BY Deepti Chavan and Debshree Lokhande
Fear and paranoia have gripped the world today because of COVID-19 — a highly infectious disease. There is uncertainty, stigma and resulting mental health stress for those at risk or affected. People forget, however, that before this, there have been other infectious diseases such as SARS, HIV and the ancient TB.
These infectious diseases have only ever been talked about in hushed tones. Even more hushed are whispers about mental health issues. But when it comes to talking about infectious disease and mental health together — all that exists is silence.
As we fight COVID-19, what can we learn from TB and HIV and their impact on patients’ mental health? As survivors of drug-resistant TB, having battled the disease for years, we have experienced the impact of infectious disease on mental health.
Dealing with a TB diagnosis is mentally exhausting. A drug-resistant TB diagnosis is even more traumatising. As news reports indicate, a diagnosis of COVID-19 is no different — people panic, and some even flee because of the fear of being in quarantine.
TB treatment is long — nine months for drug-sensitive TB and two years for DR TB; and involves taking multiple medicines, and in some cases, even painful injections. It comes with a host of mental health side effects such as psychological distress, anxiety, depression and psychosis that affect a patient’s quality of life.
For COVID-19 patients, from the moment of diagnosis, the absence of a cure, the fear, stigma and the guilt of infecting others has an enormous mental health impact. In both cases, patients feel depressed, frustrated and anxious about recovery.
In TB, certain TB medicines like Cycloserine directly impact mental health. It causes extreme mood swings, depression and anxiety. In extreme cases, it can cause mental breakdowns and worsen pre-existing mental health conditions. In COVID-19, the stigma and fear play a similar role. Patients can become paranoid, irritable and sometimes even aggressive.
Moreover, in COVID-19 and in pulmonary TB, patients are forced to isolate due to the highly infectious nature of these diseases. These patients struggle with loneliness and despair. In both cases, depression and/or anxiety are obvious outcomes. Simple tasks like eating or taking a shower seem impossible. Not surprisingly, patients find it difficult to speak about their challenges, access health services or even take their medicines. In extreme cases, many patients report feeling suicidal.
Even after cure, there is the obvious stigma and lack of self-esteem. In the case of COVID-19, affected individuals don’t know how to disclose their status. It is the same in TB and HIV. The residual stigma from TB and the continuing stigma in HIV cause patients to lose their self-confidence, and it causes self-blame. They withdraw from people and social situations, and this isolation often leads to depression.
Yet, alongside exists a promising reality — COVID-19 is not always dangerous, TB is curable and HIV is almost a chronic disease. So mental health challenges, if addressed, can be transitory. Stories from TB and HIV are proof of this.
These are stories of hope. One of our fellow drug-resistant TB survivors now spends his vacations mountain climbing. Another TB survivor, a copywriter, found solace in writing. Yet another TB survivor rediscovered a new career as an educator. People living with HIV also have gone on to live perfectly normal lives, speaking about it without fear. Each of them faced mental health challenges during treatment but overcame them.
We need to incorporate a mental health component in our COVID-19 response to help patients cope.
First, we need to sensitise medical professionals and health workers about mental health and COVID-19, TB or HIV and train them in basic counselling. Second, screen COVID-19 patients for mental health issues at the time of diagnosis and intermittently during treatment.
Also, counsel patients and families through diagnosis and treatment to sensitise them about the impact these diseases have on mental health. It also includes equipping them with self-care strategies and with ways to cope. Families need to be encouraged to support patients by giving them positive stories of hope and recovery from other diseases as well.
Also, acknowledge that there is no shame in having mental health issues and seeking help. Not only can these survivors turn their lives around, but they can also help others.
Finally, we need to create a public narrative on mental health and destigmatize it by stressing that mental health is important for everybody. Nobody is immune to mental health issues or infectious diseases. This is a time of crisis, and mental stress is a given. A cure for COVID 19 may come when it comes, but empathy and consolation are our most important medicines right now.
India needs to talk about mental health and COVID-19, HIV and TB in its homes, offices, schools, and colleges. Mental health and these diseases need to become the subject of mainstream conversations. There has never been a better time to do this.