Psychological aspects and effects of COVID-19 and recommendations on preserving mental health
After the first information on COVID-19 coronavirus outbreak in late 2019 in China and its further spreading to other countries, the level of engagement of many experts, decision makers, media and general population has increased. Coronavirus is at the centre of attention across the globe and is affecting the lives of many families and individuals.
How we act
As in other emergencies, we witness various human behaviour. Some people adhere to the guidelines and information provided by relevant institutions and protect themselves and others and minimise the damage. There are however persons who ignore the warnings and are convinced this won’t happen to them or are only concerned about themselves and their families. Their behaviour may jeopardise themselves and persons in their surroundings.
In order to minimise the risk it is necessary for everyone to ne responsible and follow the guidelines for protection. Remember:
This is how we need to act
Everyday activities that prevent infection and illness
- Frequently wash your hands with soap and water, for at least 20 seconds at a time, especially after going to the toilet, before eating and after blowing your nose, sneezing and coughing.
- If soap and water are unavailable, you can use alcohol based hand disinfectant with minimum 60% alcohol. If your hands are visibly dirty make sure to wash them with soap and water.
- Avoid touching your nose, eyes and mouth with your hands
- When coughing and sneezing do it into your elbow or in a paper tissue. Try not to cough or sneeze into your hands because you may spread the virus further. After sneezing into the tissue, throw it into garbage. If you sneeze into your hands, do not touch anything and immediately wash your hands with soap and water.
- Keep your distance from other persons, minimum 1-2 metres.
- Do not shake hands
- Whatever you need to do during the day, try as hard as possible to do it at home or near your home – do not use public transportation, especially not during the crowded hours
- Regularly air out your apartment
- Avoid close contact with persons who have symptoms of illness
- Stay home when you are sick.
- Clean and disinfect everything you touch frequently using the usual household disinfectants and wet wipes
- It is not recommended for persons who feel well and have no symptoms to wear masks
- Protective masks should be worn by persons with symptoms that may indicate COVID-19 infection in order to prevent others from infection. Also, wearing masks is very important for health workers and persons providing care to ill persons, like their family members.
- If you feel the symptoms first call the telephone numbers provided by the Ministry of Health: 064/89-45-235 and the Institute for Public Health 011/26-84-566 and 060/018-02-44.
How we feel
The situation with COVID-19 is new and many details are unknown so it is possible for this to amplify the sense of danger and the fear for personal health and the health of the family members and other loved ones. Fear, it may be said, is natural in such situations. Some people also experience panic – intense fear. Fear is a reaction to the real or perceived threat. In the situation we are in, with the coronavirus, our fear is not a reflection of the real risk, based on scientific, epidemiological data, but a reflection of our personal perception of risk and danger. The less we know about a threat, the greater our fear and the sense of dread. We then tend to overestimate the danger of new risks so we exhibit behaviour that aims to regain control (hoarding stocks, food, protective gear, regardless of the fact that having a stock of disinfectant at home will not help us if our neighbours don’t have any).
We still do not have much information about panic and fear in the current situation but we can make some conclusions based on behaviour and emotional reactions. There are few research studies on the effects of infections on mental health but we do know that they affect mental health and that attention must be paid to preserving mental wellbeing.
In every epidemic it is normal that individuals will feel scared. Usual responses of persons directly or indirectly affected include:
- Fear of falling ill and dying
- Avoiding approaching health facilities due to fear of becoming infected while in care despite having symptoms
- Fear of losing livelihoods, not being able to work during isolation, and of being dismissed from work
- Fear of being socially excluded/placed in quarantine because of being associated with the disease (e.g. racism against persons who are from, or perceived to be from, affected areas)
- Feeling powerless in protecting loved ones and fear of losing loved ones because of the virus
- Fear of being separated from loved ones and caregivers due to quarantine regime
- Refusal to care for unaccompanied or separated minors, people with disabilities or the elderly due to fear of infection, because parents or caregivers have been taken into quarantine
- Feelings of helplessness, boredom, loneliness and depression due to being isolated
- Fear of reliving the experience of a previous epidemic
There are specific stressors particular to COVID-19 outbreak that affect the population.
- Risk of being infected and infecting others, especially if the transmission mode of COVID-19 is not 100% clear
- Common symptoms of other health problems (e.g. a fever) can be mistaken for COVID-19 and lead to fear of being infected
- Parents may feel increasingly worried for their children being at home alone (due to school closures) without appropriate care and support.
- Risk deterioration of physical and mental health of vulnerable individuals, for example older adults and people with disabilities, if caregivers are placed in quarantine if other care and support is not in place.
How to cope with fear?
- Follow the available information that are verified and provided by the relevant public institutions
- Adjust your behaviour to follow the guidelines so that you lower the risk, be disciplined and follow the recommendations of the experts.
Recommendations of improving mental health
- Above all be take care of your health and follow the instructions of the public institutions but also be aware that most people infected with COVID-19 only experience mild symptoms
- Work is being done to help persons who may be more vulnerable to the coronavirus, such as older persons and persons living with disabilities.
- Follow the news about the epidemic, and make sure you follow the verified and relevant information provided by the websites of the Ministry of Health and the Institute for Public Health as well as the World health Organisation. Communicate your to your parents and the Children (Relevant websites: https://covid19.rs/, https://www.zdravlje.gov.rs/, http://www.batut.org.rs/, https://www.who.int/emergencies/diseases/novel-coronavirus-2019).
- Talk to your older parents and share with them important information and recommendations on behaviour. Emphasise that for their health it is essential that they follow the guidelines listed above. Underline the importance of sticking to guidelines and assist them in procuring important articles and other activities. Social isolation is very important for them at this time.
- Neighbourly assistance: try and organise the community, in the apartment building or in your street so you can collectively assist older persons (especially those living alone) using all the protective measures (such as masks, gloves, no handshakes…). Older persons in your community may not be included in its activities or may not be receiving any support from the institutions and you may be their only support. Try and arrange within the community so that there are persons who will go for the groceries for them, pay their bills or walk their dogs.
- Your children may also feel fear because they see your behaviour and reactions. Therefore it is important to communicate with them, about the behaviour and self-protection but also to ensure they stick to routine while at home. It is also good to somewhat restrict their access to different media so that their anxiety is under control. You can play board games and other games with them and perhaps teach them some old games that they may not know.
- Remain in touch. Keep in touch via social networks as this will help reduce stress and reinstate the sense of normalcy without increasing the risk of infection. You can create Skype, Viber and WhatsApp groups with your family and friends, neighbours and relatives. You can talk on the phone, exchange text messages and use other services. Feel free to share useful information you find on public institutions’ web sites. This will help your family and friends deal with anxiety.
- Red Cross organisations can with their older beneficiaries and older volunteers create telephone circle programmes which acts as a form of psychosocial support. In such a circle, 15 older persons and a Red Cross person call each other every day at the same every day so that every person knows when to expect the telephone call. The Red Cross volunteer starts the circle and calls the first older person. That older person calls the second older person and this goes on until the last person in the circle calls the Red Cross volunteer to close the circle and report whether anyone needs any assistance. The individual conversations should not exceed 15 minutes.
- Persons who experience great anxiety, long lasting sadness or other long lasting reactions that affect their work or interpersonal relationships should consult trained and experienced mental health experts and get help with their extreme stress.
- Be responsible, conscious, maintain solidarity and follow official guidelines.
Some of the activities to maintain older persons’ wellbeing during isolation or quarantine:
- Regularly take food and your prescription therapy
- Regularly drink water (8 glasses per day)
- Physical exercise (e.g. yoga, tai chi, stretching)
- Cognitive exercises (including crossword puzzles)
- Relaxation exercises (e.g. breathing exercises, meditation)
- Reduce the time spent looking at fearful images on television, search information from reliable sources
- Reduce time listening to and thinking about unconfirmed rumours
- Reduce time looking for information (1-2 times per day, rather than every hour
- Read books and magazines
- Try and work on some of your talents that you haven’t had the time to work on before (painting, poetry writing, story writing, origami, knitting)
- Regularly talk to your family and friends on the telephone. Create Skype, Viber and WhatsApp groups with your friends, relatives and family and regularly communicate. You will have increased sense of safety because someone cares about you and you care about others, which will also give you a sense of responsibility.
Some other activities to do while in isolation
- Sorting your old photographs
- Sorting your old recipes. You may type them in the computer and gift them to your children or share them with friends
- Those who already use the computer and the internet can pursue their usual hobbies: playing chess online, exchanging tips of sewing etc.
It is important that your day is structured and your time organised so you preserve your physical and mental health.
Make sure your behaviour does not bring damage or harm to others by exposing them to additional risks (if you are ill do not go to work or to home visits, do not hoard goods at home as they are unnecessary and you will jeopardise other people’s livelihoods and indirectly bring yourself and your family to increased risk because if your neighbours do not have disinfectants, that is also a risk to you)
Make sure, best you can that older persons and children you provide care to are safe and are protected from physical and mental harm (wash your and their hands, make sure they keep distance of one metre minimum from others at all times, cough and sneeze in your elbow or paper tissue and use protective gear whenever needed).
Treat people with respect and observing their cultural and societal norms (if a person is infected do not stigmatise them).
Make sure that people can access information and assistance equally and without discrimination (also considering their and your safety).
Assist people in getting the help that is available.
Act only in the best interest of every person you are in contact with (observing the recommendations on behaviour and protection).
American Psychological Association (2020). Speaking of Psychology: Coronavirus Anxiety. https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety (on 14 March 2020)
Center for the Study of Traumatic Stress (CSTS). Mental Health and Behavioral Guidelines for Response to a Pandemic Flu Outbreak. https://www.cstsonline.org/resources/resource-master-list/mental-health-and-behavioral-guidelines-for-response-to-a-pandemic-flu-outbreak (on 14 March 2020)
Inter-Agency Standing Committee IASC Reference group for Mental Health and Psychosocial Support in Emergency Settings. Briefing note on addressing mental health and psychosocial aspects of COVID-19 OutbreakVersion 1.0 (2020)
(on 15 March 2020)