Passengers wearing protective face masks arrive at Suvarnabhumi Airport in Bangkok on February 9, 2020. The coronavirus in China has killed over 800 people and hammered tourism in SE Asia. Photo: Mladen Antonov / AFP

For decades, people have perceived risk and what causes them to overreact to epidemics, terrorist attacks and other extreme events, even when their personal risk is infinitesimal, yet at the same time have been less attentive to other threats that are far more likely to harm them, such as the flu.

What happened after the outbreak of the Wuhan coronavirus is quite consistent with what we know about risk perception. The minute the threat was communicated, it hit all of the hot buttons: It can be fatal, it’s invisible and hard to protect against, exposure is involuntary, and it’s not clear that the authorities are in control of the situation. As people try to protect themselves from this mysterious new virus that has spread from China, face masks have reportedly sold out in some countries – despite experts questioning how much protection they offer.

Rapid development in Asia, Africa and elsewhere has resulted in millions of people from rural areas pouring into big cities, where diseases can become established and spread quickly, and an explosion of air travel has meant that outbreaks in one part of the world can spread quickly to others. Though the spread of Covid-19, as the disease caused by the Wuhan coronavirus has been named, may have gained serious attention, it is not a surprise that people have outsized fears.

Timely, honest communication from a source an audience deems credible is essential to containing fear during an epidemic, but governments have the tough job of explaining risk and telling people how to act without also seeding alarm. The deepening crisis in China has caused fears of more global contagion. While the World Health Organization has praised China’s handling of the epidemic in contrast to its cover-up of the outbreak of severe acute respiratory syndrome (SARS) in 2002-2003, others insist Beijing should be more open.

The 2019 novel coronavirus (2019-nCoV), believed to have originated in a wet market in Wuhan, Hubei province, at the end of 2019, has gained intense attention nationwide and globally. Authorities have placed some 56 million people in Hubei under quarantine, in an unprecedented effort to stop the new coronavirus from spreading.

The emergence of 2019-nCoV has parallels with the 2003 SARS outbreak, which was caused by another coronavirus that killed 349 of 5,327 patients with confirmed infection in China. So far, mental-health care for the patients and health professionals directly affected by the 2019-nCoV epidemic has been under-addressed.

Patients confirmed to be or suspected of carrying 2019-nCoV may experience fear of the consequences of infection with a potentially fatal new virus, and those in quarantine might experience boredom, loneliness and anger. Furthermore, symptoms of the infection, such as fever, hypoxia and cough, as well as adverse effects of treatment, such as insomnia caused by corticosteroids, could lead to worsening anxiety and mental distress. This virus has been repeatedly described as a killer, for example on WeChat, which has perpetuated the sense of danger and uncertainty among health workers and the public.

Mandatory contact tracing and 14-day quarantines, which form part of the public health responses to the outbreak, could increase patients’ anxiety and guilt about the effects of contagion, quarantine, and stigma on their families and friends.

Health professionals, especially those working in hospitals caring for people with confirmed or suspected 2019-nCoV infection, are vulnerable to both high risk of infection and mental-health problems. They may also experience fear of contagion and spreading the virus to their families, friends or colleagues.

Timely mental-health care needs to be developed urgently. Multidisciplinary mental-health teams established by health authorities at regional and national levels (including psychiatrists, psychiatric nurses, clinical psychologists, and others) should deliver support to patients and health workers.

Second, clear communication with regular and accurate updates about the Covid-19 outbreak should be provided to both health workers and patients in order to address their sense of uncertainty and fear. Treatment plans, progress reports, and health status updates should be given to both patients and their families.

Third, safe communication channels between patients and families, such as smartphone communication and WeChat, should be encouraged to decrease isolation.

Fourth, suspected and diagnosed patients with Covid-19 as well as health professionals working in hospitals caring for infected patients should receive regular clinical screening for depression, anxiety, and suicide risk by mental-health workers.

Timely psychiatric treatments should be provided for those presenting with more severe mental-health problems. For most patients and health workers, emotional and behavioral responses are part of an adaptive response to extraordinary stress, and psychotherapy techniques such as those based on the stress-adaptation model might be helpful.

In any biological disaster, themes of fear, uncertainty and stigmatization are common and may act as barriers to appropriate medical and mental-health interventions. Based on experience from past serious novel pneumonia outbreaks globally and the psychosocial impact of viral epidemics, the development and implementation of mental-health assessment, support, treatment, and services are crucial and pressing goals for the health response to the 2019-nCoV outbreak.

Fawad Kaiser

Dr Fawad Kaiser is a professor, Fellowship Diplomate of the American Board of Psychotherapists, and a member of the International Association of Forensic Criminologists. He is currently a consultant forensic psychiatrist in the UK.

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1 Comment

  1. Wonderfully written. The understated issue of mental health is as pressing as the coronavirus itself and needs to be addressed with the same enthusiasm. For some patients, its the fear of being in quarantine that worries them more and that could be as dangerous as the virus, if not more.

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