Slow pandemic reintegration posing a problem for healthcare professionals

By LYNNE JETER

Coronaphobia, a newly minted term, perhaps best describes patients suffering from social anxiety spurred by the pandemic – and it’s a problem for doctors.

Some patients have become accustomed to sequestering in their homes during the early stages of the pandemic – while also transitioning to zoom meetings and phone calls with medical providers – that they’re reluctant to return to in-person visits, especially when restrictions are placed on companions in the waiting room. The problem has led to more-than-usual cancellations and no-shows.

“Coronaphobia describes the excessive fear of contracting the virus and the stress and avoidance of public places and situations that result from fear,” said Mary-Catherine Segota, PsyD, co-founder of Counseling Resource Services. “An increase in anxiety during the pandemic led to fears of leaving the house for some, and eventually symptoms of agoraphobia and panic disorder. What does this mean for healthcare providers, and how does it influence how we screen and probe for psychiatric issues?”

Individual reactions to the pandemic have differed in many ways, Segota explained.

“The initial adjustment to the shock of sudden and necessary lockdown and dealing with such issues as virus contagion, contamination fears, distance from loved ones, changes in patterns and routines, and isolation was difficult for almost everyone,” she said. “Adding to this was the unanticipated extension of the pandemic spanning two-plus years, which led to additional difficulties adjusting and more distress. Now that we are beginning to return to integrated social interactions and a ‘new normal,’ we see that some individuals have not adjusted as well as anticipated nor resumed their prior level of functioning.”

Preliminary anxiety related to the pandemic was initially associated with obsessive compulsive disorder and health-related anxieties, said Segota.

“An increase in anxiety during the pandemic led to fears of leaving the house for some and eventually symptoms of agoraphobia and panic disorders,” she said. “Agoraphobia typically last six months or longer and is accompanied by symptoms characteristic of panic disorder.”

Dr. Brian Thoma, an interventional pain physician for Cahaba Pain and Spine Care in Hoover, Ala., said the nearly six-week surgical shutdown in early 2020 greatly impacted patients who rely on pain-relieving procedures to stay functional. That includes the new SGB block for patients with PTSD that many military veterans call a game-changing reset.

“Early in the pandemic, I recall a young woman being referred to us for an epidural blood patch, a procedure we’re asked to do for patients with a terrible headache after a lumbar puncture,” said Thoma. “The patient was reluctant to come in, but ultimately the headache was bad enough that she wanted the procedure. Fortunately, it worked well for her.”

As society transitions to a new phase of the pandemic, it’s essential to ask critical questions to help assess the presence of clinical anxiety and to help differentiate disorders, said Segota, who suggests implementing a questionnaire that assesses COVID-related stressors and socialization reintegration difficulties.

“Ask about the following stressors: financial problems (difficulty paying bills, debt), work problems (unemployment, decreased hours/roles, conflicts with colleagues), educational problems (difficulty completing course work), housing problems (instability, moves), relationship problems (isolation, separation or divorce, conflict with family or friends, intimacy problems), personal or loved one's health problems (new or worsening illness, medication issues, disability) and caregiving problems (emotional stress, time demands). Ask about mood and adjustment to changes, sleep, energy, appetite, and desires for activities outside the home. Ask about attempts to increase activities outside the house or avoidance of those activities.”

Some health systems have introduced new programs to address these problems. For example, Kaiser Permanente this month is unveiling to its members on-demand emotional support through the Ginger app. Ginger’s emotional support coaches are available 24/7 to help with stress, low mood, sleep troubles and more. The first 90 days are free.

Jacqueline Hobbs, MD, PhD., an associate professor in the University of Florida College of Medicine’s department of psychiatry, emphasized the importance of the pandemic not being over.

“It’s a pandemic seemingly without end. It’s a recipe for a mental health crisis,” she said. “The latest coronavirus variant is fueling a surge in cases while Americans worry about ever-more infectious versions to come.”

The pandemic is so prolonged that it has become a chronic stressor, said Hobbs.

“People don’t feel like there’s an end in sight,” she said. “We get little glimpses of the finish line, but then we’re right back at it.”