A GLOBAL HEALTH CRISIS
Lockdown protocols may reduce our ability to fight off infection – just when we need it most
By Sarah Pressman, AXA Award Recipient
The COVID-19 outbreak is having a profound effect on our mental health, but it likely doesn’t end there. It’s important to realize that negative thoughts of anxiety, frustration and stress don’t just magically stay in our heads. Rather, they also have very real effects on the day to day functioning of our hearts, hormones, brains, and most critically, on our immune systems. The result is that we may be less able to fight off infection at the very moment we need it most: in the midst of a pandemic.
First, it’s worth asking: why is the current COVID-19 crisis so stressful? And the answer is uncertainty. We don’t know when it will end, or even if it will end. We don’t know if we will fall ill or, if we do, how serious the illness will be. In many cases, we don’t even know if we’ll have a job after the crisis, or if we’ll have enough money to feed our family over the next year. People feel a complete lack of control, which is why we have observed such odd behaviors: people buying a year’s supply of toilet paper or protesting over having to wear a simple mask. It’s an attempt to wrestle back control. Unfortunately, stress is at its worst when it is uncontrollable and unpredictable. The very situation we are in today.
In the short term, stress is not that harmful and something our species is well designed for. From an evolutionary point of view, we’re built for fight or flight. If we’re faced with immediate danger, our bodies divert energy away from slow moving bodily processes, e.g. reproduction and some immune functions, that won’t save us in the short term and send energy over to places like our muscles that (in theory) can help us escape the threat. This is great if you are being chased by a wild animal, but not so adaptive when stress is prolonged for months and months like it has been. When we perceive constant threat, our bodies start to break down – they fail to return to a resting state – and you begin to see physiological consequences including an increased risk for catching an infectious illness if you are exposed to one.
“To date, it seems we have been entirely focused on biological and demographic factors like past illnesses, age, blood type, or race, ignoring the known evidence that our thoughts, emotions, and behaviors also play a critical role in who gets sick and how seriously.”
Under high stress, people also turn to coping activities that are unhealthy. We eat too much high-fat and high-carbohydrate food, looking for that boost of energy that our bodies think we need. We smoke or drink heavily as a way to cope with our negative emotions. The healthiest stress copers might try other things like coping via religious ceremony, social activity, playing team sports, or taking a vacation, but right now, these activities aren’t available to us. Plus, it’s also hard to disengage and relax in any meaningful way when the workplace and home intersect 100% of the time, and childcare is absent. Finally, the stress, the late hours trying to squeeze in work you can’t do during the day, and the existential worry and isolation means sleep may be disrupted. All of these factors together pack a known immune-compromising punch that may mean that your body isn’t as capable of fighting off illness as it normally would be.
Also critical, we know that one of the best ways to combat stress is having people around to support us. This pandemic is eroding our ways of connecting. As humans, we are very sensitive to social isolation and distancing. We need to be with people – our bodies need physical contact. Research has shown that social isolation is as bad for our health as smoking two packets of cigarettes a day. In fact, it’s even more strongly tied to mortality than our weight, age, activity level, body mass, or drinking. Relationships are also one of the most effective ways to reduce the negative consequences of stress, yet it’s the one factor being affected most by lock downs, work from home practices, closed schools, and quarantines. It’s no wonder we are seeing more and more indication of people violating the rules – the drive to connect is simply too powerful in a time of stress that is this high.
All this has a profound effect on our mental health. The result may be depression or anxiety. Sadly, in some cases, it may be suicidal behavior. It’s exactly this feeling of hopelessness that leads to clinical depression. Critically though, it’s not just our mental health at risk. As stated earlier, our minds and bodies are not separate systems. What we think and feel has the potential to alter our physiology and our physiology impacts our mind. We already recognize the link, and there are countless statistics supporting this. The risk of heart attack is 9.5 times higher in the hours following intense anxiety. Loneliness is tied to double the mortality risk in older adults. And as we hinted at before, high stress is tied with about twice the risk of catching a cold when you are exposed to the virus.
“We need to think differently and alter some guidelines in favor of finding solutions that aren’t knee jerk virus safety decisions but ones that also consider psychological well-being as a critical and weighty factor.”
Right now, we are understandably focused on basic but effective public health initiatives such as required distancing, business and school closure, hand washing, and mask wearing. Surprisingly, however, we are talking much less about why some people are more susceptible to this illness than others. Why do some get symptoms and some do not? Why do some go to the hospital or pass away, while others never even know that they have the illness? To date, it seems we have been entirely focused on biological and demographic factors like past illnesses, age, blood type, or race, ignoring the known evidence that our thoughts, emotions, and behaviors also play a critical role in who gets sick and how seriously.
Our response to long-lasting pandemics like this must start to include measures to protect and foster mental health rather than the simpler instinct to isolate everyone. We have to bring well-being experts into the discussion and be open to solutions that factor in the need for psychological wellness in the face of a world disaster. This might mean finding safe and creative solutions that allow for individuals to get outside and experience the stress and immune-enhancing effects of nature and exercise. It means figuring out ways to let children safely reconnect with their friends on a play structure rather than wrapping each up in caution tape. It means allowing innovations to let group exercise classes, massage or haircuts happen in the outdoors or with ample safety considerations. These types of services and activities are deemed non-essential by so many, but self-care and connection are essential, especially in these times of high anxiety, stress and depression.
Critically, it also means finding ways of getting childcare handled. Parents are struggling to manage with the schools currently closed and the lack of childcare coupled with working from home – and so are the children. We need to think differently and alter some guidelines in favor of finding solutions that aren’t knee jerk virus safety decisions but ones that also consider psychological well-being as a critical and weighty factor. The simplest solution is almost never the best well-being solution and this approach is bound to store up physical health problems for the future.
This stressor is going to last a long time and we need to start making decisions and creatively problem solving in a way that prioritizes our physical, social and psychological well-being. We should do so as though our lives depend on it, which ultimately, they do.
Readers also read
- Employees will not return to old ways of working, by Yi Mien Koh
- COVID-19 will accelerate the trend toward more online health, by Claudio Gienal
AXA Award Recipient and Professor of Psychological Science, University of California, Irvine (US)
Dr. Sarah Pressman is a Professor of Psychological Science at the University of California in the US. Her research focuses on physical health and stress-protective effects of positive emotions, and the capacity of psychological and behavioral factors to influence biology. Findings from Sarah’s research have been featured in media outlets, including the New York Times, CNN and the Wall Street Journal. She is the recipient of an AXA Award for her work on Happiness: An Anti-Stress Elixir for Better Health.