. Financial loss can be a serious problem during quarantine, with people unable to work and having to disrupt their professional activities without planning it; the effects can be long lasting. Financial loss as a result of quarantine can create severe socioeconomic distress that is a risk factor for symptoms of psychological disorders, as well as anger and anxiety that can remain several months after quarantine.
The impact on doctors, nurses and health workers. Health professionals have to deal with extreme situations on a daily basis, becoming heroes against their will. The contagion figures of professionals in some cases are alarming. The most traumatic thing is to be under the pressure of care and have to decide on a case-by-case basis the fate of serious patients who require intensive care. There is talk that numerous cases of post-traumatic stress disorder are likely to arise among these professionals. In addition, they are people who may have their family in confinement, or with the COVID19, so their anxiety and stress add to the one they suffer as a professional.
About 50, 000 years ago Homo Sapiens appeared, that is, us. Over these thousands of years, we have faced calamities, wars, epidemics, etc. We have arrived to this day thanks to a very efficient immune system, although it may fail as now, but in our history we have survived many epidemics. Many scientific research agrees that what has allowed us to overcome the challenges that have arisen is our ability to collaborate with each other. Thanks to language and our emotional heritage, humans have built extraordinary civilizations. We have also destroyed them when cooperation, dialogue, solidarity have fallen victim to ignorance, selfishness and manipulation by egotistical, psychopaths and/or power-hungry elites. Without cooperation and generosity, we will not leave the pandemic we are living.
Our brain, which is a marvel, loves predictability and distresses uncertainty. Human survival has depended on both fear and anxiety, forcing us to react immediately when we encounter a threat, for example, a lion around the corner, as well as to be able to reflect on perceived threats, noises, roars, movements, probable distance, decide whether to stand still or flee in a hurry , but how do we know it’s best to save us?
Today we are fighting COVID-19. Where will our world be in 2030? Panic begins when a brain negotiation goes wrong, the amygdala, the emotional center of the brain, wants us to get out of harm’s way right away, and doesn’t care how we avoid the lion. But the frontal cortex, which handles his behavioral responses, insists that we first think about the lion’s situation.
Sometimes anxiety can interfere. Instead of talking directly to the parts of our brain that are good at planning and making decisions, the frontal cortex is confused with all the cross-conversations between other parts of the brain that are determined to represent all possible scenarios of how we might become a lions dinner. Panic happens when everything short-circuits.
What I must do? How will my life be in a few months? With a loss, of family, friends, economic resources, employment, etc., personal identity can be destabilized. Who am I? What is the point of my life? If positive scenarios do not arise over time, or there is not enough resilience, anxiety and depression can be timed
Strange feeling that I through my body can contaminate or be contaminated. If you add previous health fragility like chronic diseases, my body feels devalued. My body is a problem, which means loss of self-esteem.
Our body, which is a great communicator, because of the pandemic, cannot embrace, kiss or feel the warmth of other human beings. Having almost achieved so-called sexual liberation, what about those who have multiple or sporadic relationships? How can young people start sex without fear of contagion? If the pandemic has an end, all these issues are resolved, but if it is not fully eliminated and a thousand precautions must be followed, we are facing a serious personal and social problem.
WHAT TO DO WHILE WE WAIT FOR THE STORM TO COME DOWN?
There is an urgent need to give psychological support to the people most affected, which is already happening from entities and volunteer associations today.
Beyond psychological problems, every one of us will need to evaluate our lives and careers. Following the Chinese wisdom in which the word crisis also means opportunity, it is perhaps the time to reinvent ourselves. Abandoning ballast, changing goals, defining new ways of living and working. Perhaps we will discover that our lives are monotonous and without passion, and that the time has come for our personal revolution.
Review and evaluate our values. Discover that we can be happy without the need for many things, objects, junk and big plans for holidays. Realizing that solidarity is the only way out of this crisis and others to come. That the number of “likes” or applause on social media is somewhat banal. Find new ways to love others. In the face of uncertainty, love overcomes fear. Humans have survived through cooperation between us. And we’ll do it again, whatever it takes.
WORKING ON A NEW ARTICLE…COVID-19. THE SOCIAL IMPACT…
- L Hawryluck, WL Gold, S Robinson, S Pogorski, S Galea, R Styra
SARS control and psychological effects of quarantine, Toronto, Canada
Emerg Infect Dis, 10 (2004), pp. 1206-12
- DL Reynolds, JR Garay, SL Deamond, MK Moran, W Gold, R Styra
Understanding, compliance and psychological impact of the SARS quarantine experience
Epidemiol Infect, 136 (2008), pp. 997-
- Z Marjanovic, ER Greenglass, S Coffey
The relevance of psychosocial variables and working conditions in predicting nurses’ coping strategies during the SARS crisis: an online questionnaire survey
Int J Nurs Stud, 44 (2007), pp. 991-
- E Robertson, K Hershenfield, SL Grace, DE Stewart
The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers
Can J Psychiatry, 49 (2004), pp. 403
- Law & Neuroscience: The Case of Solitary Confinement. Jules Lobel & Huda Akil. 2018 by the American Academy of Arts & Sciences doi:10.1162/DAED_a_00520
- The Psychological Trauma That Awaits Our Doctors and Nurses
Returning to resilience: The impact of COVID-19 on mental health and substance use
The psychological impact of quarantine and how to reduce it: rapid review of the evidence
Dealing with Stress, Anxiety, and Grief during COVID-19