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Societal mental health consequences of pandemic need to be addressed


Dr Mohammed Rizwan*
In pandemics, reactions super cedes responses and COVID 19 is not an exception, so the benefit of doubt in case of loopholes and subsequent damages always goes to the reacting parties. But reactions should always lead to responses and our response to post pandemic era will determine whether, we were really, entitled for that benefit of doubt.
It’s almost certain now, that post COVID 19 world will be different (if not altogether!! but different) from what it is today, economically, geopolitically, and off course socially. In a continent like country of ours, these impacts will be palpable, mostly at urban level.
In this post COVID pandemic world we require to formulate effective responsive strategies in the following domains.

Post Pandemic Phobia Management

As rightly envisioned things are not going to be all right after 3rd May 2020 (overnight!). “If we are understanding the chronology “period of a complete lockdown will soon over, restrictions on movement will be sooner or later eased …R0 is relatively contained, drop …..and slowly life rolls on .
But what remains would be fear of infection, phobia of virus and its spreaders, (reports are already pouring in for people not accepting groceries and vegetable from particular community people.) and zealous masses trying get to the “Normal” .
In such circumstances phobia management would be crucial, top of the list would be management of misinformation regarding infection catching, social distancing etc. A sneeze, a fever, a skull cap , a beard, a burqa all will be seen as potential corona infection spreaders (my father in law is a bearded, skull cap wearing, 70 year old ,while riding on his bicycle to bring essentials, in a lower middle class, urban, predominantly Hindu locality of a medium size town Nagpur, where he lives, was told “yahi dadhi wale to infection phaila rahe hain”(These bearded people are spreading the disease. ) by two middle aged man standing outside their homes!! He is saddened, traumatized and told me never in his 70 years of life he heard such kind of words targeting his identity !! I just consoled him… ).
The (mis)information laundry has fast eroded the common sense of masses , irrespective of how hatred could get into so deep in common sense, the challenge is to revive at least basic common sense among masses about virus infection and its probable death rates, infection sources and its related aspects.
Second would be filling the gap in information regarding infection dynamics such as say fomites ( in short fomites are non-human potential virus carrier) . Fomites are poorly understood in terms of (at least spreading )corona virus , the parcel we get, the currency notes we exchange , the newspaper, the milk packet etc. ,all are fomites but all of them doesn’t spread the virus, so overly precaution about fomites will add nothing but to panic alone .
The humongous thrust which was used to infuse ill-informed processes through which infection spreads among masses will be a real challenge to deal with in a post pandemic world. Speculation about spread of infection through virtually anyone is a debatable aspect in epidemics, say ,a barber , may only infect you if he is symptomatic or asymptomatic , doesn’t wear a mask, sneezes right in front of you, uses contaminated towels etc., otherwise he is fine. A slightly raised temperature doesn’t mean you have corona? A slight difficulty in swallowing may be a simple upper respiratory tract infection, all this information should be dealt at public level, to the last strata of our population, with same level and intensity through which the precautions were spread.
Most importantly the clarity on the million dollar questions of, when is virus going to leave our lives? And whether it will come back? Is virus changing (mutating!!)? Do we need another vaccine if it changes? Will we have a treatment? These question needs to be addressed and people needs to be informed that unless a vaccine comes in or herd immunity sets in virus will remain in the environment
One of the most important aspects of the post pandemic phobia management would be spreading the fact about Herd immunity Indian veteran epidemiologist Jayaprakash Mulliyil had his say on herd immunity, in the absence of a vaccine , and an anticipated delay of almost a year in its arrival, people are bound to fall sick, infected, either cured or died what matters would be numbers , and how our health care system performs, but virus remain in the atmosphere unless a substantial number of people in a given population are infected and acquire immunity to it , with this fact, countries with COVID 19 are left with limited options of flattening the curves of infection bringing down the R0 and open up , sequentially, the lockdown ,keep the finger crossed and let the herd immunity creeps in, increase testing, find hot spots, read transmission dynamics , ease the clutches of lockdown gradually , and watch, ….or wait for the vaccine, keeping the people lockdown and face the inevitable economy collapsing and broken supply chain related deaths. Post May 3, 2020 these two options are glaring at the decision makers.

Managing Post pandemic psychological burden

India already witnesses a massive psychological burden (see statistics by NIMHANS), mostly underreported. Lockdown is severely impacting the mental health of elderly and children in particular; insomnia, emotional fatigue and depression are already at alarmingly high, as reported in private conversations.
Post lockdown psychiatric illnesses are bound to increase mainly due to economical collapses, financial distress and post pandemic trauma leftover.
School going children will have a plethora of psychological issues to deal, with once school will be reopen, that will ultimately stress the parents and teachers so a chain reaction with a vicious circle of post pandemic trauma may set it.
Psychiatric epidemiology deals with all thse aspects, which is relatively unknown term in this part of the world which broadly discuss how epidemics changes psychiatric landscape of infected and surviving population of a pandemic .we hardly have any experts on this ,may be a working group of experts can be formed to deal with post pandemic psychological burden.
The societal mental health consequences of the pandemic needs to be addressed. It is proven that collective trauma may lead to mass violence and genocides. We have already witnessed and still witnessing the fear mongering, misinformation feeding, and targeting particular communities for spread of virus at an unprecedented level to all this will determine how well we understand willing and execute a a mature response to post pandemic Psychological issues.

The Rural distress

The rural populations are probably the worst hit in pandemics in the past and in the present, most rural population depends directly or indirectly on formal and informal agriculture activity for their livelihood being an agricultural country and Monsoon approaching the pandemic has delayed all activities of agricultural chain by almost 40 days that will add to already burgeoning rural distress with supply chain minimally operative and the preparations of field for sowing the procurement of seeds and fertilizers etc. are terribly hampered. How an effective response to repair this chain will determine the near future of rural distress
Managing, upgrading, and restoring the faith in public health system: Post lockdown restriction ease will bring in the wave of inevitable infections how it’s managed is the second most important aspect of post lockdown response. How elderly and children can be safeguarded from infection will remain a challenge.
Number of per capita ventilators and ICU beds data are out in open how innovative strategies are adopted to use the judiciously will determine the death ratio. Innovation elsewhere in the world can be considered.
Up gradation of existing ICU facilities , looking beyond the conventional frames to provide the health care to rural population and restoring the faith in public health care system probably is once in a life time opportunity now, are we ready to response is a question?
In a longer run, an overhaul in existed health care policy directives both in terms of structure, finance and administration would also be a facet of post pandemic response.
Special task force for Biological disaster Management: Finally, although National Disaster Management Authority (NDMA) is there, if we take the words of experts, pandemics are here to stay, do we need a special task force purely dedicated to Biological disaster management or a subsection in NDMA will do. Do we have enough experts on board to cater the needs of the nation in times of Biological disaster? Do we have enough world class molecular epidemiologist, pathogen evolution biologist and psychiatric epidemiologist? Or we need to design a process to start making of these crucial human resources, inevitable for formulating cognizable responses to outbreaks, epidemics and pandemics.
The answers to the above will be our response after knee jerk reactions to COVID 19, a pandemic of an unparalleled comparison since last 50 years.

*Department of Molecular Biology and Genetic Engineering, RTM Nagpur University, Nagpur

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