We are all consumed by the escalating COVID-19 pandemic that is likely to become much worse in the coming weeks. However, given the situation in China, it is likely that within several months the situation will stabilize and we will begin the recovery process. But as our collective physical health improves, our mental health will likely suffer for months and years to come.

We know through published reports that globally, mental health casualties among survivors are intrinsic to all natural disasters. The elderly, women, patients with premorbid psychopathology and high direct or indirect trauma exposure, and those with poor social supports and low socioeconomic and educational backgrounds are at the highest risk [1].

Another type of Coronavirus, albeit much less widespread than COVID-19 and with much lower mortality rate was the 2002-2003 outbreak of SARS. In a study of 129 patients quarantined with SARS, 28.9% met criteria for posttraumatic stress disorder (PTSD) and 31.2% for clinical depression [2]. In a study of 124 hospitalized SARS patients, 35% had clinical depression and 47% had symptoms of PTSD 3 months after discharge. Among those afflicted, there was a high rate of failure to return to work and carry out daily responsibilities at home [3]. In a study that investigated the psychosocial responses of children and their parents to pandemic disasters, self-reported criteria for PTSD was met in 30% of isolated or quarantined children and 25% of quarantined or isolated parents [4]. Approximately 46% of physicians who provided care to patients with SARS experienced significant psychological distress [5]. The reasons included the necessity of wearing protective R-95 inhalators for protracted periods, the exposure to the morbidity and mortality of coworkers, and the fear of infecting family members.

While there are no verifiable reports on prevalence of somatic reaction to fears of exposure or exposure-related PTSD during recent pandemics and epidemics, extrapolation of the aforementioned data makes projected numbers nontrivial.

Moreover, COVID-19 may be increasing incidence of another public health epidemic, domestic violence, a key driver of PTSD. The social distancing protocols being widely adopted to limit community transmission isolate individuals, including abused individuals, with their abuser. There now are reports from China indicating that domestic violence has increased due to the COVID-19 pandemic [6]. This effect also seems to be occurring here in the US, as in Portland, Oregon, our home state, calls to a domestic violence hotline reportedly doubled last week [7].

Given the severity and the widespread nature of COVID-19 even when using the best-case scenario, we are looking at millions of new cases of PTSD and related psychiatric disorders in the coming months, if not years. These cases will be associated with significant morbidity, alcohol and substance abuse, domestic violence and suicidality.

Pharmacologic treatments for PTSD are of very limited value but psychotherapy appears to be more effective. However, it is both expensive and time consuming. It is very likely that in the coming months the specialists proficient in this treatment modality will rapidly become overwhelmed. Thus, while pre-COVID-19 the unmet need for new, effective and safe pharmacologic treatment options for PTSD had been high, it will become exponentially more acute in the nearest future.

We believe that our safe and promising therapeutic can revolutionize the way we treat PTSD and other neuropsychiatric disorders [8]. Given the urgency of the situation related to COVID-19 pandemic Nobilis Therapeutics has engaged with several governmental agencies in pursuit of accelerated support for funding of its phase IIb/III clinical trial. The company has a goal is to start the trial as soon as the pandemic deescalates, which should coincide with a rapid increase in the incidence of PTSD and the potential for mental health resources to become overwhelmed in the aftermath.

References:

1.            Shives LR, ed. Basic Concepts of Psychiatric-Mental Health Nursing. 6th ed. Anxiety Disorders. Philadelphia: Lippincott Williams & Wilkins.

2.            Hawryluck L, Gold WL, Robinson S, et al. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10:1206-1212.

3.            Styra R. Ongoing distress in patients who have recovered from SARS. Presented at: the 45th ICAAC meeting of the American Society for Microbiology; December 16-19, 2005; Washington, DC. Accessed October 9, 2007.

4.            Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7(1):105–110.

5.            Grace SL, Hershenfield K, Robertson E, Stewart DE. The occupational and psychosocial impact of SARS on academic physicians in three affected hospitals. Psychosomatics. 2005;46:385-391.

6.            Wanqing Z. Domestic violence cases surge during the COVID-19 epidemic. The Sixth Tone, Fresh voices from today’s China. www.sixthtone.com/news/1005253/domestic-violence-cases-surge-during-covid-19-epidemic; accessed March 22, 2020.

7.            Crombie N. Calls to Oregon’s domestic violence crisis lines spike amid coronavirus crisis. The Oregonian, www.oregonlive.com/crime/2020/03/calls-to-oregons-domestic-violence-crisis-lines-spike-amid-coronavirus-crisis.html; accessed March 22, 2020.

8.            Dobrovolsky A, Bogin V, Meloni EG.   Combining Xenon Inhalation With Trauma Memory Reactivation to Reduce Symptoms of Posttraumatic Stress Disorder: Case Report, Justification of Approach, and Review of the Literature. Primary Care Comp CNS Disord.  2019; doi: 10.4088/PCC.18nr02395