MARTA ABATEPAULO DE FARIA
Considered the most severe respiratory syndrome since the Spanish flu (an H1N1 pandemic) in 1918, which killed between 20 and 50 million people worldwide[1], the Covid-19 pandemic has been spreading fear and uncertainty in the population.
Ornell et al. (2020)[2] e Schmidt at al. (2020)[3] discourse about how efforts to contain the pandemic end up underestimating the psychological and psychiatric implications secondary to this situation. Uncertainties resulting from fake news, lack of knowledge about the physiopathology of the disease and treatment, as well as inaccurate epidemiological data generate fear in the population, added to the unpredictability of the duration of the pandemic and its consequences. Ornell et al (2020) still claim that the implications for mental health can last longer than the pandemic itself. These authors say that “in Brazil, a large developing country with marked social disparity, low levels of education and a humanitarian-cooperative culture, there are no parameters to estimate the impact of this phenomenon on mental health or on the behavior of the population.”
In Curitiba, Telepaz (“Telepeace”) was created to serve the general population and health professionals who feel anxious due to the pandemic[4]. The service is offered during the days of the week by a team of 15 psychologists. In the first 17 days of its implementation, 330 calls were registered[5]. The proposal is not to perform a therapeutic intervention, but to perform listening and welcoming. What was observed were complaints of anguish and fear due to social isolation, as well as an increase in the use of cigarettes and alcohol. Other frequent complaints were nervousness, body pains and tachycardia. If a situation that triggers some pathology is perceived, the person is advised to seek help in person.
The fear among health professionals can be exemplified by the report of a nurse at Hospital de Clínicas of the Federal University of Paraná[6]. She reports on strenuous training routines and changes in hospital organization workflows. In addition to needing to keep distance from her son and missing her family, she describes the daily ritual of dressing up for work in the ICU and how it affects small daily tasks, such as drinking water, eating or going to the bathroom, which cannot be performed after wearing protective clothing. The performance of these small activities would imply changing all the clothes, which would generate costs for the hospital. She says she even got diapers from her husband, but she was unable to wear them even “with the bladder exploding”. Another topic pointed out by her was the difficult task of transmitting news to coronavirus patients and the loneliness they experience in hospital.
This anxiety and anguish are also felt by health professionals who are working in primary care. The minimum vestment, in addition to the institutional coat, is the use of the surgical mask and the facial shield. The mask hurts the face, the elastic pinches the ears and the glasses fog up. In addition, the distance we must keep from patients makes communication difficult. It is common in hallway conversations to express the fear of contaminating someone in the family, the doubt about the duration of the pandemic, the uncertainties of the treatments being tested and the absence of a vaccine. With the projection that there are several asymptomatic people moving around, all the patients are “suspects” and fear surrounds health services … as an administrative assistant told me this week: “There is no use in running, the virus is coming … everybody will catch it, you will see. ”
With almost the entire health system focused on Covid19, several elective consultations were canceled and this has generated a feeling of uncertainty and abandonment in patients. In addition, it has been observed that patients with other serious diseases (such as heart attacks and strokes) are not going to health units for fear of contamination and arrive late in health services for care, in an advanced state, compromising treatment[7]. Or even desperate people, in a panic crisis, seeking care when feeling the slightest flu-like symptom.
There are no studies on the impact of the pandemic on people’s mental health[8]. Existing studies are based on quarantining small groups for periods of up to 21 days as in the case of other epidemics and report increased alcohol abuse, post-traumatic stress and depression. In the case of Covid-19, the fear of being infected by a potentially fatal virus, depression, anxiety and stress have been identified in the general population and health professionals (Schmidt, 2020).
There are also reflections of the economic situation and other consequences of public health measures, such as the impossibility of experiencing grief (deprivation of farewell and comfort from family and friends), suspension of classes, increased risk of domestic violence and uncertainties regarding the maintenance of jobs. A survey of 4 693 Brazilians carried out by the editorial group Abril[9] showed that 54% of respondents are extremely concerned with the situation of Covid19; 70% fear losing labor rights; 76% fear overcrowding in hospitals; 47% cannot relax and 23% have difficulty sleeping. The University of São Paulo recently started a study with 15,000 employees of public institutions of higher education to assess the psychological repercussions resulting from the pandemic[10] and soon will be available.
The situation is quite particular in Brazil since there is a political crisis in the midst of the pandemic: there is no definitive health minister after two changes and there is no coordinated work to combat the pandemic between the presidency and states and municipalities. We continue with an increase in the number of cases and deaths and the mismatched information contributes to increasing the population’s insecurity.
The pandemic can be understood as a total social fact, once it involves several sociocultural aspects, from scientific knowledge, its meanings and interpretations, to its effects on people’s behavior. It is not possible to estimate how long this pandemic will last, but we have already realized that it will be necessary to adapt to a new reality. The way people in different social contexts will respond to this will certainly be a vast field of research in the near future.
ABOUT THE AUTHOR
Marta is a doctor specialising in obstetrics/gynaecology. She has been working in the public health care of Curitiba (capital of Paraná state) since 1996. She received a History degree in 2004 and took part in a group on gender & technology studies at a local university. She then studied Anthropology at Federal University of Rio Grande do Sul (UFRGS). Her field of study was the understanding women have about their bodies when it comes to contraceptive methods and reproductive physiology, and how it affects their choices on motherhood (or not). She has worked as a professor (a subject called “methods for working with families”) in a specialisation course for social assistants and also worked for a short period of time at a Medical School in Curitiba teaching women’s health at the public health care. Nowadays she works as an ob-gyn in a support group for GPs at the city health care system.
Photographs by the author
[1] https://doi.org/10.5123/S2176-62232018000300001
[2]http://www.ufrgs.br/ufrgs/noticias/arquivos/pandemia-de-medo-e-covid-19-impacto-na-saude-mental-e-possiveis-estrategias
[3] https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-166X2020000100501
[4] https://www.curitiba.pr.gov.br/noticias/telepaz-e-o-novo-servico-para-enfrentar-a-ansiedade-devido-a-covid-19/55452
[5] https://www.curitiba.pr.gov.br/noticias/servico-de-acolhimento-emocional-atendeu-a-cerca-de-330-ligacoes-em-17-dias/55593
[6] https://www.bemparana.com.br/noticia/enfermeira-de-uti-de-curitiba-fala-sobre-o-combate-ao-coronavirus-lembra-historia-de-terror#.Xr6XdERKiM8
[7] https://www.gazetadopovo.com.br/curitiba/medo-da-covid-faz-curitibanos-com-avc-e-infarto-buscarem-atendimento-tarde-demais/
[8] https://doi.org/10.20344/amp.13877. Disponível em www.actamedicaportuguesa.com
[9]https://saude.abril.com.br/mente-saudavel/a-epidemia-oculta-saude-mental-na-era-da-covid-19/
[10] https://jornal.usp.br/ciencias/maior-estudo-epidemiologico-do-brasil-avalia-impacto-da-pandemia-na-saude-mental/
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