– Deidre Samson – deidres@ifr.sun.ac.za

Every day we are regaled with the fact and figures of Covid-19, how many people have been infected, the number who have died and how many have recovered. On television, we are faced with the harrowing stories of first-line responders working long shifts, with or without the necessary personal protective equipment (PPE), going home to their families at night and self-isolating to reduce the chance of passing on the virus.

Pandemic. Even the word itself raises the heartbeat and induces a sense of fear. Yet very few people speak about the psychology of this global nightmare and, perhaps, about its long term effects on the psychological well-being of our citizens. This is the current untold story and the next chapter could well be a long lasting, unintended legacy that affects our society for generations to come.

We have all seen dramatic accounts, both fiction and non-fiction, of the effects of war on soldiers, of the post-traumatic stress disorders (PTSD) that serve to haunt the lives of those who return from battle. But what of the victims of this pandemic? Those who have been afflicted and who fought their own battles to recover, attached to ventilators with only a small chance of survival. The angst and anguish of families who have had to watch their suffering, whilst fearing for their own health. The small business owners who cannot sleep because of their fear that the bank will foreclose on their business, dashing their dreams and impacting the livelihood of the people who depend on the business for their employment. Of the families who have used up their savings and have no more money to pay the bills. Of those with fragile mental health to start with who have been further traumatised by isolation, the absence of professional assistance and the constant exposure to toxic relationships.

There is no doubt that the primary threat posed by Covid-19 is to people’s physical health. It is right that we focus our resources right now on dealing with this “clear and present” danger. However, the reality is that it is also taking a strain on the social and cultural fabric of our society and is sapping our mental health, day by day, as it continues on its inexorable path. Fear, uncertainty and isolation – the three horsemen of our emotional tsunami and potential future mental health apocalypse.

As humans, at the best of times, we have an illusionary control over our future. Yet our small comfort comes from our routine, knowing what we are going to do today, tomorrow and next week. The lethal confluence of fear over our own health and those close to us, a lockdown that alters our routine and an imposed isolation from the reassuring social contact with others, takes away even that limited sense of control.

The World Economic Forum argues, that with 2.6 billion people all around the world in lockdown, we are going through what is in some sense the largest psychological experiment ever. An experiment, they argue, that has the potential to result in a secondary wave of burnout and stress-related absenteeism as we return from our safe cocoons into the harsh reality of a Covid-19 traumatised world. As we prepare for the pandemic to peak in South Africa, we need to ask ourselves the important question – what are we doing to build the capability to deal with PCSD – Post-Covid Stress Disorder?

Research has shown that people who are quarantined or isolated are likely to develop a wide range of psychological stress symptoms. These include depression, irritability, insomnia, anxiety, anger, emotional exhaustion and burnout. How will this impact not only our own long-term wellness, but that of our families and communities? How will it impact our work when we return, the productivity, economic and social health of business? Is it possible that people returning to work will be both more resilient AND traumatised?

The sad reality is that not everyone will be affected in the same way. In an already unequal society, a minority of people will have weathered the COVID-19 storm in suburban houses and apartments with the necessary access to technology to create some sense of social contact and business continuity. In townships and informal settlements, the less privileged have had to live with their fears, exacerbated by the reality that social distancing is almost impossible. Economically too, these are the hardest hit. The first employment casualties of any crisis are those dependent on piece employment, the informal and part-time work on which so many depend. The long queues for food parcels amply demonstrate the effect of work deprivation on so many. Suntosh Pillay, a psychologist working in KwaZulu-Natal, believes that this stress could have long term consequences, “I think there’s going to be intense feelings of depression after this, especially as we’re dealing with the aftereffects of the economic meltdown.” (Cleary, 2020).

So, how do we build a meaningful response? In New York, Governor Cuomo called on mental health professionals to donate their time pro-bono to serve on 24-hour helplines to contribute to a “first response” to the anxiety caused by the pandemic. In South Africa, we have not seen any such appeal. Our already over-stressed mental health care resources seem to not have the capacity to respond in such a way. The reality is that a failure to plan and put in place the resources required to mitigate the psychological impacts of quarantine is likely to undermine our financial and economic recovery. It would appear that, in South Africa, our stage is set for major future mental health implications if we cannot advocate for the necessary resources to be made available by the state, by clergy, by medical aids, by NGOs and by ordinary citizens who care and can offer counsel.

There are some who have recognised the need to do something. “Mind Your Breath” is a multi-faceted approach, offered by an enterprising pair of health care professionals, Dr Annelien Nieman and Zoe Douglas, for use by schools and businesses. Douglas explains: “Through a combination of skills teaching and coaching this programme aims to assist and alleviate some of the side effects of trauma and loss as well as focusing on personal transformation and growth in order for individuals and groups to achieve their highest potential. Training and coaching sessions can be done face to face or online.”

The question we all have to ask is – are we getting ready for the second pandemic of COVID-19 mental health challenges? Ignoring this reality is not a response we can afford.