Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological and Psychological Perspectives

*Ranjan Bhattacharyya*

#### **Abstract**

Following any natural disaster, tragedy, calamities, there are upsurge of mental health issues found worldwide. COVID 19 is no exception to them. Public health and infection control domains were the first hit at the peak of pandemic. The news and information were bombarded in traditional print and electronic Medias as well as in social Medias. The tsunami of infodemic was a recent topic of discussion. The responsible reporting, media role, role of Government and Non Government organizations are immense. To combat these challenges and ensuring peace and tranquillity are the biggest task of the policymakers ahead.

**Keywords:** Pandemic, infodemic, psychological first aid, social media, mental health issues

#### **1. Introduction**

It all started with the ophthalmologist Dr. Li Wenliang. In the pages of history, probably his name will be printed in golden letters for being the whistle blower of COVID-19 pandemic. He was born on 12th October, 1986 in a tinsel town Beizhen Liaoning in the Republic of China. He was a student of Wuhan University and was watching closely the developments. After going through the papers he suspected the presence of this deadly virus and shared his findings in WeChat group. He had been manhandled by the police of Wuhan city for which they extended apology letter. In this process Dr. Li Wenliang has contacted with SARS CoV2 and died on 7th February 2020 at the age of only 33 years [1, 2].

In the seminal paper published on 24th January 2020 about 59 suspected cases presented with fever, dry cough in Jin Yintan Hospital at Wuhan, China, 41 patients were confirmed to be infected with 2019-nCoV. The Signs and symptoms were typically respiratory symptoms which include fever, cough, shortness of breath, and other cold-like symptoms. Majority of cases (82%) reported to date have been milder; about 15% appear to progress to severe cases, some 3% are critical. Less than a 25% of cases experienced severe illness. Chinese authority's reports on 2% of people infected with the virus have died [3].

The Coronaviruses belonging to the family of *Coronaviridae* infect both animals and humans. Human coronaviruses can cause mild disease similar to a


#### **Table 1.**

*Chronology of development OF COVID-19.*

common cold, while others cause more severe disease (such as MERS - Middle East Respiratory Syndrome and SARS – Severe Acute Respiratory Syndrome). Some coronaviruses found in animals can infect humans and thus called zoonotic diseases [4].

#### **1.1 Source and mode of transmission**

Based on current information, an animal source seems the most likely primary source of this outbreak. It is likely that an intermediate host played a role as well in the transmission of the disease from our understanding, there are two types of transmission: zoonotic transmission (transmission from animals to humans) and human to human transmission. Current estimates of the incubation period range from 1 to 12.5 days with median estimates of 5–6 days [5, 6]. The chronology of how COVID 19 has evolved has been summarized in **Table 1**.

#### **1.2 Active case finding**

To control any pandemic there should be a dedicated, systematic, team approach needs to be followed. For each case the possible contact tracings needed to be done. One infected person is capable of infecting 3–4 people. Therefore initial approach of the public health experts were active case finding involves a wider search, focusing on certain key areas summarized in **Table 2**.


#### **Table 2.**

*Systematic tracing of contacts of cases.*

*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*

#### **1.3 The modification of search engines**

If one clicks over to Google, type in "coronavirus", and press enter, the results will bear little resemblance to any other search. There are no ads, no product recommendations, and no links to websites that have figured out how to win the search engine optimization game. Government, NGO and mainstream media sources dominate. Algorithms and user-generated content are out; gatekeepers and fact checking are in. Silicon Valley has responded to the "infodemic" with aggressive intervention and an embrace of official sources and traditional media outlets.

#### **2. COVID-19: a pandemic or infodemic: a real story from Iran where hundreds die over false belief**

Alcohol poisoning in Iran has skyrocketed amidst the corona virus pandemic as being an Islamic country sale of ethyl alcohol is prohibited. More than 728 people have died from ingesting toxic methanol alcohol since February 2020 [7]. John Zarocostas, WHO informed about WHO's newly launched platform to combat misinformation. He mentioned that, "To combat Infodemic all stakeholders need to join hand with hands." [8] Immediately after COVID-19 was declared PHEIC, WHO's risk communication team launched WHO Information Network for Epidemics (EPI-WIN) [9]. Sylvie Briand, director of Infectious Hazards Management at WHO told "We know that every outbreak will be accompanied by a kind of tsunami of information, misinformation, rumours, etc [10]. Aleksandra Kuzmanovic, social media manager of WHO told *The Lancet* that "fighting infodemics and misinformation is a joint effort including Facebook, Twitter, Tencent, Pinterest, TikTok etc. Kuzmanovic noted that Google has created an SOS Alert on COVID-19 for the six official UN languages, and is also expanding in some other languages. Dr Tedros informed that WHO also uses social media for real-time updates. WHO is also working closely with UNICEF and other agencies having extensive experience in risk communications e.g. International Federation of Red Cross and Red Crescent Societies. WHO Director–General Tedros Adhanom Ghebreyesus at the Munich Security Conference on 15 February 2020 said that; "We're not just fighting an epidemic; we're fighting an infodemic", WHO Information Network for Epidemics (EPI-WIN) was launched as a new information platform after COVID-19 was declared as a Public Health Emergency of International Concern (PHEIC) [11].

#### **2.1 Social media infodemic**

As an example, CNN had anticipated a rumour about the possible lock-down of Lombardy (a region in northern Italy) to prevent pandemics, publishing the news hours before the official communication from the Italian Prime Minister. As a result, people overcrowded trains and airports to escape from Lombardy toward the southern regions before the lock-down was in place. Another example of hazards attributable to improper health communication can be drawn from Nigeria. In India, a father of three was reported to commit suicide upon hearing his diagnosis of COVID-19 [12].

#### **2.2 Interventions to address misinformation/rumours**

The rumours are widespread which added salt to the wound to people affected globally **[**13, 14]. Some of the interventions to control the spread of rumours or misinformation are mentioned in **Table 3**. It is also important to flatten the infodemic curve also to break the chain of misinformation (**Figure 1**).


#### **Table 3.**

*Steps to prevent hoax news, false information and infodemic.*

#### **Figure 1.**

*Flattening the 'infodemic' curve (adapted from WHO website https://www.who.int/news-room/spotlight/ let-s-flatten-the-infodemic-curve).*

From birth to death an individual is invariably exposed to various stressful events. The modern world is not only called as world of achievement but also a world of stress. The term has been defined as external pressure that comes from the environment and perceived as strain within the person. Though the term originally coined for the purpose for physics, but in Medicine it was coined by Canadian endocrinologist Hans Selye. It's defined as the capacity of our body to adjust to a new challenging environment. The environmental stimuli tries to misbalance the homeostatic process and our body tries to bounce back to balance with tensions. The high level stresses also incur high expenditures by virtue of increase health service utilization. Stress persists beyond the period of absenteeism causing much longer period of disability. A stressor, which can be a biological or chemical agent, environmental condition or external stimulus arising in a person due to high pressure in professional and personal life. The physical factors, life events, environmental factors, personal factors coloured by own perception and emotion determines the severity and outcome of a stressful event. The different kind of stressors has been summarized in **Table 4**.

*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*


#### **Table 4.**

*Symptoms and management of stress and its consequences.*

The role of psychiatrists has been felt when there is widespread panic, fear, apprehension (in the stage of fear) when people became fanatic and lots of mental health issues in are piling up in addition to their normal duty schedule which have been summarized in **Table 5**.

#### **2.3 Psychological first aid**

It has been described as humane, supportive response to a fellow human being who is suffering and who may need support [15]. PFA involves the following themes which are highlighted in **Table 6**.


#### **Table 5.**

*Role of Psychiatrists in COVID 19 pandemic.*


**Table 6.** *Psychological first aid.*

#### **Figure 2.** *Caesarian delivery were not locked down.*

All the processes were not locked down during this pandemic. COVID positive mother deliveres beautiful child (**Figure 2**). The Health workers including doctors, nurses, paramedics, medical tecchnologists, Gr C & Gr D staffs, sweepers worked in tandem selflessly and whole heartedly at a strtch for 8–12 hours wearing PPEs and without drinking or eating anything and going to toilets. Other frontline warriors, police, fire fighters, media personal, municipality workers extended all kinds of services to distressed people (**Figure 3**). The general wards, condemned building, newly constructed extensions have been converted to isolation and SARI ward in no time (**Figure 4**).

*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*

**Figure 3.** *Health check up team waiting to receive Migrant workers.*

**Figure 4.** *SARI ward & CCU constructed and renovated.*

## **3. Types of stress**

#### **3.1 Positive stress**

As per Yerkes-Dodson's law (**Figure 5**), some amount of positive stress is beneficial during initial phase which enhances the performance.

#### **3.2 Eustress**

A positive form of stress that helps us to perform, and is usually experienced when we are going through happy events like a graduation, a wedding, the birth of a child, a competitive event, or a vacation.

#### **3.3 Negative stress**

This can be of three types.


In **Figure 5**, it has been shown clearly that some amount of stress/arousal (x axis) is beneficial for performance (y axis). It looks like a symmetrical bell shaped curve. Initially with stress, performance enhances, used as a marketing strategy to enhance performances of employees. The same can be observed before examination. But at the optimum level (dy/dx), in marketing it's known as break-even point where marginal costs equal to operating cost, more arousal/stress has detrimental effect on performances. The maximum level of stress a person can handle (optimal arousal) is known as following which all stresses become distress.

The most common stressors during quarantine are (i) Fear of infection, (ii) Duration of quarantine, (iii) Frustration, (iv) Inadequate supplies. In this pandemic we have gone through three phases as mentioned below [16].


*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*

The resilience is defined as the capacity of an individual to bounce back successfully against the adversity and building up academic, social and vocational competence amidst severe stress. The vulnerable population lie children and elderly need to be care with utmost vigilance. The certain determinants like attitude, behavior, practice decide the future vulnerability of an individual at home, school and college and work place with respect to law abuse violence and use of alcohol and other drugs. The factors that strengthen social competence are – Responsiveness, Care, Empathy, Communication skills, Flexibility, Application of Mature defense like humor and other prosocial behaviour, problem solving skills, autonomy, healthy expectancies, Gold directedness etc. The competence and confidence are achieved at comparatively younger age which makes an individual more resilient. The strength of character, moral fortitude, tenacity, connectivity, communication skills are key factors which enable resilience especially during this pandemic. The positive and adaptive strategies during the presence of adverse stressful is called coping. When the individual becomes self reliant with adaptability and positive coping strategy he or she gains mastery and control over the situation. The Resiliency wheel comprises the following components


The conditions that buffer individuals from the negative impact of COVID pandemic are promotion of positive behavior general and psychological well being and strengthening external (Time management, empowerment, boundaries and expectations and support and internal (positive values and identity social competencies and commitment to learning) assets.

The protective factors can be built by social development strategies, healthy beliefs and bonding which improves personal skills and shape up individual characteristics. The COVID pandemic has taught us how to strengthen up attachment, bonding and commitment (ABC) at individual (positive peer pressure, school (online classes and activities, community (caring neighborhoods' being a role model and serving community at various levels and finally at family level by providing support, communication improving relationships participating in music, art, drama, sports and hobbies. The seven C's of positive development are competence, confidence, character, connection, contribution, coping and control [17]. The adolescent are exposed to adverse childhood experiences (ACEs) which can have deleterious effects and make them more vulnerable to behavioral issues and suicidal ideation. This can be dealt by addressing the unique needs of adolescents, building the concept of nurturing resilience [18]. The ten phase process described on resilience are as follows: (1) Practice story, (2) Phenomenon of interest, (3) Theoretical lens, (4) Preliminary core qualities, (5) Reconstructed story, (6) Mini – saga, (7) Refined core qualities with definitions, (8) Concept definition, (9) Model, (10) Mini synthesis [19].

The core structure of nurturing resilience is built up with a processed manner amidst environmental hardships. The four stages nurturing resilience are secure connections, self acceptance, temper reactivity and resilience. The building

resilience in regional youth in a study in Australia described 6 stages of module which are (1) Taking good care, (2) Introducing masterpiece, (3) Obstacle courses, (4) Media messages, (5) Changing worlds, (6) New beginning. The sources of stresses among adolescent can come from school work, friends and family. However


**Table 7.**

*Molecules (neutotransmitters, neuropeptides, hormonal) factors mediate stress and builds up resilience.*

#### *Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*

the source of strength in adolescents comes from social connectedness, self reliance and personal attributes [20]. Mental issues related to the health emergency, such as anxiety, depression, post-traumatic stress disorder (PTSD), and sleep disorders are more likely to affect healthcare workers, especially those on the frontline, migrant workers, and workers in contact with the public. Job insecurity, long periods of isolation, and uncertainty of the future worsen the psychological condition, especially in younger people and in those with a higher educational background. Multiple organizational and work-related interventions can mitigate this scenario, such as the improvement of workplace infrastructures, the adoption of correct and shared anti-contagion measures, including regular personal protective equipment (PPE) supply, and the implementation of resilience training programs [21]. A study on 152 doctors completed responses in an online survey showed 34.9% were depressed and 39.5% and 32.9% were having anxiety and stress. Significant predictors for psychiatric morbidities found in this study were experience in health sector, duty hours, use of protective measures, and altruistic coping. In another online survey it was revealed that (71.8%) and one-fifth (24.7%) of the respondents felt more worried and depressed, Half of the respondents (52.1%) were preoccupied with the idea of contracting COVID-19 and one-fifth (21.1%) of the respondents were repeatedly thinking of getting themselves tested for the presence of COVID-19. only a minority of the respondents (2.2%) took help through the helpline [22, 23]. The COVID-19 pandemic provides unique opportunities for robust evaluation of interventions. When selecting interventions aimed at supporting frontline workers


#### **Table 8.**

*Genetic and Epigenetic factors related to stress and resilience.*

(FLWs) mental health, organisational, social, personal, and psychological factors may all be important [24]. Resilience is used in different fields including but not limited to psychiatry, psychology, social sciences, anthropology, medicine and allied healthcare systems. The healing and healthy lifestyles governed by various protective and salutogenic factors are key players to build up effective resilience. The rising above the adversities in challenging times and shedding off negativities and imparting positivity all around helps an individual to bounce back to normal life. It's like the tensile strength of an elastic material which is acquired with empathy, personal strength and constructive criticism [25]. The factors that improve to build up resilience are support system, inner strength, capacity to handle adversities and toughening up self to fight against stressful working environment, balance in professional and personal life, maintaining connections and reconciliations etc [26].

The interplay of genetic, epigenetic, environmental, hormonal factors and involvement of neuropeptides, neurotransmitters, neural circuits decide the ability to cope up against stress related disorders which has been summarized in **Table 7** [27].

The improved resilience also helps to delay the aging process and improve quality of life which can be strengthened by modelling and input from mentors. The genetic and epigenetic factors implicated in stress and building resilience with effective coping strategy have been mentioned in **Table 8** [28, 29].

The biopsychosocial and spiritual dimensions can be effectively changed by resilient coping strategies which can decrease the caregiver's burden, reduces emotional distress and improves quality of life [30]. In literature, various interventions durations, complex programmes have been mentioned to improve resilience [31].

#### **4. Mental health and psychosocial considerations during the COVID-19 outbreak**


*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*


During this pandemic we have learnt many things. We've learnt how much resources are required for an individual for the livelihood. We've learnt to help each other. We have rediscovered our family and friends. The history repeats itself, the Gripe Esponela (the Spanish influenza flu) almost 102 years ago (1918) had been revisited in literature to compare with COVID 19. But one thing for sure, the budgetary allocation should give the priority on health and education. More funding is required for Research & Development as we've enough manpower but unfortunately we're running ultramodern software in a heavily loaded hardware. Soon this phase will pass away and we'll live in a world with 'new normal' adaptations.

*Anxiety, Uncertainty, and Resilience During the Pandemic Period - Anthropological...*

#### **Author details**

Ranjan Bhattacharyya1,2

1 Department of Psychiatry, West Bengal Medical Education Services, India

2 Charak Square Diagnostic and Research Center, India

\*Address all correspondence to: drrbcal@gmail.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Anxiety, Uncertainty and Resilience during the Pandemic Period-Anthropological… DOI: http://dx.doi.org/10.5772/intechopen.98841*

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#### **Chapter 17**
