With the dawn of the year 2020, a serious public health crisis occurred in the world with the spreading of novel Coronavirus (COVID-19). The virus possibly originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. The virus is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3% (Indian J Pediatr 2020).The global impact of this new epidemic is yet uncertain.
To retrospect the recorded human history we found the impact of plague across Europe during the seventeenth century and its nature similar to eCOVID-19. The Black Death was a devastating global epidemic of bubonic plague that struck Europe and Asia in the mid-1300s. The plague arrived in Europe in October 1347, the Black Death probably originated in Central Asia or East Asia, from where it travelled along the Silk Road, reaching Crimea by 1343( Advances in Experimental Medicine and Biology 918: 1–26). Italy was by far the area worst struck.
The plague is most prevalent in Africa and is also found in Asia and South America. In 2019, two patients in Beijing, and one patient in Inner Mongolia, were diagnosed with the plague, according to the Chinese Center for Disease Control and Prevention. It is transformed from animal to human being and has been lingering on them.
According to New York Post, scientists have discovered that coronavirus could linger in patients for more than a month, which means they could transmit the virus long after symptoms subside (the findings published in the Lancet, March 28, 2020). The study also notes that 48% of coronavirus patients had comorbidities, such as hypertension, diabetes and coronary heart disease, which decreased their odds of kicking the virus, along with old age.
It indicates that the current recommendation for isolation — two weeks — may not go far enough to prevent transmission of the virus. It is tough to stay weeks apart from friends and family, cut off from work and daily activities, and confined to a single room.
However, it’s important to remain vigilant, calm and level-headed and follow recommendations from the experts: Do the Basics, But Don’t Panic
- If you’re sick don’t go to work, self-quarantine for 14 days and avoid public places.
- Wash your hands often with soap for 10-20 seconds or use a greater than 60% alcohol-based hand sanitizer whenever you return home from any activity that involves locations where other people have been.
- Practice social distancing, at least 6 feet from others.
- Refrain from touching your face.
- No handshaking. Use a fist bump, slight bow, or elbow bump.
- Use your knuckle to touch light switches, elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove.
- Open doors with your closed fist or hip—do not grasp the handle with your hand, unless there is no other way to open the door, especially on bathroom, post office and commercial doors.
- Keep a bottle of sanitizer available at each of your home's entrances and in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.
- If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to.
- Be proactive and keep your immune system strong, get ample sleep, exercise and eat well.
It’s a harsh new reality: but we have to face it. Then they can develop a source of stress including persistent anxiety, worry, insomnia, or irritability, decreased sensory stimulation, limited social support, and lack of access to standard coping strategies, such as spiritual or religious practices or exercising outdoors. These circumstances, along with missing work and other obligations, can trigger a powerful sense of losing control. Though studies on the psychological effects of quarantine are limited, research shows that patients in medical isolation can experience increased symptoms of anxiety and depression, as well as feelings of fear, abandonment, loneliness, and stigmatization (Kin-Wing Cheng, S., et al., The British Journal of Psychiatry Vol. 184, No. 4, 2004; Catalano, G., et al., Southern Medical Journal, Vol. 96, No. 2, 2003).
Further, The Government of Nepal issued a complete lockdown order. As per the order, all residents and visitors in Kathmandu are required to remain in their place of residence. Furthermore, self –isolation is called quarantine in a pandemic. In Buddhism, it is called a retreat. From the cave of our home, like the meditators of ancient times, we can consciously kindle the lamp of compassion.
Compassion because: (i) we are all in this together; (ii) different people act according to their past conditionings during challenging times, some of which may not agree with us, but which we need to understand if we are to reduce conflict; (iii) it lightens our hearts; and (iv) it makes us look after ourselves better make the right choices for us and others. Sometimes staying at home is a superpower.
Psychological factors play an important role in how people and communities respond to illness and manage its spread.
People are reacted differently to the threat of eCOVID-19. Some people under-respond to it thinking there is no danger just people exaggerated. Under-responders may not practice good hygiene, and they don’t stay home if they’re sick; these behaviors help the virus to spread. Under-responding could spread the infection to family and friends. On the other hand, some are over-respond to the threat of COVID-19. These people become highly anxious about the infection and how to keep themselves safe. They may become xenophobic (i.e., needlessly frightened of foreign people), may needlessly wear protective masks (while wearing a mask may prevent you from spreading your infection to others, masks are not effective in preventing you from catching an infection from someone else), and may hoard supplies of food and other necessities. Over-responding could seed fear in others because fear is contagious. If you act frightened or engage in panic buying, then others will react with fear as well. You have a responsibility to your loved ones, friends, and the rest of the community to deal with the COVID-19 outbreak in a sensible, reasoned manner. Remind yourself that the current crisis will pass, and life will return to normal.
In this emergency period, it is important to look after yourself, self-care help encourages a positive frame of mind. Everybody practices self-care differently with some examples including • maintaining good social connections and communicating openly with family and friends • making time for activities and hobbies you enjoy • keeping up a healthy lifestyle by eating a balanced diet, exercising regularly, getting quality sleep and avoiding the use of alcohol, tobacco and other drugs to cope with stress • practicing relaxation, meditation and mindfulness to give your body a chance to settle and readjust to a calm state.
Another psychological issue is feeling stigmatized particularly vulnerable during epidemics and pandemics. Fear and anxiety about a disease can lead to social stigma toward people, places, or things. It can put them and others at increased risk. They may not seek health care when they need it and may further isolate themselves, which comes with its health risks. Stigma affects the emotional or mental health of stigmatized groups and the communities they live in. Stopping stigma is important in making communities and community members resilient.
Psychological treatments can be very effective, sometimes more effective than medication, in helping people recover from anxiety. To find a psychologist, you can consult the psychological association in your province or city. Your local hospital, community health clinic, local public health department, or primary care provider (e.g., family doctor or nurse practitioner) may also be of assistance.
Finally, I would like to quote the statement of WHO Director-General we’re all in this together and we can only succeed together.
Usha Kiran Subba is the president of 'Association of Psychologists in Nepal'.
