The evolving pandemic of Covid-19 has caused anxiety and alarm amongst many in our community. Daily government updates are instructive as to how to protect ourselves and our loved ones. The experts agree that we need to slow the progression of the virus in our community in order for our health system to cope with the inevitable mammoth influx of people requiring health care and, in particular, requiring precious resources such as ventilators and intensive care (ICU) beds. If the number of new cases rises too rapidly, then our health system will not cope, and we will be in the situation that Italy finds itself to be in, namely that of needing to make difficult decisions about who is eligible to be admitted to their precious few ICU beds.
Experts are calling for the government to enforce a more intense public prevention response such as what we have seen in recent weeks in South Korea, Singapore, Taiwan and Hong Kong where the number of new cases has not risen as sharply as in Italy, France, the UK and other European nations. This means that health services are able to keep up with demand. The spread of the virus in these Asian nations has been slower because they have successfully implemented appropriate hygiene and social distancing strategies.
We mustn’t forget that a high percentage of health care staff will also be infected and therefore the health system will be placed under even more strain.
If we suspect we are infected then we need to follow the current government recommendations to ascertain whether we have in fact been infected and we need to follow the guidelines regarding self isolation even before we know the results. In particular we need to be mindful of not spreading the illness to the more vulnerable in our community, such as the elderly, the very young, the pregnant and those with chronic illnesses. This means avoiding visits to parents and grandparents, not visiting aged care facilities and hospitals and other places where the vulnerable in our society may congregate (eg church). Many Orthodox Church jurisdictions have already provided sensible hygiene and social distancing recommendations to their flocks.
The common initial symptoms are a dry cough, fever, sore throat, fatigue and difficulty breathing. Some people will only have a very mild illness. Others will become very ill. We know that the virus is highly contagious.
If unwell, the best strategy to avoid spreading the virus is to avoid contact with others as much as possible. Practising good hand and cough/sneeze hygiene is imperative.
Many of us may need to self isolate at home and some will be able to continue to work from home using technology (eg the government has introduced new Medicare items as of 13 March 2020 to facilitate all doctors and other health care workers seeing patients who are infected or who are suspected of being infected or who are at high risk of infection if they leave their homes).
Below is some common sense advice to assist with our mental and spiritual well-being if (or, more correctly, when) we find ourselves needing to be quarantined in our homes.
Self isolation and quarantine measures may have a number of psychological and psychiatric consequences. Common responses include insomnia, anxiety, fear of illness, and desire to increase alcohol and tobacco use. Children and adolescents may experience regression, social isolation, or aggressive behaviors, all of which can be misinterpreted as “acting out.”
There are simple ways to reduce overall stress, such as getting adequate sleep, eating regular meals, exercising, staying connected to friends and family, and utilising relaxation techniques.
Use trusted sources, to obtain the most updated information on keeping your family safe and healthy, which can decrease distress. These include:
1. The Australian Department of Health (DHS) Covid-19 webpage https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov
2. The Victorian DHS Covid-19 webpage https://www.dhhs.vic.gov.au/coronavirus
3. The DHHS also has a dedicated Covid-19 hotline for the public: 1800 675 398
4. Global updates on the epidemiological situation can be found at the WHO, ECDC and CDC websites.
Develop a family plan for dealing with outbreaks, which reminds you that there are steps you can take to care for yourself. Knowing your work and/or school plans for dealing with Covid-19 also helps reassure yourself about steps being taken by others to safeguard their health.
Try to limit exposure to outbreak-related traditional and social media. Increased media exposure is often associated with higher levels of distress.
We can become empowered by becoming educated about the psychological effects of isolation and quarantine. Short-term effects may include anxiety, anger, fear of infecting others, and frustration, with those who experience longer periods of isolation being more likely to develop post-traumatic stress symptoms or increase substance use. Ensuring that we have adequate supplies and that we access and are provided with comprehensive, ongoing, updated information reduces distress and uncertainty.
Importantly, we need to look after ourselves and our loved ones. Check on neighbours and colleagues who may be isolated and not supported by others. Ensure they have adequate supplies including their usual medications. Ensure that they are able to access medical help either via technological means or in person if required. And remember that spiritual well-being is just as important to focus on as physical and psychological well-being.
Many long term positive social outcomes can arise from a situation like the one we are facing. This is the silver lining to this looming black cloud.
*Dr Kokkinias is a Consultant Psychiatrist, Secretary of the Hellenic Medical Society of Australia, and, a Board Director of Fronditha Care.
** The self-care aspects of this article have adapted from an article by the American Psychiatric Association (APA) authored by Joshua C. Morganstein, MD. Useful resources are available on the APA’s website.