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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 76-82

Preservation of physical and mental health amid COVID-19 pandemic: Recommendations from the existing evidence of disease outbreaks


1 Department of Public Health Dentistry, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
2 Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India

Date of Submission04-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Dr. Hunny Sharma
MD 264, Phase 4, Near AIIMS Residential Complex, Kabir Nagar, Raipur - 492 099, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_47_20

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  Abstract 


COVID-19 disease caused by the SARS-CoV-2 virus and originating in China's Wuhan City is now a pandemic. In the current situations where no certain prevention or treatment measures are available, and all countries have implemented travel bans, mass quarantine, and isolation measures to restrict the spread of the virus. It is anticipated that people will be likely to suffer from multiple negative psychological effects if not taken care of. The government and researchers must develop ways to determine these adverse effects of unprecedented long-term quarantine and develop various approaches to cope with those effects. Authors by this paper had tried to provide insight into why pandemic disease exposes individuals to physical and mental disorders, what can be done to prevent them among citizens, children, self-isolators, health care professionals, telemedicine in management of mental health burden, and some appreciable steps taken through the Indian government to elevate some of these adverse effects among Indians through unprecedented long-term lockdowns. Hence, this narrative review based on existing evidence from various outbreaks aims to recommend steps that can be considered to preserve the physical and mental health of the citizens amid the COVID-19 pandemic.
The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice-based learning and improvement.

Keywords: Coronavirus, mental health, pandemics, physical fitness, public health, viruses


How to cite this article:
Sharma H, Verma S. Preservation of physical and mental health amid COVID-19 pandemic: Recommendations from the existing evidence of disease outbreaks. Int J Acad Med 2020;6:76-82

How to cite this URL:
Sharma H, Verma S. Preservation of physical and mental health amid COVID-19 pandemic: Recommendations from the existing evidence of disease outbreaks. Int J Acad Med [serial online] 2020 [cited 2020 Jul 7];6:76-82. Available from: http://www.ijam-web.org/text.asp?2020/6/2/76/287957




  Introduction Top


Amid the outbreak of COVID-19, isolation and quarantine are the only way of shielding the person from this life-threatening virus. In other words, “quarantine” is the other way to isolate and limit the movement of those who have been exposed to the infectious disease to determine whether or not they actually have the disease and thus protect people who are not exposed to it.[1] Whereas the term “isolation” describes the mechanism by which the person identified and diagnosed with infectious disease is isolated from the people who do not have the disease.[2]

The terms were used in the ongoing COVID-19 epidemic when the countries placed unprecedented mass quarantine to protect the citizens from the lethal virus. While those returning home from a foreign visit were either asked for self-isolate for 14 days or sent to legally enforceable isolation.[3]

It is well known that quarantine and isolation impose rather draconian restrictions on individuals or citizens and is far more unpleasant for those who are placed in it. Loss of freedom, boredom, and a sense of separation from the loved one creates stress, anger, and anxiety among individuals. There are also incidences of finding posttraumatic stress symptoms, often after quarantine relaxation.[4],[5]

It is the government's and researcher's responsibility to set out numerous guidelines for the effective use of quarantine and isolation as public health measures to contain the virus and prevent the disease from escalating to the epidemic while reducing the negative effect associated with its implementation.[6] For this purpose, detailed intervention plans should be developed to address these psychological crises in the context of the COVID-19 pandemic. Accordingly, this narrative review, based on existing evidence, seeks to suggest some recommendations for preserving physical and mental health for citizens, parents taking care of children, self-isolators, and health-care workers in the middle of the COVID-19 pandemic.


  Why Pandemic Diseases Subject Individuals to Physical and Mental Disorders Top


Pandemic diseases, especially those who require isolation and quarantine, impose lots of mental health risk to those suffering. The individual can suffer from anxiety at various levels, both from direct and indirect sources. Direct sources of anxiety include fear of contamination from the CoV associated with COVID-19, stress, depression, and grief owing to the death of loved once, while indirect sources of anxiety can be economical and social chaos which occurs throughout the world at individual and societal levels during these infectious pandemic diseases.[7]

A study conducted by Jalloh et al. in 2018 during the Ebola outbreak revealed that symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were common after 1 year of the outbreak, especially among those with Ebola-related experiences. This not only shows the ugly side of pandemic disease related to physical health but also to mental health during and postpandemic outbreak.[8]

The primary reason for anxiety, depression, and PTSD experienced suffering outbreaks is insecurity regarding food and resources, shame and discrimination for those who suffer from the disease, threat of being infected, a high number of deaths and high level of uncertainty prevailing in the society regarding the lockdown and isolation.[8]


  Why it Is Important to Preserve Physical and Mental Health Amid Covid-19 Top


In countries around the world, anxiety and mood disorders are widespread in the general population. The pandemic infectious disease not only imposes a country to economic crises but also makes the citizens vulnerable to adverse psychosocial effects due to unprecedented quarantine for an uncertain period. Today in early stages of information about COVID-19, lack of information about the incubation period of the virus, possible routes of transmission coupled with misinformation, and overburdened information from social media may cause additional fear, stress, and anxiety among the citizens. This can affect the physical activity of the individual as well as the metal health due to limited socializing ability and strict lockdown rules.[9],[10],[11]

Fear related behavior can harm mitigation towards pandemic disease. Awareness of infectious disease and financial uncertainty not only render the patient homebound, but also prohibits people from accessing health care services for fear of being exposed to the disease in health care settings.[12]

Fear driven discrimination and stigma can be an important factor for instilling fear, anxiety, and depression in citizens amid COVID-19. A 2014 national survey in Sierra Leone reported one such data, in which a survey on Ebola survivors found that 95 percent of all survivors experienced of having at least one discriminatory attitude towards them. A sense of appreciation should, therefore, be created in citizens to prevent discrimination against survivors of COVID-19.[13]

Frontline health-care works that strive relentlessly to save lives may also endure discrimination, social alienation, neglect, and depression when reintegrating into their communities and society. Special consideration should be rendered to the health-care provider, who suffered from the disease while treating the patients and recovered so that they do not experience similar accidents.[14]

Hence, a thorough plan to tackle all these factors, which creates fear, anxiety, depression, and PTSDs among citizens, should be created, considering all age groups and socioeconomic status.


  Recommendation to Preserve Physical and Mental Health Amid Covid-19 Top


Mental health is an important issue to be addressed at the time of lockdown being implemented in various countries and during the quarantine. The government should focus equally to mitigate the adverse effects considering individuals from all the age groups such as citizens, children, self-isolators, and at last for health-care professionals who are continuously working to save lives during this pandemic.

Recommendations for citizens

It is well-known that during disease outbreaks, in the situation of chaos. Citizens can experience stressful situations and negative emotions, such as fear, frustration, and disgust. It is crucial for people to be made aware that it is common to feel anxious at this moment. In some cases, anxiety plays a key role in instilling positive behavior, such as the habit of wearing a mask and washing hands, while in some cases, anxiety can lead individuals to negative effects on their health, such as feeling overly sensitive and emotionally draining their minds and real power.[15]

It is imperative that stress about getting exposed to infection can lead to a constant pursuit of information. Overexposure to this information may lead to decreased rational judgment and a new feeling of anxiety and fear.

Cooperation and being a helping hand at the time of crisis is much-needed human behavior. Awareness should be created to cooperate and help individuals and organizations which are involved in crisis relief actions and prevention. Awareness should also be created to keep the distance from the individuals who do not help to prevent infection spread by hiding information and individuals who are infected. A sense of understanding should be created that it is the infectious person who is the enemy, not the infected person, and hence each individual should show compassion to save lives by preventing infection.[16]

Physical stress symptoms such as headaches, insomnia, and indigestion and mental symptoms such as fear, anxiety, boredom, loneliness, and tension to some degree are acceptable and can be eliminated by getting involved with the conversation and physical activities such as playing games and cooking with the family members. However, in case of experiencing an excessive amount of fear anxiety, it is better to consult a psychiatrist or a mental health professional or counselor, especially if insomnia persists.[16]

Anxiety and fear can also develop an individual to think that something which is happening now will be worse in future and is going to be dangerous and life-threatening for him/her. It these moments positive thinking and emotions can help overcome an individual from a difficult time and also may play a pivotal role in strengthening the immunity.[17]

Although it is well known that lockdown and social distancing may disturb daily lifestyle to some extent due to the limitation of physical and mental activities, maintaining a normal lifestyle is an important aspect. Normal routine life cycles such as waking up or sleeping at the time, regular eating habits, and regular physical exercise help to maintaining good mental health.[18]

Although COVID-19 disease has a very less mortality rate, the geriatric and immunocompromised patients are at high risk. It is essential that all the individuals support each other and especially those who are older or are immunocompromised.[19]

Recommendation for parents taking care of children

It is well known that children have tremendous power to cope up with the stress when they understand that their parents listen to them and understand their feelings of anxiety and fear and are there to care and love them. The parents need to listen to the child's question scenically and answer them in their level of understanding and guide them to deal with fear and stress.[20]

Parents can be role models by setting a positive and healthy living example for their children by following preventive guidelines and lockdown rules. Practicing personal hygiene and preventive steps such as wearing a mask, washing your hands, and refraining from going out can instill this positive attitude and feeling of self-care among children.[21]

The parents need to refrain the child from getting over-exposed to telemedias and social websites where lots of misguiding and misleading information keeps on pouring day today.[15],[22],[23]

A child in quarantine can experience fear, loneliness, frustration, and irritation because of isolation. From the earlier research, it is established that the children in isolation and quarantine may be more prone to developing acute stress disorder, adjustment disorder, and grief.[24] Hence, they should encourage themselves to keep themselves busy with home-based games, pictures, storytelling, and online studying. There the web media and cell phones can be used to keep the child in content with teachers and friends to avoid feeling lonely and frightened.[20],[25],[26]

Recommendation for self-isolators

Self-isolation and quarantine are methods to reduce the chances of the spread of this pandemic disease. It should be made clear to every individual that isolation and quarantine are not only a better way to observe the symptoms and treat the disease more effectively and efficiently but also protect the society in which we live and people we love and care about.[27]

Although rules and guidelines for isolation and quarantine can be strict and stressful and make people distressed, awareness should be created that it is extremely necessary for the containment of this virus. During isolation and quarantine, individuals can keep himself-busy with online games and books to keep themselves busy. Living a positive life with the sense that the disease can be cured when treated correctly can help to limit stress and anxiety.[28]

A person in self-isolation and quarantine should be made aware that being in isolation and quarantine is a pride moment as he/she is protecting his/her society and his/her loved ones and the citizen and the country is deeply grateful that you helped to contain the virus. Individuals returning home from isolation and quarantine should live with pride and confidence that they served the country at the time of need.[4]

Recommendation for medical staff involved in fight against COVID-19

It is well known that pandemic and infectious disease depletes the available medical resources of the nation and creates public health crises. It is the medical staff who are the frontline fighters who have to deal with the situation.

Due to increased work intensity and longer working hours, medical staff fight this COVID-19 may experience fatigue, exhaustion, depression, and social isolation. Furthermore, the difficulty in wearing protective gear for long duration and risk of acquiring infection may expose them to additional fear and anxiety. It is important to look for early symptoms and take care.

Medical staff engaged in isolation wards should have a limited working hour and in shift with adequate quality of food and sleep. The institution and the country must make them feel proud that what they all are doing is the most prestigious job. It should be ascertained that they have proper personal protective equipment (PPE) to prevent themselves from being infected and being a carrier. It is important the regular monitoring of these medical staff should be carried out for mental and physical conditions. It is the duty of the government and the country to ascertain a basic health guarantee for the medical staff involved in this duty.[29]

PPE, which is the need of an hour to prevent the spread of the COVID-19 disease, is also essential for preventing the fear and anxiety of being exposed to the disease.

Doctors in the isolation ward or in treatment facilities should be allowed to work in teams as teamwork may boost morale and also instill a sense of support and protection. Teamwork also, to some extent, reduced workload and work-related stress and elevated the fear and anxiety.[30]

Although it is indispensable for proper pretraining of the staff for all the procedures necessary to be carried out by them to fight this pandemic, still, it has expected that some instances may create a feeling of anger and self-imposed guilt. In case of being stressed and mental breakdown in the event of any death in the isolation ward, the doctors dealing with it should send for psychological counseling to reduce the mental stress and self-imposed feeling of guilt to improve the quality of care.[31]


  Tele-Medicine in Management of Mental Health Burden Top


The current pandemic had not online forced government of various countries to impose mass quarantine but has also subjected populations of various countries to experience various mental health consequences. Management of mental health crisis in active cases or the case in active quarantine poses a challenging task to health care providers owing to the highly infectious nature of the current pandemic disease. Telemedicine is one of the innovative solutions for those who are not only critically ill but also for the individuals who are devoid of health-care services in current scenario due to the lack of resources or accessibility.[32]

In addition to being relatively simple and cost-effective, telemedicine offers a variety of other benefits like eliminating the need of nonurgent direct interaction of doctor-patient and ease of accessibility from anywhere globally. The current use of telemedicine includes the examination of remote patients without medical staff, delivering medications without the direct involvement of health-care providers and measuring vitals such as temperature, blood pressure, and pulse. However, the other methods of telemedicine, which had proved to be beneficial for managing mental health include Internet and telephone based on depression, panic disorder, and generalized anxiety disorder.[32],[33],[34]

The currently ongoing pandemic of COVID-19 has again realized the importance of telemedicine to deliver effective health care by reducing the risk of cross-contamination. However to ripe the most potential benefits of telemedicine requires the integration of telemedicine in health-care delivery, on a daily basis. It may also require flexible funding for proper arrangements of infrastructure and training of the health workforce for the management of acute, post-acute, and emergency situations.[35]


  Some Appreciable Steps Were Taken by India to Combat the Negative Impact of Quarantine and Isolation Measures Top


There are currently different steps being taken around the world to mitigate the harmful impacts of mass quarantine. One such appreciable measure was taken by the Indian government when India's prime minister, Narendra Damodardas Modi, asked Indian people on March 22, 2020, to ring bells, blew conches, and clap at 5 p. m. on Sunday to offer a 5-min standing ovation to medical and other workers on the front line of the COVID-19 war. This not only provided positive motivation and boosted the citizens' morale after the first long quarantine to combat the new pandemic but also generated a sense of solidarity for fighting toward COVID-2019.[36]

Another event which caught the world's attention was when millions of Indians came together at the appeal of Indian Prime Minister Narendra Damodardas Modi on April 5, 2020, to turn off the lights in their homes at 9 p. m. And light candles, oil-filled lamps, or cell phone torches for 9 min, showing the nation's “collective determination and solidarity” in the COVID-19 war with that symbolic gesture. This not only brought together millions of Indian people to combat COVID-19 but also improved morale and relief from the tension associated with quarantine to some degree.[37]


  Conclusion Top


Overall, it is evident from the literature that quarantine and the isolation of citizens can have a wide range of physiological effects on their health. As the current COVID-19 pandemic is spreading rapidly, and there are currently no specific methods of prevention and treatment available, quarantine and isolation is the only way to protect citizens. However, long-lasting unprecedented quarantine or isolation may have various devastating effects and should be carefully implemented to minimize negative health impacts. It is the responsibility of the government and the research scientist to devise a wide range of suggestions, covering all physical, emotional and social aspects at all age levels, to make negative experiences as tolerable as possible. This can be achieved by making the people aware of what the current situation is, why the quarantine is needed and for how long, what are the things that can be done to keep themselves occupied and by ensuring sufficient supply of the food and resources available. It is well known that if people suffer from the adverse effects of quarantine and isolation, individuals may be subject to posttrauma stress symptoms even after the relief from quarantine or isolation. Telemedicine, which is one of the most neglected methods in the management of mental health during pandemic disease, can be proved to beneficial in the management of adverse effects of these mass quarantine measures. With this narrative analysis, we aimed to raise awareness about maintaining physical and mental health in the middle of the COVID-19 pandemic. Therefore, considering the above evidence, it is proposed that governments around the globe should be well equipped to manage the instability and the related negative effects on physical and mental health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

This manuscript represents a literature review. Because this project involved no experimental design, the Institutional Review Board approval was not required. Applicable EQUATOR Network (http://www.equator-network.org) reporting guidelines were followed.



 
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