Managing COVID-19 Related Stress and Anxiety
A Need for Preparedness
When facing an existential health threat such as that of the novel coronavirus pandemic, we are likely to preserve life and limb if we know something of the nature of our adversary and how we might best compensate for its harmful actions, which for some segments of society can be quite devastating, even fatal. We increase our chances of survival, individually and collectively, by taking the advice of those who best know the danger and the steps we need to take to reduce its spread.
The Lay of the Land
We are in the midst of an unprecedented struggle to cope with the formidable health threats posed to all members of our society by COVID-19, a serious and, for many, a potentially lethal and highly infectious respiratory disease caused by the novel coronavirus. At present we have no preventive vaccine to halt this scourge. The earliest expected date for a vaccine that has been tested and found safe for use is seven or eight months away. Hope of medical treatment for COVID-19 is on the horizon, however. In controlled trials carried out as part of a Federally sponsored research program, Remdesivir, a drug originally developed to treat Ebola, appeared to be somewhat effective in facilitating recovery from COVID-19. Patients treated with Remdesevir recovered more rapidly from their COVID-19 symptoms than did patients treated with a placebo. These results are preliminary, but promising.
As we await the development of a vaccine to prevent the spread of the novel coronavirus and other medications to treat it, we continue to rely on behavioral changes endorsed by the Centers for Disease Control (CDC) as a first line of defense against contagion. These behavioral changes include: 1) social distancing, which means keeping a distance of six or more feet from others; 2) group avoidance, which means not joining in gatherings of more than eight others; 3) hand washing or sanitizing, which means doing so right after coming home from outside as well as after touching surfaces—doorknobs, shopping cart handles, money, etc.—that may be contaminated with the coronavirus; and 4) face covering (e.g., the wearing of a mask or scarf), which means the nose and mouth are to be covered when entering stores and other public settings. A facial covering provides added protection to the social distancing rule by catching the aerosol spray of invisible droplets from an asymptomatic person with COVID-19 before it can spread through the air carrying the coronavirus with it. Masks and scarves should be replaced or disinfected after use. Testing to identify asymptomatic carriers of the novel corona virus and tracing of individuals who may have been infected by an identified asymptomatic carrier will eventually add an important layer to of protection against the novel cornonavirus. Testing and tracing, a material and labor intensive process, is not likely to be used on a national scale.
Numerous epidemiological studies show that the widespread practice of the aforementioned behavioral changes works to dramatically slow the spread of COVID-19, unburden our healthcare system and save lives. It has been estimated that more than two million COVID-19 deaths would result if social distancing and other behavior changes were not practiced. Because they have been widely enacted throughout the U.S., total COVID-19 deaths are expected to range around seventy-five thousand by about August of this year. While still a staggering number of deaths from a single source, such an outcome, if achieved, would represent both a collective victory for the nation and a powerful example of what can be achieved through a combination of motivational factors such as self-preservation, social responsibility and concern for the well-being of others. To ensure this victory, social distancing and related behavioral changes will have to remain in place for the foreseeable future.
This favorable result, however, is being put in jeopardy by a desire in many areas of the country to return to a state of normalcy sooner rather than later. The procedures being used to loosen existing guidelines in those areas vary widely. Spikes in rates of COVID-19 infections, should they occur, will likely spread to regions that continue to follow the CDC guidelines. We shall know something of the effects associated with the various plans to relax the CDC’s social distancing guidelines in those areas in a few weeks. In the meantime, adherence to CDC guidelines for social distancing and other related practices is encouraged on an individual basis in those areas where it is not being practiced on a regional or state basis.
What We’ve Been Facing
The main signs or symptoms of COVID-19 are: fever, difficulty breathing, intense chest pressure or pain, etc. Any person with these symptoms should immediately self-quarantine and seek medical advice regarding COVID-19 testing and other healthcare procedures. Call ahead before going to an ER, a doctor’s office or a hospital.
Persons infected with the novel coronavirus typically show no symptoms for a week or two. Testing of all asymptomatic carriers is currently not feasible. So, the majority of asymptomatic carriers go undetected. The CDC guidelines are designed to defend against the accidental or inadvertent spread of the novel coronavirus by carriers who are asymptomatic. Premature relaxation of the CDC guidelines runs the risk that new cases of COVID-19 will spike, as asymptomatic carriers come in close contact with others as they move about.
The elderly (65 and older), who number upwards of 49.2 million, which is about 15 percent of the total U.S. population, are a segment of our society that is most likely to suffer severe, life-threatening COVID-19 symptoms. Recent audits suggest that the elderly account for about 80 percent of the more than 60,000 deaths due to COVID-19 reported in the U.S. Individuals of any age with a pre-existing medical condition such as asthma, diabetes, heart problems, compromised immune systems, are also highly vulnerable to the ravages of COVID-19. We follow CDC advice on prevention and containment not just to protect ourselves, but also to protect those at greatest risk.
The CDC recently reported that children under the age of eighteen are least likely to suffer severe COVID-19 symptoms. This does not mean that all children and adolescents are in some as yet unknown way protected from acquiring severe COVID-19 symptoms. Some have, and unfortunately some have died. While they are at an appreciably lower risk than those nineteen or older, they are not risk free. Further, children and teens with even mild cases of COVID-19 can transmit the novel coronavirus to more vulnerable segments of the population.
Weighing Risks and Benefits of Life-Saving Measures
Life saving measures, such as social distancing and crowd avoidance, set back our once vibrant national economy and interfered with education of our children and youth. Widespread financial hardship has resulted from the shuttering of nonessential businesses such as factories, offices, restaurants, malls, museums, theaters, arenas, and baseball stadiums throughout the U.S. In some instances, employees can work from home. For many that option is not available. Upwards of 20 million workers in the U.S. have become unemployed. When the economy reopens, the lives of unemployed and displaced workers will for the most part have been saved. In the meantime, the Federal Government is rushing to put an economic safety net in place for unemployed workers and for employers and business operators forced to shut down.
All of the adults I encounter through my practice are able to work from home. However, job security is no longer a given. They are also concerned to a greater than usual degree with the potential for the loss of life, either their own or that of a loved one. In this respect, too, the mounting COVID-19 death toll weighs heavily on some. The running of errands has become a source of worry even for those who scrupulously follow the CDC guidelines.
Another unsettling spin-off from social distancing and crowd avoidance is that education has shifted from the classroom to the dining room. Students of all grades and ages, from nursery school through college, have been told to stay home and attend virtual classrooms on the internet. What will be the effects of prolonged internet learning on academic progress? Will an extended reliance on chat rooms and other social media platforms provide the same opportunities for social learning and bonding as classrooms, cafeterias, dorms, libraries, gyms, and playgrounds? What will be done to help the underprivileged who lack access to computers and/or the internet catch up?
Common themes among the middle and high school students I have talked to suggest that they miss the spontaneity that emerges from direct social interactions among friends. They also regret the cancelation of extracurricular activates and school ceremonies such as proms and graduations. The possibility that remote learning may not be as robust as classroom learning is suggested by remarks suggesting that remote learning is less demanding.
Customary habits and routines that give predictable structure and flow to daily life have been upended. We are being asked to adjust rapidly to changes everywhere we turn as we learn what it means to practice social distancing andgroup avoidance as part of a concerted world-wide effort to halt, or at least slow, the spread of COVID-19. Increases in anxiety and stress are normal responses anytime our health is seriously threatened and medications in the form of vaccines and treatments are not readily available. Normal stress and anxiety levels are likely to be intensified when the primary remedial interventions require major disruptions to our daily routines and experiences as well as fundamental adjustments to our customary social structures and institutions. There is little doubt that scientific and governmental efforts to manage the spread of the novel coronavirus are inadvertently stirring up stress and anxiety in all segments of our society.
Anxiety and Stress Factors
Summing up, we can see that some of the main causes of COVID-19 related stress and anxiety are:
- Fear of death, especially one’s own or that of a loved one.
- Financial insecurity.
- Disruptions to customary routines.
- Restrictions on movement.
- Limitations on social interactions.
The Objective and Subjective Sides of Things
Like everything else that we experience, factors that cause anxiety and stress have two components or sides to them. There is an objective side, and there is also a subjective side. The first, the objective side, results from tests, measurements and observations we can make regarding a stress inducing factor. The second, the subjective side, results from how we think and feel about that factor as well as how we physically react to it—that is, whether we tighten up or loosen up. The potency or strength of anxiety and stress associated with a causal factor arises mainly from its subjective side. To the extent that we keep our thoughts and feelings about the novel coronavirus in perspective and aligned with the scientific evidence and to the extent we moderate our breathing and relax our muscles we will be better able to follow life-enhancing advice and take steps accordingly that will reduce the risk of COVID-19 for ourselves and others.
To optimize our response to the COVID-19 dangers we face, we must also avoid the psychological extremes of, on the one hand, denying or minimizing real danger, or, on the other hand, catastrophizing or maximizing the extent of real danger. Denial robs us of any reason to practice life-enhancing measures like social distancing, crowd avoidance and hand washing and, thereby, leaves us exposed to the onslaught of the novel coronavirus. Catastrophizing fills us either with an immobilizing fear of doom that also stops us from protecting ourselves or with a frenetic fear of danger that results in impulsive and disorganized behavior that is useless in the face of a menace like the novel coronavirus.
Rational Acceptance: A Strategy for Managing COVID-19 Stress and Anxiety
How we think about the CDC guidelines is important to managing COVID-19 related anxiety and stress. A productive step we can take in this regard is to inhibit or reject any tendency to view the CDC guidelines as unjustified limitations on our personal freedom and happiness. Let us instead try to accept the changes recommended by our national health authorities as the life saving adjustments they are intended to be. The life-saving effects of these measures more than compensate for any hardships they create. In this instance, the end amply justifies the means. Lost paychecks can be recovered whereas lost lives are gone forever.
Rational acceptance is not unconditional. Health professionals and scientific experts are not infallible. They can make mistakes and err in judgment, especially under the exigent challenges of dealing with a nation-wide health crisis. However, with regard to COVID-19 nationally recognized health experts are better informed than any other group, and, therefore, far less likely to misstep or misstate. Also, their mistakes are most likely to spring from good intentions. They aim to save lives by providing the unvarnished truth as they know it. They hope to earn the public trust by consistently presenting the facts and only changing guidance when it is justified by circumstances.
Rational acceptance allows for constructive criticism that gives the benefit of the doubt to those who have to make tough decisions on an urgent basis. Rational critics respectfully point to possible or potential flaws and offer well thought out remedies to correct them. As we go forward, let us imagine that members of our family, our friends, neighbors, coworkers or classmates may be among those whose lives are saved, if for the time being we act responsibly and practice social distancing, crowd avoidance, hand washing, and face covering as the experts advise.