Infectious disease outbreaks, such as the novel coronavirus (COVID-19), create significant distress for the public and strain health care systems tasked with caring for affected individuals and containing the disease. Fear and uncertainty heavily influence public behaviors (1). Concerns focus on personal and family safety, inability to distinguish the new disease from more established and benign illnesses, potential for isolation and quarantine, effectiveness of treatments being used, and trust in institutions responsible for managing the response.
Adverse psychological and behavioral responses to infectious disease outbreaks are common and include insomnia, reduced feelings of safety, scapegoating, increased use of alcohol and tobacco, somatic symptoms (physical symptoms, such as lack of energy and general aches and pains), and increased use of medical resources (2). While media can be a useful tool for sharing knowledge, it also enables rumors and conspiracy theories to be amplified, which can distract public attention from accurate sources of information, reduce participation in health-promoting behaviors, and further community divisions (3). Distress about the infectious disease outbreak is often increased by exposure to traditional and social media content, which is often sensational in nature and may contain misinformation (4).
Health care workers experience additional challenges during infectious disease outbreaks, including concerns about the health of themselves and their family, stigma from within their communities, and managing the distress of patients (5). In more highly affected areas, health care systems are often overwhelmed by a surge in care demand that is simultaneously experiencing staffing shortages. The shortages result from illness in health care workers, the need for health care workers to care for sick relatives, or absence due to fear of contracting the illness (6). Health care workers working with infected patients often experience concern about the adequacy of their personal protective equipment, the use of which can be uncomfortable as well as restrict the ability to communicate and perform work tasks.
During an outbreak, timely and accurate information play a critical role in controlling the spread of illness and managing fear and uncertainty. Knowing what to do helps people feel safer and enhances the belief that they can take meaningful steps to protect themselves. During an infectious disease outbreak, the recommendations below are helpful for patients and their families:
Stay informed. Obtain current information about the outbreak from trusted sources, such as the Centers for Disease Control and Prevention at www.cdc.gov and the World Health Organization at www.who.int. Educate. Follow and share basic information about hygiene to reduce spread of illness, such as handwashing and cough etiquette. Correct misinformation. For health care workers, help correct inaccurate information and misperceptions by sharing credible, established public health resources.Limit media exposure. Use media enough to make informed decisions, then turn it off. Anticipate and address stress reactions. Keep in mind that it’s normal to feel stress in reaction to an infectious disease outbreak and be aware of signs of stress in yourself or family members. Take steps to minimize and address stress, such as keeping normal routines, taking part in enjoyable activities, focusing on positive aspects of your life and things that you can control; seeking support from friends and family; and engaging in stress reduction techniques and physical activity.
In addition to the recommendations above, health care workers whose patients are affected by the outbreak should be encouraged to take care of themselves through these additional recommendations:
Meet basic needs. Eat, hydrate, and sleep regularly to optimize your ability to provide care for yourself and others.Take breaks. Rest and relaxing activities can provide a helpful distraction.Stay connected. Giving and receiving support from family, friends, and colleagues can reduce feelings of isolation. Stay updated. Rely on trusted sources of information. Participate in work meetings where relevant information is provided.Self check-ins. Monitor yourself for signs of increased stress. Talk to a family member, friend, peer or supervisor if needed.Honor service. Remind yourself (and others) of the important work you are doing. Recognize colleagues for their service whenever possible.
The recommendations above for patients and families are adapted from mental health education fact sheets at the Center for the Study of Traumatic Stress at www.cstsonline.org.
Joshua Morganstein, M.D.
Department of Psychiatry, School of Medicine
Uniformed Services University, Bethesda, Maryland
Chair, APA Committee on Psychiatric Dimensions of Disasters
1. Bults, M., Beaujean, D. J., de Zwart, O., Kok, G., van Empelen, P., van Steenbergen, J. E., et al. (2011). Perceived risk, anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys. BMC Public Health, 11, 2. http://doi.org/10.1186/1471-2458-11-2
2. Morganstein, J.C., Ursano, R.J., Fullerton, C.S., Holloway, H.C. (2017). Pandemics: Health Care Emergencies. In R.J. Ursano, C.S. Fullerton, L. Weisaeth, B. Raphael (Eds.). Textbook of Disaster Psychiatry, 2Ed (pp. 270-283). Cambridge University Press. Cambridge, UK.
3. CNN, Feb. 4, 2020. https://www.cnn.com/2020/02/04/us/coronavirus-school-district-petition-trnd/index.html
4. Towers, S., Afzal, S., Bernal, G., Bliss, N., & Brown, S. (2015). Mass Media and the Contagion of Fear: The Case of Ebola in America. PLoS ONE. http://doi.org/10.1371/journal.pone.0129179.s001
5. Smith, M. W., Smith, P. W., Kratochvil, C. J., & Schwedhelm, S. (2017). The Psychosocial Challenges of Caring for Patients with Ebola Virus Disease. Health Security, 15(1), 104–109. http://doi.org/10.1089/hs.2016.0068
6. Goulia, P., Mantas, C., Dimitroula, D., Mantis, D., & Hyphantis, T. (2010). General hospital staff worries, perceived sufficiency of information and associated psychological distress during the A/H1N1 influenza pandemic. BMC Infectious Diseases, 10, 322–333. http://doi.org/10.1186/1471-2334-10-322