Shortening the Health Footprint of COVID-19

TTUHSC Expert Discusses How to Combat the Fourth Wave of Pandemic

• By Rachel Burroughs
• May 21, 2020

COVID-19 swiftly took over the American way of life but effects of this pandemic may continue on for months after the first wave. COVID-19 is creating a large health footprint that experts say come in four waves that impact health care.

The first wave was the reaction and response to the pandemic and its immediate mortality. The second impacts acute non-COVID-19 conditions - short term conditions for which people generally visit the emergency room. They are likely to avoid hospitals because they are fearful of a COVID-19-filled hospital. The third wave affects chronic conditions of those who have not been to regular doctor’s appointments or those possibly not taking their medications.

The fourth wave is the longest and has to do with mental health. Sarah Mallard Wakefield, M.D., chair of the Department of Psychiatry and director of child and adolescent psychiatry services at Texas Tech University Health Sciences Center, stressed how the U.S. and the world will have to respond to this at the end stages of the COVID-19 pandemic.

“The fourth wave starts as soon as the pandemic hits and it doesn’t come back down until long after the pandemic ends,” Wakefield said. “The mental health response starts immediately and just grows and grows for a long time for many reasons.”

Wakefield added this pandemic has brought frustrations which are causing even more stress and anxiety. Situations can include people who have lost loved ones unexpectedly and were not able to be with them at the end; others have thrown exercise and nutrition by the wayside; and there is a resurgence of excessive drinking issues and other addictions with which to cope.

Disruption of routine causes emotional distress for all Americans but may be especially true for certain groups. Increased stress, confusion and emotional distress can worsen symptoms of already existing conditions in our older citizens. For senior citizens with existing illnesses such as dementia, these sudden changes can be significantly more destabilizing.

Suicide rates tend to spike in the elderly, especially during a time of increased stress and confusion. It is important to find new ways to reach out to seniors and check on them. Maintaining relationships with seniors and loved ones through social engagement like watching movies together over the phone can relieve some emotional distress.

“One of the leading causes of death in the country in a normal environment is suicide,” Wakefield said. “Now we’ve taken people, stressed them out and isolated them.”

Providing people with different ways to combat mental health struggles and promote intact mental health is vitally important. One of the biggest resources available is technology, which allows everyone to stay connected despite physical isolation.

Technology allows counselors to provide support through telehealth. Schools and offices use video calls to communicate with each other daily. Some organizations create themed meetings to generate positivity and engagement. Families and friends connect with each other to check in and hang out via various communication apps. Creating positive social interaction despite physical isolation improves mental health.

Wakefield said shifting the focus off of what we wish we could do to new things that can be done changes past expectations to fit with the current reality. Instead of wishing to be with a loved one, ask what an appropriate substitute might be. Set up a call, send a video recording reading their favorite book or sit outside their nursing home window and talk on the phone.

“Some of our distress comes from how different things are from our expectations. When we shift our focus to being grateful for what we can do, that can really improve mental health quickly for all parties involved,” Dr. Wakefield said.

A misconception of social distancing is that is has to change the social aspect of living. There is a difference between physical isolation and social interaction. Due to COVID-19, people do not have the luxury of hugging, touching or shaking hands with each other. However, they can still see and talk to each other and take part in tele-experiences.

“The ability to have this synchronous tele-experience where we’re seeing each other and talking in real time simulates a normal social interaction,” Wakefield said.

She also recommended that we look at the social experience of responding to the pandemic.

“What could be really good for mental health is thinking about the collective and social experience and what we’re all doing together. This pandemic will not last forever.” Dr. Wakefield said.

She added that if we work together to shorten the course of the first wave of the pandemic, we will likely also improve the second, third and fourth waves as well.

“It is amazing what we can accomplish together,” Wakefield said.