else can we not control? Is our entire way of life changing forever? Will anything ever be the same?
All of these responses are understandable, but many are either unhelpful or misguided, or both. As a psychiatrist, I am accustomed to treating people with all kinds of anxiety: panic disorder, phobias, social anxiety, generalised anxiety, post-traumatic stress disorder and many other conditions. Anxiety has myriad forms and shows itself in many different ways. It can involve anxious thoughts (worries, obsessions, ruminations), emotional problems (tension, depressed mood) and physical symptoms (perspiration, heart racing, hands trembling, poor sleep). Each person tends to have their own combination of these symptoms, which can change over time.
You might think that addressing the anxiety provoked by coronavirus would be similar to treating established anxiety disorders and, in some ways, it is. The feelings of anxiety are similar in many of these conditions, even if the triggers and patterns are different. And the broad approach to care is similar in many respects for most disorders that are associated with anxiety.
But, in certain other ways, the anxiety associated with coronavirus is quite different to the anxiety seen in traditional anxiety disorders. Take the example of a person with agoraphobia, a well-recognised anxiety disorder in which the person experiences severe anxiety in an environment that they perceive to be unsafe with no easy way to escape. This condition manifests quite commonly as a paralysing fear of crowded places, so that a person might experience overwhelming anxiety in a supermarket and feel they have to leave. As part of treatment, a psychotherapist can, over the course of months, guide the person to go progressively nearer to a supermarket, then to enter one, and then to remain there for five minutes, ten minutes and eventually longer. Slowly the person will become accustomed to being in the supermarket and realise that there was nothing to fear apart from the anxiety itself.
This approach works well with many anxiety disorders, such as agoraphobia, social phobia and various others. But the key to treating these conditions is that, in all of these disorders, treatment helps the person to see that their anxiety has no basis. There is nothing to fear.
The problem with the anxiety associated with coronavirus is that there is indeed something to fear: the virus. There is nothing good about coronavirus. While the illness is generally mild, with over 97 per cent of people who are diagnosed surviving the infection, that is no consolation if you are one of the few who develops a severe illness or if you fear for a relative who is vulnerable, elderly or ill. Clearly, there is plenty to fear with coronavirus.
And that is what makes the anxiety associated with coronavirus so ubiquitous, so persistent and – to an extent – so challenging to manage. This obstacle is not, however, insurmountable once we bear in mind that traditional techniques for managing anxiety simply need to be adapted to the new situation. Our task today is not to teach ourselves that there is nothing to fear – clearly, there is – but rather to teach ourselves how to keep our anxiety proportionate to the risk, how to live with a certain amount of worry, and how to navigate the uncertainty that coronavirus has brought to our broader lives.
Some people might respond to this situation with denial and apparent indifference. They might ignore public health warnings. This, too, is psychologically understandable, but it is very unhelpful and clearly dangerous. A realistic appraisal of the risks we face and proportionate, considerate and responsible behaviour are what we need – not denial, not complacency, not panic.
The good news is that, just as we are capable of finding sophisticated ways to make ourselves more anxious, we are equally good at finding sophisticated ways to manage our anxieties, once we put our minds to it. Established anxiety-management techniques help greatly once they are modified to suit the new situation that we face.
That is what this book is about.
HOW DID WE GET HERE?
Wuhan is a city of 11 million people in Hubei province in China. It is a city of some significance. On two occasions, in 1927 and 1937, Wuhan served briefly as the capital of China, and it is near to the famous Three Gorges Dam, a power plant and popular tourist attraction. The city is an established centre for finance, education, culture and transport, leading some to call it ‘the Chicago of China’. It is now infamous as the centre of the current outbreak of coronavirus.
In late December 2019, a patient in Wuhan Jinyintan Hospital was diagnosed with pneumonia, a severe infection of the lungs. Pneumonia is a very common condition, but this case was different. In this patient, the illness seemed to be caused by a novel virus, i.e. a certain type of transmissible infective agent that was new to humans. Following rapid genetic testing, the new virus was found to most closely resemble a particular virus that was previously found in bats. The virus was characterised as a new ‘coronavirus’ and named ‘COVID-19’.
The novel virus spread rapidly in China. By 20 February 2020, there were over 75,000 cases reported in the country. The age of those infected was usually around 51 years but ranged from just two days to 100 years old. Over three-quarters of cases were aged between 30 and 69 years. Just over half were male.
Over the following months, the new coronavirus spread around the world, well beyond the Chinese border. There was a particular cluster of cases in northern Italy, from which the virus spread rapidly onwards again. By early March 2020, most of the world was experiencing blanket media coverage about coronavirus, how it spreads and – to a lesser extent – what can be done to prevent transmission. By the middle of March, over 170,000 people were infected across 158 countries. More than 6,600 had died. The World Health Organization (WHO) declared a pandemic.
Throughout this period, WHO’s official website (www.who.int) has consistently provided comprehensive, accurate and up-to-date information about the outbreak. It is now clear that the disease spreads from person to person through small droplets that come from the nose or mouth when someone with coronavirus coughs or breathes out. The droplets land on surfaces and objects around the person. Transmission occurs when other people touch those surfaces and objects, and then touch their own eyes, nose or mouth. People can also breathe in the droplets, so the WHO advises staying more than 1 metre (3 feet) away from anyone who is coughing or sneezing.
The symptoms of the condition are quite non-specific: fever (high temperature), tiredness and dry cough. There may also be aches and pains, nasal congestion, a runny nose, sore throat or diarrhoea. These symptoms are usually unpleasant but mild, in that they resolve on their own. Approximately 80 per cent of people get better without needing special treatment, but approximately one person in every six will become seriously ill, often with difficulty breathing. This progression is more common among older people and those with pre-existing medical problems such as hypertension (high blood pressure), heart problems or diabetes. People with relevant symptoms should seek medical attention at once, in line with local or national guidelines (see the section on ‘What to do if you think you have coronavirus’ at the start of this book).
Antibiotics are ineffective against viruses, so treatment of coronavirus is supportive. This means that the symptoms of the virus can be treated and interventions such as oxygen therapy can be used while the person’s own body fights the virus. In extreme cases, life support is needed – generally in the intensive care unit of a hospital.
The mortality rate with coronavirus is under 3 per cent of those diagnosed and might be under 1 per cent (as not all those with the infection are diagnosed). In other words, over 97 per cent of people diagnosed with coronavirus will survive it and around 80 per cent will have a mild illness (which probably will not require hospitalisation). For comparison, there was an outbreak of severe acute respiratory syndrome (SARS), a somewhat similar virus, between 2002 and 2003, and that had a mortality rate of 10 per cent but spread less widely. Clearly, however, the current coronavirus pandemic is a public health emergency of the highest order and we must all help to bring it to an end.
Prevention
