By Rita Corser
Understanding the Four-phase approach: Preparatory/Combat/Recovery/Post Pandemic Phases
There is a universal acknowledgement that the Covid-19 pandemic presents a herculean global public health challenge not seen since the Spanish Flu Pandemic of 1918. In the case of the disease-causing pathogen responsible for Covid-19, the SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus Virus 2), is one that the scientific world is currently battling to unravel in order to fully understand the true nature of the disease-causing mechanism and its impact on a global population that is yet to acquire population immunity nor develop a vaccine to offer protection from the virus.
While the measures currently adopted by institutions and governments worldwide, informed from the onset by the World Health Organization (WHO), continues to yield significant results in getting a grip on the transmission rate of the disease, a growing body of evidence suggests that we may as yet find ourselves dealing with a different kind of global challenge. The impact of Covid-19 on the mental health of individuals, is an equally urgent crisis unfolding alongside the more visible impact on the socio-economic health of countries around the world which must be addressed quickly.
Governments are actively involved in rolling out measures, with the creation of policies and economic packages, to stimulate their economies for a quick recovery from what is being seen as the greatest economic downturn and disruption to public life in living memory. That same coordinated effort in ensuring quick economic recovery, and possibly more, needs to be directed at preventing a pervasive mental health crisis long after the last case of the disease is eradicated around the globe.
The WHO’s findings on the psychological impact of Covid-19 on the emotional well-being of individuals, suggest that this is a growing public health crisis within an existing health crisis. Emerging data from early research suggest that individuals are reporting high levels of anxiety about work, reduced household income, food insecurities and of course, fear for their own personal safety.
Mental health service providers are also reporting a significant increase in demand on their services as people with existing mental health illnesses have found their conditions exacerbated by the ongoing impact of Covid-19. This is also the case with individuals who hitherto considered themselves as having no mental health issues, now report experiencing high levels of anxiety stemming from uncertainty about their future, alongside onset of insomnia and eating disorders.
Right from when the first positive case of Covid-19 was announced, research has rightly been the crucial tool underpinning the strategies adopted by nation-states around the globe towards addressing the pandemic.
To present a proper overview of the current pandemic, it would be helpful to see it in the context of four crucial phases. The first, the preparatory phase, was an anticipatory period in which the nations of the world were alerted about the emergence of the disease by WHO and warned to make adequate provisions for their index case.
This phase was closely followed by the second, the combat phase, once again guided by WHO directives on hand washing techniques, social distancing and ‘test, track and trace’ measures, all underpinned by robust scientific research aimed at understanding, tackling, and monitoring the progress of our global handling of the pandemic. The race to develop a vaccine to protect the population also remains an urgent part of this phase at the moment.
Already, countries have begun taking steps towards the recovery phase. Although in its infancy, emerging data suggest the focus has been mostly socio-economic, aimed at re-opening the countries of the world for business. Such economic recovery measures are aimed at workforce returning and companies adapting to new ways of working, like remote or home working, staggered shift patterns, and social distancing in the workplace environments.
There is, however, a need to look ahead towards the fourth phase of this pandemic, and this is the post-pandemic phase. This is a phase that needs urgent attention well before such a time, as when the pandemic would be declared over by the WHO. Ideally, this phase, like ongoing research suggests, should have been an ongoing focus at the very start of the pandemic and factored into the preparatory phase. It is, however, understandable that the unprecedented global impact of this novel disease created a situation in which every country was learning as it progressed.
The global death rates from Covid-19, coupled with quarantine and social distancing measures have resulted in what can be described as a sustained emotional trauma on individuals. For instance, support networks have been lost in the light of social distancing rules, the very backbone for coping with the loss of loved ones, and the customs around burying the dead and finding closure.
These practices had to be put aside or scaled-down greatly in the interest of public health and safety guidelines. Consequently, the bereavement and healing process has been disrupted.
Similarly, the role key workers play in providing essential goods and services at a time when every other group is being told to ‘stay at home’, is one that potentially leaves them open to higher levels of anxiety, akin to that experienced by ‘shielded’ vulnerable groups in society. In particular, healthcare professionals trained to deal with sickness and death find themselves fighting to cope with the pressure of the daily risk to their welfare which is sorely exacerbated by the anxiety-inducing possibility of bringing home the disease from the frontline to their loved ones.
Thus, the emotional burden of caring for very sick patients in a climate of uncertainty surrounding the true nature of this highly pathogenic coronavirus cannot be overstated. This is an important aspect that must be recognized and understood by the agencies charged with developing policies to aid post-pandemic recovery in all aspects of society.
In the same vein, it is important to ensure that the effects of the lock-down measures on the emotional state of the public are studied and understood and salient lessons learned from the process. One such lesson and its subsequent application to similar public health crisis in the future, is determining which various groups of the population require what type of support system. The reason being that a ‘one size fits all’ approach will be detrimental to the success of this process.
Consequently, it may be that healthcare professionals as one group of the population, would benefit from structured time away from work to reduce the stress of dealing with the pandemic alongside continuous emotional therapy provided to them by certified mental health professionals. In the case of other groups in the wider population, it may suffice to roll out targeted programs which encourage family re-integration, uptake of new skills like practicing mindfulness, nationwide programmes like gardening and various arts and crafts skills, which will greatly contribute to alleviating emotional distress in individuals.
The government, through its public health agencies and not for profit organisations, needs to gather the requisite data on the nature of this problem. Using survey as a tool, a representative sample size of the population could be polled to determine the impact of the ongoing crisis on the emotional well-being of individuals.
The resulting data would then present a snapshot of how widespread this challenge is and what demographic groups have the most pressing need for mental well-being interventions. This will serve as a guide for the government to develop robust emotional support programmes to reduce anxiety and strengthen emotional resilience in the population during and after this pandemic.
As has been detailed, the very nature of the Covid-19 pandemic has presented a sustained level of emotional trauma which is highly damaging to the emotional well-being of individuals in the medium to long term. Governments around the world are urged to get on board and employ the various tools of the state to provide targeted support to groups of individuals identified as needing this support, informed by sound scientific evidence, to prevent a pervasive mental health crisis in the future.
Rita Corser (B.A, MAPR, PGDip A.N) is a Clinical Researcher based in the United Kingdom.