“Whether an illness affects your heart, your arm, or your brain, it’s still an illness, and there shouldn’t be any distinction. We would never tell someone with a broken leg that they should stop wallowing and get it together. We don’t consider taking medication for an ear infection something to be ashamed of. We shouldn’t treat mental health conditions any differently. Instead, we should make it clear that getting help isn’t a sign of weakness—it’s a sign of strength—and we should ensure that people can get the treatment they need.” –Michelle Obama, former first lady
In addition to managing the acute symptoms associated with SARS-CoV-2, the virus that causes COVID-19, the medical community has another reason to worry about, which is the virus’ detrimental effects on organs besides the lungs. Because of the rudimentary understanding of pathophysiology associated with COVID-19, no one knows yet what the long-term impacts will be. COVID-19 often strikes the lungs first, but the causative virus does not solely afflict the respiratory system. During the process of hands on learning, we are seeing that there are patients where the lungs are not the worst-affected organ. This is most likely related to many different organs harboring the ACE2 receptor, which is the virus’s major target, but also to the infection harming the immune system, which pervades the whole body.
Anecdotal reports suggest that neurologic symptoms are common, not only for patients currently infected with COVID-19 but also for those recovering from it. Coronavirus “long-haulers“—a term adopted by patients who remain sick for months—commonly report brain fog, memory loss, difficulty concentrating and dizziness.
A study published in June 2020 by the Centers for Disease Control and Prevention found that symptoms of anxiety and depression nationwide increased significantly during April through June of 2020 compared with the same period last year. This study found that adverse mental health symptoms were disproportionately reported in young adults, Black and Hispanic adults and essential workers. Frontline healthcare workers face a substantially higher risk of infection and death due to excessive COVID-19 exposure, consequentially facing high levels of depression, anxiety, insomnia, and symptoms of a trauma- and stressor-related disorder (TSRD).
One of my closest friends, VV, who resides in Jaipur, India, is an exceptionally talented urologist. He recently acquired the SARS-CoV-2 infection and his deteriorating health prompted admission to the intensive care unit. I have known VV for the last several years and he has always impressed me with his vibrant personality, witty sense of humor, and an optimistic outlook towards life, even during turbulent times. He called me this past weekend via WhatsApp. My dear friend, still recuperating from the aftermath of COVID-19, appeared and sounded the exact opposite of the person I have come to know since my training days. Observing his drooping shoulders and listening to his frail voice made me realize that my friend was in mental agony. His despondency was palpable. VV who has always been a beacon of hope to everyone, including his patients, his OR staff, and his friends, sounded dejected. The debilitating fatigue, abrupt changes in body temperature, the fear of reacquiring the infection, and the ensuing guilt related to him transmitting the infection to his beloved ones appeared to have shattered the confidence of this internationally acclaimed urologist. Despite his mental state, VV still yearned to remain in frequent contact with friends across the globe.
VV’s desire to maintain social connection even in the face of adversity is a great teaching point. Social connection improves physical health and mental and emotional well-being. Strong social connection strengthens our immune system. Research by Steven Cole, a genomics researcher at the University of California, Los Angeles, shows that genes impacted by loneliness also code for immune function and inflammation. Perhaps this could be considered as one of nature’s innate defense mechanisms bestowed on us and becomes salient as the pandemic continues to rage. VV’s desire to be in touch with friends also illustrates that social distancing and social connection are not mutually exclusive.
Markedly elevated prevalence of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions. Periodic assessment of mental health, substance use, and suicidal ideation should evaluate the prevalence of psychological distress over time. Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently.