Now such messages have become rare: the fun is gone, the outlooks are bleak and there seems to be no light at the end of the tunnel. Even the life after we are allowed to leave our houses is becoming less and less attractive. The economy is in shatters and most of us are going to feel this in our pockets. In hotspots people will deal with immense grief because of the thousands of life lost. Even when we can resume our lives we still will need to maintain various levels of physical distancing, and virologists keep on reminding us that the virus may be back, and some even add to this that the second round might be worse. The picture ranges from grey to black, and only rarely do we see a glimpse of light.
Initially, the stage was dominated by politicians and virologists, whose predictions were taken as almost absolute, with little contradiction. Gradually other branches of medicine became involved, warning that the effects of the almost total concentration on COVID-19 could have far-reaching consequences for persons with other health issues. There were reports that up to two-thirds of patients with coronary-vascular illnesses failed to see their physician at for instance the Erasmus Medical Center in Rotterdam, either because their doctors were busy with corona or because they were afraid to become infected once visiting the hospital. Essential surgery was postponed, and so far there are no figures as to how many secondary deaths COVID has caused. However, some scientists believe that the secondary deaths – those who died because they did not get proper treatment – might be as high or even higher than the number of deaths from COVID-19 itself.
Gradually there is also more attention for the psychological side, but unfortunately it is still very limited and rudimentary. Also in better days mental health was the permanent “orphan” of the medical profession, and now it is not much different. We tend to focus on issues that we can grasp, such as how to keep the children from being bored and what to do about the enormous surge in domestic violence. All very important stuff, don’t get me wrong, but what is happening under the surface is mostly ignored. Domestic violence is not a stand-alone issue, it is a symptom of what is happening in much broader terms, it shows the illness underneath. When after the Russian-Georgian War of 2008 the displaced Georgian population was housed in refugee villages with endless rows of identical houses, the level of domestic violence and sexual abuse soared. They were symptoms of the total absence of belief in any viable future, of mental paralysis and grief over a lost life at the ancestral home.
Last month the most acclaimed British medical journal Lancet published a study on the psychological impact of quarantine, a review of earlier publications on the matter. The article provided a number of key recommendations how to deal with such situations, and all of them are of importance today. Some of them are nothing but logical, even though not always implemented until this moment. The authors indicate that public health officials need to emphasize the altruistic choice of self-isolating, the importance of providing information to those quarantined and that general and medical supplies need to be provided. The latter is of course one of the most distressing aspects of the current crisis, that even medical personnel wo have to deal with infected persons, in many cases doesn’t have sufficient protective materials. The percentage of health care workers among the infected is unacceptably high. In some of the cases I have seen, authorities have come up with very detailed instructions without providing any of the mentioned protection measures, and did so only to check the box that they fulfilled their duty and cannot be held responsible later.
A very interesting aspect that the authors point out is that much of the adverse effect comes from the fact that the restriction on freedom is imposed on those in lockdown. As they point out, “voluntary quarantine is associated with less distress and fewer long-term complications”, which explains that even people who normally already had a small social environment and led a self-imposed life of social distance are very much affected by the lockdown, because now it is an outside authority that makes them stay at home, rather than the result of their own decision.
I think one of the most important recommendations, though, is the fact that the “quarantine period should be short and the duration should not be changed unless in extreme circumstances”. Now I realize that the current circumstances are extreme, but this repeated prolongation is really a major factor of concern. It also explains why the jokes and fun on social media have almost dried up. In most countries, the lockdown was announced for a period of two or three weeks, which was then extended by another two. Now we see that countries like France already entered their second extension, even longer than the previous one (four weeks), and citizens of countries where the current extension will last till the last week of April already know that it is very likely they will also be subjected to a further extension. This is really devastating. It means you can no longer plan, it results in an all-encompassing paralysis, and in the end to a society grinding to a halt even more than would be otherwise. It also results in such psychological distress that people basically give up.
In Soviet times, dissidents who knew they would be arrested preferred to be sent to a camp or prison rather than a psychiatric hospital. The main reason was not the fact that the prospective of being “treated” with neuroleptics was scary, to say the least. The main reason was that a sentence to prison or camp carried a fixed sentence: you knew you would be in for three or seven years. In the case of forced hospitalization there was no such certainty: incarceration in a psychiatric institution could be limitless, and the length fully depended on the decisions of the institution or, rather, the KGB. For many this was the most devastating part of their imprisonment.
We are now like these Soviet political prisoners in a psychiatric hospital: we do not know when we will be released, and every hope that there is light at the end of the tunnel is shattered by a continuous stream of distressing information combined with an ongoing bombardment of restrictive measures. The end will be a collective trauma of immense proportions. And again, the under-financed, under-staffed and under-valued mental health care system will not be able to cope. The next pandemic is in the making.
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