In addition to the long-term effects of Covid-19 on the body, there is growing recognition of the psychological effects of Covid-19 on the entire community, and concerns about its permanent effects on the psyche.
The numbers confirm the concern: 66.4 million people are rescued from Covid; Tens of millions who have not yet recovered; and the families of the 2.6 million dead.
The psychological effects of previous pandemics suggest what to expect as Covid-19 continues to affect physical and mental health. The results of the outbreaks of Ebola, H1N1 pandemic influenza (2009), Severe Acute Respiratory Syndrome (SARS, 2002/2003) and Middle East Respiratory Syndrome (MERS, 2012) show that changes in their daily routine, fear, grief, Loss and stigma long after the worst was over.
Current research shows that patients who were intubated while in hospital for Covid-19 had significantly more PTSD symptoms than patients who had mild symptoms and were cared for at home.
Eugene Lipov, MD, who specializes in psycho anesthesia, told Medical Daily that patients hospitalized with Covid-19 have PTSD symptoms due to the fear they have.
When told they have Covid-19, these patients fear they may die, knowing that more than 500,000 people in the US have died so far. The fear increases with the need for intubation and leads to one staring into space, which, according to Dr. Lipov is a sign of PTSD.
Hospital patients are not alone in developing anxiety, depression, and PTSD symptoms. Few are untouched by this pandemic. This includes nurses, frontline workers in grocery stores and other retail stores, teachers, and healthcare workers. Some of the pandemic events that people experience are:
- social isolation
- financial loss
- Loss of identity in connection with employment or business closure
- Loss of control due to lack of accurate information regarding spread and treatment
- Loss of cultural identity and rituals
- Disbelief if healthcare professionals develop Covid-19
- Fatigue from multiple, unexpected responsibilities such as raising distance teachers
- Caregiver fatigue while caring for a Covid-19 patient at home
- Caregiver fatigue caring for a Covid-19 survivor after discharge from hospital
- Guilt for survival if family members are sick or have died of Covid-19
- Panic if the local case numbers increase and fluctuate
With an expected explosion in Covid patients developing PTSD, health professionals are investigating effective treatments and medications.
Dr. Lipov, who prefers the term Post Traumatic Stress Injury (PTSD) to PTSD, has worked with combat veterans to help them recover from PTSD using a nerve block. His interest in working with veterans comes from the number of veterans who have PTSI. Dr. Lipov told Medical Daily that 25% of combat veterans and 90% of women who are sexually abused while serving in the military will experience PTSI.
His nerve block treatment is applied to two places on the neck. Part of the stress response, said Dr. Lipov, involves the germination of numerous nerve fibers. These fibers release norepinephrine, which leaves the person stuck in the fight or flight response. This treatment trims the nerve fibers and prevents new fibers from growing. Norepinephrine production decreases and the patient’s symptoms improve. Dr. Lipov has collected treatment data and expects his work to be submitted for peer review in the near future.
Since Covid-19 is a neurotoxic virus, as evidenced by loss of smell and taste, Dr. Lipov that the nerve block will help those suffering from PTSD from Covid-19.
Non-invasive vagus nerve stimulation (nVNS)
One study suggests that stimulating the vagus nerve may decrease activity in parts of the brain that are involved in visualizing a previous traumatic event. Participants had a history of psychological trauma but no PTSD. They heard stressful stories that activated areas of the brain that are known to respond to stress. A hand-held device was used to apply a light electrical charge to the neck and vagus nerve. A bogus device that felt the same but did not apply an electrical charge to the vagus nerve in the neck was also used. Participants were in a PET scan when the handheld devices were used. The PET scan showed that there was less brain activity when the vagus nerve was stimulated with the electric current than with the sham device. This decreased activity in the areas of the brain that perceive stress has resulted in long-lasting reductions in anxiety and holds promise for PTSD victims.
There is some evidence that mindfulness training can significantly reduce PTSD and the severity of depression. One hundred veterans were divided into 4 groups. The first group took part in a self-body scan. Here you should focus on different areas of the body and become aware of the different sensations. The mindful breathing group listened to a guided meditation focusing on breathing. The third group focused on slow breathing and the fourth group sat quietly. The only group that did not experience any reduction in symptoms was the slow breathing group.
There is mixed evidence about the effects of yoga on PTSD symptoms. However, there is evidence that yoga tailored for military use is effective in reducing the severity of PTSD symptoms. Given the different types of yoga and practices that are available, one that is tailored to the specific needs of those struggling with PTSD might be more effective.
Make a movie
Programs exist that allow PTSD victims to create a video to tell their story in a way that allows them to be in control of the story. There are also programs available that the person can use to create a video in which the traumatic event is rewritten so that the new image replaces the stressful memory, thereby reducing the stressful response to that memory.
There is growing evidence that psychedelics play a role in treating PTSD. Recently the FDA approved two psychedelics for use in psychiatric cases, and several more are being considered for PTSD.
Gregory Hammer, MD, professor of anesthesiology, perioperative medicine, pain medicine and pediatrics at Stanford University School of Medicine, told Medical Daily that treatment for PTSD is not a one-size-fits-all treatment. Patients are unique individuals with unique responses to treatment. For example, norepinephrine and nerve growth factor – an important agent that aids in the growth, survival, and specialization of neurons – play different roles during a stress response. They activate some reactions and dampen others. Too much or too little can unbalance the body, making it difficult to find the perfect balance.
Dr. Hammer said he believes it makes sense to use hallucinogens in treating PTSD to help rewire brain circuitry, thereby reducing the memory impact of traumatic events.
There is increasing evidence that people can change their thoughts by being aware of their thoughts. This is an area that should be explored to help patients change the effects of traumatic memories and improve their PTSD.
Yvonne Stolworthy MSN, RN graduated from Nursing School in 1984 and spent many years in critical care and as an educator in a variety of settings including clinical trials.