Mental Health In COVID

Mental Health in the Era of COVID-19

By Maria A. Pugliese, M.D.

May 2021 has been named Mental Health Awareness Month. We all want good mental health but what exactly is that?

The best definition I have found is that of the World Health Organization (WHO):

“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.”       

COVID-19 has certainly affected the mental health of us all. It has been a challenging two years in many ways:

  • Exposure to a potentially fatal illness and many deaths
  • Overstressing our healthcare systems
  • Restriction of social connections
  • Loss of jobs and income leading to inability to pay rent and mortgages
  • Difficulty putting food on the table (finances and supply)
  • Transformation of schools from in-person to virtual
  • Transformation of medical and psychological services to virtual

COVID-19 has also brought out the strength and resilience of our nation:

  • Our family bonds have tightened.
  • We have seen incredibly hard work from our first responders.
  • We have seen great generosity in providing food for others.
  • Some jobs have continued successfully from home.
  • The government has assisted with some financial help.
  • Wi-Fi and laptops were provided for minority children to continue their education.
  • Most people who entered the hospital returned home.
  • Vaccines were developed at lightning speed.
  • Over 40% of Americans have gotten it with the goal being 70%.
  • Restrictions and mandates are slowly being lifted.
  • Schools will be back to in-person learning as of the Fall semester, 2021.

Beside the emotional and financial strain of the virus on us all, we need to look at how the virus has affected the brain. People with chronic medical and psychiatric illnesses were most likely to catch the virus and die from it. But the virus affected the brains and nervous systems of everyone who caught it. There were the acute effects and the chronic effects called “long COVID.” What were the effects both general physical, peripheral neurological, and central neurological (on the brain) ?

  • Respiratory distress and failure
  • Coma, seizures, or strokes were occasionally seen.
  • Loss of taste and smell
  • Chronic headaches
  • Chronic severe fatigue
  • Rare Guillain-Barre illness

A good summary article in our National Institute of Health (NIH) Director’s Blog is:

What does COVID-19 do to the brain to harm it so? Scientists do not actually know, but there are several types of theories presented by Dr. Robert Stevens in Johns Hopkins Medicine: The Severe Infection Theory, The Immune Overdrive Theory, The Chaos in the Body Theory, and The Blood-Clotting Abnormalities Theory. To read more, check out this article:

The Severe Infection Theory

            Any severe infection associated with a high fever will affect the brain and make it at risk for seizures. Seizures can lead to brain damage. Because of the strange effect of loss of taste and smell, it is possible the virus enters the brain through the nose and olfactory bulb. In a few cases that have been autopsied, the virus has been found in the spinal cord and even in the brain.

The Overdrive Immune Theory

            In this theory, the immune system goes into a hyperactive state to fight the virus called a “maladaptive inflammatory response.” The virus floods your immune system causing the body to release inflammatory proteins called cytokines. A “Cytokine Storm” can lead to tissue and organ damage. This cytokine storm may end up being more damaging than the virus itself.

The Chaos in the Body Theory

            This theory states that the lack of oxygen as well as the high fever could be causing the damage all by themselves. This then leads to comas, seizures, or strokes. Any of these could cause the brain damage seen in those who are seriously ill.

The Blood-Clotting Abnormalities Theory

The fourth theory explains why people in their 30s and 40s have had the virus causing a stroke. When the blood supply to the brain is stopped or decreased, the result is a stroke. When this happens, the supply of oxygen and nutrients are cut off to the brain leading to cell damage or death. There are ischemic (thrombus or embolus) or hemorrhagic (bleeding into the brain) strokes. A blood clot or bleed can occur in any part of the body. A blood clot can also travel to the lungs cutting off the oxygen supply. When tested, these patients have had extremely abnormal blood clotting mechanisms.

The Pandemic’s Effect on Everyone’s Mental Health

          We know that those who have been sickened by the virus also have mental health effects. But what is also true is that those who have never gotten the virus still feel its impact on their mental health. Both adults and children have felt loneliness, fear, boredom, anger, and depression. What must we do to counteract those feelings? The answers go back to the simpler things in life.

  • Listen to our body’s physical and emotional signals and get help if needed.
  • Self-care is important. If we do not take care of ourselves, no one else will.
  • We need projects to help us through our boredom even if they are simple things.
  • We must nurture our support network through phone or the Internet.
  • We must be optimistic but predict and prepare in advance for the worst.
  • We must do our best to prevent the spread of the virus (masks, social distancing, vaccines).
  • We must learn to control what we can and let go of the rest.

May we never have to go through this again.

Contributed By:  Maria A. Pugliese, M.D.  for Dr. Maria A Pugliese-Hieble, MD is a doctor primarily located in Malvern, PA, with another office in Philadelphia, PA. She has 47 years of experience. Her specialties include Addiction Medicine, Psychiatry.

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