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COVID-19
PANDEMIC

Whisperings from Solitude

By Rajam Ramamurthy, MD

The unexpected abundance of time, the unprecedented break in protests and riots, depression and PTSD are seen at a heightened
routine, and a measure of solitude could render the mind blank like level not only with those directly affected, but also as a spillover ef-
a clean chalkboard. One day I was walking up and down our drive- fect on those not involved. Economic stress adds to the problem.
way trying to accumulate steps. Thoughts began to form a picture Drops in the stock market are devastating, however, more impactful
on the blank chalkboard. How do you console a mother who has are the economic effects on a larger proportion of the population
lost a child to COVID-19? What does a woman with three children who depend on their daily earnings to sustain life and health.
do whose physician husband is fighting for his life hooked up to a The pandemic is a psychological crisis as well. Sherry Cormier, a
heart-lung machine (ECMO)? What do you say to a high school psychologist who specializes in grief mentoring says that in addition
senior, valedictorian, who will not have a graduation ceremony? to individual losses of a loved one or a job, even people who have
How do you explain to a six-year-old, the vice president of the not lost anything are in a phase of "communal grief as we watch
country, not wearing a mask when visiting a hospital while she is our work, health-care, education and economic systems…destabi-
not allowed to play with her friends without it? When do we get lize,". These losses include our loss of control, predictability, fair-
back to the baseline? What is the baseline? What could be the new ness and belief that we can protect our children, our elders, and
baseline? These and other thoughts keep me, and perhaps many of ourselves. The loss is not only of lives but dreams as well. It can in-
you awake at night. clude the loss of home — our income plummets, and as a result we
Pandemics have occurred throughout man's history, COVID-19 don’t have the resources to invest in that first house we dreamt of
is the first in the age of digital media that is both a fantastic tool or worse, we are evicted. It impacts our profession — suddenly, the
and a curse. The instantaneous communication that is possible research project stops for lack of funding. Aspirations are washed
through today's digital media is unprecedented and is partly respon- away — the gymnast who is training for the club trophy or the
sible for the containment of the spread of the virus, the 'flattening Olympic gold medal. These and numerous other situations could
of the curve.' Conversely, the constant bombarding of the mind all be such profound losses.
with news local and global has a tremendous effect on the psyche Grief is turning inwards and recalibrating. It is natural and ben-
of people. What have we learned from past experiences? eficial, even while grieving, to experience moments of acceptance,
It is fascinating to read an article that chronicles pandemics as far even happiness, laughter, and the most healthy grieving involves
back as 165 A.D, which was a pandemic that affected Asia Minor, going in and out of these phases. Mental health professionals talk
Egypt, Greece, and Italy, was thought to be caused either by Small- about 'Naming and Claiming Grief.' It is an organized way of help-
pox or Measles. It was brought to Rome by the returning Roman ing oneself cope. Some suggest writing or keeping a journal as a
army from Mesopotamia, and it decimated the Roman army. The way to relieve stress. I can personally vouch for the power of writing
death toll was 5 million, with a world population of about 160-300 on grieving and healing. The writing was my mantra when I faced a
million. The most recent pandemic before COVID-19 is the family health crisis.
HIV/AIDS infection. It peaked between the years 2005-2012, Staying home, especially with children of different ages, has made
claiming 36 million lives worldwide. parents learn so much about their children. The American Psycho-
A 2004 study from Canada, following the 2003 SARS (Severe logical Society (APS) has guidelines for helping children cope. A
Acute Respiratory Syndrome) epidemic, found a high prevalence of preschool child fears being alone, regresses in bowel and bladder
depression and PTSD (Post Traumatic Stress Disorder) among the control or may lose appetite. There could be an increase in temper
quarantined population. It is essential to keep this in the equation tantrums, whining and clinging. On the part of the caregiver, in-
as we move from the phase of response to that of recovery. Fol- creased tolerance, short-term changes in sleep arrangements, main-
lowing other catastrophic events like hurricanes, forest fires or mass taining regular routines like bed and mealtime, and avoidance of

28 San Antonio Medicine • June 2020