Corona Virus

The COVID-19 pandemic is a threat to both physical and mental health.
Large numbers of people are affected by adversity associated with loss of livelihoods and sudden uncertain futures due to the economic consequences. Fear from the virus is spreading faster than the virus and inducing mental health and psychosocial consequences among those affected directly and those who are following the news. Fear, depression and anxiety/worry are likely common reactions in all affected countries. For some these reactions are prolonged, severe and disabling, thereby leading to increases of mental health conditions among adult males and females, girls and boys.
• Concerns about health, beloved older relatives, financial stability and feelings of helplessness are all very common emotions reported around the world across all age groups and genders.
• Physical distancing, self-isolation, quarantine, and working from home are triggering reactions of isolation, loneliness, and loss of social contacts among large number of people worldwide.
• Extreme stressors may induce, worsen or exacerbate pre-existing mental health conditions. Older adults and people with pre-existing health, mental health and substance use conditions are among the most vulnerable.
• There are mental health and psychosocial consequences of discrimination towards persons who have been infected and their family members and there is social stigma towards those treating and caring for people with COVID-19.

Scenario in Pakistan,during Covid 19 Pandemic .
Prof (Dr)Unaiza Niaz MD,FRCPsych,
President IPTP

Pakistan is a densely populated country of more than 210 million, with megacities Lahore and Karachi each teeming with more than 10 million people, the government took important steps early to stop the spread of the disease, and each of its provinces implemented varying levels of lockdown in the past week as the number of cases rose. As of March 26, Corona virus(COVID 19) cases in Pakistan — the world’s fifth most populous country. A special relief packages was announced by the government, thus the criticism and blame of inadequate measures and negligence has reduced.

The country’s health system — with dated and limited public health facilities, and costly private hospitals inaccessible to all but the rich — is woefully unprepared to deal with COVID-19 and its influx of critically ill patients. Doctors lack personal protective equipment; at least one of the nine victims so far is a doctor.
Since last several days we are homebound, and the household workers (cook, driver, maids and living -in) have become jittery, irritable, quarrelsome and lazy. Parttime workers as cleaners,laundry man are given complete leave from work. Adolescents and young men have similar mental state and often make excuses to break isolation. Advice to keep busy with household work, hobbies etc does not appeal to them. Reading and writing appeals to few people. Especially in densely populated areas and flats/ condominiums, people feel tired, bored, and often complain of restlessness, lack of concentration and mood swings.

I personally think, we have not done too badly, our both the death rate and infected patients is very low, considering our resources, however the pandemic is still spreading with now secondary spread as well.

Social media, mostly used is WhatsApp and Twitter. On WhatsApp mostly there are herbal treatments and suggestions for reciting Quran for forgiveness. We are mostly Muslims; we practice our routine prayers and special prayers during distress. Even minorities have Faith and they pray in mosques and temples.
Religious congregations restricted, but the mosques are open and governments instructions are that not more than five people can say the Jumma Prayers. Police and Rangers(Army) had to disperse extra crowds.

Mental Health & Other Professional Organizations.
WHO, has provided guidelines for general public and health care workers.
World Psychiatric Association(WPA), World Federation of Mental Health(WFMH),and others have prepared guidelines for Mental Health Problems in Patients and Family; Healthcare Workers(doctors,nurses and paramedical personnel).

Healthcare worker’s mental health challenges in the COVID19 pandemic.
There is a real and pressing need to acknowledge the mental health challenges that healthcare workers will face over the coming months.
It is vital that the right support is made available to them in a timely fashion. says, Professor Neil Greenberg, King’s College London
• Challenges like the psychological distress which results from actions, or lack of them, which violate someone’s moral or ethical code.
• Allocating scant resources to equally needy individuals, to balance one’s own physical and mental healthcare needs with those of patients, and to align one’s desire and duty to patients with those to family and friends.And how to provide care for all severely unwell patients with constrained or inadequate resources.
• -Healthcare workers will encounter situations where they cannot say to a grieving relative “we did all we could”, but only “ we did the best we could with the staff and resources available, it wasn’t enough”. That is the seed of a moral injury. It will hurt, and perhaps hurt for a long time, unless we now start to prepare and support our staff who will have to face this challenge
Neil Greenberg et al suggest six ways to potentially mitigate the negative moral impact of the COVID-19 outbreak for healthcare workers:
• Healthcare workers should be prepared to face moral dilemmas during the pandemic, which means they should be given a full and realistic assessment of what they will face.
• Team leaders should help staff make sense of morally challenging decisions they have to make, perhaps through discussions.
• The routine support processes, such as peer support programmes, for healthcare staff should include a briefing on moral injuries, as well as an awareness of other causes of mental ill-health, and what to look out for.
• All team leaders should be aware that no one is invulnerable. Even the most resilient team members may become overwhelmed by situations.
• There is a need to ensure all those who are supervising others are also supported as they may be affected by being part of any difficult decision-making.
• After the pandemic is over, supervisors should ensure that time is made to reflect on and learn from the extraordinarily difficult experiences to create a meaningful, rather than traumatic, narrative.
Advice to Public Team Leaders in Community
1. Orient workers in psycho-social aspects of COVID-19 response, including workers working in points of entry, basic needs services, law enforcement, education, emergency, social welfare, health, and any inpatient or long-term care facilities. (
2. Ensure inter-sectoral referral pathways are established and contextualized to the situation of limited physical distancing. (Mapping of and establishment of phone, internet and emergency referrals)
3. Distribute timely information on services, coping strategies and updates in accessible formats. (Adaptation, translation and dissemination of information and messages through multiple media channels – newspaper, community/ neighborhood noticeboards, social media, TV, radio and other channels)
4. Provide support to people in isolation and support people in quarantine. (Phone Counseling, Helplines Remote PFA and Tele-MHPSS)
5. 5. Protect the mental health and well-being of all responders and ensure that they can access mental health and psycho-social care. (Strengthen or establish MHPSS services for staff, peer-peer support initiatives, team meetings for frontline responders, shift rotations, childcare support whilst they are working, support groups on social media and, confidential helplines. Disseminate information on positive coping strategies)
6. Address mental health and the basic needs of people with pre-existing mental health conditions who are affected by COVID-19. (Build capacity of health and social care responders, identify needs, strengthen the  existing mental health and social welfare services. Introduce a distance support/ guided self-help component where feasible)
7. Address mental health needs of older adults and other vulnerable people. (E.g., appropriate targeting of this population; adapting accessible messages and communicating them)
8. Address stigma by providing positive messages about staff and affected population. (Organize activities and messaging to honour people affected and frontline responders)
9. Establish opportunities for the bereaved to mourn – even from a distance. (Orientation of response teams on MHPSS considerations and mourning, in line with IASC Guidelines (2007) action sheet 5.3)
10. Integrate response activities into existing services. (MHPSS focal points identified in all COVID-19 response
services)
Target: at least two persons (one male: one female) trained and a system in place to provide and coordinate services for MHPSS in all facilities engaged in COVID- 19 response. (Health, Education, Camps, Social Services and others) [adapt target to context/budget]
Budget: include costs for building capacity, orientation seminars, tele/remote- MHPSS services, adaptation, translation and dissemination of IEC materials, focal points assignments and providing services. [Adapt budget to local context]
Practical tools and additional information (click on hyperlinks to access materials for your reference):
Inter-Agency Standing Committee. Briefing Note about MHPSS aspects of COVID-19, 2020
WHO. Mental health and psychosocial considerations during the COVID-19 outbreak , 2020
WHO Coping with stress during COVID-19
WHO helping children cope with stress during COVID-19
WHO How to address social stigma powerpoint
Social media cards
IASC. IASC Guidelines on MHPSS, 2007

Messages for General Population
1. COVID-19 has and is likely to affect people from many countries, in many geographical locations. When referring to people with COVID-19, do not attach the disease to any particular ethnicity or nationality. Be empathetic to all those who are affected, in and from any country. People who are affected by COVID-19 have not done anything wrong, and they deserve our support, compassion and kindness.

2. Do not refer to people with the disease as “COVID-19 cases”, “victims” “COVID-19 families” or “the diseased”. They are “people who have COVID-19”, “people who are being treated for COVID-19”, or “people who are recovering from COVID-19”, and after recovering from COVID-19 their life will go on with their jobs, families and loved ones. It is important to separate a person from having an identity defined by COVID-19, in order to reduce stigma.

3. Minimize watching, reading or listening to news about COVID-19 that causes you to feel anxious or distressed; seek information only from trusted sources and mainly so that you can take practical steps to prepare your plans and protect yourself and loved ones. Seek information updates at specific times during the day, once or twice. The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried. Get the facts; not rumours and misinformation. Gather information at regular intervals from the WHO website and local health authority platforms in order to help you distinguish facts from rumours. Facts can help to minimize fears.

4. Protect yourself and be supportive to others. Assisting others in their time of need can benefit both the person receiving support and the helper. For example, check by telephone on neighbours or people in your community who may need some extra assistance. Working together as one community can help to create solidarity in addressing COVID-19 together.

5. Find opportunities to amplify positive and hopeful stories and positive images of local people who have experienced COVID-19. For example, stories of people who have recovered or who have supported a loved one and are willing to share their experience.

6. Honour carers and healthcare workers supporting people affected with COVID-19 in your community. Acknowledge the role they play in saving lives and keeping your loved ones safe.

7. Feeling under pressure is a likely experience for you and many of your colleagues. It is quite normal to be feeling this way in the current situation. Stress and the feelings associated with it are by no means a reflection that you cannot do your job or that you are weak. Managing your mental health and psychosocial well-being during this time is as important as managing your physical health.

8. Take care of yourself at this time. Try and use helpful coping strategies such as ensuring sufficient rest and respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with family and friends. Avoid using unhelpful coping strategies such as use of tobacco, alcohol or other drugs. In the long term, these can worsen your mental and physical well-being. The COVID-19 outbreak is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses. Even so, using strategies that have worked for you in the past to manage times of stress can benefit you now. You are the person most likely to know how you can de-stress and you should not be hesitant in keeping yourself psychologically well. This is not a sprint; it’s a marathon.

9. Some healthcare workers may unfortunately experience avoidance by their family or community owing to stigma or fear. This can make an already challenging situation far more difficult. If possible, staying connected with your loved ones, including through digital methods, is one way to maintain contact. Turn to your colleagues, your manager or other trusted persons for social support – your colleagues may be having similar experiences to you.

10. Use understandable ways to share messages with people with intellectual, cognitive and psychosocial disabilities. Where possible, include forms of communication that do not rely solely on written information.

11. Know how to provide support to people who are affected by COVID-19 and know how to link them with available resources. This is especially important for those who require mental health and psychosocial support. The stigma associated with mental health problems may cause reluctance to seek support for both COVID-19 and mental health conditions

Protocols for helping health care workers
I am a healthcare worker. ❤️
Keep in mind that we in the healthcare world also have families to come home too! Some come home to their children, spouse, significant other and elderly parents. So please be kind we’re doing the best we can. Don’t get offended when we ask you to keep your masks on or to cover your mouth if you cough or yawn at that! When we wipe down everything and sanitize its protocol for your protection and ours!
Schools closed
Offices closed
Restaurants closed
Malls are empty
Events called off
Flights grounded
Economy down
Even international borders closed
People are scared to look at each other, forget touching..
But, hospitals, dentist and doctors offices are still open.