The Other Epidemic

Social distancing measures necessary to slow the spread of COVID-19 could have adverse effects on the mental health of millions.

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A week and a half ago, President Trump was starting to think about reopening the economy. “You have tremendous responsibility. We have jobs,” he told the handful of White House reporters spread across the James S. Brady Press Briefing Room. “People get tremendous anxiety and depression, and you have suicides over things like this when you have terrible economies. You have death. Probably and—I mean, definitely would be in far greater numbers than the numbers that we’re talking about with regard to the virus.”

Only, the numbers with regard to the virus got worse. At the time of publication, 6,058 Americans have succumbed to COVID-19, and the administration’s own models now peg 100,000 deaths as the pandemic’s best case scenario. In 2018, 48,344 Americans died by suicide, per the CDC.

So the president changed course, accepting his public health advisers’ recommendations and extending current guidance—working from home whenever possible, avoiding discretionary travel, limiting gatherings to no more than 10 people—through at least the end of April. More than 300 million Americans—92 percent of the country—are currently, or about to be, under a shelter-in-place or stay-at-home order. “We had no choice. We did the right thing,” Trump said on Wednesday. “But you will have … domestic violence, you have violence, you’ll have suicide, you’ll have drug addiction. A lot of people are going to be lost.”

And Trump—who lost his own brother to alcoholism in 1982—may have a point. 

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  1. Avatar photo
    RandyMc

    I've countered my coworkers joking about how they are getting along at home with their spouse that I am very thankful that my teacher wife has been home during this time. I don't know if I have ever worked harder than the past three weeks, from home, trying to do everything we can to keep my responsibility for the business moving, not collapsing. I did not think I would make it the first week or so, I can't imagine doing it in an otherwise empty house. Video conferencing and phone calls weren't pleasant, they were gauntlets to be survived. Talking to friends doesn't work because they have their own problems, including losing their own business in at least one case.

    I think this was most complicated by having elderly parents with needs, including an 85 year old mother scheduled for surgery, and not knowing if she would get the surgery, survive the surgery, or not survive without the surgery (she survived the surgery and is home), along with a needy dad that worries about how everything affects him, even during good times.

    Things have settled in a bit, but I have friends complaining about being bored. I'd give just about anything for a bit of boring. In any case, things are better, but I do not want to live like this, and I don't think many of us will go along with this arrangement for many more weeks, much less months. Things are supposed to "apex" in the next week or so. I know people say that, even then, this staying at home has to go on much longer. I don't see it, and frankly, no one is going be pleased with both public health AND public policy when we see how this resolves.

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  2. Patrick G. Radel

    shameless plug for my son's YouTube channel - but might bring someone a much-needed laugh! https://www.youtube.com/watch?v=pdtjMU2qCeA

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    Visibly

    I will report from Norway, a week or two in advance of your situation in US. We have closed down society completely, including schools and kindergardens. Our pediatric units repport «missing children» . Our doctors and health workers think that this is because staff in schools and kinder gardens can no longer protect these vulnerable children. It is heart aching.

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      Visibly

      Domestic violence is a mental health problem, most of all for those abused, but also for the abuser.

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    Pat Riot

    I think the "good" news here is that much of this problem is already priced in to our society: millions of Americans *already* live a life of physical social isolation.

    First, because of the "Bowling Alone" phenomenon chronicled by say Putnam and recently Tim Carney: millions of Americans (mostly men) no longer connect to their communities. (And now, the word, "good" is in heavy quotes above because this phenomenon can be traced directly to the recent epidemic of suicides among younger men among other things).

    Second, an actual non-terrible reason, which is that we have, well, the Internet. I think we take it for granted these days that we all keep track of how our group of friends and extended family are doing all of the time even know we haven't physically seen them in years.

    Mr. Garvey is absolutely correct in getting in front of all of the effects of the crisis, but it's probably not as severe as it could have been, and maybe we can learn from some of those who have already been in this battle.

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      Declan Garvey vertical-nib Author

      This is a really good point. Some of this has definitely already been happening, gradually, over the years. I wonder if, once we're through this, the mandatory isolation will be enough to reverse some of those trends. People will be craving some of those social/community bonds they've let lapse!

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        Pat Riot

        We can hope. Sadly, my own sense is that it will actually make things worse...

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    Kevin C. Smith

    This is an excellent and important piece. Declan’s stories are great (and his Cubs fandom makes him the most critical Dispatch Crew, in my opinion), but this one should be shared by as many of us as possible!

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      Declan Garvey vertical-nib Author

      Thank you, Kevin! Having Len & JD on TV every night would go a long way to helping us all get through this

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    Butch Earl

    This is a topic that definitely hits home. I've been treated for OCD (Obsessive Compulsive Disorder) and GAD (Generalized Anxiety Disorder). Talk about ironies, my primary symptom for OCD is a tendency to constantly wash my hands and my primary symptom for GAD is too much social distancing. The scariest part of COVID-19 is the entire world is turning into Butch Earl. Ouch, what an awful thought!

    My advice to sufferers is to remind them that worrying is not problem solving. It makes no sense to worry about that which I cannot control and no sense to worry about that which I can control until I need to. It's tough being forced back into a lifestyle from which I've been trying to escape but, COVID-19 is not going to be cured by me worrying about it and there is no nobility in me worrying more than the guy next door.

    A hint: I've discovered a site called WildEarth.tv. They have live safari broadcasts and are on YouTube and Twitch. In general, I find live webcams a morale boost as it helps me to realize there is still a planet Earth outside my bedroom window and it is still turning on it's axis. No, it won't replace human contact but, it definitely helps postpone the worry until that contact becomes possible again.

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      Declan Garvey vertical-nib Author

      Thank you for sharing this, Butch, and I'm glad you've found some good coping mechanisms. Will have to check out those safari broadcasts!

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  7. jJay

    I think some of the isolating could be slowing the spread too much in some areas. There are hospitals laying people off because nothing for some workers to do. Anecdotal, but I drove by a large hospital in the Dayton, OH area this weekend and the parking lot was almost empty. Not saying isolating decisions are easy, especially with still mostly incomplete data, but we should be looking at this more as managing infections, not just shut everything down. Most are going to get this virus at some point, in some areas we should open some things up, understanding and being ok with this causing some to be infected earlier than they would under total lockdown. Just my view from middle America where nobody in my family or their friends knows of anyone that has gotten it. Side note: I have 3 daughters in college including 2 who had to come back from Europe recently and had been in hotspots like Paris, one going through JFK customs that first weekend after restrictions when it was a nightmare, and......nothing. Or we got mild cases and want our certificates (tattoos?), saying we are immune! :)

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      Idontdocute

      John, there is another way to look at the empty hospitals right now. We have a looming supply shortage that isn't just masks and gowns but drugs. We have been fighting market manipulation for years. If we stop all elective procedures for a few weeks it will be ok if it saves the Ativan and Dilaudid. I would rather have my staff take a break now and be rested when it gets heavy. It is eerie walking through the hallways of the hospital, that are usually jammed with people, being empty and having to read eyes of the few walking by instead of faces because everyone is in a mask at all times.
      I am saddened though for my patients that culturally expect family to be around them when they are ill and have no one, no one is allowed in. There are many elders from extended families that have never been alone in their entire lives and just feel abandoned, especially if they aren't fluid in English or use to cellphones not attached to a grandchild to help. It's like someone told Grandma to sit right here and we will be right back and then never came back.

      As for middle America not seeing it yet, it will get there. Hopefully, by the time it does, we will have some idea what to do as there is not many treatments now besides symptom control. But if you aren't using those vents or masks right now......

      I am glad you got your children home safe. Be well.

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    Earl King

    The virus and economic dislocation, will produce death. An NIH study suggested "social ills" cause a percentage of deaths in America. Suicides will occur regardless of a virus or the economy....but more will likely come from this mess. I will not be prepared if my one man C Corp folds. Things were going great. Forced retirement with less money will cause stress and anxiety. Losing loved ones will be hard. But when you add the likely uptick in crime, drug abuse, alcoholism, divorces that will occur if the economy doesn't bounce back quickly, many will say it was not worth it. Americans are great at ignoring death. 80,000 died from the flu in the 2017-2018 season. 72,000 in 2017 died from drug overdoses...we largely just kept walking.

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      Idontdocute

      If the preliminary CFR, or percentage of death for infected population is 1%, which some would consider on the light side, and that the majority of the population of 330,000,000 will be exposed before the vaccine is released, I think we are going to have to up this considerably from the 80,000 mark.

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      Visibly

      But you do know now that it is not mortality that it is the problem, although very sad. It is morbidity of so many otherwise healthy adults desperately needing ICU care for survival.

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    Aylene Wright

    Thanks for the very insightful article, and conceding that Trump may have a point. While I do think social distancing right now is the lesser evil, not being honest about the costs is going to eventually result in some people falling away. I also agree that it is ironic that social networking may actually alleviate loneliness now, instead of contributing to it.

    BTW I sent an email earlier requesting this, but an article focusing more on how the pandemic could further exacerbate the "loneliness epidemic" or "alienation" that many social or "communitarian" conservatives have lamented about in the past, would be interesting. This article does touch on that, but more from a "mental health if the individual" perspective. I'd be interested in a more sociological perspective.

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      Aylene Wright

      PS: Okay, I never thought I'd commend anyone for "conceding Trump may have a point", but there are many Trump critics who have a knee jerk response of immediately rejecting anything he says, no matter what, just because it is him saying it. But on occasion he can be right, or at least stumble on part of the truth.

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      1. Rexvanard

        But on occasion a broken clock can also appear to be right.

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    CynthiaW

    *** “We had no choice. We did the right thing,” Trump said on Wednesday. ***

    It's very likely that "We did the right thing," but it's simply not true that, "We had no choice." There is always another choice, though it might not be a better choice. That "no choice" plea is part of the mindset that leaves people vulnerable when some of their external support system is removed. "I'm not an active agent: I'm the victim of forces beyond my control." Forces beyond your control are indeed in action, but you still have choices, and the more you look for opportunities to make positive ones, the better your outcome is likely to be."

    The Great Courses (discounts on the streaming service during the current lockdown, I believe) has a series on Cognitive Behavior Therapy, which might help many people see themselves as the active agents of their own health, including mental health. They also have language learning, art and music classes, cooking, gardening, and (my personal favorite) the late, great Professor J. Rufus Fears on classical history and literature, Winston Churchill, "the history of freedom," and many other deeply engaging topics.

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