Pandemics beget pandemics: What started as a physical health crisis quickly birthed a mental health one
As a former Psychology major, I’m always interested in the way global events can influence us in the most minute of ways. But, setting my interest aside, no amount of curiosity or even an admitted bent towards schadenfreude can justify the horror that I’ve seen during 2020.
Living through a pandemic — any pandemic, even one that like Covid-19, hasn’t yet reached Spanish Influenza or Black Death levels — is poisonous across micro and macro levels. There’s no doubt that coronavirus has caused social disruption across the board which, in turn, has manifested itself in serious ways, especially on the ways it influenced our mental health.
Historically, pandemics differ from other types of disasters. We have hurricane warnings, and the actual storms, every year or so along with every other kind of natural disaster. Spree shootings have become an, unfortunate, way of life. The economy can nosedive on a somewhat cyclic basis-as we learned during the 2008 recession and, to a lesser extent, during the recession of the early 1990s? Sexism, racism, and homophobia remain prevalent in all parts of societies. And in some part of the world, war always rages on.
But pandemics aren’t as frequent or ever present, probably because as a species we wouldn’t be able to survive them, physically or mentally, if they were. And, unlike other sorts of disasters, they don’t always have a prescribed amount of time devoted to them. As we’ve learning during Covid-19, a pandemic can go on and on. In comparison to equally disastrous events such as genocide which is constrained to specific destinations and populations, a virus, once it becomes a pandemic, has no such boundaries.
Now a key difference between the Spanish Flu and coronavirus is that so far, young adults are not dying in droves from corona. At the same time, though the demographics of who is most likely to die due to the virus varies, the death rate for both hovers around 2%. Corona, as it is still spreading and developing, has sometimes been estimated to have a death rate of 5%. In marked difference, the death rate of the seasonal flu is less than .1%, though people have insisted on drawing inaccurate comparisons between the two since the corona pandemic started.
A mortality of 2% might seem “low”, to some people. Still, every time I see that number, I’m strangely reminded of the plot of HBO’s “The Leftovers”-an HBO show that is, arguably, about the suddenness, the lack of security, and the inexplicably of death-one day a “mere” 2% of the population vanishes. The 98% of the remaining population is left in a horrific state of PTSD, anxiety, grief, and arrested development. I’d argue that this show, conceived in 2014, isn’t far from where we are now, where, daily, we are under the threat of sudden and irrevocable loss: a population walking across cracked glass.
And of course, we’ve had pandemics between the Spanish flu and Covid-19, though they’ve been largely overlooked. The most cited is the HIV/AIDs pandemic, which has killed over 36 million people since 1981. The 1968 Flu Pandemic had a comparatively low death rate of .5 percent but still resulted in over a million deaths. There was the 1947 epidemic which spread across the world but caused relatively few deaths. Between the two was the Asian Flu H2N2, which killed nearly 70,000 in the United States alone. Now, if you want a record-breaking pandemic, we can journey back to the Black Death which ravaged its way through multiple populations, taking the lives of nearly 200 million people across various continents in a matter of years.
As we can see, pandemics, while relatively, and thankfully, rare, are completely devastating when they occur. While a Tsunami or an Earthquake can dismantle a city, it can’t easily dismantle multiple countries or threaten entire populations. But pandemics, obviously, are diseases which have successfully spread across borders, becoming everyone’s issue, everywhere, at any time.
And now, still in a country wracked with corona cases, there is a second pandemic. It’s mental health pandemic, where related issues and illnesses have skyrocketed across the last few months in a landscape ill-equipped to deal with them. While I’ve previously written about the stigma against mental illnesses, this stigma has mutated into something that’s become particularly sensitive considering our coronavirus situation.
Even the CDC has come out with guidelines on how to deal with mental health crisis during Covid-19, showcasing the seriousness of our collectively fragile mental health. As the site states “Mental health is an important part of overall health and well being. It affects how we think, feel, and act. It may also affect how we handle stress, relate to others, and make choices during an emergency.” The site goes on to list potential corona related stressors and mental health management tips.
Now before the Covid-19 pandemic, within the broken US healthcare system, mental health issues have been consistently sidelined. While millions of Americans suffer from mental disorders, they’ve often had to deal with preconceived notions (such as bipolar episodes end in violence, a trope often perpetrated in media, or that those with mental disorders are “hard to relate to” or “impossible to deal with”, another common misconception) that are dangerous to the majority of those suffering from such illnesses. Moreover, in a country that doesn’t have the greatest healthcare system, or insurance that covers the cost of mental health professionals, mental healthcare has always been a “nice to have” but hardly a necessity, leaving many to suffer without proper treatment or support systems.
In fact, prior to corona, only about 28% of youths with serious mental issues were retrieving treatment. Should this come as a surprise? In 2017, 8.1% of insured patients had coverage that did not extend to mental health counseling. And mental health issues have been consistently growing, especially among young adults for the past decades. Part of this has been linked to new pressures young adults face, such as how they spend their time with multitudes of studies citing ways social media can negatively influence young people, from disrupting sleep habits to promoting body dysphoria.
In contrast, older generations, especially those over 65, have seen some declines in depression related symptoms. Still, among all ages, depression and other mental illnesses have been on a rise, with about 1 million deaths a year attributed to suicide. Now, add the plethora of new issues caused by corona to this already dismal shared mental state.
A recent study showed that mental distress increased among 500,000 participants from 18.9% to 27.3% after only one month into shelter in place. Another study has shown that in persons without previous mental health disorders along with those with preexisting conditions have shown marked increases in mental health disorders like stress, depression, and anxiety since the start of the pandemic.
These issues can manifest in many ways. On the less extreme end of the spectrum, people have been panic buying, oversharing and over-activity on social media-perhaps in response to our inability to share in person-, and immersing themselves in fantasy worlds or, as a study by Hulu recently revealed, binge watching shows or reverting to re-watching old favorites (The Office has been recently trending among Generation Z on TikTok), as a form of digitized comfort food.
On the more extreme side, there has been a marked increase in alcohol abuse (sales have surged upwards of 250% with surveys showing marked rises in day drinking, including during working hours). There have also been spikes in drug abuse, especially the abuse of prescription opioids; Oxycontin, Valium, and Xanax remain some of the most addictive and most abused. At the same time, the latter two are often necessary to get people through the equally marked increase in anxiety, stress, hopelessness, and panic related to coronavirus, leading to a vicious cycle.
And people are more likely to be prone to rages, depression, bouts of grief, and panic attacks. After all, they are isolated, frightened, and bored. They might be taking their escapes from reality in whatever form it can come in, from immersing themselves in a beloved 90s TV show to downing a handful of pills.
And, as mentioned, the multitude of negative factors that make up a pandemic are driving more and more people to relapse or turn to abuse substances. Life expectancy in America is decreasing for the first time in a very long while. As Princeton professors Anne Case and Angus Deaton state this is not just due to corona but instead due to:
“Deaths of despair,” or deaths related to bleak economic or social circumstances, and those largely driven by suicide, drug and alcohol overdoses, and alcoholic liver disease. As we face COVID-19 with little end in sight, we have to wonder how the pandemic will influence rates of substance use in our country, and in turn, deaths of despair.”
Within the framework of a pandemic, some groups are more at risk for mental health issues than others. Young adults (between the ages of 18–29), who have been more likely to lose job prospects or graduate into a failing job market, and be laid off during the pandemic, have reported the highest levels of anxiety and depression due to corona, with 42% reporting the former and 36% reporting the latter. Even though this group is, largely safer than others from the virus, they are the most likely to have their social, school, job, and dating lives negatively impacted. Or, for months, completely ameliorated. In contrast, in the high risk group of those over 70 year old, only 16% reported anxiety. This decreased to 11% for those in their 80s, one of the groups highest at risk for dying from the virus.
At the same time, about 83% of currently employed workers have reported increases in common symptoms related to mental health crises. When we consider that workers are now often performing for reduced pay, increased responsibility, and in dangerous circumstances-while operating under the omnipresent threat of job loss-this seems like a natural mental progression.
Still, the mental health pandemic hits harder for those unemployed, especially as the months stretch on. Dr Petsanis states that “We had so much stress before World War II that too many people got rheumatoid cardiopathies correlated with unemployment. Actually, it wasn’t just correlation, causation was established. We know that stress kills, first of all because it provokes two things, vaso-spasm in the vascular system and immunodepression, the suppression of the immune system.”
Now, amid skyrocketing unemployment rates and companies declaring bankruptcy, it doesn’t seem unlikely that these symptoms will repeat, ad-nauseum. Add in the lack of government funding and unemployment benefits ending, plus the dire job market, and people have a perfect storm of reasons for their immune systems to break down under the stress of it all.
On the same vein, job security and a financial egg’s nest have helped curb mental health issues during corona crisis. People who made over $100,000 a year-and have not lost their jobs-reported far less anxiety and depression than those who made less than $25,000. And back to those who have lost their jobs during the corona pandemic, who’ve since reported dire symptoms such as increased depression, hopelessness, and suicidal idealization, with a direct correlation with the longevity of their job search and repeated rejections. This also keeps the unemployed caught in a web of isolation, without the normal support that goes into a job search from friends and family or, yes, a consistent job with coworkers to vent to.
The latter is particularly concerning for everyone, not just for those currently unemployed. As an avid lover of classical sociology and psychology, I’m a fan of Durkheim’s theory that it’s our social relationships which keep us alive. Yet the pandemic and, by extension, shelter in place, has curbed our ability to successfully do so.
In fact, the American Psychological Association has written a great deal about the adverse effects of social isolation. Consider that it’s often older people who suffer the worst from isolation and, in the corona pandemic, these are also the people who must take the most pains to remain isolated to stay alive.
But, as mentioned, social isolation and loneliness is a poison to everyone.
A 2018 study conducted by Cigna found half of surveyed adults felt completely alone. And the ill effects of loneliness are well documented, with correlations from everything to binge eating and drinking, increases in the aforementioned drug use and alcohol abuse, increased smoking, cognitive decline, depression, over or under sleeping and, across races and genders, a predisposing the lonely to early death, among other symptoms. That’s not to say intersectionality isn’t at play.
Both Black men and Black women are more likely to report feelings of social isolation than their white counterparts; now add in that the former two groups also face higher risks of death from Covid-19, creating a chicken and egg situation where to stay safe, you might have to isolate yourself even more.
After all, in previous times of economic instability-the 2008 Recession and the Great Depression-there have been sparks in suicide rates. On a similar note, during times of widespread physical health crises, such as during the 1918 pandemic, suicide rates also spiked. Now, we have both issues at play. Doctors have noticed a marked increase in suicidal thoughts and idealization among patients. Many of these idealizations have been positively connected to the hardships brought on by coronavirus.
After all, for something as sensitive as suicide, the recent barriers to mental health treatment the increase in economic stress, the loss of social support, anxiety about the feature, and more, are all key players in what might drive someone to it. Suicide rates, which has been on the rise, increasing 35% between 1999 to 2018, are expected to increase in substantive ways through the current landscape. Now, with even gun sales up, the effects of coronavirus on suicide rates are not completely known but seem very close towards teetering towards a different, but still dangerous, type of pandemic.
In fact, a recent study by Dr. Roger McIntyre highlights that the issues brought on by coronavirus will lead to excess suicides, with a projected 3000–8000 more deaths by suicide related to Covid-19 in the US alone. Dr. McIntyre states:
“The link between unemployment, economic shock and suicide is highly replicated in population health. The anxiety of the virus with the economic shock, along with the physical distancing, is an unprecedented assault on mental health. By conducting this analysis, we are able to get ahead of the curve of mental illness and suicide.”
As the Covid-19 pandemic is still ravaging states, due to our admittedly disastrous attempts to contain it-or, in some cases, ignore it completely-it’s obvious. We need to do more to help fix our broken system when it comes to mental healthcare and our managed care systems. Coronavirus has helped to exacerbate mental health related symptoms to the point where it would be criminal to continue to ignore them any further, unless we want to loss more lives who lose could have been prevented.