Image: REUTERS/Francois Lenoir
While we’re treating the COVID19 pandemic, we are creating a second epidemic – which we’re ignoring
Anxiety, stress and PTSD will cause a spike in absenteeism and burnout three to six months after the lockdown ends
With some 2.6 billion people around the world in some kind of lockdown, we are conducting what is arguably the largest psychological experiment ever. Unfortunately, we already know what it will result in: a second epidemic of burnouts and stress-related absenteeism for the second half of 2020. We are late to address the psychological side of this pandemic, but it’s never too late to act.
Author: Prof. Dr. Elke Van Hoof, trauma psychologist
In the mid-nineties, France was one of the first countries in the world to adopt a revolutionary approach for the aftermath of terrorist attacks and disasters. Apart from setting up a medical field hospital or triage post, the French crisis response includes setting up a psychological field unit, a “Cellule d’Urgence Médico-Psychologique” or CUMPS.
In that second triage post, victims and witnesses who were not physically harmed receive first psychological help and are checked for signs that they need further post-traumatic treatment. In those situations, the World Health Organization recommends protocols like R-TEP (Recent Traumatic Episode Protocol) and G-TEP (Group Traumatic Episode Protocol).
Since France led the way more than twenty years ago, international playbooks for disaster response increasingly call for this approach of building “two tents”: one for the wounded and one to treat the invisible, psychological wounds of trauma.
Today, in treating the COVID19 pandemic, the world is scrambling to set up enough tents to treat those infected with a deadly, highly contagious virus. In New York we see field hospitals, literally, in the middle of Central Park.
But we’re not setting up the “second tent” for psychological help, and we will pay the price within three to six months after we come out of this unprecedented lockdown, at a time when we will need all able bodies to help the world economy recover.
The mental toll of quarantine and lockdown
Currently, an estimated 2.6 billion people – one third of the world population – lives under some kind of lockdown or quarantine. This is arguably the largest psychological experiment ever conducted.
And unfortunately, we already have a good idea of what it will result in.
In late February 2020, right before European countries mandated various forms of lockdowns, The Lancet published a review of 24 studies documenting the psychological impact of quarantine*. The findings offer a glimpse of what is brewing in hundreds of millions of households around the world.
In short, and perhaps unsurprisingly, people who are quarantined are very likely to develop a wide range of symptoms of psychological stress and disorder, including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms. Low mood and irritability specifically stand out as being very common, the study notes.
In China, these expected mental health effects are already being reported in the first research papers about the lockdown.
In cases where parents were quarantined with children, the mental health toll became even steeper. In one study, no less than 28 percent of quarantined parents warranted a diagnosis of “trauma-related mental health disorder”. (Jokes on the internet are already suggesting that any babyboom resulting from the lockdown will consist entirely of first-born children.)
In hospital staff that was quarantined, almost 10 percent reported “high depressive symptoms” up to three years after being quarantined. Another study reporting on long-term effects of SARS quarantine among health-care workers found long-term risk for alcohol abuse, self medication and long-lasting “avoidance” behavior. Meaning: years after being quarantined, some hospital workers still avoided being in close contact with patients by simply not showing up for work.
Reasons for stress abound in lockdown: there is risk of infection, fear of becoming sick, of losing loved ones, as well as the prospect of financial hardship. All these stressors, and many more, are present in this current pandemic.
The second epidemic – and setting up “the second tent” online
Already, we see a sharp increase in absenteeism in countries that went into lockdown. People are afraid to catch COVID19 on the workfloor, and avoid work.
But we will see a second wave of impact in three to six months. Just when we need all able bodies to repair the economy, we can expect a second, sharp spike in absenteeism and burnout.
We know this from many examples, ranging from absenteeism in military units after deployment in risk areas, companies that were close to Ground Zero in 9/11 and medical professionals in regions with outbreaks of ebola, SARS and MERS.
In our own research we can see resilience in the (Belgian) population sliding as we go into the third week of the lockdown.
Right before the lockdown, we conducted a benchmark survey among a representative sample of the Belgian population. In that survey, we saw that 32% of the population could be classified as highly resilient (“green”). Only 15 percent of the population indicated toxic levels of stress (“red”).
In our most recent survey after two weeks of lockdown, the green portion shrunk to 25% of the population. The “red” part of the population increased by 10 percentage points to fully 25% of the population.
These are the people at high risk for long-term absenteeism from work due to illness and burnout. Even if they stay at work, research from Eurofound reported a loss of productivity of 35% for these workers.
In general, we know that the at-risk groups for long-term mental health issues will be the health care workers who are in the front line of this war on the corona virus, young people (< 30) and children, the elderly and those in precarious situations, such als mental illness, disabilities and poverty.
Actually, all this should surprise no one, as the insights on the long-term damage of disasters have been accepted in the field of trauma psychology for decades.
Source: Beverly Raphael (1986). When disaster strikes.
But while the insights are not new, the sheer scale of these lockdowns is. This time, ground zero is not a quarantined village or town or region. Today, a third of the global population is dealing with these intense stressors.
We need to act now to mitigate the toxic effects of this lockdown.
What governments and NGOs can and should do today
It helps that there is broad consensus among academics about the psychological care following disasters and major incidents.
A few rules of thumb:
- Make sure self-help interventions are in place that can address the needs of large affected populations
- Educate people about the expected psychological impact and reactions to trauma if they are interested in receiving it. Make sure people understand that a psychological reaction is normal.
- Launch a specific website to address psychosocial issues.
- Make sure that people with acute issues can find the help that they need
In Belgium, we recently launched “Everyone OK”, an online tool that tries to offer help to the affected population. Using existing protocols and interventions, we launched our digital self-help tool in as little as two weeks.
There is no need to reinvent the wheel.
When it comes to offering psychological support to their populations, most countries are late to react – as they were to the novel coronavirus. But better late than never.
- Brooks et al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet; 395: 912–20
- Eurofound (European Working Conditions Survey, 2016: Job quality in Belgium: https://werk.belgie.be/nl/nieuws/een-analyse-van-de-jobkwaliteit-belgie-2015?id=45604
- IASC (2020) Briefing note on addressing mental health and psychosocial aspects of COVID-19 Outbreak- Version 1.1
- Jalloh MF, Li W, Bunnell RE, et al. (2018) Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ Glob Health;3
- Jones, David. (2020). History in a Crisis — Lessons for Covid-19. New England Journal of Medicine. 10
- Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 2020; 33
- WHO (2020) Mental Health and Psychosocial Considerations During COVID-19 Outbreak
Prof. Dr. Elke Van Hoof is a clinical psychologist and an authority in the fields of stress, burn-out and trauma. She is a professor in health psychology and primary care psychology at the Vrije Universiteit Brussel, and serves as an expert for the Superior Health Council of Belgium and the European Parliament. She is the founder of Ally Institute.
(* We use “quarantine” and “lockdown” interchangeably here, as they both refer to the “restriction of movement of people who have potentially been exposed to a contagious disease”. This is different from “isolation”, which is the separation of people who have been diagnosed).
Publication on World Economic Forum