Thoughtfulness to COVID-19 

KATHMANDU: With the beginning of the new year 2020, the emergence and spread of a new kind of virus, novel Coronavirus 2019, threatened people all over the world. It is a serious public health crisis. The virus is said to have originated in bats and was transmitted to humans via yet unknown intermediary source, the first known cases appearing in Wuhan, Hubei province, China in December 2019.

The disease is transmitted by inhalation or via contact with infected droplets and the incubation period ranges from two to 14 days. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The symptoms are mild in most people while 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, however, are even  asymptomatic. The case fatality rate is estimated to range from 2-3% (Indian J Pediatr 2020). The global impact of this new epidemic is still uncertain.

According to some researches, scientists have discovered that coronavirus could linger in patients for more than a month, which means it’s possible they could transmit the virus long after symptoms subside (the findings published in the Lancet, March 28, 2020).

This indicates that the current recommendation for isolation — two weeks — may not be 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 limited space.

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, stay at least 6 feet away 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 a 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. The current 'arrangement' 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).

As per the government's recent order, people are required to remain in their place of residence for a week, which has now been extended by seven more days. 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.

Different people react differently to the threat of the Coronavirus epidemic. Some people 'under-respond' to it thinking there is no danger and that the threat is exaggerated. Under-responders may not practice good hygiene, and they don’t stay home if they’re sick; these behaviors help the infection to spread. Under-responding could spread the infection to family and friends.

On the other hand, some 'over-respond' to the threat of COVID-19. These people become highly anxious about the infection and about keeping 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, engage in self-care and encourage a positive frame of mind. Everybody practices self-care differently, for example • 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 stigamatisation, particularly of those vulnerable during epidemics and pandemics. Fear and anxiety about a disease can lead to social stigma toward people, places, or things. It can put those facing stigmatisation and others at increased risk. They may not seek health care when they need it and may further isolate themselves, which comes with its own health risks. Stigma affects the emotional or mental health of stigmatised groups and the communities they live in. Stopping stigma is important in making communities and community members resilient.

Psychologists can deliver lessons on wellness and resilience to the people, including strategies for mindfulness, relaxation and cognitive behavioral therapy-based healthy thinking. An expert can work with providers to prepare for the unit’s activation by determining what aspects of the experience will be most challenging for them and knowing when to draw on their psycho-social support networks and other coping tools.

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.

In conclusion, I'd like to quote a line from WHO director-general's statement fro March 16, 2020 - "We’re all in this together, and we can only succeed when we're together."

Dr Usha Kiran Subba, Association of Psychologists in Nepal