“Don’t panic!” advised Laura Waters, M.D., the chair of the British HIV Association, in a recent aidsmap webinar. That’s not just good advice for interstellar travelers, but useful when contemplating the COVID-19 pandemic. While panic may not be helpful, acknowledging the anxiety provoked by the current situation is useful, said Roxane Cohen Silver, Ph.D., of the University of California Irvine in a SciLine media briefing: “This anxiety is appropriate under the circumstances.” However, as a community, we need to transcend that fear. “If we work together, we can save lives,” she said confidently.
Staying calm may be difficult for the 16% of people living with HIV (PLWH) who already were living with generalized anxiety disorder even before this pandemic. By comparison, 2% of the general population were suffering from anxiety at that time. Research tells us that social isolation can exacerbate anxiety and depression, even in the absence of a catastrophe.
After previous disasters, the number of people experiencing mental health issues, including depression and anxiety, rose significantly, Karestan Koenen, Ph.D., of Harvard University, explained in a Boston University webinar. But why is this pandemic different from all other disasters? Prior events, such as earthquakes or terrorist attacks, were relatively brief and localized, Sarah Lowe, Ph.D., of Yale University, said in the same webinar. This time, the threat from the virus is global in scope—and of undetermined duration.
But PLWH see similarities to an earlier epidemic. “It is extraordinary, the parallels between the early HIV epidemic and the current pandemic,” Gus Cairns, the coordinator of pre-exposure prophylaxis (PrEP) in Europe, noted during the aidsmap webinar. At the same time, COVID-19 is different, because the virus affects everyone, not just stigmatized groups: “This is an equal-opportunity virus.” Memories from the early days of HIV can trigger mental health issues now that may be debilitating for some PLWH, observed Valerie Wojciechowicz of CAN Community Health in Sarasota, Florida.
That anxiety may be exacerbated for essential employees who must interface with the public, such as grocery store workers, Wojciechowicz noted. They face a difficult decision: If they present a doctor’s note to be allowed to stay home, they risk disclosing their serostatus; if they don’t, they may risk a worse outcome should they contract COVID-19. Her clients are terrified of losing their jobs and may take health risks as a result. “I am not taking any chances, regardless of what they say” about PLWHs’ risk related to the novel virus, she said, but she acknowledged that she is fortunate to be able to isolate herself to that extent.
However, not everyone handles stay-at-home orders equally well. “Some team members are really struggling with having to stay inside,” reported Wojciechowicz. She advised them and her clients to try breathing techniques and meditation and focus on positive aspects. “Every week, I make them write a list of good things that have, are, or can come out of this,” she said.
While difficult, staying home and practicing good hand hygiene can allow people to feel in control, added Michelle Kohler, RN, of St. Luke’s University Health Network. She also counseled clients to limit their exposure to the news, find ways to distract themselves (e.g., puzzles, video games), take socially distanced walks, and keep a journal. However, “Other human contact is important,” she noted.
While physical contact may not be possible at this time, people can connect virtually. Cairns urged those struggling with mental health issues to reach out to therapists and others. “You won’t necessarily have the touch of another person, but you’ll get support,” he said. “These are tools that can help us through this crisis but should not become the new normal until we have more data” on how they affect mental health and wellbeing, cautioned Julianne Holt-Lunstad, Ph.D., of Brigham Young University, during the SciLine briefing.
On the bright side, “I think what we’re starting to see—quite widely—is the importance of our relationships,” Holt-Lunstad said. That realization may go beyond personal friendships: “We can potentially see more solidarity as communities and as a society.” Local mutual-aid groups are one example of that community spirit. They may provide help with grocery shopping or other errands to vulnerable people, advice on applying for unemployment, even food or other assistance. In many cases, help can be solicited without disclosing one’s serostatus. That is especially true for older PLWH, who account for half of people living with HIV.
Older people may be especially hard hit by isolation orders. Loneliness was already a problem among older adults, and PLWH in particular, prior to the current situation. If you know someone living alone who may struggle with depression or other psychological problems, don’t only call them up, but also encourage them to reach out to someone else as part of their daily routine, advised Robin Gurwitch, Ph.D., of Duke University, during the SciLine briefing. “That’s where we have to recognize that we are in this—what’s the hashtag?—‘alone together’,” she said.
Such connections may ultimately stave off some of the long-term effects of the COVID-19 pandemic. While one may encounter depressed robots in science fiction, only our fellow human beings will need mental health help on Earth.