As numbers of people diagnosed with Covid-19, hospitalized on account of it and dying of it increase, mental health, which has always received secondary attention, is undergoing greater neglect. Experts have cautioned against a rising mental health crisis. Some of them are already labelling it an ‘epidemic’ in its own right. As we deal with the ongoing Covid-19 calamity, it is pertinent to start preparing for post-pandemic psychological effects. This requires starting a dialogue, however speculative, and taking steps at every level to establish systems and policies and allocating resources to deal with the psychological aftermath of Covid-19.

Our experience of the current situation can be described as prolonged exposure to direct or indirect trauma. Individuals who’ve been infected or know someone who has been infected, or have witnessed death due to coronavirus can suffer the direct effects of trauma, such as post-traumatic stress disorder (PTSD) that, among other things, can result from natural or human made disasters.

A spike in the number of infected cases is expected as lockdown eases and individuals become more exposed. PTSD can be experienced in the form of revisiting the trauma through memories, nightmares, hyper-arousal (being easily alarmed or startled), negative moods, thoughts and beliefs such as “the world is an unsafe place.” Feelings of guilt, shame or fear may also be present along with avoidant behaviors, in this case taking extreme measures to avoid getting sick. However, it is important to remember that individuals with indirect experiences, by learning about traumatic events, are also being exposed to repeated prolonged mental trauma and stress, with undetectable consequences but which can nonetheless affect lives and functioning in the short- and long-term.

In its aftermath, Covid-19 can instill unfounded fears of falling sick, result in increased psychosomatic complaints, irrational concerns about one’s general health and hyper-vigilance. It is possible to have an increase in number of cases of hypochondriasis, characterized by anxiety and preoccupation with having or acquiring a serious undiagnosed disease in the absence of physiological symptoms or mild symptoms. Those with pre-existing psychological conditions, such as depression or OCD, would have to work harder to manage their symptoms and in some cases, overcome relapse. There have also been reports of an increase in domestic violence that can leave long-term traumatic effects. The last pandemic of this scale was the Spanish Flu in 1918 and there is little research available on its long-term effects on mental health. But, if trauma of natural disasters is taken into consideration for comparison, research shows there is likely to be an increase in cases of depression, anxiety, and substance use following the disaster.

The psychosocial impact of Covid-19 governed by social distancing and isolation practices may well change the way individuals connect with one another when this is over. There had already been questions about social media’s association in declining in-person, face-to-face interactions, quality of contacts, loneliness and isolation. Moreover, with the shutdown of different support systems of friends and family, the reliance on social media to connect with others and reduce isolation has increased. Presently, there are those who are rigidly following social distancing and isolation practices even within their homes and others who either loosely follow them or not at all. It would be interesting to see the role of social media and the effect of prolonged social distancing and isolation and whether it will harbour further loneliness and cause a decrease in quality of communication and our ability to connect with one another once this pandemic has passed.

Habituation to behavioural patterns developed as coping strategy in this situation can affect our appropriate responsiveness to situations later. Similarly, cognitive or thought patterns adopted now can later interfere with processes of effective communication. Studies show that maladaptive cognitive processes can result in faulty misinterpretations of situations yielding inadequate responses. It is unclear how new norms developed in this unusual situation will apply in the absence of Covid-19 and when social distancing and isolation practices cease. Possibly, we may have to re-learn healthy cognitive and behavioural patterns.

There is some literature that also suggests the role of media in developing short-term PTSD-like symptoms after the trauma, raising questions if indirect experience could possibly make these symptoms last longer than direct exposure. Research further posits that low-vulnerability populations may yield low-impact trauma, where symptoms become relatively quickly resolved. However, in Pakistan we not only lack the means to identify these low-vulnerability populations, but also adequate resources for psychological support to build a low-vulnerable population. As people experience prolonged exposure to media coverage of Covid-19, they may experience trauma indirectly and vicariously with little thought to its consequences in the long-term. The effect of distress due to vicarious traumatization can go undetected for a long period of time and may be exhibited in quality of sleep, ability to concentrate, irritability, anger, fatigue, or changes in appetite.

This pandemic has shaken individuals’ hierarchy of needs – people who lose their jobs during this pandemic will suffer the stress of finding employment and financial strain threatening their basic needs of sense of safety, security, shelter and access to resources. Covid-19 demands that social distancing be practiced as prevention, and this will likely impact relationships, intimacy, belongingness and sense of connection to other people. It will hamper with the process of self-actualization, reaching one’s fullest potential, leading to feelings of uselessness or unworthiness.

The actual short-term and long-term psychological impact of trauma of Covid-19 is yet to be determined. As we deal with the severe physical effects of this virus, it is imperative to start conducting research and developing a mental health preparedness response at all levels that include institutional, organizational, societal, and personal. There is a very real possibility that we will see an increase in the number of cases of depression, generalized anxiety, and PTSD after this crisis is over. In the absence of existing systems, policies, and resources we need to start building an evidence-based foundation for our response to psychological trauma for the future.