The Pandemic’s Mental Toll: More Ripple Than Tsunami

The Four Percent


The evidence from recent surveys asking people about their emotions during the pandemic is not convincing one way or the other either, experts said. One reason is that these surveys often do not make distinctions between people in the thick of the action — front-line workers, in this case — and everyone else. Millions of Americans have been juggling Zoom cocktail hours with Netflix binges: a time-management challenge, perhaps, but not one that has been linked to prolonged trauma.

Moreover, psychological distress usually takes time to consolidate into the kind of persistent condition that drives people to seek treatment, revealing a diagnosable psychiatric disorder. Generalized anxiety disorder, for instance, is defined in part by excessive anxiety for at least six months. Post-traumatic stress requires, first, experiencing a life-threatening event, either personally; through a loved one; or up close, like witnessing deaths in an intensive care unit. Nightmares and other reverberations of the trauma are common, but these typically must persist for at least three months to qualify for the full diagnosis of a chronic condition.

“There are a number of surveys out there, and I think they are all useful, to some extent,” said Emma Beth McGinty, an associate professor in the Johns Hopkins Bloomberg School of Public Health. “But they’re using a mishmash of measures of symptoms of depression and anxiety, and not a validated psychiatric instrument,” or questionnaire.

The best American survey to date, posted early this month by JAMA and led by Dr. McGinty, administered a standard, widely studied psychiatric questionnaire online to a nationally representative sample of 1,468 adults. It found that 14 percent of people had high levels of psychological distress, compared with an average of 4 percent during the pre-Covid era. It found little difference in respondents’ feelings of loneliness, compared to averages before the pandemic.

“The longer people experience these levels of psychological distress, the more likely they are to present with a diagnosis that would benefit from treatment,” Dr. McGinty said in a phone interview. “But the question of whether that’s really going to happen is an open one. We did this in early April, right as the shutdown and stay-at-home orders were implemented, when people were experiencing all this for the first time. One might hypothesize that the stress has eased, we’ve gotten more used to this and the world has opened up a bit.”

  • Updated June 16, 2020

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      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

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      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

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      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

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      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Dr. McGinty and her collaborators plan to conduct another such survey later this summer, she said, and possibly one in the fall, to see whether levels of psychological distress change as the epidemic changes shape through the year.

The fear of infection and disruptions caused by the coronavirus, without question, have intensified the distress of many individuals, especially those who have lost regular access to care as a result, or who had pre-existing dread of infections — from obsessive-compulsive disorder, for example.



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