COVID-19 and Psychiatry: An Open Letter to President-Elect Biden

The high priority of getting ahead of the crashing COVID-19 mental health wave.

Posted Nov 22, 2020

Dear President-Elect Biden,

Congratulations on your election victory. Your administration assumes authority in the United States at an unprecedented time in history, facing great challenges in reducing polarization in the context of a pandemic, accelerated by the as-yet poorly understood influence of social media and information technology. 

Recent research in the journal Lancet Psychiatry looking at data from more than 62,000 COVID-19 survivors within three months of infection finds that rates of new psychiatric illness, predominantly anxiety disorders, insomnia, and dementia (in older patients) are double that found in survivors of a comparison set of other diseases, with nearly 6 percent reporting new-onset illness.

The overall rate of psychiatric illness, including those with recurrence of pre-existing conditions, among COVID-19 patients is nearly 20 percent. This is largely independent of infection severity, stressors, and demographic variables. COVID-19, while clearly a physical health crisis, is also a mental health crisis. This is true for all people, and especially those at risk, including people with prior conditions, essential workers, and frontline physical and mental healthcare personnel.

According to the CDC, the US is passing 12 million cases with over a quarter of a million dead, implying that more than 700,000 new and 2 million total cases of psychiatric illness may be expected. This will only increase as COVID-19 infection numbers are rising exponentially. Preventing disease spread is of paramount importance, as is addressing the “crashing wave” of anticipated neuropsychiatric illness.

As much as social media creates bubbles of competing political views and even worldviews, the story of division is only half the story. The other half is that, on a more fundamental level, social media and information technology have forced people into close proximity to one another in a vast and unpredictable social experiment.

Being confronted with each other’s contrasting, competing and often incompatible views seems to have accelerated pre-existing divisions. This is an issue that has dangerously compromised our ability to mount a coherent response to the pandemic, climate change, racism, gender-based violence, human rights issues, poverty, and a myriad of other challenges by embroiling people in conflict.

Collective trauma and moral distress are thereby inflamed. The mental health and broad societal impact are defining outcomes for the next several decades. What we do now is critical. We are at a global tipping point on many levels—socioeconomic, cultural, political, and in terms of global physical and mental health. Our choices today will shape the future for generations to come.

I would like to respectfully suggest that the mental health dimensions of the pandemic are proactively addressed. Please take steps to ensure that your advisors include people with psychiatric and related disaster mental health expertise in the event this has not been fully secured. In addition to the current outstanding talent and collective experience of professionals from many walks of medicine and public health and policy, the COVID Advisory Board would benefit from including members with knowledge of psychiatric illness, treatment and access to care, the impact of mental illness across the lifespan and in special populations, family and community systems, and disaster mental health. 

Long after the initial medical and socioeconomic needs are addressed, the mental health consequences and impact of trauma and moral distress may linger. While resilience is the norm for many, for a large percentage, based on prior experience, the long-term impact will snowball if resources are not allocated early. Past traumatic events, such as the Holocaust, the Vietnam War, and more recently 9/11 and the aftermath, indicate that for a meaningful percentage of those affected, the impact of untreated traumas may be passed down through generations of Americans to come. An ounce of prevention is worth a pound of cure. 

For the sake of U.S. citizens and people around the world who look to the U.S. as a role model, thank you for your courage in facing this unfamiliar, often surreal territory.

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