COMMENTARY

How to Improve Our Response to COVID's Mental Tolls

Lloyd I. Sederer, MD

Disclosures

May 10, 2021

We have no way of precisely knowing how many lives might have been saved, and how much grief and loneliness spared and economic ruin contained, during COVID-19 if we had risen to its myriad challenges in a timely fashion. However, I feel we can safely say that the United States deserves to be graded with an "F" for its management of the pandemic.

To render this grade, we need only to read the countless verified reports of how critically needed public health measures were not taken soon enough, or sufficiently, to substantially mitigate human and societal suffering.

This began with the failure to protect doctors, nurses, and technicians, who did not have the personal protective equipment needed to prevent infection and spare risk to their loved ones. It soon extended to the country's failure to adequately protect all its citizens and residents. COVID-19 then rained its grievous consequences disproportionately upon people of color, those living in poverty, and those with housing and food insecurity — those already greatly foreclosed from opportunities to exit from their circumstances.

We all have heard, "Fool me once, shame on you; fool me twice, shame on me."

Bear witness, colleagues and friends: It will be our shared shame if we too continue to fail in our response to COVID-19. But failure need not happen because protecting ourselves and our country is a solvable problem; complex and demanding for sure, but solvable.

To Battle Trauma, We Must First Define It

The sine qua non of a disaster is its psychic and social trauma. I asked Maureen Sayres Van Niel, MD, chair of the American Psychiatric Association's Minority and Underrepresented Caucus and a former steering committee member of the US Preventive Services Task Force, to define trauma. She said, "It is [the product of] a catastrophic, unexpected event over which we have little control, with grave consequences to the lives and psychological functioning of those individuals and groups affected."

The COVID-19 pandemic is a massively amplified traumatic event because of the virulence and contagious properties of the virus and its variants; the absence of end date on the horizon; its effect as a proverbial ax that disproportionately falls on the majority of the populace experiencing racial and social inequities; and the ironic yet necessary imperative to distance ourselves from those we care about and who care about us.

Four interdependent factors drive the magnitude of the traumatic impact of a disaster: (1) the degree of exposure to the life-threatening event; (2) the duration and threat of recurrence; (3) an individual's preexisting (natural and human-made) trauma and mental and addictive disorders; and (4) the adequacy of family and fundamental resources such as housing, food, safety, and access to healthcare (the social dimensions of health and mental health). These factors underline the "who," "what," "where," and "how" of what should have been (and continue to be) an effective public health response to the COVID-19 pandemic.

Yet existing categories that we have used to predict risk for trauma no longer hold. The gravity, prevalence, and persistence of COVID-19's horrors erase any differences among victims, witnesses, and bystanders. Dr Sayres Van Niel asserts that we have a "collective, national trauma." In April, the Kaiser Family Foundation's Vaccine Monitor reported that 24% of US adults had a close friend or family member who died of COVID-19. That's 82 million Americans! Our country has eclipsed individual victimization and trauma, because we are all in its maw.

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