Effect of COVID-19 on Loneliness and Depression

The Leaning Tower of Pisa (Dr. Noorali Bharwani)
The Leaning Tower of Pisa (Dr. Noorali Bharwani)

Stress, anxiety, and depression are not unusual for people of all ages.

Under the current environment (COVID-19), loneliness, stress, anxiety and depression are felt by most people. Certain individuals are affected more than others.

Whatever the level of anxiety and depression you have, you should know there is help.

Alberta Health Services has resources and services, such as Text4Hope, available to help you or someone you know. Remember, if you are struggling you are not alone. There are supports in place to help you.

Let us focus on two things: depression and loneliness.

Depression

Depression isn’t a weakness. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.

It is also called major depressive disorder or clinical depression. It affects how you feel, think and behave. This can lead to a variety of emotional and physical problems. This can affect your daily activities.

Depression may require long-term treatment. Good news is most people with depression feel better with medication, psychotherapy or both.

Depressive symptoms vary a lot. Symptoms can be mild to severe. Symptoms can cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as: biological differences, brain chemistry, hormones and/or inherited traits.

Mental distress is common in public health emergencies like COVID-19. After a disaster, population rates of psychological distress tend to double or triple. Recovery time may vary from a year to several years. People who have a history of depression may take longer to recover.

Depression should be taken seriously. If you have a history of depression or if the current environment is affecting your mood and health then you should seek help.

Can we prevent depression?

There’s no sure way to prevent depression. However, some strategies may help. For example, take steps to boost your self-esteem, reach out to family and friends, especially in times of crisis, to help you weather rough spells. Get treatment at the earliest sign of a problem to help prevent depression from worsening. Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Loneliness

Loneliness is the state of mind. You can be in a company or relationship and you may feel lonely. You may be alone and feel sorry for yourself. It’s a feeling of sadness or even anxiety that occurs when you want company.

Feeling of loneliness can occur in a crowded place where you are not interacting with others.

Loneliness has a wide range of negative effects on both physical and mental health, including stress, depression and cognitive decline. It can affect your heart. It can lead to stroke. It is associated with functional impairment and dementia.

Humans are social animals. Our connection to others enables us to survive and thrive.

There is no medical treatment for loneliness. As loneliness cannot be effectively treated with medications or acute care, health care practitioners may consider social prescribing to connect with sources of support in the community.

The bottom line is, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose.

Having a sense of purpose is important. Keep yourself mentally and physically active at home. Take care. Be safe. Be patient.

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Why are scientists baffled by the global COVID-19 outbreak?

Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)
Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)

Globally, there have been more than 10 million confirmed cases of COVID-19, including 500,000 deaths (WHO statistics).

It is estimated, more than one billion people face increased risk of severe COVID-19. Can we control this terrible pandemic? Hopefully, yes. But there are few challenges.

First challenge:

People with illnesses like diabetes, heart and lung problems and other medical conditions form 20 per cent of world’s population. This population is at increased risk of severe disease.

Analysing data from 188 countries (A. Clark et al. Lancet Glob. Health) the authors of this article estimate 1.7 billion people worldwide have an elevated risk of severe illness. The researchers also estimate nearly 350 million people – some of whom do not have underlying conditions – would require hospitalization if infected.

With these facts in mind, experts around the world are trying to assess how many high-risk people will need a vaccine once it is developed. The number will be in billions.

How many hospital beds will be needed? How many doctors, nurses and all other health care workers who are stressed and overworked will need care? Who will look after them?

Second challenge:

There are currently no drugs licensed for the treatment or prevention of COVID-19. According to some reports, there are at least 254 treatments and 172 vaccines currently in development to fight COVID -19. U.S. taxpayers are funding six COVID vaccines currently being fast tracked and tested. If the results are promising it may take at least a year before people can take advantage of it.

Third challenge:

Recognising the illness is not easy. Although majority of the patients with COVID-19 have classical symptoms that can be mild to severe, some patients may not exhibit any symptoms. You may not know you have symptoms of COVID-19 because they are similar to a cold or flu.

COVID-19 can make some people very ill. More rarely, the disease can be fatal. Older people, and those with pre-existing medical conditions (such as high blood pressure, heart problems or diabetes) appear to be more vulnerable. Many experts believe this kind of illness has not been seen before in our lifetime.

Fourth challenge:

Getting the facts from reliable sources versus the stories getting ahead of the science. This causes sheer confusion.

It is estimated between 1,500 and 2,000 articles per week are published on the subject. Majority of the articles are considered of poor quality by many experts. But there is some outstanding work going on at a speed not seen before in scientific research. That is extremely positive.

Fifth challenge:

Long term effects of COVID-19. COVID-19 affects individuals in many different ways. Scientists are only starting to understand the vast array of health problems caused by the virus, some of which may have long-term effects on patients and health systems.

Coronavirus is not only a respiratory virus, the virus can affect your brain, heart, liver, kidneys and other organs. Some patients experience blood clotting disorders that can lead to strokes, and extreme inflammation that attacks multiple organ systems. The virus can also cause neurological complications that range from headache, dizziness and loss of taste or smell to seizures and confusion.

Sixth challenge:

Getting people to follow preventive measures. For example, getting them to wear a mask. But mask alone will not prevent the spread of COVID-19. You must consistently and strictly adhere to good hygiene and public health measures, including frequent hand washing and physical distancing. Stay at home. Go out only for essential things and keep yourself mentally and physically active at home.

Take care. Be safe. Be patient. It’s not over yet!

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How reliable are COVID tests?

Columbia Icefield (Dr. Noorali Bharwani)
Columbia Icefield (Dr. Noorali Bharwani)

COVID-19 pandemic took us by surprise and hit us hard, spreading from country to country and continent to continent. It has been with us for the last six months or so and shows no sign of stopping. In fact, we are warned to be ready for the second wave.

In the meantime, scientists all over the world are working round the clock to find an appropriated vaccine and antibiotic that would help. Most urgent focus has been to increase access to tests to diagnose people with current infections.

The possibility of COVID-19 should be considered primarily in patients with new-onset of fever and/or respiratory tract symptoms like cough and difficulty breathing. In some ways, COVID-19 is similar to influenza.

However, there are some key differences between COVID-19 and the flu. COVID-19 causes severe disease in a higher percentage of cases than seasonal influenza.

We need to do a laboratory (microbiology) test to establish COVID-19 diagnosis. Sensitivity of testing depends on the type and quality of the specimen obtained and the duration of illness at the time of testing.

In case of COVID-19, the virus that causes the disease – SARS-CoV-2 – is detected through a test known as a reverse-transcription polymerase chain reaction test, or RT-PCR. This is the most common type of test used in Canada.

A study of the accuracy of RT-PCR testing for COVID-19 found the test did not detect the virus on day one of infection and produced false-negative results 38 per cent of the time on day five and at least 20 per cent of the time after day eight. If patient has symptoms but the test is negative then test result should be ignored and patient should be kept in quarantine and tested again.

Types of testing

I have been curious to know how accurate are the tests done to diagnose COVID-19. Here is what I learnt.

Nucleic acid-based testing – for detecting nuclear acid specific to the virus. This is the preferred initial diagnostic test for COVID-19.

Scientifically speaking, this is a nucleic acid amplification testing (NAAT), most commonly with a reverse-transcription polymerase chain reaction (RT-PCR) assay to detect SARS-CoV-2 RNA from the upper respiratory tract.

This test is the gold standard used in Canada and abroad to diagnose active COVID-19 infection in patients with symptoms. There are very few false positive results. False negative results depend on timing of the sample in relation to the stage of the illness.

False negatives can occur up to 30 per cent of the time if we swab people who are asymptomatic and swab them too soon after they’ve been exposed to COVID-19.

False positives depend a lot on the machine itself, but also how much COVID-19 is in a town or community that is being assessed. It is hard to nail down a rate that applies to every machine that is used.

Test sensitivity depends on timing of sample collection. According to Centre for Disease Control and Prevention (CDC) proper collection of specimens is the most important step in the laboratory diagnosis of infectious diseases. A specimen that is not collected correctly may lead to false negative test results.

Serology-based testing – for detecting antibodies to the virus.

Serologic tests are blood tests that look for antibodies in the blood. They can involve a number of laboratory techniques. This test is not intended for use in clinical diagnosis. Serological tests do not detect the virus itself. Instead, they detect the antibodies produced in response to an infection.

Health Canada confirms that authorized COVID-19 tests are well supported by evidence indicating they will provide accurate and reliable results. That means very few false positive results. In Alberta, any person who wants to be tested can now be tested, even if they don’t have symptoms.

I hope this information helps. Take care. Be safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

What have we learned about COVID-19?

Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)
Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)

Here is the good news. The spread of the COVID-19 pandemic in Canada is slowing down. But the bad news is, health officials warned it could come back with a vengeance this fall if contact tracing and testing aren’t stepped up.

What we are trying to do is to contain the virus because there is no vaccine or medications to kill the virus. Once the lockdown is lifted, it will leave many people vulnerable to infection as they begin to venture out again.

Unless there is a miracle, SARS-CoV-2 Vaccine will take time to be ready to be used.

The COVID-19 pandemic is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Alberta has the third-most number of cases of COVID-19 in Canada. By June 3, there were 7,076 confirmed cases and 145 deaths. The majority of cases have been in the Calgary zone, which has 4,909 cases.

What do we know about coronaviruses?

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

There are people who are infected but have no symptoms. Others have mild to moderate to severe symptoms.

Classical COVID-19 symptoms may appear two to 14 days after exposure to the virus. That is the incubation period. The common presentation is fever, cough, and tiredness.

Other symptoms can include: shortness of breath or difficulty breathing, muscle aches, chills, sore throat, loss of taste or smell, headache, and chest pain.

Other less common symptoms have been reported, such as rash, nausea, vomiting and diarrhea.

People who are older or who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or have compromised immune systems may be at higher risk of serious illness.

It is important you contact your health care provider if you have any of these symptoms. You should call 911 if you have trouble breathing, persistent chest pain or pressure, inability to stay awake, new confusion, blue lips or face.

The virus appears to spread easily among people. Data has shown that it spreads from person to person among those in close contact (within about six feet, or two meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby.

It can also spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes.

Prevention is better than cure. Since there is no vaccine to prevent COVID-19 the next best thing is to reduce your risk of infection by doing the following:

  1. Avoid large gatherings
  2. Avoid close contact
  3. Stay home as much as possible
  4. Wash hands often
  5. Wear a mask in public places
  6. Avoid touching your eyes, nose and mouth.

Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease.

If you have COVID-19 related symptoms you are legally required to isolate yourself.

If you have symptoms, take the online assessment to arrange testing.

Take care. Stay healthy.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!