Emergency Psychiatry encompasses disaster psychiatry, a part of which is epidemic and pandemic psychiatry. This should address three targets: (1) public suffering uncertainty and isolation consequences, (2) medical workers and families who face stigma besides, and (3) patients who face biological consequence besides and besides.
Literature about mental health during pandemics remains scanty
The earliest studies reported 22% lifetime prevalence of depression in human immunodeficiency virus (HIV) patients in the early 1980s. Mental health of medical workers, patients in isolation, and survivors were studied for severe acute respiratory syndrome (SARS) caused by coronavirus in China in 2003. Post-traumatic stress disorder (PTSD) was recorded in 20% of medical workers. WHO Mental health policy was accused of creating “panic-demic” peddling unproven vaccines during the Swine flu H1N1 in Mexico in 2009. Zika in Uganda in 2014 appeared in social media, perhaps for the first time in history, and this allowed social researchers to study the public sentiment, also known as the emotional epidemiology. It indicated that 4 out of 5 posts on Zika on social media were accurate; yet, those that were “trending” were “fake news” .
Novel coronavirus disease in 2019 (COVID19) is a zoonotic beta-coronavirus that was first reported and then became widespread within Wuhan, the capital city of Hubei Province of China. Then, the disease rapidly spread throughout China and elsewhere, becoming a global health emergency . Clinical presentation of COVID19 greatly resembled viral pneumonia such as SARS and MERS. Most cases are mild cases (81%) whose symptoms were usually self-limiting and recovery occurred in 2 weeks. Severe cases progressed rapidly with acute respiratory distress syndrome (ARDS) and septic shock and eventually ended in multiple organ failure . World Health organization stated in its COVID19 situation report -198, that global cases exceeded 18 million cases and deaths exceeded half a million .
To face this existential anxiety, problem solving parallels emotional coping. Problem solving includes trying to find medications and vaccines, prepare serums, and minimize infection through preventive policies like (a) travel restrictions: protective sequestration, quarantine, and sanitary cordon; (b) shelter-in-place and social distancing: cancel mass gatherings, school, and workplace closures; and (c) case separation and staff high isolation (gloves, eyewear, waterproof gown, N95 respirator). These policies lead to isolation and lack of emotional support (separation from loved ones, masked facial expression, no skin contact) beside the baseline uncertainty about getting sick, recovering, surviving, or loosing loved ones [5,6,7].
Emotional coping can be externally controlled to a great extent. Mood and behavior spread in populations by exposures to surrounding people or through media. We imitate most outspoken, encouraging, in similar situation persons . This creates an emotional and behavioral contagion (public panic or mass hysteria) shadowing the original pandemic. In 2256 adults poll commissioned by National Health Council, medical news were influential, as half viewers took some health actions .
When problem solving and emotional coping fail, there are expected high rates of PTSD, anxiety, depression, or substance abuse among the public during pandemics .
Disseminating solid evident epidemiological facts in outbreak is the best countering to anxiety-inducing uncertainties, rumors, and speculations. We need to address emotional pandemic accompanying actual outbreak [10, 11]. Ignorance and fear can lead to massive uncontrollable behaviors that have deleterious effects for entire societies. If pandemic is triggered, in bioterrorism or biological war, emotional epidemiology becomes a target in the era of social media with organized hostile malicious feeds as rumors, half-truths, and “fake news” to maximize impact by heavily manipulating pre-existing and developing public attitudes .
Managing emotional epidemics shadowing microbial epidemics is essential especially in biological warfare and bioterrorism as a mean of defense in psychological wars.
Significance of the study
Psychiatric studies in pandemics remain scanty. This study assesses COVID19-related anxiety in Egypt and correlates it to knowledge and stigma in Egypt.
Knowledge about COVID19 decreases anxiety and stigma related to it.