A stressful transition

We must now begin to think in a fundamentally different way about how we live and work

What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.

                                                                                                                 - From The Plague by  Albert Camus


n my usual early morning bicycle ride, as I pedalled my way around my neighbourhood, I was surprised by the huge turnout for Eid prayers given that Eid had been announced very late the previous night after a tussle between the Ministry of Science and the hordes of the Ruet-e Hilal committee. What I was not surprised by was the complete lack of precautionary measures for Covid-19 by most worshippers headed to mosques and parks.

Perhaps half the people were wearing face masks. A cursory glance at the people assembling for Eid prayers indicated that no one appeared to have any idea about ‘social distance’, the very simple recommendation for people to keep at least six feet distance between one another to prevent infected aerosol droplets from infecting people.

For me, a healthcare worker (HCW) on the frontlines of the battle against Covid-19, this utter disregard for elementary healthcare precautions during a global pandemic is immensely frustrating.

On chaand raat, I was on a call with my colleagues at Mayo Hospital, the main referral centre for Covid-19 patients in Lahore. Our hospital is filled to the brim with Covid-19 patients and unlike the early days of the pandemic, we are now only admitting serious or critical patients (those at risk of dying if not admitted and monitored constantly). The call was with other senior faculty members of King Edward Medical University who provide medical cover to Mayo and other affiliated hospitals (we have seven other affiliated hospitals which serve hundreds of thousands of completely destitute patients from all over the Punjab; Mayo hospital is a tertiary hospital meaning patients are referred to us from tehsil and district hospitals all over the province and we are often the ‘last line of defence’ for patients who cannot be treated anywhere else).

Earlier, I had been on the phone with a very dear student, a brilliant graduate of our university who had, along with her husband, recently ‘matched’ i.e. obtained a post-graduate residency position in the US. In Lahore though, her physician father-in-law was admitted in Mayo with Covid-19, fighting for his life. Because of his pre-existing medical problems including diabetes, hypertension and asthma, his lungs had become overwhelmed by the virus. During the process, he had become confused and disoriented – a common outcome of severe medical illness. He was agitated and yelling, refusing medicines and hallucinating; thus the call to me.

This scene is being repeated over and over in our hospital and will be repeated again and again in the days and weeks to come. According to government statistics, the number of confirmed cases of Covid-19 in Pakistan has crossed 60,000. There are over 21,000 cases in the Punjab alone. The numbers have spiked sharply since the national lockdown was eased and people poured into streets and bazaars like hungry lions converging on a wildebeest carcass.

Simultaneously, the conspiracy theories and denial rumours reached a crescendo. Confused and mixed messages from government authorities have not helped although their bewilderment is understandable since most governments in the world have struggled with putting out consistent public health messages given the novel character of the virus and the rapid updates in scientific knowledge.

But none of this justifies the completely obdurate denial of the illness on display in Lahore and the rest of Pakistan.

From a psychological perspective, the outpouring of people from their homes when the lockdown was eased appears to make sense: children had been cooped up in their homes away from schools and colleges, and their homemaker moms were probably ready to commit themselves to a psychiatric ward; workers, both male and female, suddenly forced to work online, had found the dividing line between ‘work’ and ‘home’ erased. I had personally found this transition stressful even though I have worked online for many years. But having to move all your personal interactions into the virtual world is very stressful. Elders cooped up inside and deprived of their daily walks or interaction with the neighbours were getting restless and anxious, and were starting to focus more and more on their real and imagined illnesses, making it stressful for families. And the complete lack of any indication of when this would end and life would go back to ‘normal’ was making things worse all around.

Elders cooped up inside and deprived of their daily walks or interaction with the neighbours were starting to focus more on their real and imagined illnesses making it stressful for families.

Events of great social importance such as wars, famines, earthquakes, floods and natural disasters tend to amplify a person’s inner personality quirks, sometimes to the point of converting them into psychological symptoms. Thus, a global pandemic with no known cures combined with the instantaneous spread of every WhatsApp and social media message across the entire globe within seconds tends to magnify misinformation. It’s easier to just read/see/hear the latest WhatsApp share and pass it along as gospel truth.

While social media has made sharing information and staying connected easier, it has also amplified the ‘noise’ in our general environment, making it next to impossible to separate information from misinformation. In addition, our ubiquitous mobile devices have progressively shortened our attention spans to the point where it’s easier to keep ‘consuming’ the information coming at us from all sides rather than try and parse it for accuracy.

I have seen several people in the last two months with symptoms of what would probably classify as ‘hypochondria’, loosely defined as having a persistent fear of a real or imagined illness despite medical evidence to the contrary. For example, a gentleman who had locked himself inside his house for the last two months and refused to even walk in his own lawn for fear of becoming infected even though lack of exercise was worsening his pre-existing diabetes. This is the exact opposite of the recklessness on display in Eid bazaars recently where most of the shoppers appeared to have forgotten about Covid-19 entirely. Both approaches, of course, are erroneous.

By all accounts, we still have at least 4-6 more weeks to go of rising case numbers before the graph begins to ‘flatten’ and cases start declining slowly. But it may spike again in winter and Covid-19, like Dengue fever, will likely become endemic. This means we all have to prepare, mentally and physically, to permanently alter our lifestyles and begin to think in a fundamentally different way about how we live and work.

Going forward, both work and education will likely be a mixture of online and in-person work with online work gradually becoming more and more prevalent. As the technology improves, and real time holograms and Star Trek-like innovations dissolve the boundaries between the real and the virtual, the stress we are all feeling may dissipate slightly, which is not to say that other types of mental health issues will not arise from our new lifestyles.

But change is hard and human beings, by nature, seek comfort and avoid pain. For those of us who are willing to think differently, work hard and soldier on through the storm, we will come out stronger and more prosperous at the other end.

And in Mayo Hospital at least, I can personally vouch for the heroism and courage of hundreds of my colleagues – nurses, doctors, technicians, support staff – all battling valiantly to save who we can while putting our lives and, by extension, the lives of our families at risk. When we see people belittling the seriousness of this illness, we feel hurt and betrayed; as if our sacrifices to save lives mean nothing at all to our fellow citizens.

So here is an appeal from a healthcare worker on the Covid frontlines: please take precautions, heed the warnings and spare yourselves, your families and us the agony we will otherwise go through. It’s always hard to do things differently but it is also a good thing to step outside your comfort zone, to reach out and stretch your mind and body for new challenges. It is the only way a person can grow and achieve.

The writer is a psychiatrist and faculty member at King Edward Medical University. He taught and practiced psychiatry in the United States for 16 years. He tweets @Ali_Madeeh

A stressful transition: We must now begin to think in a fundamentally different way about how we live and work