'Take precautions, but don't panic'

'Social isolation itself can create panic among people. So, stay connected.'

People the world over are anxious and scared because of the coronavirus outbreak, and Indians are no exception

"The more anxious you are, the more stressed you are, your immunity level comes down, and you are likely to pick up the virus," psychiatrist Dr Lakshmi Vijayakumar tells Rediff.com's Shobha Warrier.

A man believed to be infected with covid-19 committed suicide while people ran away from the quarantine centre in Mumbai. Is it normal for people to be anxious and depressive in a situation like this?

There are three ways of looking at how a person responds to a situation like this. One is on an individual basis. The second is on the community level, and the third is on the health system.

All these three factors interact together and work on a person to behave in a certain way.

Even people who are absolutely normal, when faced with something like this over which you have no control and which disrupts your lifecycle, daily routine and social life completely, can become depressed and anxious.

We have the evidence that during the initial outbreak in Wuhan in China, more than 50 per cent of the population suffered from depression and one-third of them had moderate to severe anxiety; anxieties about themselves and their families.

There was generally an increased level of anxiety.

Is the anxiety about getting the disease and the eventuality?

It is mostly the uncertainty of the whole situation. The disease is pandemic, and the virus is spreading fast. So far there is no treatment available.

So, when you do not know much about the virus which spreads really fast, and you do not have a vaccine, the general anxiety level of the population increases tremendously.

In such a situation, people who are vulnerable psychologically are more likely to be upset.

You said 'those who are vulnerable psychologically'. But we see that even generally healthy people getting anxious about the disease. Is it normal?

It is normal. Even normally healthy people who are not exposed to covid-19 become worried and anxious when they develop a cold and cough. This can be distressing.

When I said those who are vulnerable, I meant those who are already depressed or anxious, and it aggravates.

For example, these people may wash their hands continuously.

In the case of this virus, the really vulnerable are the old people above the age of 70. The epidemiological studies have shown that the virus seems to cause mortality in older people with prevailing health conditions like hypertension and diabetes.

Many elderly people are on ACE inhibitors (medicine to control hypertension) and if they contract the virus, they are more likely to have problems.

When you are older, the tendency to be anxious and depressed is more, and it will be even more in situations like these where you have no control.

Children who do not know much about the virus also can get anxious because of the situation they are forced into and also by picking up news from here and there.

They also see their parents being anxious which makes them behave in such a way that parents will find it difficult to control them.

Schools, colleges and universities are closed. People are working from home. In such a situation, all the family members are in the confines of the home 24x7.
What kind of stress can the space between the members disappearing, create in a family?

It can make or break the family.

They can develop more bonding as they can't go out and are forced to interact with each other. In a fairly stable family, it can foster bonding and they may enjoy the togetherness.

But if the family is already wobbly and discordant, when they lose the space which they use to have is gone, there may be more flare-ups. This can be more damaging.

So, it entirely depends on the family's pre-existing situation.

Is it common to have anxiety, panic and depression in the case of all epidemics?

Yes, we have similar kind of statistics from all epidemics that the anxiety level, depressive level and worries of people goes up.

Did people behave in the same way when the HIV virus first appeared?

No. That was different because in the case of HIV, the spread happened only when people were in contact. So, people were more relaxed about the HIV virus. They knew that only if they had physical contact would they contract the virus. So, HIV did not create this kind of anxiety.

But covid-19 is not a contact virus; it is a droplet virus.

Even if you have not met a person who has covid-19, if you touch the glass he has used or the railing or the lift button he has touched, and then you touch your eyes, nose or mouth, you get the virus.

It means you do not know from where you are getting the virus.

When the environment itself causes danger, there will be more anxiety.

From your experience, do you think this is the most anxiety-causing epidemic in recent times?

I think so. This is a pandemic. HIV was an epidemic. So also Ebola, and they were able to contain it fast. We were able to come out with a vaccine for SAARS and H1N1 quickly.

No other virus has reached the scale in which this is in. What is worrying about covid-19 is the rapidity of its spread.

If you look at the RO number, that is how many people each infected person infects, it is the highest in the case of covid-19.

The RO number for SAARS was 2 while it is 6 in the case of covid-19. It means each covid-19 infected person is capable of infecting six other people.

Is this the deadliest virus?

I won't say this is the deadliest virus.

Yes, it spreads very fast, but if you look at the mortality rate, it is only 2% to 3% of the people who contract it. But it is highly contagious.

We see panic all over the world; panic buying, panic hand washing, panic reactions. How can we face this calmly?

I would say, you should face it calmly.

The more anxious you are, the more stressed you are, your immunity level comes down, and you are likely to pick up the virus.

You should follow precautions, but you should not panic.

Social isolation itself can create panic among people. So, stay connected. Unlike 20, 30 years ago, today you can stay connected with people.

I also would say the biggest creator of anxiety and panic is social media because the kind of fake news that gets circulated. That's why WHO said, please avoid listening to fake news.

Listen only to accurate and not falsified numbers, figures, localities, etc put out by the government.

Will yoga and meditation help people tide over anxiety?

Definitely. Anything that makes you feel better and calm, is advised.

In Maharashtra, those who tested positive were stamped. Some people say this can boomerang on the mental health of the people. How do you look at this as a psychiatrist?

I would say there are better methods of tracking than stamping. It was like in the Nazi times, you stamped people!

What happens is, when you so something like this, a person feels isolated from the community. When s/he goes out, the entire community may pounce on him.

So, s/he feels rejected by the community. This will scar the person. This can also generate xenophobia.

When you have the technology, there are better ways of tracking a person.

Also, make the quarantine places reasonably comfortable for people, provide access to their families, and there should be enough guards to see that they don't escape from the facility.

Among young people, there is the fear of a global recession once this subsides...

Absolutely. Unfortunately, the global estimates say the world may go into a deep recession by July. That will have more impact on young people than older people. The young people will be anxious about job losses, pay cuts, etc.

We know the economic consequences will be terrible, but we do not know how terrible it will be. 

What can the government do to calm people down?

The government should keep the people informed of the situation every day with up-to-date figures, up-to-date resources and correct news so that they don't listen to fake news. Then the anxiety level comes down.

Not knowing the real picture causes more anxiety.

Is the government facing the virus the right way? 

As of now, it seems they are doing the right way.

One thing India has done well which other countries have not done is spreading awareness through the telephone. With this, the general level of awareness has gone up. It is a very positive thing.

But they should be testing more people. I think more people need to be tested than what is being done now. We need more testing centres. For example, what South Korea has done. They even had drive-in testing centres.

As a psychiatrist, what will be your message to people?

As a psychiatrist, I will say, take precautions, but don't panic. Because panic will reduce your ability to fight the virus.

Have a good routine; eat well, sleep well, exercise, go out for small walks and maintain social contact.