Physical Distancing With Social Connectedness

On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) to be the most serious global pandemic and crisis in the 21st century. As of June 26, 2020, more than 9.6 million cases and more than 489,900 deaths have been confirmed from COVID-19 [1]. These figures may have been underestimated due to lack of testing facilities in many countries [2]. Vulnerable countries include Bangladesh, which had its first three cases confirmed on March 8, 2020; as of June 26, 2020, the total number of cases has reached 130,474 with 1,661 deaths reported [3].

The increasing number of confirmed and death cases, current lockdown, and inadequate health care facilities may increase the risk of mental problems. Research shows that the lack of social contact may have adverse mental health consequences, including fear, stress, anxiety, and mood disorders [4]. Continuous media coverage and reports of COVID-19 situations are causing further stress. The likelihood of an economic downturn may, in turn, increase mental and psychological stress among the people in Bangladesh, which may lead to increased psychological and mental health problems and may disrupt all health care services. However, people with a mental health problem and disabilities and people on a low income may be at higher risk from social isolation [4].

Health care professionals and other emergency service providers on the frontline may be at increased risk of infection and risk of mental health problems as well. Moreover, during infectious disease epidemics, older people are more susceptible to infection and psychological disorders [5]. Among the confirmed cases of COVID-19 in Bangladesh, only 7% are in people aged over 60 years, but they have accounted for around 40% of deaths [3]. A recent study reported that more than half of older people in Bangladesh had depressive symptoms [6]. Children and young people in Bangladesh are also at a higher risk of developing mental health problems during COVID-19 [7]. People affected by mental disorders need routine outpatient visits for evaluation and management, but fear of infection and nationwide restrictions on travel may impede and delay regular visits.

In these circumstances, ‘physical distancing with social connectedness’ may be an effective alternative way in health care services [8]. In Bangladesh, telehealth or online health care services may be effecrive [9] for children, young and middle-aged people. As older Bangladeshis have limited access to the Internet and little ability to use such services, mass media, particularly television, may play an essential role for them through telecasting special mental health programmes for older people.

References

1. COVID-19 Dashboard-Johns Hopkins Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html.

2. Ebrahim SH, Ahmed QA, Gozzer E, Schlagenhauf P, Memish ZA. Covid-19 and community mitigation strategies in a pandemic. BMJ. 2020;368:m1066. https://doi.org/10.1136/bmj.m1066.

3. Institute of Epidemiology, Disease Control and Research (IEDCR). https://www.iedcr.gov.bd/.

4. Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020;369:m1557. https://doi.org/10.1136/bmj.m1557.

5. Yoshikawa TT. Epidemiology and unique aspects of aging and infectious diseases. Clinical Infectious Diseases. 2000; 30 (6):931-933. https://doi.org/10.1086/313792.

6. Rahman MS, Rahman MA, Ali M, et al. Determinants of depressive symptoms among older people in Bangladesh. Journal of Affective Disorders 2020; 264:157-162. https://doi.org/10.1016/j.jad.2019.12.025

7. Rahman MS, Lassi ZS, Islam SM. Risks to Bangladeshi children and young people during covid-19 outbreak. BMJ. 2020;369: m2299. https://doi.org/10.1136/bmj.m2299.

8. Bergman D, Bethell C, Gombojav N, Hassink S, Stange KC. Physical Distancing With Social Connectedness. The Annals of Family Medicine. 2020;18(3):272-277. https://doi.org/10.1370/afm.2538.

9. Liu S, Yang L, Zhang C, et al. Online mental health services in China during the COVID-19 outbreak. The Lancet Psychiatry 2020;7 (4): e17-18. https://doi.org/10.1016/S2215-0366(20)30077-8.