As the coronavirus epidemic continues to rage and threatens to become a pandemic, the world remains in a state of paranoid vigilance. The coronavirus outbreak has taken the world by shock and surprise, and all nations are rightly fearful of the consequences of the threat due to the increasing number of deaths and the lack of an effective vaccine as yet.
Countries across the world have commenced the repatriation of their citizens back to their homelands. Repatriated citizens are being nursed under quarantine conditions to minimise the spread of the virus. This Saturday, February 1, saw the first contingent of around 300 Bangladeshi citizens being repatriated back from Wuhan, China; these individuals will remain under quarantine at the Ashkona Hajj Camp for 14 days, under the supervision of the Bangladesh Army. During this period, according to The Daily Star, individuals quarantined will not be allowed to meet their family members or any others.
In view of the virulence of the coronavirus and in the interest of public protection, it is entirely appropriate that repatriated individuals remain under quarantine for the 14-day observation period to minimise the risk of the virus spreading. However, it is important that we remember our duty of care towards these quarantined individuals; this duty includes looking after their mental health alongside their physical health, which can otherwise be easily overlooked. When under quarantine, individuals are likely to suffer from significant psychosocial difficulties that need to be addressed from the very start of their quarantine period.
Currently, many of the 300-plus individuals who remain quarantined are likely to be suffering from anxiety and fear—they will be anxious that they could be harbouring the coronavirus in their bodies, or that they may be in close proximity of another who may be infected with the virus. They would suffer feelings of guilt and the shame of being alienated from society. They are highly likely to be suffering from boredom due to isolation from their families and social networks. They would be harbouring feelings of frustration and possibly anger that they are under constant watch round the clock. Some are likely to be preoccupied with anxiety about how society would respond to them when their quarantine is terminated. They are unlikely to have adequate access to resources that provide them comfort, such as books, music and television, the lack of which will certainly add to their feelings of frustration and boredom. Indeed, the mental strain the quarantined patients are going through will be immense.
Try to put yourself in the shoes of a quarantined person. These individuals will have been greeted by healthcare workers—fully covered in Hazmat suits—unable to see their faces properly. They will be subject to rigorous daily clinical examinations and tests; they will have to anxiously wait for the test results to return, and be constantly aware of any signs or symptoms that may indicate they are infected. They will be constantly hyper vigilant and on the lookout for other quarantined individuals who show symptoms suggestive of a coronavirus infection, and want to isolate themselves from the person in a state of panic. They are likely to be intensely praying that they do not become the next victim of the deadly virus. And this would certainly not be the end of their mental trauma.
Research from the last SARS outbreak revealed that even individuals who were quarantined during the epidemic developed symptoms suggestive of a post-traumatic stress disorder (PTSD) or clinical depression as a result of the emotional trauma of being isolated from society for a prolonged period of time. The study showed that the longer the quarantine period, the more likely a person was likely to develop a diagnosable mental health condition in the future. When under the restrictions of quarantine, individuals undergo periods of high emotional stress secondary to the uncertainty they face about their health, which makes the need for mental health support during this period of isolation essential.
Once quarantine is terminated, individuals may face societal stigmatisation; their social support structures may become avoidant towards them due to fears of contracting the illness, which in extreme cases can lead to isolation and ostracisation from society.
For those in quarantine, recognition of the stress and the fear they go through is tremendously important. They should be assured that their feelings of fear and anxiety are a normal response to the situation they are in. They should be allowed a confidential space to speak about their stressors with trained mental health professionals competent in dealing with high-pressure situations. Clinicians should avoid labelling these emotions as being pathological at the first instance, and instead attempt to provide psycho-education and teach coping strategies to allow them to deal with their intense feelings in a therapeutic manner. Given the finite resources and time, healthcare professionals should try their best to provide emotional support and spend time with these individuals to reduce fear and the sense of isolation. Interventions should be put in place to enable access to the outer world through the provision of Internet and teleconferencing facilities, such as access to Skype, Viber and WhatsApp, to allow them to stay in regular touch with friends and family. Access to television and newspapers would help them maintain a sense of connection with the outside world.
It is the government’s responsibility to provide accurate and evidence-based information about the coronavirus to the public in a timely manner to avoid mass panic and emotional distress. Any delays or secrecy in launching a public health campaign would undermine the belief people have in the government’s credibility in dealing with the coronavirus epidemic. The provision of clear, factual information to the public is therefore paramount. Campaigns should be consistent and easily understandable, and be clear about the risks of exposure and the actual threat of the virus on the population. Certain quarters of Bangladeshi media have the propensity to fear-monger by exaggeration of news reports that perpetuate panic within people. The public health department should, therefore, work in close alliance with the media to stop sensationalisation of the epidemic and disperse scientifically accurate and precise information to the public to maintain calm whilst the prognosis of the virus still remains uncertain. Public education about good hygiene to minimise the risk of infection should be done in a detailed, step-by-step manner using a variety of visual formats, such as infographics.
The provision of mental health support to those under quarantine is not a choice but an essential component of their clinical care. Clear communication, regular updates and provision of interventions to reduce isolation whilst in quarantine will reduce emotional distress and instil hope for the future among these individuals. Timely, accurate public health communication by the government is key to reducing fear, eliminating mass hysteria and controlling the spread of infection if a positive coronavirus case emerges in Bangladesh in the future.
Dr Mehtab Ghazi Rahman is a consultant psychiatrist specialising in Intensive Care Psychiatry. He works for the National Health Service of the United Kingdom.