Inside Covid-19: Mental wellness in lockdown; Respirators from PMB; Remdesivir; Zoomlash – Ep 16

In episode sixteen, a bumper post-long-weekend edition of Inside Covid-19, features how to maintain mental health during lockdown; insights from two editors who are also specialists in the spread of infectious disease; our regular update from global health and HIV expert Prof Alan Whiteside; the Pietermaritzburg company that’s ready to restart making respirators after corruption forced them to abandon the line 17 years ago; a Zoomlash after the hugely popular video conferencing tool becomes a hack-fest; and the race to discover effective treatment against Covid-19 after a promising 53 person trial for remdesivir. – Alec Hogg

First in the Covid-19 headlines today:

  • Total deaths from Covid-19 had risen above 116,000 Sunday, with the US now the hardest hit nation with almost 23,000 mortalities, surpassing Italy at just over 20,000, Spain at 17,500, France at 14,400 and UK at 11,300. New York is the epicentre of the US pandemic with almost 7,000 deaths, around a third of the American total. The university’s analysis says that after trending downwards, Italian mortalities are on the rise again, while neither the US nor the UK have yet peaked. Spain, France and Germany, however, are all on a declining path. The mortality per 100,000 of population is over 30 in Spain, Italy and Belgium, with France at 21 and the UK 16, double the rate of neighbour Ireland, which implemented lockdown two weeks earlier. The US mortality is at 6.7 per 100,000 of population. Sweden, which has rejected lockdowns, is now reporting a mortality rate of 8.83 per 100,000 citizens. South Africa and India are at mortality rates of 0.04 and 0.02 respectively while China, where Covid-19 originated, has a mortality rate of 0.24 per 100,000 of population.
  • Lockdown restrictions are being relaxed in Spain with some businesses expected to re-open after being closed for the past month. In the US, the suddenly famous head of infectious diseases Dr Anthony Fauci, is tipped to become yet another high ranking official to be relieved of his services after disagreeing with President Donald Trump. Interviewed by CNN on Sunday morning Dr Fauci said the government could have saved more lives had it moved sooner to impose social-distancing restrictions. Trump retweeted a message that called for Fauci to be fired. Trump and Fauci has disagreed on various issues including the effectiveness of chloroquine, the anti-malaria drug the president has repeatedly promoted as a possible treatment for the virus.

As South Africa approaches its fourth week of lockdown, new areas of concern are emerging, including the impact of isolation on mental health. Here’s Dr Seranne Motilal, Clinical Wellness specialist at Vitality, who is eminently well qualified to unpack the issue for us…

My background is quite diverse. I am a medical doctor trained in South Africa and spent a good proportion of my career in psychiatry. I have a diploma in mental health and was fortunate enough to be awarded a scholarship to go to Harvard where I did my Master’s in Public Health – a great opportunity – and it’s been very helpful especially given the context that we find ourselves in at the moment.

Having studied at Harvard, having seen the incredible brains that the Americans have, has it surprised you at the poor way that they seem to be handling Covid-19?

Yes and no.

What’s interesting about America is that there’s so much diversity, so much brilliance, but a lot of variety and a lot of different takes and a lot of different opinions. I think that’s what makes America so powerful, is that everybody has that freedom and everybody is expressing their opinions which perhaps sometimes doesn’t lead to the best response. Time will tell and will definitely tell us more about how good their response has been. It has been a little bit surprising because we look to America as leaders and I think for this particular instance that hasn’t been demonstrated so well.

Getting on to mental health and the lockdown, is there much of a relationship between what goes on in our heads and the way our environment is. Particularly when we’re forced to stay indoors?

Definitely. Let’s start by taking a step back. I think generally – especially in South Africa – mental health and mental wellbeing is starting to find its way into normal mainstream discussions and into our focus and we’re getting increased awareness, but I still think that awareness has a long way to go. Then comes along a major pandemic and there’s a lot of trauma and a lot of mental distress and upheaval. Now that we have to stay at home, our environments and our worlds have been turned upside down – in the last 3 weeks – and they’ll continue to be for the foreseeable future. I think that extra stress and upheaval has really compounded our mental health and our mental well-being and has led us into unknown and uncertain territory. The thoughts, frustration, anger, the sadness or the loneliness, all these emotions that we’re seeing and that’s demonstrated by family members and friends, is expected because of the distress that we’re all going through at the moment.

How do you actually manage a situation where you are having to stay indoors, there is a lockdown, there is clearly a threat to your mental health because of all of this. Some people who work for companies know that they are going to be struggling to come out of this alive, if at all?

Yeah and I think that’s an important point. General health sits in several buckets. There’s biological reasons for what we go through, psychological reasons, there’s environmental reasons and social reasons. I think it’s important to highlight that there’s a lot of social factors at the moment that are out of our control staying at home. Worrying about job security or financial instability. A lot of that at the moment might feel very out of control and what we should try to focus on are the things that remain in control and remain in our domain. It’s not to diminish that these external factors play a significant role but it’s one of the ways that we can support ourselves, one of the coping mechanisms that helps us – not only maintain mental wellbeing while we’re in lockdown – but also help us cope with and deal with these external stresses. The first step is the awareness and to let ourselves off the hook for feeling a variety of things. A lot of people are feeling scared at the moment, are feeling sad, feeling angry or frustrated and a lot of people are feeling very lonely and these are all normal emotions in a pandemic. That’s not to say that we should diminish them, but rather give ourselves enough time to be able to process them. If we’re not feeling our best selves that’s normal and that’s OK. We can still function and we can still be OK despite this and I think that’s the first step. You’re going to be seeing a lot of mental health advice and it’s valuable and worth it to reading and staying informed. But the other things that are happening at this moment is we’re being overwhelmed with information. We’ve been overwhelmed with stress and anxiety. It’s coming from social media or the news, it’s coming from family members. It’s important to limit that and to structure and make routine in our days. So we’re not just sitting and being overwhelmed continuously with this information that maybe doesn’t really add too much to our lives. It’s important to stay informed but it’s also important to not let it become too overwhelming. A lot of the information is misinformation which is not helpful in any way. Fundamentally the advice would be, stick to reputable sources for your information, this would be the government, WHO, the CDC, just really trusted sites and news sources. And to limit it – 30 minutes a day – to check information or watch a particular news broadcast. That’s one way of starting to filter out some of the information you’re getting. It’s a tough one but I think as you start to actively practice limiting information or limiting the time spent on a phone on your TV, all of a sudden you’re going to be exposing yourself less to those sources of information.

As far as Vitality is concerned, your whole business is about keeping people well, not just physically but mentally as well. What are the life hacks that you suggest to Vitality members? 

So there are quite a few. We’ve actually launched the Vitality at Home program. I don’t know if you’ve had a chance to have a look at it.

I looked at it and was very impressed. Is much of that live?

Yes. So we continuously work on this to make sure that it’s updated regularly and the great thing about Vitality at Home is, it’s open to absolutely everyone. What we have at the moment – and what we are continually updating – is a fitness at home channel, nutrition at home channel and a mental wellness at home channel. What you can find on these different channels are educational materials, videos, podcasts, all sorts of information to try and maintain your physical activity, your healthy eating and your mental well-being while you’re staying at home. The way we’ve vetted the resources that are available on this site, is we really put thought into what’s useful, what can we do. What can people can still do even though they’re at home and even though we’re going through a pandemic? So we’ve tried to really make it a useful resource for information that you can access in order to maintain both your general physical and your mental health.

How important is that link, that relationship between exercise and mental health?

Extremely important. It might not feel intuitive. I think we’re all well aware that physical activity has great benefits to our overall health. Sedentary lifestyles can be a huge risk and lead to premature disease and death. So I think we’ve established that physical activity is good for our health, but what we’ve recently been seeing is physical activity is really good for our mental health as well. There was a study published in The Lancet Psychiatry in 2018 – which is really interesting because it looked at the relationship between physical activity and mental health – and what they found was that individuals who exercise, reported 43% fewer days of poor mental health compared to individuals who did not exercise. This is for all exercise types, all were associated with a lower mental health burden. This mental health benefit was noted in people who exercise for longer durations, up to 45 minutes and more frequently in the week, 3 to 5 days a week. The link between physical activity and actual mental health and mental wellbeing is quite significant. 

What about the people who might be sitting at home with clear mental health issues like getting into depression or just feeling completely out of sorts, what could they do?

I think the first thing is – especially for those who have been diagnosed with a mental illness – is to continue on the advice of your health care provider. Continue your medication as prescribed and to reach out to your health care provided should you be experiencing any problems at this time. For people who are going through unmanageable mental health distress, there are many facilities and hotlines available that can help in this situation. For example SADAG (South African Depression and Anxiety Group) – who we will be working with as well in vitality – have hotlines and crisis hotlines that people can call to talk about this and to talk about the distress they’re going through. It’s also important to remember to talk to people around you, to people you trust. This is something that we’re all experiencing and it’s important to discuss it and to let people know so they can also support you in finding help. It’s imperative to reach out to health care providers and to get the help that you may need in this time.

Don’t underestimate it. Just to close off with, you did work at the Department of Health in Gauteng, how well prepared are we and do we have the facilities here to manage this Covid-19 a pandemic? 

So I think what we can all feel extremely proud of is our government’s response to Covid-19, it’s been absolutely stellar. It’s been world class and probably better than most nations. One of the main reasons for the lockdown was to try and allow ourselves the time to increase resources to prepare our hospitals to deal with any potential crises that may arise in the future and I think the government is really utilising the time to do that. So in short, yes we’ve had long standing problems, but I think they’ve done a great job and I have full faith that this will continue into the foreseeable future.

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