The COVID-19 pandemic has proven to be an unprecedented time within modern history. The virus has to date, infected over 37 million people, and claimed the lives of over a million people globally. The global economy has been hit by a recession and has seen the GDP of several countries recline significantly. Unemployment globally, and within South Africa is the highest it has been in ten years and continues to soar (Plecher, 2020).
These factors along with the significant and sudden changes individuals have had to adapt to on a personal level have had a concerning impact on the mental health of a large portion of the World’s population. One of the aspects that have proven to be concern to scientists has been the negative impact of the pandemic on the mental wellbeing of both the general population, and front line and healthcare workers, the latter of which having been active components in curbing the spread of the disease.
This pandemic has confined the day-to-day lives of individuals significantly and has restricted their social interactions with others to the bare minimum with no physical contact. These necessary precautions have exhausted the mental and emotional state of people and have caused a significant degree of mental distress.
This has been no different for healthcare and frontline workers who have seen the most devastating effects of the pandemic. They have also been at the centre of the response to effectively curbing the spread of the COVID-19 pandemic. A number of these workers are also overwhelmed and overworked and have, in most cases made great personal sacrifices, such as not seeing their families to serve their communities.
This article seeks to examine the impact that the COVID-19 pandemic has on mental wellbeing and the causal factors that have played a role in contributing to it. It will also explore the different psychiatric symptoms that experts have identified thus far and also look at the toll the pandemic has taken on the emotional and mental wellbeing of frontline and healthcare workers. Lastly, it will elaborate on the possible precautions and methods that can be used and implement to counteract the negative mental effects of the COVID-19 pandemic.
An introspective into the events of the COVID-19 pandemic thus far
The COVID-19 virus has been a fixture within the world for 10 months now. Within this relatively short amount of time, several fundamental interactions and society have changed across the globe and a new normal has been established which ensures the safety of individuals as they interact with each other and the world around them.
One of the first and most crucial changes has been the consistent use of personal protective gear such as masks when going out in public. The use of disinfectant products such as sanitizing sprays and hand sanitizing liquids has become the norm before entering and when returning from interactions with a public area.
These public protocols have now become the norm within society as the virus is spread by close contact with others (Chu, Akl, Duda, Solo, Yaacoub, & Schunemann, 2020). Another method that has become the norm is keeping a physical distance between individuals to avoid close contact. Chu et al (2020) found that this method was effective from a distance of 1 meter or more, and combining this with the use of a face mask decreased the risk of infection substantially.
Within South Africa, with the recommendations from the National Command Council and the National Department of Health, many regulations have been put in place to maintain adequate social distancing. These regulations also mandate for a mask to be worn in public areas at all times and for there to be hand sanitizing stations to be made available within retail establishments and public spaces.
Social interactions have also been cautioned against. These are interactions that are physical in nature such as the shaking of hands or hugging. This was mandated as a safety protocol to limit the amount of close contact that individuals have with one another. This was especially important as it is also an additional method of precaution employed to ensure the decreased risk of infection for individuals within a vulnerable population (OECD, 2020).
The South African national government has demonstrated firm rules and guidelines around public and social interactions to limit the spread of the pandemic. There are a number of protocols in place which ensure the complete protection of vulnerable populations. Individuals with an existing co-morbidity or is within the regulated age group is mandated to work from home until the threat being posed by the virus has subsided substantially. With individuals returning to work under level 1 regulations, all the necessary guidelines provided by the South African National government needs to be implemented for a workplace to be seen as compliant.
Individuals with certain conditions and comorbidities are particularly vulnerable and face the possibility of more severe symptoms should they become infected. Comorbidities associated with the respiratory or the circulatory system is vulnerable as well as individuals with a compromised immune system (WHO, 2020).
The elderly are also at risk for more severe infections as countries such as Italy or Spain with a historically skewed older demographic has been hit harder with more severe cases being the norm (Roser, Ritchie, Ortiz-Ospina & Hasell, 2020). This could be due to a compromised immune system that is the result of a progression in age and as a result, the body is unable to cope with the virus and a cytokine storm is more likely which often leads to systemic failure within the respiratory system and other key functions within the body (Perrotta, Corbi, Mazzeo, Boccia, Aronne, D’Agnano, Komici, Mazzarella, Parrella & Bianco, 2020).
Throughout the incursion of the COVID-19 pandemic, the South African government and the National Department of Health have put numerous contingencies in place to ensure that vulnerable populations such as the elderly and individuals with comorbidities are protected as far as possible from the possibility of infection.
The regulations in place with the current level of lockdown have allowed for the easing of a number of restrictions, however, there are still strict protocols to adhere to such as the continued use of masks at public and private events. A curfew is still in place and alcohol sales are only allowed from Monday to Friday. Public events have still been banned and businesses are still working on a rotational basis to ensure a decreased capacity (The Republic of South Africa National Department of Health, 2020).
The Impact of COVID-19 on Mental Health thus far
One aspect that has been indirectly impacted by the COVID-19 pandemic is mental health. As governments across the world imposed restrictions that kept large portions of the general population inside, several psychiatric symptoms and illnesses surfaced as a result of the continued isolation and significantly decreased lack of social interaction with others.
Humans by nature are a social species, and thus require interactions and cooperation with others to thrive and effectively survive within their environment (Nature Human Behaviour, 2020). The social life of an individual consists of the various relationships that they form with others such as family, friends, work colleagues, and so on (Psychology Today, 2020).
COVID-19 has severely impacted the amount of social interaction that has occurred between individuals which have also included severe limitations on the physical interactions between individuals. This lack of socializing and decreased interactions with the outside environment has had a severe impact on the mental wellbeing of individuals across the globe.
The COVID-19 pandemic has been seen as an additional stressor that individuals have had to face as part of their daily lives. According to Lahav (2020), the stress currently being caused by COVID-19 could eventually lead to the development of a mental disorder. Individuals who have previously been exposed to a traumatic event or have experienced continuous traumatic stress are particularly vulnerable to the possible development of a mental illness related to the COVID-19 pandemic (Lahav, 2020).
The continued isolation from other individuals and pre-existing support structures also acts as an aggressor for the possibility of a mental disorder (WHO, 2020). Certain socio-economic aspects have also been seen as a possible contributor to the development of a mental disorder as Lahav (2020) found that certain factors such as the income level, social relationships, and living alone during the pandemic led to a higher possibility for at least one psychiatric symptom related to the distress caused by the COVID-19 pandemic.
The symptoms related to the distress caused by the COVID-19 pandemic are also very personal in nature and can vary from person to person. A study conducted by Rohde, Jefsen, Norremark, Danielsen & Ostergaard (2020) reviewed clinical notes taken by healthcare professionals when individuals admitted themselves or were taken in to treat a mental disorder.
These notes showed that words strongly associated with factors around the COVID-19 pandemic came through for a significant number of patients. Furthermore, a portion of these patients had a pre-existing mental condition that was further aggravated by the COVID-19 pandemic (Rohde et al, 2020). Symptoms such as anxiety and depression were seen most frequently as well as high levels of stress (Rohde et al, 2020).
Psychiatric symptoms have also been noted in individuals who have contracted the virus and have caused a number of different psychiatric problems. Patients with COVID-19 have experienced a range of psychiatric symptoms. According to Stein (2020), insomnia was the most common symptom being experienced by COVID-19 patients followed by impaired attention or concentration.
Anxiety and depression were also common and were associated to contracting the virus and the consequences thereof. Cognitive responses were also impacted on as memory impairment and general confusion was experienced by a significant number of patients. According to Stein (2020), delirium was also a common manifestation as a result of COVID-19 due to the physical impact of an increased fever.
Within the general population, anxiety had reportedly increased as well as depression and distress (Stein, 2020). These symptoms also have underlying issues that could have stemmed from changes to the stability of several factors within everyday life. Post-traumatic stress disorder have also become prevalent within individuals, particularly individuals who have been directly or indirectly affected by COVID-19.
COVID-19 also significantly impacts on the central nervous system of an individual that has been infected and studies have also suggested that COVID-19 has impacted on the cognitive functions of an individual as well as on neurological function. Patients have shown manifestation of neurological impact such as increased agitation and confusion as well as severe headaches and delirium (Stein, 2020).
The Impact on frontline workers
Since the discovery of COVID-19 in December of last year, it has placed tremendous pressure on health infrastructures and essential services across the globe. Health systems have been overwhelmed attempting to cope with the influx of cases that have happened as the virus spread at an alarming rate.
The pandemic has also seen the loss of a significant number of healthcare and frontline workers as they have become infected when attempting to treat patients. As a result of the constant contact with patients who have tested positive, frontline and healthcare workers have also had to spend extended amounts of time in isolation away from their families and loved ones to ensure that they don’t become infected ( Stein, 2020).
The overwhelming number of cases has also meant that healthcare and frontline workers have had to work longer shifts and extend beyond their day-to-day services to cope with the additional workload that had been brought about by the COVID-19 pandemic (Nelson & Kaminsky, 2020). In some countries such as the United States of America, there has also been a shortage of personal protective equipment for healthcare and frontline workers and a shortage of tests due to the influx of cases which has meant that healthcare and frontline workers were not been prioritized when displaying symptoms related to the COVID-19 virus (Nelson & Kaminsky, 2020).
The combination of these factors has placed a significant amount of strain on the mental health of healthcare and frontline workers. Stein (2020) found that a significant amount of healthcare and frontline workers experienced severe psychiatric symptoms with almost half stating that they have experienced traumatic stress. This was closely followed by depression and anxiety.
These psychiatric symptoms were aggravated by the loss of colleagues to the COVID-19 pandemic and the trauma of these losses has also caused symptoms associated with post-traumatic stress disorder in many frontline and healthcare workers (Shaukat, Ali & Razzak, 2020). The significantly higher risk healthcare and frontline workers face of being infected has also caused an increase in the stress and pressure being experienced by frontline workers (Shaukat et al, 2020).
In some countries, the burden on healthcare and frontline workers has been noticeably higher and as such has had a higher number of healthcare and frontline workers experience more severe psychiatric symptoms. The United States of America has seen the highest number of cases in the globe at present and these numbers have overwhelmed the healthcare systems within the country (Nelson & Kaminsky, 2020).
Due to these numbers and often understaffed health facilities, the United States of America has seen a large number of healthcare and frontline workers fall victim to the repercussions of the COVID-19 pandemic (Nelson & Kaminsky, 2020). The physical and mental toll on healthcare and frontline workers has been devastating as the continuous and elevated stress experienced exacerbated by short periods of frustration and helplessness has been at the highest seen during this pandemic.
In stark contrast, the due preparedness and strengthened health infrastructure within South Africa has seen the influx of new cases and management of day-to-day functions adequately overseen and has ensured that healthcare and frontline workers do not bear the brunt of the COVID-19 pandemic alone.
South Africa has used out of the box thinking to effectively manage the COVID-19 and curb the spread of the disease. There have been improvements to hygiene practices in health facilities and rigid protocols ensure that no individual within a health facility is seen without a mask (WHO, 2020). By putting these measures into effect, it ensures that healthcare and frontline workers have the required reassurance and can effectively carry out their duties without undue strain or pressure.
While there have been cases that have seen healthcare facilities overwhelmed, the South African government and the National Department of Health has responded by increasing the number of beds available. This ensures that individuals who have tested positive and need to quarantine and receive treatment can do so with the possibility of spreading the infection minimized as far as possible.
The inclusion of these additional services has ensured that healthcare and frontline workers are not overwhelmed and have been provided with the necessary tools and support to effectively manage the cases that arise as a result of the COVID-19. The South African government has also ensured that the mental wellbeing of its’ healthcare and frontline workers have been adequately provided for as the services provided by national counselling hotlines have been ramped up and psychological counselling is available to those who need it. The South African government has also provided a COVID-19 toolkit on its website which is focused on the maintenance of good mental health.
Steps to maintaining good mental health
The South African National Department of Health has outlined several different ways in which individuals can cope with the stress and mental strain that has been caused by the COVID-19 pandemic. These strategies attempt to minimize the effect of the COVID-19 pandemic on the mental wellbeing of the general public as far as possible.
The first thing recommended is for individuals to ensure that a balance is reached between the amount of information being exposed to with regards to the COVID-19 pandemic and their own personal interests and other aspects of their lives. Overexposure to information that is distressing for prolonged periods could increase the risk of psychiatric symptoms such as anxiety and depression.
Individuals should also ensure that any information that they are exposed to is accurate and from a reliable news source. Necessary information such as updates on government protocols and regulations regarding public safety should be taken from a trustworthy news source or government websites. Falsified news and inaccurate reporting can often lead to confusion and frustration which only increases any tension or stress being experienced already.
Maintaining healthy habits such as eating well and exercising regularly is also encouraged strongly as this is closely linked to a good state of mental health. Ensuring sleep habits are maintained and avoiding excessive amounts of alcohol or caffeine are also recommended. Recognizing the early warning of stress is also integral to effectively managing and containing the effect that it has.
Practical methods of relaxation assist with this such as controlled breathing exercises and meditation. Finding a balance between these practices and stressful activities also ensures that the stress caused by these activities is also minimized as far as possible. Talking about negative feelings with loved ones and creating a support system is also important as it assists an individual with recognising the sign of stress or anxiety before the episode occurs and ensures the necessary assistance is given as needed.
The South African government also addresses the mental strain placed on healthcare and frontline workers during the COVID-19 pandemic and has also outlined different factors and strategies to take into consideration when placed under pressure or in distress.
The strategy recommended by the South African government recommends that healthcare and frontline workers should not place undue expectations on the decisions being taken or the actions that were undertaken when treating patients during the COVID-19 pandemic. It outlines stepping back and rationalizing the need for these decisions. It also outlines the need for patience or consulting with a colleague when feeling guilty to reinforce that the decision taken was the right one and the empathy assists the individual in rationalizing the decision made. Counselling is also encouraged should these feelings persist.
It also encourages healthcare and frontline workers to also take a break and find balance when working to ensure that there is no additional and unnecessary pressure is placed on any one person. Support should always be readily available in the form of a supervisor or colleague and the infrastructure within a health facility should be adequately managed and supervised to ensure that there is a balanced work schedule for everyone involved.
Lastly, while frontline and healthcare workers have carried out their duties with heroic dedication and efficiency, it is important to also take a retrospective in what is being done and prioritize duties and responsibilities in a manner that ensures that each patient is receiving the optimum care that is available. The key factor to remember is that the management of a pandemic continues for an extended period and pace and patience is an absolute necessity in its management.
It has been ten months since the COVID-19 pandemic began. Since then there have been hundreds of articles and studies conducted into the impact it has had on the mental wellbeing of different key populations across the globe. The amount of research done is an indication of several different points.
Firstly it is an indication of the severity of the impact that the COVID-19 pandemic has had on people across the world. As the global society attempts to adjust to the new normal and cope with the loss of loved ones, their mental well-being has had to evolve. This evolution has had to increase the capacity individuals have to cope with multiple traumas and significant changes simultaneously. While this has happened, the occurrence of psychological distress during this evolution has been unavoidable.
It is this study of mental illnesses that have shown how much the world has been traumatized by the pandemic and continues to experience this as second waves occur in countries across the globe. No individual has been left unaffected including healthcare and frontline workers who have had to bear the biggest burden in this pandemic.
The burden of being responsible for curbing the spread and saving the lives of those who have tested positive for the COVID-19 virus has taken its toll on the global healthcare community. The studies done into this community have proven this through the number of individuals who confirmed having experienced anxiety, depression, or distress at some point during the pandemic.
All the results of these studies show that now, more than ever, it is paramount that mental health is highlighted and given the importance it requires. It is only in doing this and working together as a global community that the pandemic will be overcome and the trauma it has caused becomes something of the past.
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