Looking Into The Crystal Ball:

Psycho-Social Consequences of the Pandemic

Yvonne Vissing

None of us in our lifetimes have seen anything like what we are experiencing in the coronavirus pandemic. Leaders are scrambling to figure out what to do to address the problem before it gets worse. The general public feels like deer-in-the-headlights, seeing potential tragedy heading right for them as they feel frozen, not knowing exactly which way to run for safety. If terror is intense, extreme or overwhelming fear, especially when confronted with something beyond our control, then what we are experiencing with the pandemic is truly terrifying. It’s like we are in a nightmare, and hope to wake up and it will all be over and things will be as lovely in our lives as they used to be. But they’re not. And from the sounds of it, they never will be again.

We are normal people trying to figure out how to navigate our everyday lives. And we are not sure how best to do it, given the confusing, conflicting, and chaotic news that seems to change daily.

It’s not like the government didn’t consider the possibility of a pandemic. It did. The US once had a National Security Council pandemic unit. It anticipated the possibility of a health epidemic like the one we are now experiencing. But the Trump administration disbanded it in 2018, despite warnings not to do so. ABC News reports that public health and national security experts shook their heads in dismay when President Donald Trump said the coronavirus “came out of nowhere” and “blindsided the world.”

It’s not like the healthcare system was in great condition either, despite the rhetoric that we have the best healthcare system in the world. A World Bank study measuring human capital in 195 nations from 1990 to 2016, found the US had fallen from 6th to 27th place when it comes to healthcare. A 2019 Peterson Center on Healthcare and Kaiser Family Foundation study comparing the US healthcare system to other countries found the U.S. has poorer rates of amenable mortality, as measured by the Healthcare Access and Quality Index. We have a higher disease burden and a higher mortality rate for respiratory diseases than in comparable countries. Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries, who have quicker access to a doctor or nurse when they need care. Moreover, the U.S. was found to have higher rates of medical, medication, and lab errors than comparable countries.

In a bifurcated nation with healthcare haves and have-nots, the US continues to stand almost entirely alone among developed nations that lack universal health care, according to a study in The Atlantic. Our nation’s patchwork of a health care system fails to serve people well on a good day, which this is not. Governors, hospitals, businesses and local government representatives are taking the lead of what to do to safeguard people because there is not a coordinated national plan about how to do so. While the number of people getting health insurance increased under President Obama, it has fallen significantly since 2016. It is estimated that about 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families. Even if you have health insurance, there are co-pays, conditions that aren’t covered, challenges in finding a doctor taking new patients, wait time to get an appointment, and a host of other issues that make it hard to get the health care you need when you need it. And while presidential candidates talk about how much people like their health insurance programs — frankly, do you actually know anyone who really likes theirs?

In a 2019 report, the Global Preparedness Monitoring Board found that when there is a massive disease outbreak, the poor suffer the most. They report that “Any country without basic primary health care, public health services, health infrastructure, and effective infection control mechanisms faces the greatest losses, including death, displacement, and economic devastation… Disease outbreaks disrupt the entire health system reducing access to health services for all diseases and conditions, which leads to even greater mortality and further economic depression….Negative impacts are particularly profound in fragile and vulnerable settings, where poverty, poor governance, weak health systems, lack of trust in health services, specific cultural and religious aspects and sometimes ongoing armed conflict greatly complicate outbreak preparedness and response.”

President Trump’s initial response to the coronavirus expressed economic concern over businesses like his and the stock market, not massive concern over the lives of those who could get sick or those who are on the front lines of serving them. Emphasis has been made on helping small businesses or bailing out big ones. Instead of paying attention to health official's recommendations to reduce exposures, he encouraged the public to continue to shop, eat out, go to work, and be tourists. It has only been when faced with incontrovertible evidence that potentially 2.2 million Americans could die from the virus, that may not subside until August and push the nation into a recession that made the one in 2008 seem pale, did he change his tune to view the situation as dire as it evidently is.

The administration’s apparent desire to punish the poor for daring to be impoverished has been notable in their continued thrust to cut 700,000 people from food stamps if they don’t meet work requirements during the pandemic. They are willing to cut interest rates on school loans during this time, but that is a pittance compared to the thousands of dollars most people owe in student loans — which are not being reduced. Senator Mitt Romney has adapted Andrew Yang’s recommendation to give people $1000 a month to help them, but for most families, that may cover a month’s rent and little more. If Congress does agree to give money to individuals, then how will they get it to them in an easy, fast way before they lose their homes or be unable to pay for food or medical care? No doubt there will be qualification paper-work to fill-out and submit, only to be processed by some unidentified agency for an unknown period of time. The stock market portfolios of millions of people have just taken a nose-dive. People working in restaurants and other occupations aren’t going to have work, and lay-offs seem inevitable. People cannot count on Social Security to be there for them in the future, and one has to question how folks are going to make ends meet in the days and years to come.

The crisis in the economy, failure of our health care and the inability of government systems to meet the demands the coronavirus all are getting a lot of attention. But one doesn’t have to look into a crystal ball to see another crisis looming. Let’s turn our attention from system wellbeing to individual and family wellbeing. The psycho-social, mental health, relational problems that the virus are creating aren’t getting much coverage. So let’s turn our attention to them.

Look at the average individual. We all have economic concerns. We aren’t sure if our jobs get cut back, if our incomes are reduced, and if we experience unexpected expenses that we will be able to pay for essential things. Forget discretionary purchases. The number one reason most people (66%) file for bankruptcies is a healthcare expense. We are afraid we may not be able to pay our rent or mortgages and we could be evicted or lose our homes as a result. Average people can’t afford a house in 70% of the nation. We’re afraid we may not be able to pay for heat and utilities. Hunger is already a problem, in 2019 over 37 million people in the US struggling with hunger before this pandemic.

Worrying about not having enough money is a national past-time, with at least 59% of the population reporting that they worry about money “constantly”. The common emotional responses to money-worry include stress, fear, panic, anxiety, denial, anger, depression, sleep problems, eating problems, to name a few. One can assume that as people find their incomes cut, these negative emotions will escalate.

We are told we should engage in “social distancing”.

We are discouraged from going to the store, school, faith or community services, gyms, recreational facilities or events, or even out to eat. People are told they should limit contact, even with family members who may have unknowingly been exposed to the virus. What this means is that in order to survive this pandemic, we are to become socially isolated. While this makes good sense in terms of limiting the spread of the disease, social isolation has a down-size that we are wise to pay attention to. Many people live alone, today, 35.7 million Americans or 28% of households, live alone, and they vary widely in age. The American Psychological Association reports that the loneliness that accompanies social isolation can be deadly. Their report indicates that “There is robust evidence that social isolation and loneliness significantly increase the risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators.” Data indicates that people who are socially isolated have higher rates of depression and anxiety, poor-quality sleep, more cigarette smoking, impaired executive function, accelerated cognitive decline, higher blood pressure, more obesity, poor cardiovascular function and impaired immunity. This is true for older people, but research indicates that social isolation in children and youth is also associated with both short and long term mental health problems and physical diseases.

There is a mind-body association when it comes to stress. In this pandemic situation, we are becoming emotionally stressed over the ambiguity and chaos of the situation. If we are isolated, we can predict more stress. The Mayo Clinic reports the following stress-related problems:

Common effects of stress

On your body

On your mood

On your behavior

Headache

Anxiety

Overeating or undereating

Muscle tension or pain

Restlessness

Angry outbursts

Chest pain

Lack of motivation or focus

Drug or alcohol misuse

Fatigue

Feeling overwhelmed

Tobacco use

Change in sex drive

Irritability or anger

Social withdrawal

Stomach upset

Sadness or depression

Exercising less often

Sleep problems

If you’re alone and get sick, who will take care of you? Should you try to go to health care providers or do home self-care? While the public is told that we should seek care when we are really sick, there aren’t sufficient tests out there to tell us what illness we have and that we can make a phone call but not to show up at the ER unless we feel it is life-threatening. This is confusing information, when to seek care and when not to. Family members or friends who don’t live with you may not be eager to help you if you think you are sick. Conversely, you may not want to see friends or even your family members if you suspect they have been exposed to the virus — even if they are asymptomatic. Imagine how frustrating one may feel if they can’t get to treatment, can’t count on neighbors, and don’t know what to do, terrified about what their future may hold.

What health-related isolation breeds is a lack of trust of others. When you don’t trust people, there is a break-down of intimate relationships. Suspicion, insecurity, doubt fear, and an increase of depression and anxiety. People may withdraw from communicating what they are thinking and feeling when they feel they could be at risk. Self-protection may reign when people are afraid they could be hurt. While understandable, it undermines the fabric that holds relationships and communities together.

Turning to families, the impact of work and income disruptions, school closures, and the increase of social distancing may be significant. Home routines that have been functional, with parents going to work, children going to school, and having times when people come and go, eat, or interact with each other may all be changed. People who are quarantined may find spending too much time together, especially in small surroundings, to be very stressful. Arguing over what television show to watch, what to eat, who is using the computer, who is doing chores may all increase relationship tension. Children and teens may be bored and resent being kept inside the house, and unless resources and strategies are in place to provide them constructive options, this can result in tense parents becoming intolerant, angry, and potentially abusive.

Financial, health, relationship and situational stress are directly correlated with a rise of both domestic violence and child abuse. While there is a common view that because couples are together that there will be a baby boom nine months from now, the chances that there will be an increase in domestic violence is huge.

Research on the effects of money, work, and relationship stress on physical, verbal and emotional child abuse is well documented. The current pandemic is creating a multiplicity of stressors on families, and few tried-and-true coping strategies for a situation such as this. We are in uncharted territory — but can safely predict that a rise of family dysfunction and abuse is to be expected.

What is to happen to the children who normally are cared for in centers or schools which have closed? What about providers who themselves are sick and cannot care for other people’s children? Routines are disrupted, so one can logically expect behavioral adjustments, some of which may be challenging. What happens when daycare centers need to close? How safe can a parent feel about having their child go to one, knowing that every child there is associated with a network of people there who are associated with a large network of other people? Statistical probabilities are such that there is a chance that someone in that network will have been exposed to the virus, even if they show no symptoms themselves. While parents may be allowed to work from home for a while, some have to go to work no matter what, either because they are in occupations where they are deemed essential or if they don’t show up to work they will lose their job. Some child care providers are being encouraged to take more children in as a result, which will increase exposures to the virus, directly or indirectly.

There are concerns about what will happen for children who can’t go to school or a center where they receive food, education, or support that they will otherwise go without. At this time, we see a variety of responses. One is a “the parent will take care of it” approach. Some will, some won’t; some can, and some can’t. Another is that bus drivers, school staff, organizations or volunteers are stepping up to provide resources and supports. While good-will often emerges for the short-run, what will happen if this isolation and social disruption exist for weeks, months, or even years?

Schools, with sports, clubs and after-school activities, keep many children and teens busy in pro-social activities that they may no longer have access to during the time of the pandemic. What are they to do with their time and energy? Being social is a very important part of a young person’s life. As social distancing is encouraged, they may be discouraged from going to the park, the beach, the swimming pool, or congregate in their customary recreational haunts. There seems to be little talk about what to do for them to keep safe and engage in positive activities.

Don’t forget the impact of the pandemic on homeless and housing distressed children. Where are they to go when they are sick, or to be socially distanced from others? And then there are the children who are detained at the US-Mexico border. Healthcare for them is questionable in general, and there are concerns that the children were not allowed to have vaccines to protect them from the “regular” flu, much less protections from the coronavirus. Children are at special risk for all kinds of reasons during this, or any, pandemic.

The bottom line is that stress and social disruption impacts are going to be significant. In looking at that crystal ball, we’d better be smart enough to figure out how to address the psycho-social needs of children, teens, and families now, otherwise our lack of attention to them will become one more mess that we could have prevented but didn’t. Ensuring mental health is as much of a priority as physical health is an important thing to do. Mental health crises are around the corner. Are systems prepared to deal with that? It would seem that they are not, as mental health services aren’t available now, much less in the time of social chaos. Therapists are not longing to engage in face to face therapy right now, even as child, teen, parent, and older adult stresses skyrocket.

The national attention is on now keeping us from dying — which is good and understandable. The emphasis on making sure the economic markets are strong is also reasonable and appropriate. But our failure to pay attention to the mental health needs of the entire population is also going to wreck our social world. Anxiety, stress, and depression are inevitable. As people are socially distanced, worried about health and money, are we prepared to handle the rise of preventable suicides? What about the rise of alcoholism, drug use, cigarette smoking and vaping? And don’t forget — just as the scammer who hoarded 17,000 containers of sanitizer to sell at wildly overprices, other scammers are popping up. People who are financially desperate may end up engaging in property crime. Violent crime rise can be predicted, not just at home but as stressed and angry people interact in the community.

Where is the national conversation about that? Will we even have one? Or, is it going to be like the patchwork system we now see operating where every individual finds themselves isolated, trying to fend for themselves?