Unmasking the Hidden Pandemic Crisis
Unmasking the Hidden Pandemic Crisis
Sarah Wang Thomas Jefferson High School for Science and Technology
This article was the 2nd place winner in the 11th-12th grade division of the Teknos 2020 Summer Writing Competition.
The COVID-19 virus is ravaging the streets of almost every country in the world. Yet, there is an unspoken pandemic masked in the shadow of the virus — the mental health pandemic. With approximately 2.6 billion people, almost one-third of the global population, in quarantine, the difficulties of loneliness leading to mental health issues are as prevalent as ever.
Responding to the dire problems posed by the coronavirus, health officials have enacted strategies such as isolation of infected or at-risk individuals and social distancing guidelines for the public. However, in addition to the severe physical health concerns COVID-19 poses to billions worldwide, the strategies issued to fight the virus silently pose a threat to the brain — leading to various psychological problems including depression, anxiety, and panic disorder [3].
The pandemic likely takes the heaviest toll on the mental health of patients tested positive for COVID-19 and their caregivers, including loved ones and healthcare workers [4]. The Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 can be studied as a smaller-scale example. It was associated with a 30% increase in suicide in people 65 and older. Once the epidemic was officially declared over, approximately 50% of the population from counties affected remained anxious and 29% of healthcare workers continued to experience emotional distress. For COVID-19, social isolation causes the greatest negative impacts, as it is strongly correlated with heightened anxiety, depression, and self-harm.
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, is found to possibly infect the brain and trigger immune responses that may result in negative consequences for brain function and mental health of the patients. If SARS-CoV-2 infects the brain, the patient will demonstrate respiratory distress and failure, a key symptom of COVID. In the long run, the infection of the brain may result in persistent neurotoxic effects. When the Spanish Flu epidemic devastated the world in the early 1900s, there was a direct linkage to a spike in individuals with post-encephalitic Parkinsonism, a nerve cell damage in the brain. However, it is still uncertain if SARS-CoV-2 can cause mental health or neurodegenerative disorders immediately or years after infection, or if it even causes these issues at all.
Individuals who are not infected with the coronavirus can also face strains on their mental health, ranging from mild to very severe effects. According to John Bowlby and his attachment theory formulated in 1982, humans have an inherent need for feelings of belonging [5]. Humans are biologically wired to require interaction with other humans in order to successfully integrate into the social scene of life. If this need is not addressed properly, possible consequences include mental health deterioration and lowered ability to adapt to social settings. Quarantine and social distancing measures inevitably trigger loneliness, which may cause severe depression [7].
Children, specifically, are of main concern. Studies in evolutionary psychology show that the early onset of assimilating into social groups is an evolutionary adaptive process that promotes higher chances of nurturing and secure characteristics [5]. However, with children staying at home and some having low accessibility to online social networking, psychological problems may become an issue. Adolescents and young adults are also susceptible to the effects of social isolation. Prolonged loneliness links to symptoms such as poor sleep habits or difficulty sleeping; higher risk of feeling depressed; and in pubescent children, impaired executive functioning. Even adults and the elderly are affected by perceived social isolation (PSI), and the ramifications include cognitive decline, especially in individuals of old age. Various psychological studies suggest that loneliness is a clear predictor of brain changes in elders and can be linked to a higher risk of developing early onset Alzheimer’s disease [1].
The social brain is composed of pathways and linkages to the brain, immune system and body and serves as the central organ for forming relationships with other individuals [5]. It consists of the amygdala, the mentalizing and empathy networks, and the mirror neuron system, and builds feelings of social acceptance and safety through bonding with other humans and participating in social activities. Social isolation tampers with these brain structures and functions. Isolation is linked to hypertonic activation of blood flow and elevated blood cortisol levels in the system, which consequently leads to elevated stress. A study by Kanai in 2012 showed that among 108 healthy adults, loneliness was inversely related to gray matter density in the left posterior superior temporal sulcus (pSTS), an area that is essential for social perception [2]. The neuroscience brain model demonstrates that the brain evolves to stimulate a self-preservation mode in individuals when they feel without mutual protection. The effects of this self-preservation mode include increased vigilance, anxiety, hostility, and depression, as well as social withdrawal, worsened sleep patterns and fragmentation, effects that can extend well beyond early developmental periods. Adult brain mechanisms are biologically adapted to the demands of social environments, and if the environment is secluded, the effects show clearly.
Despite the various detriments to mental health imposed by the quarantine and social distancing measures, these restrictions are essential to the recovery of the world from the coronavirus. It is not known for certain if SARS-CoV-2 causes neurodegenerative or mental health disorders, and it is critical that we continue to research biological causes of COVID-19 related mental illness. Policy workers and researchers are continuously developing intervention methods to protect mental wellbeing, including social resources that can educate individuals about the factors that can affect mental health [4]. In addition, tracking loneliness and intervening in the early stages must be a priority.
So, how can we combat the mental health crisis amidst the lockdown for ourselves and others? First and foremost, it is crucial to understand and support frontline health and social care workers and their families so that they can remain in the field and work effectively. It is also important to prioritize your own mental health. To combat feelings of anxiety and stress, the CDC recommends establishing a daily routine; maintaining healthy exercising, diet, and sleeping habits; and practicing meditation [6]. Spending time with loved ones and staying in touch with friends and colleagues virtually is also important; several communities have built interactive platforms, and social media is one of the many ways to keep social contact [3]. Be frank about experiencing negative emotional spirals; never be hesitant to seek counsel by consulting doctors, conversing with trusted persons, or even journaling your thoughts and emotions.
Remember, we have bounced back from so many pandemics, and we will again this time. It is imperative that everyone take care of both their own and others’ physical and mental health during COVID-19. You are not alone.
References
[1] Bhatti, A. B., & Haq, A. U. (2017). The Pathophysiology of Perceived Social Isolation: Effects on Health and Mortality. Cureus, 9(1), e994. https://doi.org/10.7759/cureus.994
[2] Cacioppo, S., Capitanio, J. P., & Cacioppo, J. T. (2014). Toward a neurology of loneliness. Psychological bulletin, 140(6), 1464–1504. https://doi.org/10.1037/a0037618
[3] Hiremath, P., Suhas Kowshik, C. S., Manjunath, M., & Shettar, M. (2020). COVID 19: Impact of lock-down on mental health and tips to overcome. Asian journal of psychiatry, 51, 102088. Advance online publication. https://doi.org/10.1016/j.ajp.2020.102088
[4] Holmes, E., O'Connor, R., Perry, H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Silver, R., Everall, I., Ford, T., John, A., Kabir, T., King, K., Madan, I., Michie, S., Przybylski, A., Shafran, R., & Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, 7(6), 547-560. https://doi.org/10.1016/S2215-0366(20)30168-1
[5] Müller, J. L. (2020). Effects of the COVID-19 related Public Quarantine on Mental Health. Unpublished. https://doi.org/10.13140/RG.2.2.32203.54566
[6] National Center for Immunization and Respiratory Diseases (NCIRD). (2020, July 1). Mental Health and Coping During COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
[7] Wong, N., Shao, R., Wu, J., Tao, J., Chen, L., & Lee, T. (2019). Cerebellar neural markers of susceptibility to social isolation and positive affective processing. Brain structure & function, 224(9), 3339–3351. https://doi.org/10.1007/s00429-019-01965-y
