At least 10 people on my Instagram have declared themselves “Queen of Quarantine”. Social distancing and isolation are the two new buzzwords, and the most trending hashtags. While this is great, because we can’t flatten the corona curve without following these tenets, it is easy to forget that for some, isolation can be tough, and even triggering. People with pre-existing mental health issues might find it hard to socially distance themselves – being alone (for someone who lives away from their family) could potentially be depressing as well.
Worse still, is when someone tests positive for an infectious disease. The diagnosis in itself is a huge shock- and then there is the stigma that silently but significantly underlines most of the social distancing and isolation.
But isolation is the need of the hour, and to meet this need better, there are certain lessons we can draw in this pandemic from India’s tuberculosis epidemic and experience. Society often tends to forget to be warm to those who are suffering – and the TB experience stands as testimony to this. Not all forms of TB are infectious. However, TB patients are often compelled to physically isolate. This is because in some cases of TB, such as pulmonary TB, patients are infectious for the first few weeks of treatment and require quarantine measures. Similarly, in Covid-19, though the exact potency of the virus is still under research, we know for a fact that it is highly contagious, and thus, isolation is best advised.
The absence of warmth
In TB, the isolation is often caused by the stigma attached to TB. Patient narratives reveal that people tend to avoid being in the same physical space as them not just while they are on treatment but in some cases even after they are cured. These people could be community members, family members, and in some cases even partners.
In both cases, physical isolation – which translates to the absence of human touch and warmth – has a significant impact on the patient’s mental health, often leading to feelings of alienation, worthlessness, self stigma, and depression. TB treatment is long and is known to have mental health side effects in addition to other side effects. The length of treatment and the side effects often result in psychological distress, hopelessness, depression and in extreme cases mental health breakdowns.
News from all over the world has been pouring in about racism against people from East and Southeast Asia during the coronavirus pandemic. The fear and frenzy is gradually taking the form of a foe with which TB and HIV patients and survivors are all too familiar – stigma. And as can be observed from both these diseases, the stigma associated with a disease often not only heightens the mental health issues a patient may face as a result, but also drives the testing for, and reporting of the disease, underground.
If we do not stop and take stock of how these diseases have played out, we are bound to take the same route with Covid-19, and the future of public health then, does not look pretty. If patients abandon treatment mid-way, they might still be infectious or develop an infection subsequently, and pose the threat of spreading this infection. As a result, infection rates could go up and endanger public health.
What can we do to address the impact coronavirus has on mental health?
Phone a friend, revive the art of letter writing even if what you are sending out is actually a long email or participate in a silly social media challenge. While we must continue to remain physically distant from each other, we need to find other ways to rekindle the spark of human connection – the antidote to isolation.
Workplaces should institute work-from-home policies and provide paid leave to those affected so as to alleviate the psychological stress that comes from the threat of financial insecurity. In the informal sector, where workers do not have the luxury of working from home, employers ought to provide access to clean water, soap, and sanitisers as well as economic and social support to workers in the form of paid leave in case of ill health.
The need for empathy
At a programmatic level, we need to develop a National Covid-19 programme along the lines of the national TB programme, and integrate mental health as a critical component of it. Patients and families have to be provided counseling and support right from the time of diagnosis through the process of treatment. Additionally, public information campaigns targeted at communities and health personnel ought to be launched to increase literacy about the impact coronavirus has on mental health as well as the ways to deal with it.
Coronavirus has caused one too many casualties. Do not let your empathy be one of them. When you interact with another person, take your precautions, but remember to see the humanity in them instead of reducing their existence to “potential carrier” or “Covid-19 patient”. Dehumanisation and othering have a catastrophic impact on mental health of the person at the receiving end of such behavior.
Why should that be your concern?
Albert Camus, in his novel The Plague, wrote “From now on it can be said that plague was the concern of all of us.” This is as true for the coronavirus today as it was for the plague then. Covid=19 can happen to anybody. Please remember, we are all in this together.
Ashna Ashesh is an MDR TB survivor, lawyer and public health advocate. Vashita Madan is a writer and works in public health and communications.