The COVID-19 pandemic and mental health impacts.

TLDR: The issues related to the occurrence of fear, panic, and discrimination, analyse the causes of these phenomena, and identify practical solutions for addressing mental health issuesrelated to this pandemic for both public and healthcare professionals are discussed.

Abstract: The newly identified novel coronavirus, COVID-19, was first reported in Wuhan, China, in late 2019. The COVID-19 virus is now known to belong to the same family as SARS and Middle East respiratory syndrome coronavirus (MERS-CoV), which are zoonotic infections thought to have originated from snakes, bats, and pangolins at the Wuhan wet markets (Ji et al. 2020). The virus has rapidly spread across the globe leading to many infected people and multiple deaths (Wang et al. 2020); especially of the elderly and vulnerable (Centers for Disease Control and Prevention 2020). While efforts to control and limit the spread of the pandemic in the community are quite straight forward to follow, it seems that prejudice and fear have jeopardized the response efforts (Ren et al. 2020). In fact, the COVID-19 pandemic has already unleashed panic, as evidenced by the empty toilet paper shelves in stores, resulted in accusations against people of Asian races (Malta et al. 2020), and impacted people’s decisions to seek help when early symptoms arise (Ren et al. 2020). In this editorial, we discuss the issues related to the occurrence of fear, panic, and discrimination, analyse the causes of these phenomena, and identify practical solutions for addressing mental health issues related to this pandemic for both public and healthcare professionals. People tend to feel anxious and unsafe when the environment changes. In the case of infectious disease outbreaks, when the cause or progression of the disease and outcomes are unclear, rumours grow and closeminded attitudes eventuate (Ren et al. 2020). We know that the level of anxiety rose significantly when the SARS outbreak occurred. For example, in Hong Kong, about 70% of people expressed anxiety about getting SARS and people reported they believed they were more likely to contract SARS than the common cold (Cheng & Cheung 2005). Anxiety and fear related to infection can lead to acts of discrimination. People from Wuhan were targeted and blamed for the COVID-19 outbreak by other Chinese people and Chinese people have since been stigmatized internationally, for example, use of the term ‘China virus’ and the use of terms such as ‘Wuhan virus’ and the ‘New Yellow Peril’ by the media (Ren et al. 2020). Fear is a known (for centuries and in response to previous infectious outbreaks such as the plague), yet common response to infectious outbreaks and people react in many and individualized ways towards the perceived threat. Hypervigilance, for example, can arise because of fear and anxiety and, in severe cases, result in post-traumatic stress disorder (PTSD) and/or depression (Perrin et al. 2009). Fear of the unknown, in this case, the spread of the disease and the impact on people, health, hospitals, and economies, for example, raises anxiety in healthy individuals as well as those with pre-existing mental health conditions (Rubin & Wessely 2020). Individuals, families, and communities experience feelings of hopelessness, despair, grief, bereavement, and a profound loss of purpose because of pandemics (Levin 2019). Feelings of loss of control drive fear and uncertainty as the trajectory of the pandemics is constantly evolving; so is the advice on the action to take to stop the spread of a pandemic. Perceived mixed messaging from government or health officials can also lead to public confusion, uncertainty, and fear (Han, Zikmund-Fisher et al. 2018). People’s responses to fear and intolerance of uncertainty lead to negative societal behaviours (Rubin & Wessely 2020). Uncertainty increases feelings of alarm resulting in behaviours targeted at reducing uncontrollable situations which people fear. For example, we have seen people clearing shelves of supermarkets resulting in global shortages of food and essentials such as toilet paper (El-Terk 2020). This behaviour is purported to occur for two reasons: one because the threat of COVID-19 is perceived as a ‘real’ threat and expected to last for some time and second as a means to regain control (El-Terk 2020). While outright panic as a result of this pandemic is unlikely, it can occur as a consequence of mass quarantine (Rubin & Wessely 2020). The current state of the COVID-19 illness already paints a picture of inevitable and large-scale quarantine – some of which are already occurring. In the case of mass quarantine, experiencing social isolation and an inability to tolerate distress escalate anxiety and fear of being trapped and loss of control, and the spread of rumours (Rubin & Wessely