On my mind: Coronavirus, fear, and anxiety

An image of coronavirus from the CDC website.

With the worsening of news about coronavirus in the United States, it’s understandable that many of us are experiencing heightened levels of fear and anxiety. Some of our fears are justified. According to Denise Schepici, CEO of Martha’s Vineyard Hospital, (the primary local source of care for COVID-19), “Coronavirus will come to Martha’s Vineyard.” It has not been documented on the Vineyard yet, but that does not mean that it is not already here. What we know for sure is that coronavirus (more specifically known as SARS-CoV-2) is highly contagious and can be lethal. It is rational to be afraid for ourselves and our fellow man, especially if we or they are old or have other illnesses (especially lung problems) or compromised immune systems. 

But fear, especially when it is exaggerated, can block our ability to reason, learn, and remain compassionate. Anxiety in the form of obsessive worries, severe social anxiety, disturbed sleep, and panic attacks can be incapacitating. Sometimes, our fears are out of proportion to reality; two common components of anxiety include overestimation of risk and underestimation of our ability to deal with it. 

Robert L. Leahy, Ph.D., Director, American Institute for Cognitive Therapy, writes that eight factors lead to escalation of risk assessment and drive worry: how currently information is received, how dramatic, memorable, and intense the information is, how easily available information is, how much uncertainty there is in a risky situation, how invisible a threat is, how much control people feel they have over a situation, how horrible the possible outcomes of a risky situation might be, and how suddenly bad outcomes might occur. And I would add, people who have known trauma in their past are also likely to overestimate risk. Most of us face many risks every day but don’t worry much about them. For example, some 678,000 people die each year in the United States alone from illnesses related to unhealthy eating and inactivity, another 480,000 die from cigarette use, and another 12,000 to 61,000 die from the regular flu. But people don’t tend to experience excessive anxiety about these possibilities because the factors as delineated by Leahy are mild. But in the case of coronavirus, all eight factors are strong, and consequently, people’s sense of personal risk is heightened, and likely overestimated. 

I am not suggesting that we should be complacent about the risk that comes from the coronavirus; in fact, there is plenty of evidence that worry will lead to taking better precautions and that will lower the risk of illness and death. A lot depends on how we behave now. If we can slow the rate of infection, the healthcare system will be less overwhelmed, there will be time to find new treatments, and potentially fewer people will get infected.

But in the short run, worry, depression, and debilitating fear come at a high personal cost and can lead to poor decisions about how to proceed. There are a number of things we can do to make our anxiety more manageable. On the practical side, we can take action. Among other things, this means consistently washing our hands when exposed to possible contagions, not touching our faces, noses, and mouths, cleaning surfaces, avoiding groups, avoiding travel, social distancing, and isolation of people who have signs of infection — including ourselves if we have symptoms. People whose fears become overwhelming should turn to their primary care practitioners, psychotherapists, spiritual advisors, and/or well-informed, calm and loving friends. Crises like this one can exacerbate or trigger mental illness, but psychotherapy and natural and pharmacologic interventions can help. 

Also helpful is changing the way we frame the coronavirus situation to ourselves. What I believe and tell my family, friends, and concerned patients is that on Martha’s Vineyard, we are behind the curve of many parts of the country and world. So though the virus will come here, it may be coming here more slowly. It is much easier than in other places to live a good life here with minimal exposure to others. And while hospitals everywhere will become overwhelmed if this follows the pattern of other countries like Italy, our hospital is cleaner than big city hospitals, integrated into one of the most skilled hospital systems in the world, and has superb staff and good resources. Furthermore, it helps to remember that there are many reasons embedded in our natures that lead most of us to overestimate the risk to ourselves. If you are in good health and younger than 60, your risk of getting seriously ill with COVID-19 is relatively low. Your risk of death from numerous other preventable causes is much higher. 

Research suggests that we are programmed to overvalue danger and bad news and undervalue good news. That makes sense, given that as we evolved as a species, thinking a rock was a predator was harmless, but mistaking a predator for a rock could be lethal. Negative ideas and events are weightier in our unconscious minds than positive ones, and studies have shown that in terms of the things we say to each other, it takes five positive comments to equal the weight of one negative one. The coronavirus presents us with danger and conjures plenty of negative thoughts. So I have been collecting a list of positive thoughts. Here is a list of 10 positives with regard to the pandemic. You might find it helpful to collect your own list. It feels comforting. 

  1. As a result of the virus, we have an opportunity to step back from our usual lives, reflect and refocus on our families, home, and spiritual life.
  2. If you suffer from FOMO (fear of missing out), you can relax. Not a lot is going to be happening for a while anyway. 
  3. We are invited to enjoy our own company. There will be more opportunity to read, meditate, paint, garden, and write. 
  4. We have been living in a polarized and divided world. The coronavirus is a real and present danger to all of us. This is a common experience for most of humanity. Perhaps it will help to unite us. 

5. Yes, we need social distancing. But this is also an opportunity to reach out in safe ways to people with whom we might like to have more contact. Get all your old roommates on a video conference, call your mother or sibling every day, send a Facebook message or a quick email to anyone you miss. 

6. We are probably taking more precautions than ever before to prevent the spread of disease. In addition to protecting us from coronavirus, these precautions will also reduce transmission of influenza, the common cold, and other communicable diseases. 

7. This is a reminder of how much we all have to be grateful for. We have a relatively safe food supply, good air, abundant clean water, and we on Martha’s Vineyard live in an intelligent, well-endowed community that is rising to the challenge of keeping us all safe and well. 

8. As a human community we are putting human safety above economic prosperity.  Perhaps we will become less focused on acquiring material things and more focused on what really matters. 

9. For those of us who have been uncomfortable with the status quo, the inevitable economic upheaval may shift the political landscape. For instance, there is more momentum for paid sick leave for all, an excellent and adequately funded public health system, and universal access to the Internet.

10. It is our nature to assume that what is, is permanent. The changes that are occurring with this pandemic are a reminder that everything changes and that the only thing that is real is the here and now. This crisis may help us be more present in our lives. 

But of course, we must not underestimate the risks in this situation, and we all need to do our part to slow and even prevent the spread of infection. There is much that we each can do to minimize risk, and we must all make the effort to change habits and act responsibly so as not to get the virus ourselves, or spread it to others. If you are anxious, remember that together we have considerable control of where this pandemic goes from here. In the next few weeks we will know a lot more about how many people in the U.S. are infected, but the evidence is that it is relatively early in the course of this illness here, and we can play a big part in slowing it down. 

Dr. Charles Silberstein is a psychiatrist at Martha’s Vineyard Hospital and medical director of Island Counseling Center.