https://orcid.org/0000-0003-4706-2412
It seems humanity is capable of handling a crisis. We band together, plan, and adapt. But what happens as the crisis becomes protracted? How do we handle things when the end that should be approaching seems to be around yet another bend in the road?
Human adaptation to acute life-threatening stress is all designed to protect the body and push it until it can go no further. The adrenaline response kicks in and peripheral blood vessels narrow to direct our blood to essential organs like the heart and brain. Our kidneys shut down to conserve water and our gastrointestinal tract does likewise to preserve blood flow. Then cortisol comes charging in to raise the permanency of the stress response.
But what happens with the existential threat? The one that doesn’t immediately strike, but lurks all around. We understand how unseen psychological threats affect people. One prime example is observed in cancer patients, especially in the hundred days following the cancer diagnosis [Citation1]. However, as clinicians, we have learned and adapted care pathways to ameliorate harm [Citation2].
Yet a pandemic poses a similar type of existential threat. Like cancer, the threat to psychological health is intangible and indistinct. Yet the diagnosis forces lifestyles into unwelcome change. COVID-19 has affected our quality of life, social cohesion and connectivity with family, friends, and community. We cannot travel where we want to go. Events from which we take pleasure such as the arts and sport are canceled or played to empty stadiums. We survive, but there is a change and personal cost that wearies our resilience. The threat evolves and changes and persists.
Large national surveys and a systematic review of the impact of COVID during the first year of the global pandemic found high levels of anxiety and stress, and rates were higher in pregnant women [Citation3]. However, we are now into the successive waves, and the disease profile has changed [Citation4,Citation5]. Younger people are more affected and new viral strains have emerged [Citation4,Citation5]. The race is on to vaccinate critical population masses, and this has served to highlight social inequity between countries and individuals.
As the threat prolongs, groups initially resilient become increasingly alarmed. Infertile couples waiting for management observe their window for fertility diminish. The new strains seem increasing aggressive to younger people, raising fears and necessitating changes in advice toward vaccination for pregnant women. Our gynecology patients report feeling increasingly isolated from extended family supports. The second wave risks a greater deterioration in mental health and quality of life and threatens to overcome resilience.
Now is the time for clinicians to step up and consider how we can innovate care for our vulnerable patients as the goalposts change. How can we explain risk and benefit to women to encourage vaccination? How can we deliver care in isolation? How can we improve resilience? These are some of the questions we need to ask and answer in the next year.
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
- Ueland V, Rortveit K, Dysvik E, et al. Life after cancer treatment - existential experiences of longing. Int J Qual Stud Health Well-Being. 2020;15(1):1838041.
- Petersen RW, Quinlivan JA. Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial. BJOG. 2002;109(4):386–394.
- Sun F, Zhu J, Tao H, et al. A systematic review involving 11,187 participants evaluating the impact of COVID-19 on anxiety and depression in pregnant women. J Psychosom Obstet Gynaecol. 2021;42(2):91–99.
- Fan G, Yang Z, Lin Q, et al. Decreased case fatality rate of COVID-19 in the second wave: a study in 53 countries or regions. Transbound Emerg Dis. 2021;68(2):213–215.
- Looi MK. Covid-19: is a second wave hitting Europe? BMJ. 2020;371:m4113.