Guest Posts

Mental Health in the COVID-19 Pandemic: How to Cope in a Crisis

to Public Health On Call, a new podcast from the Johns
Hopkins Bloomberg School of Public Health. Our focus is the
novel coronavirus. I'm Josh Sharfstein, a faculty
member at Johns Hopkins, and also a former Secretary of
Maryland's Health Department. Our goal with this podcast is
to bring evidence and experts to help you understand
today's news about the novel coronavirus and what
it means for tomorrow. If you have questions,
you can email them to That's, for future podcast episodes. Today, I'm talking to
Monica Schoch-Spana, a medical anthropologist
and a senior scholar with the Center for Health
Security at the Johns Hopkins Bloomberg School
of Public Health. We spoke about the
mental health impacts of the coronavirus
epidemic and what can be done to address them. Let's listen. Dr. Schoch-Spana, thank
you so much for joining me. I know you've been looking into
the mental health dimensions of the COVID pandemic. Can you tell me
what you're finding and what you're concerned about? MONICA SCHOCH-SPANA:
Right now, we're focusing a lot on
viral transmission and interrupting it.

But we also need
to pay attention to the psychosocial dimensions. I think it's helpful
for people to think about the mental health impacts
of the pandemic in two ways. There's a diffuse distress
that we're all feeling. But then there are
special groups of us that have unique stresses being
placed on us at this time. JOSH SHARFSTEIN: Let's talk
first about the diffuse stress. Tell me about that. MONICA SCHOCH-SPANA: Sure. Well, if you look at past
pandemics and outbreaks of emerging infectious
diseases, you find that people have a
high level of anxiety. And there are a number
of reasons for that.

This is a health threat that
is invisible to the naked eye. If you're sick, you can
manifest benign symptoms that mimic other types of diseases. So you don't know if you have
COVID-19 or the flu or a cold. And at the same time that
you have that uncertainty, you also have changes
in bodily habits, like hand washing, interruptions
to social relationships because of social distancing, and
economic interruptions that place stresses. So there are many
reasons why we all have a sense of worry and concern– because this is unfamiliar,
it's interrupting routines, and we could get sick, and
our loved ones could get sick. So that generates a
diffuse sense of distress. JOSH SHARFSTEIN: That's
very well-explained. And I think people who are
listening will identify. What about for
specific populations? Who is most at risk? MONICA SCHOCH-SPANA:
Well, one group that we all have to be
concerned about and help protect are our health care workers. Health care workers undergo
many different types of distress during pandemics and outbreaks
of emerging infectious diseases like SARS and MERS, even
H1N1, 2009 influenza.

They're going to be working
longer and more shifts. They're going to be away
from their families. Their duties to their families,
such as child care and meals, will be interrupted. And there'll be
worry about that. They may themselves get sick. And they will be worrying
about that possibility. They may see their
co-workers get sick– perhaps even some severely
sick and pass away. So there are a number of
stresses on our health care workforce. So that's one group. And it's going to
be very important that health systems
provide time, space, and personnel to get
them through the stress of the pandemic. JOSH SHARFSTEIN:
I definitely want to talk about what can be
done and what that really means, what you just said. But other groups that
are top of mind for you at particular risk for
mental health consequences? MONICA SCHOCH-SPANA:
Well let's talk about people who are
in self-quarantine. OK. They face a cascade of impacts. They, while they're wading
through the incubation period, are going to be consumed
by the uncertainty about whether or not they're
going to get sick.

At the same time, they
are cut off from people. And soothing human
comfort is not going to be readily
available, just because of the social
distancing aspect. At the same time, they may be
cut off from their obligations to other people. That is, they can't fulfill
their role as a household wage earner. And that will create
additional stresses. Now, that's just while
they're in self-quarantine. If they should get sick, they
then have additional stresses. They have the uncertainty
about whether they're going to have a mild
case or a severe case. If they get recovered,
people may look at them, because they have been infected
with COVID-19, as somehow a potential threat, even if
they have fully recovered and are not passing
along the virus anymore.

So they could face stigma. JOSH SHARFSTEIN: So
what can we learn about these challenges
from previous experiences with infectious
disease outbreaks? Recognizing that this
one is unique in a bunch of different ways,
are there important lessons from the mental
health consequences of other pandemics? MONICA SCHOCH-SPANA: Well,
that experience of stigma is actually a very
definitive feature of outbreaks of emerging
infectious diseases or novel pathogens. So we saw during SARS that
health care providers who were taking care of
patients with SARS were shunned in some instances. Children of health care workers
were shunned out of a fear that the people
around them would also get infected, regardless
of what the science said. Neighborhoods where there were
large numbers of cases of SARS also were stigmatized. And even after the end of the
epidemic– the SARS epidemic– those neighborhoods
were shunned, as well. So that was seen very,
very strongly during SARS. JOSH SHARFSTEIN: So
let's talk about what can be done to
respond, mitigate, try to lessen the mental health
burden of this situation. So let's start maybe
with individuals. What can individuals do? MONICA SCHOCH-SPANA:
Well, individuals can, even in a context
of social distancing, maintain and nurture
their relationships with other people,
make phone calls, write emails, have Zoom chats
with a whole group of people.

So it's going to be
important for people to be connected to others. If you're a baker,
bake a few items. And then provide it to
your neighbors, of course, respecting social distancing
and infection control safety measures. But you need to connect
with other people. So that's what
individuals can do. JOSH SHARFSTEIN: So
physical distance doesn't mean psychological
distance, in a way.

MONICA SCHOCH-SPANA: Absolutely. There's a reporter,
Amanda Ripley, who's written about the
psychology of disasters, and now epidemics. And the importance
of avoiding isolation is absolutely critical. JOSH SHARFSTEIN: Got it. What about for policies? What kinds of policies should
be put in place to support mental health generally? MONICA SCHOCH-SPANA:
Well, we need to move mental health to the
foreground of the response. As I said earlier,
right now a lot of it is on viral transmission
concerns and health care delivery concerns. But we need to make sure mental
health is part of the financing structures.

So the financial
relief packages, both the current
and future ones that are coming from the
federal government, really need to take
mental health allocations into consideration. Secondly, public health
authorities really need to invite their
behavioral health counterparts to the table and
plan the response together. So risk and crisis communication
should include experts from a communication
perspective, a public health perspective, and a behavioral
health perspective. When you have
large-scale operations like drive-through testing,
there are operational tips that behavioral health
professionals can offer, such that the movement
of people happens in a calm and orderly fashion. And so people such as
behavioral health professionals really need to be
providing counsel right now to the
overall public health response, not just that's
specific to mental health. JOSH SHARFSTEIN: Great. I'm going to circle
back to your comment about health care workers. What can health
care organizations be doing to support the
mental health of people who are on the frontlines
of this epidemic? MONICA SCHOCH-SPANA: Right.

If you look at past
outbreaks, in particular SARS, it was very important
that health care workers be given the time to step
back from the response, so breaking up their schedules. Also, having a
literal place that's detached from the delivery
of care, where they can decompress. And also, having access, again,
to behavioral health experts, and for those for whom their
spirituality is important, access to chaplaincy
services as well. JOSH SHARFSTEIN: And
what you're saying is, that's not sort of an
ancillary part of the response. That's got to be core
to the response in order to keep health care workers
in a position to do the best that they can. MONICA SCHOCH-SPANA:
Absolutely, absolutely. There's going to be an
extreme sense of urgency– and rightly so. But as many other people
have spoken about, this is a marathon.

It is not a sprint. We want our health
care workers well, on their best game, even a month
from now, two months from now, three months from now. So we need to take care of them. JOSH SHARFSTEIN: Let me ask
you one other question, which is about people who have
mental illness before COVID-19. Are there particular
concerns and recommendations that you have for them? MONICA SCHOCH-SPANA: Yes. People who have
anxiety conditions or obsessive compulsive
disorder prior to the crisis could be facing more
acute reactions.

And that may be
happening at a time when they have less
access to the care that they would
normally receive. So I think it's important
for mental health providers to put certain interventions
in place, including telemedicine, telehealth
options if they're not already doing that. If possible, they should
cut out-of-pocket fees, cancellation fees, co-pays, just
to remove the economic burdens to care. And if they haven't already
updated their own business continuity plans
for their practices, they need to be
doing that right now. JOSH SHARFSTEIN: In other
words, to prepare in case the therapists get
sick, making sure that the patients
have other options. MONICA SCHOCH-SPANA: Absolutely. And I think that
practitioners that have special expertise
in domestic abuse are going to be called
upon at a larger rate, given the social distancing
and the social distancing requirements.

Families are now on
top of each other, under an overall
community level of stress. And there could be
some adverse effects in terms of a domestic abuse. JOSH SHARFSTEIN: That's
a pretty serious issue. Is there anything that can
be done to reduce that risk? MONICA SCHOCH-SPANA: I
think that families need to find ways to decompress. They need to give
each other space. If it means taking
a walk in nature– again, with social distancing
requirements in mind– that needs to happen. They need to reach
out to others when they feel they're under stress. And practitioners
who are sensitive to the special stresses
of marital life and other partnerships
should make themselves more available to their clients.

JOSH SHARFSTEIN: Well, this is
extremely important information and on an extremely
important issue. I really thank you
for taking time to talk to me about it today. MONICA SCHOCH-SPANA: Josh,
it's been a pleasure. Thank you for
covering this issue. [MUSIC PLAYING] JOSH SHARFSTEIN: Thank you
for listening to Public Health On Call, a new podcast from the
Johns Hopkins Bloomberg School of Public Health. Please send questions to be
covered in future podcasts to That's This podcast is produced by
Josh Sharfstein, Lindsay Smith Rogers, and Lymari Morales. Audio production by
Niall Owen McCusker, with support from Chip Hickey. Distribution by Nick Moran. Thank you for listening.

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