South Africans are gradually adapting to the “new normal” as we enter our fourth month of lockdown. The world has changed significantly, in a short space of time, and everyone has had to endure significant stressors since the identification of the first COVID-19 case in March this year. On a daily basis the numbers are increasing, and are set to increase significantly in the months that lie ahead. Some authors have written and warned about the so-called “second wave” that will follow that of the peak in infections – and that is the “tsunami” of mental health problems that are expected to follow.
Studies that are emerging from countries where the peak of infections has passed and lockdowns are being eased, report that there has been a significant increase in the rates of mental health disorders such as major depression, anxiety disorders and post-traumatic stress disorder, as well as substance use disorders. A concern is that suicide rates are expected to rise if interventions are not implemented timeously.
Current knowledge indicates that COVID-19 infection affects multiple systems in the body and the brain is not exempt. As psychiatrists we are gradually beginning to see what the virus does to the brain in those who become ill. According to psychiatrist Prof Roger McIntyre from Toronto, several factors that are already known to be “brain toxic” have been identified and have all been prominent during this pandemic: increased fear, frustration, boredom and financial insecurity. Lockdown itself has caused a surge in mental health problems and studies have shown that the longer the lockdown period continues, the poorer outcomes for mental health tend to be. The well known ill effects of prolonged periods of loneliness have been extensively documented even before the pandemic.
As we continue our extended period of lockdown in South Africa, medical practitioners have, like the rest of the population had to adjust. Many are working at the forefront of the pandemic, screening and treating patients with the disease. The challenges are significant – having to stay updated with information pertaining to the treatment and management of COVID-19 disease, epidemiological statistics that change daily and projections regarding the burden it will place on our constrained healthcare systems, and adjusting our way of work accordingly.
This is a time of huge and unprecedented upheaval and stress for doctors and other healthcare professionals in South Africa, as is the case elsewhere in the world. With our current systems, the stress experienced in both the public and private sectors is increasing, although this may be for different reasons. We all deal with patients and their families who are being affected by the viral pandemic on various fronts. We all risk becoming infected in the line of duty (and this could be so for many months to come). We are worried that we might then infect our loved ones. Forced quarantine, if and when it comes, could be an added burden, and we will not be able to work. And for many, especially those working in the private sector, there is the added worry of significant financial loss during this period.
Doctors in South Africa are generally well trained to deal with disease, and step up to face the challenge when duty calls. However, doctors are not always adequately trained to deal with the emotional burden that our work may entail. We are good at caring for our patients, but not always good at caring for ourselves. Countries that have dealt with the peak of infections have reported increased mental health problems in doctors and other healthcare professionals working with COVID-19 patients. We can expect a similar scenario in South Africa.
If you, or someone you know needs help, please contact the Healthcare Workers Care Network which offers free therapy sessions to assist in this difficult time. The network can be contacted at healthcareworkerscarenetwork.org.za, on the 24-hour helpline 0800 21 21 21, or by sending an SMS to 43001.