Intended for healthcare professionals

Rapid response to:

Letters Coronavirus coverage

Covid-19: a digital epidemic

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m764 (Published 02 March 2020) Cite this as: BMJ 2020;368:m764

Rapid Response:

Covid-19: a physical and mental health epidemic

The effects of the digital and social media response to the novel coronavirus are thought provoking. The final human cost of the Covid-19 pandemic will be far greater than can be captured by daily updates of the number infected or by figures of economic decline. With time, the extreme psychological impact of the epidemic, necessary public health measures and the unprecedented social media commentary will be realised.

Before the epidemic there was a well-documented age gap in access to psychological therapies for depression and anxiety [1,2] and it was recognised that older adults were less likely to put their mental health before their physical health. Social isolation has been a long-term problem for older adults in the UK – approximately 1 in 3 older adults in the UK lived alone, 1 in 5 were socially isolated and 1 in 3 reported feeling lonely even before recent public health measures were introduced [3,4]. Loneliness is a recognised risk factor for depression, while sociability is protective [5]. Social isolation, loneliness and living alone are also risk factors for early mortality [6]. Friends and colleagues who have had to isolate for just a few weeks recently have commented that pressures brought on from living alone for a relatively short space of time were startling. Many in the medical and psychological community are campaigning against the use of the term “social isolation” to describe public health measures currently being implemented to slow the transmission of the disease. They are championing “physical isolation” to make it clear that we should only physically isolate ourselves and make sure that we do not become more socially isolated.

Over the last few weeks many local voluntary groups have been set up and tales of neighbourly support have spread across social media. Supermarkets have created designated hours for more vulnerable customers to shop. Doctors and psychological therapy services have created resources for those with mental health problems influenced or caused by Covid-19 [7]. Many people are taking advantage of technology to keep more socially connected via video calling and virtual meetings. These developments are invaluable, however, as has been recognised with public health measures aimed to reduce transmission of the virus, we require both national leadership and significant funding in order to reach those who are most isolated in the population and may not have the familiarity of using digital platforms for face-to-face communication.

Whilst we recognise the importance of public health measures implemented to reduce transmission of the virus itself and the need to inform the public of the importance of adhering to them, it is equally important that measures are introduced to safeguard individuals’ mental health. Notwithstanding the social cost of neglecting the psychological impact of the disease, for public health measures to be effective society must adhere to advice. Social support and robust mental health will be essential in enabling those most vulnerable in our society to both follow advice and to survive in physical isolation for the weeks and months ahead. We have been impressed by the government encouragement of outdoor exercise for those who are at less personal risk throughout this unprecedented period of physical isolation and that NHS correspondence to people being asked to stay at home long-term has included signposting to the Every Mind Matters website [8]. It is vital that psychological therapy services are adequately resourced to deal with increases in demand, this will require increases in funding, resources to support remote working, and training of future staff.

The fight for parity of esteem for mental health was not won before the current epidemic. Despite government commitments, mental health problems in the UK still represent a considerably greater proportion of burden of disease than of NHS spending [9]. Without significant public health initiatives to address the impact of Covid-19 on the nation’s mental health, backed by appropriate increases in public spending, the battle against this epidemic may be lost before it has begun.

References
1 Laake JP, Parratt J, Majeed N. Improving Access to Psychological Therapies for older adults: auditing management of newly diagnosed mild and moderate depression in six general practices within the Birmingham and Solihull CCG. Postgrad Med J Published Online First: 2020. doi:10.1136/postgradmedj-2019-136996
2 Royal College of Psychiatrists. Report of the Second Round of the National Audit of Psychological Therapies (NAPT). London: Healthcare Quality Improvement Partnership 2013.
3 Office for National Statistics. General household survey 2011. London: Office for National Statistics 2013.
4 Victor CR, Bowling A. A Longitudinal Analysis of Loneliness Among Older People in Great Britain. The Journal of Psychology 2012;146:313–31. doi:10.1080/00223980.2011.609572
5 Singh A, Misra N. Loneliness, depression and sociability in old age. Ind Psychiatry J 2009;18:51–5. doi:10.4103/0972-6748.57861
6 Holt-Lunstad J, Smith TB, Baker M, et al. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci 2015;10:227–37. doi:10.1177/1745691614568352
7 Russ Harris. FACE-COVID. 2020. https://www.baps.org.uk/content/uploads/2020/03/FACE-COVID-by-Russ-Harri... (accessed 21 Mar 2020).
8 Every Mind Matters. One You. https://www.nhs.uk/oneyou/ (accessed 24 Mar 2020).
9 NHS England. NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk/ (accessed 30 Mar 2019).

Competing interests: No competing interests

24 March 2020
Jean-Pierre Laake
Medical Student
Nadia Majeed
University of Warwick
Coventry, West Midlands, UK