How have the prolonged lockdowns and loss of near-and-dear ones to Covid affected the physical, mental and social well-being of people? What are the levels of physical and behavioural changes such as obesity, social anxiety and aggressive behaviour being seen in children returning to school? What is the impact of work from home on emotional engagement? Now that we are almost two years into the pandemic with more than 250 million positive cases and 5 million deaths worldwide, it is clear that Covid is not just a disease. Beyond the illness, the pandemic has affected every aspect of our health and society in unique ways. According to a recent study published in The Lancet, both major depressive disorder and anxiety disorder rose 35% each during the pandemic period in India.
Covid beyond a disease: Prolonged lockdowns have led to physical isolation, thus weakening access to various social support systems. Besides, it has led to the loss of wage or employment, caused shifts in working patterns, reduced mobility, and interrupted exercise schedules and leisure activities. Moreover, unanswered questions, repeated images of bodies, overburdened healthcare systems and misinformation campaigns have built fear and uncertainty.
This has resulted in loneliness, irritability, anxiety, helplessness, and mood and sleep disorders. In addition, the tendency to incline towards potentially addictive and aggressive behaviours such as alcohol and substance abuse and domestic violence have also increased. Previous studies also suggest that such features commonly follow major natural disasters or economic crises.
The adverse consequences are more significant in vulnerable populations, including healthcare providers, Covid survivors, disabled and older adults, children and adolescents. Paradoxically, the methods that prevented transmission to their loved ones impaired their emotional support systems. For instance, images of doctors eating food outside their homes and going back to work while greeting their kids from a distance were familiar during the crisis. In addition, the fear of contracting Covid kept the vulnerable population restricted to their homes even when the lockdown curbs were removed, which dealt a heavy blow to their general well-being.
Health is not merely an absence of disease. According to WHO (1948), “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Hence, it is now an opportune time to review the scope of Covid beyond the disease to alleviate the pain of those suffering in silence. Systems need to be put in place to address a large wave due to physical, social and mental health impacts and prevent Covid from turning into a ‘double tragedy’.
Realising that the physical and psychosocial impacts of the pandemic will be a challenge for an indefinite time, the Ministry of Health and Family Welfare recently released post-Covid sequel modules to guide doctors and healthcare workers. However, indigenous and ingenious strategies are critical to cope with the long-term impacts.
Gain local insights: Since diverse situations present diverse problems, they require diverse solutions. To gain evidence-based insights, scientific and social research is necessary. Multidisciplinary efforts examining gender, social, economic, cultural and educational dimensions are crucial. They have the potential to uncover the extent of non-disease aspects among different groups and evaluate the effectiveness of various corrective methods such as psychological first aid. Such an exercise requires a nationally decided standardised framework. University departments, state health resource centres and medical colleges should investigate Covid beyond illness in a mission mode.
Community-based approach: All communities have inherent resources that need to be mobilised. Since locals are the best observers and counsellors, it is essential to adopt the whole-of-society approach now more than ever.
One such successful model is the community mental health programme ‘Navjeevan’ from Mahasamund district in Chhattisgarh. The initiative envisaged bringing down the high rates of suicides that were around three times the national average. Under the programme, volunteers were identified from within the community. Anganwadi workers, ASHAs, Gram Panchayat secretaries, school teachers or members of SHGs were designated as Sakha/ Sakhi/ Prerak, i.e. friends or inspirers. Specialists from NIMHANS trained these volunteers to spread mental health-related awareness and identify the deteriorating mental health symptoms through possible case scenarios and anecdotes.
The awareness campaign was carried out through Gram Sabhas, WhatsApp groups and wall paintings. The community-level screening allowed the early identification of more than 3,000 people with mental stress. The early counselling and treatment led to decreased suicidal tendencies, which prevented the situation from worsening.
Since elements within local social networks understand each other better than anyone else, they provide context-specific care. Such community surveillance and round-the-clock support is not possible through traditional healthcare service delivery. Investment in developing community-based health plans that are inherently affordable, adaptable and accessible has the capacity to build resilience beyond Covid.
Although medicines and vaccines may win the short-term battle, in the long run, we must prepare to treat Covid beyond the illness for mitigating its long-term social and economic costs. It is vital to reduce the spread of anxiety as much as the spread of the virus. Expanding our approach from ‘lives and livelihoods’, as conceived in the Economic Survey, to ‘lives, livelihood and liveliness’ is essential. Unlike the unforeseen Covid-triggered global supply chain crisis that affected the world, we need to address the upcoming pandemic before it is too late.
Dr Ravi Mittal, Chief Executive Officer of District Panchayat, Raigarh, Chhattisgarh; Dr Surbhi Jain, Consultant Physician based in Raigarh, Chhattisgarh (ravimittalid@gmail.com, drsurbhijain16@gmail.com)