Article 2: Lessons from before and after COVID-19: Why Healthcare Should Never Be the Same

This is the second article of a three part series examining COVID-19 and mental health 

The first part of this three-part series examined the effects a pandemic may have on healthcare professionals, including those who work in the mental health care sector. There is not only a toll on HCPs during the pandemic, but also in the aftermath.

However, pandemics are not new. This is not the first time the world has experienced a pandemic. If we take a step back, and look at some of the pandemics that have occurred over the last one hundred years, what lessons can we learn and possibly apply to the current COVID-19 pandemic?

Pandemics and outbreaks have been around for centuries, and much can be learnt from these, and from COVID-19, in terms of preparation for future healthcare crises.

The 1918 Influenza pandemic (Also known as the ‘Spanish Flu’) was an H1N1 strain of influenza, with a 10 -20% mortality rate. There were long lasting effects of the virus. For instance, babies born to women who had been exposed to the virus experienced increased physical ailments, lower levels of educational attainment, lower socio-economic status and lower income levels compared with the other birth cohorts.

This pandemic peaked and waned within a nine-month period, with an interesting observation noted in the book referenced at the end of this article:

‘This is how societies deal with such rapidly spreading pandemics – at first with great interest, horror and panic, and then as soon as they start to subside, with dispassionate disinterest’.

Lesson 1: We need to monitor and support women who are currently pregnant. We must provide reassurance and follow up on childhood developments and outcomes. Research will be a valuable weapon in the future.

Lesson 2: History repeats itself. Let us not forget the panic, anxiety and concern we are feeling now, as well as the mental health symptoms we may experience post COVID-19. If we are prepared and calm in the face of a future outbreak, we can lessen the panic within our communities and circles of friends.

Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) is considered a slowly progressing pandemic, with a lifetime prevalence in Sub-Saharan Africa of 25%. It is estimated that patients with HIV/AIDS have a lifetime prevalence of depression caused by many factors - the associated stigma, the shame that comes with the diagnosis and uncertainty about the future. These patients may already be experiencing cognitive impairment from the antiretrovirals (ARVs) they are taking, or from the illness itself. It would not be unreasonable to expect that the COVID-19 pandemic will have a similar lifetime mental health effect on patients.

Lesson 3: HIV/AIDS is a pandemic, occurring within a pandemic. This group of patients are already immunocompromised and at a higher risk for contracting the virus, as are many other vulnerable groups. Extra education and support need to be provided where possible.

Insights, ideas and quotations come from the following:

Huremović D, Duan C, Linder H, St. Victor G, Ahmed S Psychiatry of Pandemics – A Mental Health Response to Infection Outbreak. Switzerland: Springer Nature, 2019