Before 2020, how often did you think about the words “epidemic,” “outbreak,” or “pandemic”? According to The Principles of Epidemiology in Public Health Practice, Third Edition’s "Introduction to Epidemiology," an epidemic refers to an unexpected increase (often sudden) in the number of cases of a disease in a population in a certain area. An epidemic in a more limited geographic area is often called an outbreak. As we now know well, an epidemic that has spread over several countries or continents, affecting a large number of people, is a pandemic.
The implications of these levels of disease spread are not only physical, but also mental, emotional, political, and economic. In the weeks surrounding World Mental Health Day 2020, it is important to take a closer look at how we’re addressing the mental consequences of the novel coronavirus pandemic, and what knowledge we can apply from the most recent Ebola virus disease (EVD) epidemic in the Democratic Republic of Congo (DRC).
Surviving the “Deadliest Outbreak Ever”
People in the DRC were already dealing with the daily trauma of violence and poor access to health care and clean water when Ebola re-emerged in the country in mid-2018. As The New Humanitarian reported at the end of last year, efforts to control and eradicate the highly infectious disease were thwarted by community distrust, anti-UN protests, and militia attacks. International relief workers often had to be withdrawn or their efforts suspended.
When the World Health Organization (WHO) declared the end of the DRC’s latest Ebola epidemic in June 2020, 2,287 people had died and 1,171 people had survived the infection over nearly two years. With an average 50 percent fatality rate, you would think Ebola survivors would feel like the lucky ones. Unfortunately, the opposite is true for many: Besides dealing with chronic physical issues like muscle and joint pain, fatigue, headaches, eye and vision problems, and loss of appetite, they are coping with a myriad of other challenges:
- Survivor’s guilt
- Loss of personal possessions
- Personal attacks
These result in a greater incidence of depression, anxiety, and post-traumatic stress disorder (PTSD). Lack of information, as well as the spread of misinformation via social media, exacerbates the mental strain.
Credible, Culturally Appropriate Services
So how are public health officials in the DRC, and those supporting them, assisting the survivors, and educating their communities? As Liberia’s former deputy minister of health for disease surveillance and epidemic pointed out in Stat, “Investing in a survivor program will cost everyone less than responding to the next full-scale outbreak.”
Early in the epidemic, the WHO recognized the psychological ramifications of surviving Ebola. Despite issues of trust as an “outside” organization, it created a national care program for EVD survivors with dedicated clinical and psychological care and biological follow-up of body fluids. (The virus can remain for months after recovery.) More than 90 percent of those who recovered from Ebola attend the monthly follow-up.
The AMA Journal of Ethics suggests that EVD treatment should always include access to follow-up mental health care: “Culturally appropriate responsiveness to mental illnesses is critical to mitigating local persons’ distrust of international clinicians….Prioritizing EVD patients’ short-term and long-term general health, including mental health outcomes, must be how good Ebola care is defined.”
Responding to Worldwide Stress
Now we are seeing people still reeling from an epidemic faced with the physical and mental consequences of an as-yet unstoppable pandemic. The DRC has already recorded nearly 11,000 COVID-19 cases and more than 275 deaths. Our organization has been on the front lines of the novel coronavirus response there, supporting essential infection prevention and control services. From providing doctors, test kits, and PPE, to getting samples to and from laboratories, and supervising decontamination activities, Bizzell is partnering with local, national, and international groups to improve health outcomes.
The psychological worldwide fall-out from COVID-19 is staggering. Imagine all the doctors, nurses, and first responders who have watched COVID-19 victims – including their own colleagues – die as they furiously worked to save them. Think of the families who were unable to be with loved ones when they passed, hoping that an employee in the hospital or long-term care facility was able to be at their side. Imagine the patients who are hospitalized for months, many awakening from comas, only to find out how their lives have been changed forever. Consider the millions who have sheltered at home for months, lost their jobs, or are fearful about contracting the virus. We cannot focus solely on the transmission of COVID-19. We must formulate an innovative and sustainable response that addresses the global mental health crisis already emerging.
One size will not fit all for the plan. Cultures, technology, education, and communication methods must all be considered. For example, one does not talk about “depression” or “PTSD” in the DRC. Rather, you ask if a person is feeling sad or hopeless or having nightmares. In the U.S., and other countries, people are more accustomed to hearing and using those terms to describe symptoms of mental illness.
The theme for this year’s World Mental Health Day, “Mental Health for All-Greater Investment: Greater Access” is perfect for the COVID era. In her message, World Federation for Mental Health President Dr. Ingrid Daniels delivered a rallying cry: “Mental health is a human right…We need to start now and continue our call to ensure that no one is left behind.” We are taking action. Are you?
“Ebola Virus Disease – Democratic Republic of the Congo.” World Health Organization, World Health Organization, 26 June 2020, www.who.int/csr/don/26-June-2020-ebola-drc/en/.
Mednick, Sam. “For Ebola Survivors in Congo, Stigma and Mental Health Issues Loom Large.” The New Humanitarian, 11 Dec. 2019, www.thenewhumanitarian.org/news-feature/2019/12/11/Ebola-mental-health-….
Nyenswah, Tolbert. “The DRC Needs an Ebola Survivor Program to Quell Its Outbreak.” STAT, 3 Aug. 2020, www.statnews.com/2020/08/04/drc-needs-ebola-survivor-program-quell-outb….
“Principles of Epidemiology.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 May 2012, www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html.
“Psychological Support for Life after Ebola - Democratic Republic of the Congo.” ReliefWeb, 5 June 2019, reliefweb.int/report/democratic-republic-congo/psychological-support-life-after-ebola.
Srivatsa, Shantanu, and Kearsley A. Stewart. “How Should Clinicians Integrate Mental Health Into Epidemic Responses?” Journal of Ethics | American Medical Association, American Medical Association, 1 Jan. 2020, journalofethics.ama-assn.org/article/how-should-clinicians-integrate-mental-health-epidemic-responses/2020-01.
“World Mental Health Day 2020.” World Federation for Mental Health, 3 Sept. 2020, wfmh.global/world-mental-health-day-2020/.