Impact of the COVID-19 Outbreak on Individuals and Communities 

BY KORTE, K.J., DENCKLA, C.A., AMETAJ, A.A, & KOENEN, K.C. AT HARVARD T. H. CHAN SCHOOL OF PUBLIC HEALTH

COVID-19 has produced a lot of uncertainty. Daily, we are faced with questions about how to best keep ourselves and our loved ones safe, as well as how to manage changes in our routines. First, know it is normal to feel stressed! Fear, worry, and uncertainty about your own health status, as well as that of your loved ones, is common. The information below may help you understand if you are stressed and what you can do to manage during this difficult time.

These are broad recommendations based on questions commonly asked. They are not intended to be comprehensive, and do not replace medical advice or public health guidance. If you or your child are concerned about COVID-19 infection or exposure, speak to your primary care provider about testing and additional precautions for your family. You may also benefit from additional mental health support and guidance. Ask your primary care providers for mental health referrals.

Know the Signs of Stress

While everyone reacts differently to stressful situations, you can take practical steps based on a significant body of research improve your well-being and reduce stress reactions related to the COVID-19 virus outbreak (Hobfoll et al., 2007). It is not necessary to have all elements in place, but implementing some of these strategies can support your overall well-being. 

When you are under stress, your thinking, emotions, body and behavior are affected. It is important to be aware of when you are stressed so that you can prioritize activities that will help you reduce your stress. Here are some signs that you may be stressed: 

  • Thinking: Being easily distracted, trouble with concentration, trouble remembering.
  • Emotions: Trouble relaxing, feeling irritable, feeling down, feeling anxious.
  • Body: Increase or decrease of energy, body tension, feeling restless, sweating, being easily startled, having headaches, changes in appetite, difficulty sleeping.
  • Behavior: Wanting to be alone, trouble completing work tasks, blaming others or getting into arguments.

Stress and Pre-existing Mental Health Problems 

Some people are more vulnerable to stress, such as those already struggling with a mental health problem, like anxiety or depression. It is especially important to be aware of the signs of stress so that you can take action or consult a healthcare provider.

Coping with the Stress of COVID-19

While everyone reacts differently to stressful situations, there are practical steps based on a significant body of research that you can take to improve your well-being and reduce stress reactions related to the COVID-19 virus outbreak (Hobfoll et al., 2007). It is not necessary to have all elements in place, but implementing some of these strategies can support your overall well-being. 

Stay Connected with Others

Epidemics restrict access to social support structures, such as schools, workplaces, places of worship, or even spending time with friends and family. Be creative about how to maintain connections with others during this time. Talking to those you trust is a helpful way to reduce feelings of isolation, anxiety, fear, boredom or vulnerability during social distancing, quarantine, or other safety measures.

  • Seek support from family, friends, mentors, and/or spiritual/religious leaders.
  • Be flexible and creative in accessing support via phone, email, text messaging, and video calls.
  • Talk about your experiences and feelings to loved ones and friends, if you find it helpful.
  • Write about your experiences and share them with others through social media and other outlets.

Ways to Manage Stress

Many people may be experiencing strong emotions (e.g., fear, anxiety, frustration) related to health threats and social and economic consequences of COVID-19. You can take steps to lessen such stress both in the short-and long-term.

  • Realize that it is understandable to feel anxious and worried about what may happen, especially when many aspects of life are uncertain or have changed.
  • Make time to unwind and remind yourself that strong feelings are tolerable and will fade. Accept, instead of suppress emotions, and “ride the wave” of strong feelings by observing how they show up in your body without judgment.
  • If you find that you are getting stressed by watching the news, reduce your exposure, particularly prior to sleep.
  • Pace yourself between stressful activities and do something fun after a hard task.
  • Relax your body and mind: practice slow, steady breathing and muscle relaxation, as well as any other soothing actions (meditation, yoga, exercise, walking, music, reading for pleasure).
  • Maintain a sense of hope; consider keeping a journal where you write down things you are grateful for or that are going well.
  • Engage in and savor pleasant activities (search online for lists of pleasant activities within your budget that can be done at home). 

Unhelpful Ways to Manage Stress

Some strategies for managing stress may feel helpful in the short-term but can have aggregate, negative long- term consequences. Balance short-term relief from fear/anxiety/stress with monitoring the impact of these strategies on your overall mental health.

  • Reliance on tobacco, alcohol, and/or drugs to manage stress and emotions.
  • Constant worrying (i.e., thinking repeatedly) about the risks or negative consequences of COVID-19 (different than recommended preparedness from CDC).
  • Co-ruminating (i.e., worrying out-loud with others) can lead to increased intensity of strong emotions.
  • Impulsive or high-risk behavior that reduces stress in short-term only (e.g., excessive spending, gambling, etc.). 

Maintain Basic Self-care and Improve Your Sense of Control and Endurance

Social distancing and other practices aimed at containing COVID-19 can disrupt your routines, finances, and sense of control over your daily life. However, there steps you can take to restore some balance.

  • Eat healthy food (avoid high-sugar foods, alcohol, and too much caffeine).
  • Engage in physical activity.
  • Accept circumstances that cannot be changed and focus on what you can alter.
  • Modify your definition of a “good day” to meet the current reality of the situation.
  • Problem-solve and set achievable goals within the new circumstances in your life.
  • Work with your employer, landlord, utility and credit card companies to reduce financial stress if your income is impacted.
  • Accept unhelpful emotions and refocus your attention on activities that align with your values.
  • Maintain daily routines and your schedule as much as is possible despite disruptions. For example, continue to wake up at a regular time even if you are working at home.
  • Increase positive coping behaviors that have worked in the past.
  • Shift negative self-statements to statements that allow you to function with less distress. Try changing “this is a terrible time” to “this is a terrible time, but I can get through this.”

Tips for Good Sleep Hygiene

When we are under stress our daily routines tend to get disrupted. During times of stress it is important to ensure we are getting enough sleep to help us regulate our emotions and response to stress. Good sleep hygiene includes:

  • Going to bed around the same time each night and getting up around the same time each morning.
  • Only trying to sleep when you are tired. If you find that you are having trouble falling asleep get up and do something relaxing or boring (e.g. do not watch TV) until you feel sleepy. One suggestion some of us have found helpful is to listen to podcasts or audiobooks that are a bit boring or use the sleep meditations available on free apps such as Insight Timer.
  • Avoid caffeine, nicotine, and alcohol at least 4-6 hours before bed.
  • Avoid taking naps during the day. If you have to have a nap, take one before 3:00 p.m. and make sure it is less than an hour in duration.
  • Use your bed for sleeping, nothing else to signal to your body that it is time to sleep.
  • Turn off the lights, TV, and put away your phone when trying to sleep. These further activate your body and make it more difficult to fall asleep and it is best to avoid light from TV, computer, and smartphones two hours before bed.

Additional Resources

The emotional impact of a crisis can depend on many factors such as pre-existing mental health conditions, availability of resources, past experiences, and social and economic circumstances. If you find that your stress reactions are significantly interfering in your daily life for several days in a row, please contact your health care provider. The following resources below may also be helpful:

Compiled based on the following resources:

Center for Disease Control

Hobfoll, S.E., Watson, P.J., Bell, C.C., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315. 

National Center for PTSD

Sleep Foundation

Substance Abuse and Mental Health Services Administration (SAMHSA)

World Health Organization