[MUSIC PLAYING]
JOSH SHARFSTEIN: Welcome
to Public Health On Call,
a new podcast from the Johns
Hopkins Bloomberg School
of Public Health.
Our focus is the
novel coronavirus.
I'm Josh Sharfstein, a faculty
member at Johns Hopkins,
and also a former Secretary of
Maryland's Health Department.
Our goal with this podcast is
to bring evidence and experts
to help you understand
today's news about the novel
coronavirus and what
it means for tomorrow.
If you have questions,
you can email them
to publichealthquestion@jhu.edu.
That's
publichealthquestion@jhu.edu,
for future podcast episodes.
Today, I'm talking to
Monica Schoch-Spana,
a medical anthropologist
and a senior scholar
with the Center for Health
Security at the Johns Hopkins
Bloomberg School
of Public Health.
We spoke about the
mental health impacts
of the coronavirus
epidemic and what
can be done to address them.
Let's listen.
Dr. Schoch-Spana, thank
you so much for joining me.
I know you've been looking into
the mental health dimensions
of the COVID pandemic.
Can you tell me
what you're finding
and what you're concerned about?
MONICA SCHOCH-SPANA:
Right now, we're
focusing a lot on
viral transmission
and interrupting it.
But we also need
to pay attention
to the psychosocial dimensions.
I think it's helpful
for people to think
about the mental health impacts
of the pandemic in two ways.
There's a diffuse distress
that we're all feeling.
But then there are
special groups of us
that have unique stresses being
placed on us at this time.
JOSH SHARFSTEIN: Let's talk
first about the diffuse stress.
Tell me about that.
MONICA SCHOCH-SPANA: Sure.
Well, if you look at past
pandemics and outbreaks
of emerging infectious
diseases, you
find that people have a
high level of anxiety.
And there are a number
of reasons for that.
This is a health threat that
is invisible to the naked eye.
If you're sick, you can
manifest benign symptoms that
mimic other types of diseases.
So you don't know if you have
COVID-19 or the flu or a cold.
And at the same time that
you have that uncertainty,
you also have changes
in bodily habits,
like hand washing, interruptions
to social relationships because
of social distancing, and
economic interruptions
that place stresses.
So there are many
reasons why we all have
a sense of worry and concern--
because this is unfamiliar,
it's interrupting routines,
and we could get sick, and
our loved ones could get sick.
So that generates a
diffuse sense of distress.
JOSH SHARFSTEIN: That's
very well-explained.
And I think people who are
listening will identify.
What about for
specific populations?
Who is most at risk?
MONICA SCHOCH-SPANA:
Well, one group
that we all have to be
concerned about and help protect
are our health care workers.
Health care workers undergo
many different types of distress
during pandemics and outbreaks
of emerging infectious diseases
like SARS and MERS, even
H1N1, 2009 influenza.
They're going to be working
longer and more shifts.
They're going to be away
from their families.
Their duties to their families,
such as child care and meals,
will be interrupted.
And there'll be
worry about that.
They may themselves get sick.
And they will be worrying
about that possibility.
They may see their
co-workers get sick--
perhaps even some severely
sick and pass away.
So there are a number of
stresses on our health care
workforce.
So that's one group.
And it's going to
be very important
that health systems
provide time, space,
and personnel to get
them through the stress
of the pandemic.
JOSH SHARFSTEIN:
I definitely want
to talk about what can be
done and what that really
means, what you just said.
But other groups that
are top of mind for you
at particular risk for
mental health consequences?
MONICA SCHOCH-SPANA:
Well let's talk
about people who are
in self-quarantine.
OK.
They face a cascade of impacts.
They, while they're wading
through the incubation period,
are going to be consumed
by the uncertainty about
whether or not they're
going to get sick.
At the same time, they
are cut off from people.
And soothing human
comfort is not
going to be readily
available, just
because of the social
distancing aspect.
At the same time, they may be
cut off from their obligations
to other people.
That is, they can't fulfill
their role as a household wage
earner.
And that will create
additional stresses.
Now, that's just while
they're in self-quarantine.
If they should get sick, they
then have additional stresses.
They have the uncertainty
about whether they're
going to have a mild
case or a severe case.
If they get recovered,
people may look at them,
because they have been infected
with COVID-19, as somehow
a potential threat, even if
they have fully recovered
and are not passing
along the virus anymore.
So they could face stigma.
JOSH SHARFSTEIN: So
what can we learn
about these challenges
from previous experiences
with infectious
disease outbreaks?
Recognizing that this
one is unique in a bunch
of different ways,
are there important
lessons from the mental
health consequences
of other pandemics?
MONICA SCHOCH-SPANA: Well,
that experience of stigma
is actually a very
definitive feature
of outbreaks of emerging
infectious diseases or novel
pathogens.
So we saw during SARS that
health care providers who
were taking care of
patients with SARS
were shunned in some instances.
Children of health care workers
were shunned out of a fear
that the people
around them would also
get infected, regardless
of what the science said.
Neighborhoods where there were
large numbers of cases of SARS
also were stigmatized.
And even after the end of the
epidemic-- the SARS epidemic--
those neighborhoods
were shunned, as well.
So that was seen very,
very strongly during SARS.
JOSH SHARFSTEIN: So
let's talk about what
can be done to
respond, mitigate,
try to lessen the mental health
burden of this situation.
So let's start maybe
with individuals.
What can individuals do?
MONICA SCHOCH-SPANA:
Well, individuals
can, even in a context
of social distancing,
maintain and nurture
their relationships
with other people,
make phone calls,
write emails, have Zoom chats
with a whole group of people.
So it's going to be
important for people
to be connected to others.
If you're a baker,
bake a few items.
And then provide it to
your neighbors, of course,
respecting social distancing
and infection control safety
measures.
But you need to connect
with other people.
So that's what
individuals can do.
JOSH SHARFSTEIN: So
physical distance
doesn't mean psychological
distance, in a way.
MONICA SCHOCH-SPANA: Absolutely.
There's a reporter,
Amanda Ripley,
who's written about the
psychology of disasters,
and now epidemics.
And the importance
of avoiding isolation
is absolutely critical.
JOSH SHARFSTEIN: Got it.
What about for policies?
What kinds of policies should
be put in place to support
mental health generally?
MONICA SCHOCH-SPANA:
Well, we need
to move mental health to the
foreground of the response.
As I said earlier,
right now a lot of it
is on viral transmission
concerns and health care
delivery concerns.
But we need to make sure mental
health is part of the financing
structures.
So the financial
relief packages,
both the current
and future ones that
are coming from the
federal government,
really need to take
mental health allocations
into consideration.
Secondly, public health
authorities really
need to invite their
behavioral health
counterparts to the table and
plan the response together.
So risk and crisis communication
should include experts
from a communication
perspective, a public health
perspective, and a behavioral
health perspective.
When you have
large-scale operations
like drive-through testing,
there are operational tips
that behavioral health
professionals can offer, such
that the movement
of people happens
in a calm and orderly fashion.
And so people such as
behavioral health professionals
really need to be
providing counsel
right now to the
overall public health
response, not just that's
specific to mental health.
JOSH SHARFSTEIN: Great.
I'm going to circle
back to your comment
about health care workers.
What can health
care organizations
be doing to support the
mental health of people
who are on the frontlines
of this epidemic?
MONICA SCHOCH-SPANA: Right.
If you look at past
outbreaks, in particular SARS,
it was very important
that health care workers
be given the time to step
back from the response,
so breaking up their schedules.
Also, having a
literal place that's
detached from the delivery
of care, where they can
decompress.
And also, having access, again,
to behavioral health experts,
and for those for whom their
spirituality is important,
access to chaplaincy
services as well.
JOSH SHARFSTEIN: And
what you're saying is,
that's not sort of an
ancillary part of the response.
That's got to be core
to the response in order
to keep health care workers
in a position to do the best
that they can.
MONICA SCHOCH-SPANA:
Absolutely, absolutely.
There's going to be an
extreme sense of urgency--
and rightly so.
But as many other people
have spoken about,
this is a marathon.
It is not a sprint.
We want our health
care workers well,
on their best game, even a month
from now, two months from now,
three months from now.
So we need to take care of them.
JOSH SHARFSTEIN: Let me ask
you one other question, which
is about people who have
mental illness before COVID-19.
Are there particular
concerns and recommendations
that you have for them?
MONICA SCHOCH-SPANA: Yes.
People who have
anxiety conditions
or obsessive compulsive
disorder prior to the crisis
could be facing more
acute reactions.
And that may be
happening at a time when
they have less
access to the care
that they would
normally receive.
So I think it's important
for mental health providers
to put certain interventions
in place, including
telemedicine, telehealth
options if they're not already
doing that.
If possible, they should
cut out-of-pocket fees,
cancellation fees, co-pays, just
to remove the economic burdens
to care.
And if they haven't already
updated their own business
continuity plans
for their practices,
they need to be
doing that right now.
JOSH SHARFSTEIN: In other
words, to prepare in case
the therapists get
sick, making sure
that the patients
have other options.
MONICA SCHOCH-SPANA: Absolutely.
And I think that
practitioners that
have special expertise
in domestic abuse
are going to be called
upon at a larger rate,
given the social distancing
and the social distancing
requirements.
Families are now on
top of each other,
under an overall
community level of stress.
And there could be
some adverse effects
in terms of a domestic abuse.
JOSH SHARFSTEIN: That's
a pretty serious issue.
Is there anything that can
be done to reduce that risk?
MONICA SCHOCH-SPANA: I
think that families need
to find ways to decompress.
They need to give
each other space.
If it means taking
a walk in nature--
again, with social distancing
requirements in mind--
that needs to happen.
They need to reach
out to others when
they feel they're under stress.
And practitioners
who are sensitive
to the special stresses
of marital life
and other partnerships
should make themselves more
available to their clients.
JOSH SHARFSTEIN: Well, this is
extremely important information
and on an extremely
important issue.
I really thank you
for taking time
to talk to me about it today.
MONICA SCHOCH-SPANA: Josh,
it's been a pleasure.
Thank you for
covering this issue.
[MUSIC PLAYING]
JOSH SHARFSTEIN: Thank you
for listening to Public Health
On Call, a new podcast from the
Johns Hopkins Bloomberg School
of Public Health.
Please send questions to be
covered in future podcasts
to publichealthquestion@jhu.edu.
That's
publichealthquestion@jhu.edu.
This podcast is produced by
Josh Sharfstein, Lindsay Smith
Rogers, and Lymari Morales.
Audio production by
Niall Owen McCusker,
with support from Chip Hickey.
Distribution by Nick Moran.
Thank you for listening.
