By Dr. Dilkhush Panjwani *
Humanity is facing close encounters with the unfolding crisis of the novel coronavirus SARS-COV-2 (COVID-19) pandemic. Doctors, nurses, paramedics, and many other essential service providers are on the frontline, risking their lives to save lives through their selfless and dedicated service in their communities and hospitals. These frontline heroes are facing many challenges in performing their noble tasks. Notwithstanding the shortage of personal protective equipment (PPE), and ventilators in intensive care units (ICUs), they face the risk of contracting the COVID-19 disease due to extensive exposures in their line of duty.
The frontline health care providers are especially at risk of contracting the virus and developing mental health related problems. Extensive face to face contact with patients suffering from coronavirus disease increases the risk of physical fatigue, mental exhaustion, and burnout in frontline healthcare professionals. The psychological trauma of witnessing seriously ill and dying patients in ICUs and hospital wards could lead to symptoms of posttraumatic stress disorder that could last for months or years. Many healthcare workers are likely to experience symptoms of anxiety, panic, and depression. It is of utmost importance to care for the carers and for their safety – the frontline healthcare and essential service providers are the backbone of our society and ensuring their safety and well-being will ease the burden on hospitals and the healthcare system.
Healthcare providers are also faced with many ethical dilemmas whilst dealing with the seriously ill persons and worried family members who are not permitted to visit them. Doctors are faced with making difficult choices. The doctors and nurses often act as facilitators, communicating between the patient and the family. Bereaved family members struggle with guilt and anger due to lack of closure and not being able to say final good-byes to their loved ones.
Sudden changes in individual lifestyle, restricted physical, social, and recreational activities tend to precipitate mental stress in an otherwise healthy population. Stress is a common denominator for most mental disorders. Each person has a different level of resilience or the capacity to bounce back from adverse and stressful life experiences. The incidence of depression, anxiety, panic, violence against women, alcohol and substance abuse, and suicide rate in the general population is likely to increase sharply during this pandemic. A phenomenon of ‘emotional contagion’ might occur when one person’s emotions, fear, anxiety, and related behaviors directly trigger similar emotions and behaviors in another person.
The novel coronavirus has shown to have a spectrum of symptoms that are so protean. Some people are asymptomatic. Others might have very mild, cold-like symptoms – runny nose, congestion, or sore throat. Yet other people have flu-like symptoms – high fevers, muscle aches, shortness of breath and continuous cough. Loss of smell and taste are also symptoms. A few most vulnerable people with other medical conditions develop a severe illness. They are admitted in the hospital with respiratory failure, requiring ICU care. In some cases, signs of blood clots, large and small purple rashes, swollen legs, clogged catheters and sudden death have been observed as complications of coronavirus. Researchers are trying to understand why it happens.
The mode of transmission of the virus is not fully understood, although close contact with an infected person is known to spread the illness from human to human. The actual incubation period is also not established. There are reports of children presenting with a serious condition named pediatric multisystem inflammatory syndrome associated with COVID-19. These children have symptoms of persistent fever, rash, abdominal pain, and vomiting. The elderly population and persons with chronic medical illnesses such as hypertension, diabetes, cardiovascular, asthma and other pulmonary diseases are very vulnerable. Persons on anti-cancer medication are immunocompromised, thus are also vulnerable. A large number of mortality in long-term care facilities have been reported. Researchers are trying to fathom how coronavirus is spreading in nursing homes, homeless shelters and prisons, where distancing is not an option. The indigenous population is also vulnerable to the spread of coronavirus.
So far, there are no vaccines or specific evidence-based treatments for the highly contagious coronavirus. Clinical trials are being conducted for a number of potential medicines for the coronavirus, and over a hundred studies of vaccine development are taking place around the world, without any unified approach. Wide based serological and antibody testing, contact tracing, isolating, and mitigation are important components in controlling the spread of coronavirus. The US Food and Drug Administration (FDA) has granted approval for a new coronavirus test that applies gene-editing technology CRISPR. The test results are available in about an hour. Innovative ways of dealing with the backlog of non-COVID medical and surgical patients should also become a priority.
Thousands of scientific papers on the pandemic have appeared in the past 15 weeks. Research on the understanding and control of the virus is ongoing. Scientists are discovering constantly changing and newer properties of the virus, which has led to regular changes in guidelines by the experts. To some extent, there is lack of coordination between countries, within the countries and sharing of valid scientific data. Disinformation and conspiracy theories are abound on social media. Quite often, there is a disagreement between policy makers and other experts. It is prudent to differentiate between facts and opinions. Amidst so much uncertainty, it is expected that the experts convey coherent and consistent messages to achieve a coordinated response in the mitigation and control of a second wave of the coronavirus infection as some countries ease restrictions.
Presently, there are gaps in our knowledge. We need answers to questions such as the duration of immunity in recovered persons, the possibility of reinfection in these people, the extent that they could infect others, the length of period that the immunity lasts, and the effectiveness of various drugs that could be available in the future.
Telemedicine has become a necessity in the recent months. It should be complementary to the traditional modes of healthcare, with optimal synergy between telehealth and in-person patient care. Notwithstanding the challenges of telemedicine, such as quality of care, privacy issues and lesser degree of therapeutic alliance in the absence of face-to-face interaction, the use of telemedicine as an alternative tool must be further developed.
Most people are adhering to the physical distancing, hand-washing, wearing a mask, and other hygiene guidelines, yet some people are not doing so. There is some degree of ‘cognitive dissonance’ in the general population, which refers to the pandemic situation involving conflicting attitudes, beliefs or behaviors. This produces “a feeling of mental discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance.” Lifestyle, working patterns and behaviors that we take for granted have changed. People need to adapt to the change. People need to build a healthy resilience and enhance their immune system with vitamin supplements, omega-3, alternative medicines, physical exercise, yoga, deep breathing exercises, and mindfulness meditation.
The global economy has plunged into an unprecedented crisis due to a significant increase in the unemployment rate, the worst seen since the Great Depression. Millions of job losses have occurred in the entire economy, affecting every major industry, small businesses and even the health care jobs. There is a paradox that millions of people in the developing countries are affected by hunger and poverty, especially the daily wage earners who are in a lockdown situation to control the spread of the coronavirus. Employers are likely to consider ‘temporal distancing’ – by allowing staggered shifts and spreading workers over time when the restrictions are eased is a stepwise manner.
The positive side of the pandemic is the unimaginable drops in carbon emissions. The CO2 concentration in the atmosphere have yet to reach net-zero. There is yet a lot to be achieved in global warming. The positive changes seen in the natural habitat and environment must be sustained. The plan to recover from the coronavirus should include climate change initiatives.
The coronavirus does not threaten the existence of humanity. Helping the most vulnerable persons in our society with compassion and humility is everyone’s moral duty. Physical distancing (six feet of separation), wearing a mask, and observing hand-washing and other hygienic protocols are here to stay, until effective and durable vaccines are developed and effectively distributed.
Some countries are beating coronavirus, some countries are nearly there, some countries need to take action, and some are regressing (Quora: https://www.endcoronavirus.org/countries).
Although the current state of the pandemic crisis is difficult to grasp, it is important that a unified effort to fight and eradicate the coronavirus is warranted. “We all are in this together” is not just a cliché – it is a powerful message of hope, compassion, tolerance, acceptance and unity for the entire humanity. A spiritual mindset should help in the war against the coronavirus. There must be no place whatsoever for fear, hate, bigotry, racism, religious discrimination, pride, arrogance, greed, and selfishness.
It is inevitable that we strive to accept, adapt and attempt to change ourselves, even though we might not be able to change the current situation. Changing times require a change in expectations.
There is always hope and light at the end of the tunnel. Yes, together we shall win and conquer the coronavirus and become better global cosmopolitan citizens. Together, we must make post-pandemic living as a new beginning of a better life and a peaceful world.
Pope Francis has called on “believers of all faiths” to unite in a day of fasting and prayer to ask “God to help humankind overcome the coronavirus pandemic.” High-level interreligious group, the Higher Committee of Human Fraternity organized the day of worldwide prayer on May 14. This is an extraordinary moment in the history of humanity, and testimony that we all are connected and faith unites us all.
* Dr. Dilkhush Panjwani is a qualified psychiatrist. He is an assistant professor at University of Toronto and consultant staff psychiatrist at Trillium Health Partners. Dr. Panjwani has vigorously promoted dignity for those suffering from mental-health issues and advocated to end the social stigma of mental illness. He was appointed to the Order of Ontario in recognition of his outstanding achievements and contribution to society.