The Pandemic Takes a Psychological Toll as Well as a Physical One

Biscuits must be a comfort food, because it was one of the items stripped from the shelves during pandemic buying this past weekend. (Source: Jason Quarles)

Panic. Fear. Anxiety. Stress.

If any of these words describe how you’re feeling these days, you’re not alone, judging by what people are saying and doing in the face of the ongoing coronavirus pandemic.

From the locust-like razing of grocery store shelves; to the closing of schools, nursing homes and houses of worship; to the canceling of concerts, political primaries, and other large events; to the ever escalating public restrictions — you can’t meet in groups of 500, no – 250, no – 50, no, better make that 25, no – let’s make that 10, just to be safe — the virus seems to have infected daily life on a scale no one expected.

There is some goodish news if you’re experiencing uneasy feelings: it’s normal to feel that way. But it matters what you do with those feelings, said Joshua Klapow, a clinical psychologist UAB School of Public Health.

“The number one thing I’m telling people is, you have reason to be anxious and the moment you can admit it to yourself, the easier it’s going to be to navigate this, Klapow said. “The more you downplay it … the more someone like me looks at you and says, ‘You know what? That’s a defense mechanism.’

“This is a big deal. It’s not necessarily life or death for any one person, but this is a huge deal. This is an unprecedented deal. So you should be anxious. You should be nervous. Not panicked. Anxious and nervous and working together to calm our own anxieties and fears, given this temporary shift in our daily existence.”

The coronavirus, known as COVID-19, is not the first disease outbreak to inspire fear. SARS, another strain of coronavirus, Ebola and MRSA have all led to similar concerns and similar psychological effects.

In a Psychology Today article titled “Mental Health in a Time of Pandemic – The psychological effects of an outbreak,” Dr. Sandro Galea saw particularly troubling distress. “In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and posttraumatic stress disorder (PTSD).” he wrote. “A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term … . This is a message that is frequently forgotten. The mental health effects of COVID-19 can shape health for many years, long past the events that precipitated them.”

Even when the outbreak is limited, the mental impact is real. Consider what happened a few years ago when a total of 10 people were infected with Ebola in the U.S.

“Although there were only 10 confirmed U.S. cases — all of them people who had direct, prolonged contact with Ebola patients — parents in Texas, Mississippi and New Jersey pulled children out of school after other students or administrators had chance encounters with Ebola patients or visited West Africa, and a teacher in Maine was put on leave after attending a conference in Dallas where the first U.S. case was discovered. The states of New York, New Jersey and Illinois mandated 21-day quarantines for health workers who had treated Ebola patients in West Africa, and Connecticut reserved the right to quarantine anyone believed to have been exposed to the virus,” according to the article “An epidemic of fear” on the website of the American Psychological Association.

Paul Slovic, a professor at the University of Oregon who studies decision-making, was quoted in the article as saying, “The minute the Ebola threat was communicated, it hit all of the hot buttons: It can be fatal, it’s invisible and hard to protect against, exposure is involuntary and it’s not clear that the authorities are in control of the situation.”

Joshua Klapow, a clinical psychologist UAB School of Public Health (Source: UAB)

The current COVID-19 outbreak shares many of the same characteristics. But it’s also significantly different in how it’s affecting us, Klapow said. Some of that has to do with terminology.

“There are some definitely unique characteristics to this particular pandemic. When you move from ‘epidemic’ to ‘pandemic,’ just the words alone have psychological impact. The word ‘epidemic’ has a psychological impact. So when you’re talking about stress … as soon as you put the words out, already people’s stress levels are elevated. And even though moving from epidemic to pandemic for many reasons doesn’t change anything at the individual level, it sounds worse. And it is from a global population standpoint, but it’s not worse from yours. It’s just the word has connotations. So the words alone have impact,” he said.

Another difference between COVID-19 and previous disease outbreaks is that people are having trouble settling on how to feel about it. They know the disease can be deadly — but mostly to people in certain age groups. And it doesn’t have the scary disfiguring characteristics of something like Ebola. “So what you’re getting from people is this moving back and forth psychologically between it’s really bad and it doesn’t look that bad in terms of the illness itself,” Klapow said.

So, at the same time as some are focused on the fact that other diseases are more likely to kill people than COVID-19, they’re also being asked to make significant sacrifices to contain it. “We’re being told that we have to get out of school, work at home, and we can’t gather in groups of 50 or more. So there’s this kind of confusion between, it isn’t bad or doesn’t look bad … but we’re taking these, what feel like, extreme measures. And people forget we’re taking the extreme measures to prevent the larger population hospital systems from being overwhelmed. That’s just new for us.”

All the changes are coming fast. “Those types of changes we’ve never had in such a swift time period,” Klapow said. “And as a result, you put all of that together, and you create great uncertainty, great flux in our daily lives, and habits and routines. And so that’s what’s causing, probably not so much panic, but fear and confusion, and what I would call a lot of anticipatory anxiety.”

Hoarding Toilet Paper

Some of that “anticipatory anxiety” contributes to how people are buying stores out of normal everyday items, even staples like toilet paper, which is completely unrelated to an upper respiratory illness like COVID-19.

“They’re buying up all the rational things, and then they’re buying the irrational things, which again is the great ‘why is everybody buying toilet paper’ story,” Klapow said. “What we’re seeing is just a more extreme version of what we see very frequently when we have … threat of snow, threat of severe weather. People go and they start buying things, buying things that they feel will either protect them, make them feel comfortable, are perceived as a necessity or — this is the interesting one — are being bought by other people. It’s a kind of modeling behavior. And so the toilet paper, people started buying extra toilet paper, and it sort of caught on.”

The by now well documented raiding behavior, taking every last scrap of whatever coveted item is on the shelf, “That comes from the uncertainty,” Klapow says. “If, for example we were told in no uncertain terms there’s going to be … a one week period … and the message was unified and it was across the board and after a week everything will return back to normal, you’d still see some raiding, but not as much.”

He pointed out that even in countries such as Spain, where COVID-19 has caused a more drastic public lockdown, people are being allowed to go to the grocery store.

So why are Americans grabbing up everything they can? “This is a function of social media, mass media and Americans who are used to having access to all that they need, whenever they need it,” Klapow said. “A lot of it’s fear, but it’s not fear of ‘I’m going to die.’ It’s fear of inconvenience, to be honest with you.”

Disrupting Routines

People are especially fearful because their daily routines are being disrupted, he said.

“If you think about it psychologically, short of fear of harm, the next thing that makes people most distressed is when you prevent them from engaging in their habits and routines. And that’s what’s happening to us right now,” he said. “It’s the beginning of a significant disruption of our habits and routines.”

Another cause of distress is the forced “collective altruism,” Klapow said, meaning that people are being asked by the authorities to disrupt their own lives and routines for the sake of other people. “This is the struggle public health officials are having. They’re saying, ‘Look, we’re going to have to shut these things down because the reality is we need everybody to adhere to this so that people don’t get sick.’ We’ve never been in that place before,” he said. “We are on the whole pretty egocentric … . This has thrown us for a loop because it’s asking us to preventively be responsible to look out for one another.”

Seeking Simple Messaging

One thing that can ease fears is messaging from authorities that is simple, clear and consistent, according to the article on the American Psychological Association website.

“Timely, honest communication from a source an audience deems credible is essential to containing fear during an epidemic, but governments have the tough job of explaining risk and telling people how to act without also seeding alarm, said Carnegie Mellon University psychologist Baruch Fischhoff, PhD. “The discipline is very straightforward: Identify the few things that people most need to know and figure out how to explain them in clear, trustworthy terms,” Fischhoff said.

Klapow agreed that simple, consistent and repeated messaging that everyone can understand is critical to help manage anxiety during a pandemic.

Social media works against that effort however, he noted. “Social media and the internet creates so much communication noise that you almost can’t fight that. And that’s what gets people most anxious,” he said. If people went only to a few trusted local sources, for example the CDC, the Alabama Department of Public Health and the Jefferson County Department of Health, for information, the noise, confusion and anxiety would diminish, Klapow said.

Establishing a Routine

Accepting that anxiety is normal in circumstances like these is the first step toward dealing with the fear a pandemic causes, he said. “We should be nervous and we should be actively doing things to try to make ourselves feel less nervous. That’s an OK behavior, taking some time for yourself. Spending some time with your family. Taking a walk by yourself. Praying. Meditating. Whatever you need to do to kind of ground yourself, it’s important to do right now. That’s not something to blow off. Because there is collective anxiety.”

He added that as public restrictions keep increasing in an effort to contain COVID-19, “It is very important that you try to find some routine, even if your routine has been disrupted. So, what can you do on a regular basis if you can’t do what you were doing before? Getting up at the same time, exercising every day, eating breakfast — things that allow you to say, ‘No I can’t go to the movie theater and soccer’s canceled … but here’s what I do every day.’ Having routine helps us reduce our own distress and it gives us purpose.”

Finally, he added, stop fighting the restrictions. “The more you try to fight or rebel against the guidance,” the longer the restrictions will be in place for everyone,” he said. If that’s the case, “You as an individual contribute to the perpetuation of our disruption.”