4-Out-Breaks

Definition of outbreaks

An outbreak is when an illness happens in unexpected high numbers. It may stay in one area or extend more widely. An outbreak can last days or years. Sometimes, experts consider a single case of a contagious disease to be an outbreak. This may be true if it’s an unknown disease, if it’s new to a community, or if it’s been absent from a population for a long time. Disease outbreaks are usually caused by an infection, transmitted through person-to-person contact, animal-to-person contact, or from the environment or other media. Outbreaks may also occur following exposure to chemicals or to radioactive materials. For example, Minamata disease is caused by exposure to mercury. Occasionally the cause of an outbreak is unknown, even after thorough investigation.

An epidemic: is when an infectious disease spreads quickly to more people than experts would expect.

A pandemic: is a disease outbreak that spreads across countries or continents. It affects more people and takes more lives than an epidemic. The World Health Organization (WHO) declared COVID-19 to be a pandemic when it became clear that the illness was severe and that it was spreading quickly over a wide area.

The number of lives lost in a pandemic depends on:

▪ How many people are infected

▪ How severe of an illness the virus causes (its virulence)

▪ How vulnerable certain groups of people are

▪ Prevention efforts and how effective they are

Stressors in outbreaks:

Acute stress: The response to a single experience that creates heightened demands for a limited period of time

Chronic stress: the cost of daily living: bills, kids, jobs… stress we tend to ignore or suppress

Traumatic stress: The reaction to situations that are shocking and emotionally overwhelming, often involving actual or threatened death, serious injury or betrayal.

But there is also a good type of stress which is Eustress, it is stress in daily life that has positive elements: being challenged at work, birth of a child, pushing oneself physically, etc.

The outbreak of diseases may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Stress during an infectious disease outbreak can include:

▪Fear and worry about your own health and the health of your loved ones

▪Changes in sleep or eating pattern

▪Difficulty sleeping or concentrating

▪Worsening of chronic health problems

▪Worsening of mental health conditions

▪Increased use of alcohol, tobacco, or other drugs

▪Everyone reacts differently to stressful situations

Effect of outbreaks on mental wellbeing

People can experience a wide range of reactions in response to outbreaks. They can feel overwhelmed, confused or very uncertain about what is happening. They can feel fearful and anxious, or numb and detached. Some people may have mild reactions, whereas others may have more severe reactions. In general, how someone reacts depends on many factors, including:

1. The nature and severity of the event;

2. Their experience with previous distressing events;

3. The support they have in their life from others;

4. Their physical health;

5. Their personal and family history of mental health problems;

6. Their cultural background and traditions;

7. Their age (for example, children of different age groups react differently).

• People tend to feel anxious and unsafe when the environment changes. In the case of infectious disease outbreaks, when the cause or progression of the disease and outcomes are unclear, rumors grow and close‐minded attitudes eventuate. the level of anxiety rose significantly when the SARS outbreak occurred.

• For example, in Hong Kong, about 70% of people expressed anxiety about getting SARS and people reported they believed they were more likely to contract SARS than the common cold. Anxiety and fear related to infection can lead to acts of discrimination. People from Wuhan were targeted and blamed for the COVID‐19 outbreak by other Chinese people and Chinese people have since been stigmatized internationally, for example, use of the term ‘China virus’ and the use of terms such as ‘Wuhan virus’ and the ‘New Yellow Peril’ by the media.

• Fear is known (for centuries and in response to previous infectious outbreaks such as the plague), yet a common response to infectious outbreaks and people react in many and individualized ways towards the perceived threat.

Hypervigilance, for example, can arise because of fear and anxiety and, in severe cases, result in post‐traumatic stress disorder (PTSD) and/or depression

Fear of the unknown, in this case, the spread of the disease and the impact on people, health, hospitals, and economies, for example, raises anxiety in healthy individuals as well as those with pre‐existing mental health conditions.

• Individuals, families, and communities experience feelings of hopelessness, despair, grief, bereavement, and a profound loss of purpose because of pandemics. Feelings of loss of control drive fear and uncertainty as the trajectory of the pandemics is constantly evolving; so is the advice on the action to take to stop the spread of a pandemic. Perceived mixed messaging from government or health officials can also lead to public confusion, uncertainty, and fear.

• People’s responses to fear and intolerance of uncertainty lead to negative societal behaviors. Uncertainty increases feelings of alarm resulting in behaviors targeted at reducing uncontrollable situations which people fear. For example, we have seen people clearing shelves of supermarkets resulting in global shortages of food and essentials such as toilet paper.

This behavior is purported to occur for two reasons: 1. because the threat of COVID‐19 is perceived as a ‘real’ threat and expected to last for some time 2. as a means to regain control.

• While outright panic as a result of this pandemic is unlikely, it can occur as a consequence of mass quarantine. The current state of the COVID‐19 illness already paints a picture of inevitable and large‐scale quarantine – some of which are already occurring. In the case of mass quarantine, experiencing social isolation and an inability to tolerate distress escalate anxiety and fear of being trapped and loss of control, and the spread of rumors.

• Rumors fuel feelings of uncertainty and are extricably linked to issues such as panic buying and hoarding behavior. Anxiety related to this pandemic is also compounded by people being reminded of their own mortality that can lead to an

‘urge to splurge’, that is an increase in spending as a means to curb fear and regain control.

• Throughout history, people have sought to allocate blame to someone in order to calm their fear of disease outbreaks. This fear and othering are often present with pandemics. For example, the 2014 Ebola outbreak was considered an

African problem resulting in discrimination against those of African descent, while the 2009 H1N1 flu outbreak in the USA saw Mexican and migrant workers targeted for discrimination. Misinformation, public anxiety, and rumors must be addressed by Government and Health officials, that help mitigate the adverse effects of stigmatization and help provide protection of vulnerable populations.

• Ultimately, to apportion blame in any circumstance can damage everyone involved and can reduce individual and community resilience both in the short and long term. Fear and guilt can also occur as a result of being infected by the virus. Infected people, while also the target of discrimination, also experience self‐blame or guilt. Unfortunately, this feeling culminated in the suicide death of a health worker recently who feared she had contaminated seriously ill people she cared for while infected by COVID‐19.

Example on using (PFA) in outbreaks as (Ebola):

Ebola virus disease is a severe, infectious disease that can be fatal (the case fatality rate of the 2014 outbreak in West Africa is about 50%). It can be spread only by direct contact with the body fluids or tissues of a person who is sick with the disease or who has died.

▪(PFA) role in Ebola outbreak

In the case of Ebola disease, information is vital. So, those providing (PFA) can help to dispel myths, share clear messages about healthy behavior and improve people’s understanding of the disease.

(PFA) also helped people suffering in other ways as a consequence of the Ebola disease outbreak. This may include people who have lost multiple family members and loved ones to Ebola, particularly orphans who need extra care and protection. PFA may also be useful for people who may be stigmatized by their communities, such as:

People who have recovered from Ebola

Health care providers treating people with Ebola;

Frontline workers of Ebola operations (e.g., people involved in dead body management)

▪ Effects of (PFA) during Ebola outbreak:

According to a study, which took place in Ebola-affected West Africa, aimed to investigate whether and how PFA strengthens the provision of mental health support to acutely distressed people in humanitarian crises

There are some findings:

Those trained in PFA during the Ebola outbreak reported very positive personal changes (e.g. learning to understand reactions of others and manage one’s own emotions; improved use of self-care strategies; improved relationships with friends, family and colleagues as they began to use the skills).

The prospective study showed that PFA training increases understanding of helpful ways to respond to someone who is distressed. The health care workers who participated in the PFA training showed an increase in knowledge of how to respond to a person in distress and gave more appropriate responses to hypothetical scenarios, compared to those who did not participate. These changes were maintained up to six months after the training.

In the context of the Ebola outbreak, the rapid scale-up of PFA training had established valuable knowledge among non-specialists. However, training participants still had challenges in the following areas:

1) How to calm a person without making false promises, telling own / others stories, telling the person how they should feel, etc.

2) Supporting a person to identify their own

coping strategies and resources (strengthening self-efficacy) – rather than

giving advice or trying to solve the problem

3) Putting the ‘link’ action principle into practice.