Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
Many changes have occurred in our world
in so many little time, as a novel situation that we all have had to cope with
such as a sudden and unexpected pandemic. Psychological approaches such as
skepticism, uncontrollability, new emotions to new stimuli, irrational thoughts
or behaviors are some common consequences of the situation and we will
elaborate them briefly in this text. Some basic clinical and medical
explanations about the intermediate specie, common symptoms or possible brain
affection are described in the text. With the perspective of a healthy future
without viruses attacks, based on Scientific knowledge and the experience of
producing laboratory experimental results.
Introduction
The global pandemic year 2020 has been a
humanitarian challenge that affected everybody and has changed our lives and
routines. Because of the sudden appearance, there is very few experts on
Pandemic in the general population. Fear of disease has been daily present in
our thoughts and worries in a much higher percentage: ten percent of patients
infected with the SARS-CoV-2 generates a severe acute respiratory syndrome and
becomes critical, requiring special care from the intensive care unit (UCI).
The autoimmune response to this virus in the fight for self-cure might be
disproportionate some cases, causing excessive swelling in vital organs which
leads to incompatibilities to life. Skepticism and disbelief were common false
friends present at the beginning of the spread of the plague. Uncertain or the
complete absence of knowledge about its origin, its nature, its spreading
behavior, how the metabolism might react, its effects over the organism,
medicines to prevent (vaccine) or to cure, etc., were adding panic and fears to
the situation, creating the ideal environment for corrupted approaches, faked
information, shamanic cures, discrimination or unhealthy unsupportive
responses. Government control measures meant in some cases extreme surveillance
and complaints from neighbors without much evidence about other people behavior.
An infected person could be forcibly examined and quarantined against his/her
will. Scientific and clinical teams have worked hard together and improved our
contrastable information about the virus and disease: a) the spread ration (R0
= basic reproduction number) of this virus is higher than a normal flu (R0 =
2.5 vs R0 = 1.3), b) the spread mechanism is so aggressive and long lasting
(saliva which might remains over superficies for up several days).
Coronaviruses over inanimate surfaces like metal plastic, metal or glass had
been observed for up 9 days, being the minimal contact time for contagious of
30 seconds [1]. Some cases its effects over organism are of a considerable
damage and harm for human life. Mean for incubation period is 5.2 days with the
95th percentile of the distribution at 12.5 days [1], having the 80% of
patient’s mild symptoms but the amount of virus enough to spread it.
Intermediate Specie
The host creature for the virus was the
bat, because of zoonoses, since this winged creature is the only mammal capable
of powered flight for migration and having a longer range to spread the virus
very rapidly, compared to land mammals. The most likely path of contaminations
would be from the bat to the humans through saliva onto fomites or surfaces or
through virus-laden aerosolized urine and faeces, with another intermediate
specie (Figure 1) [2, 3]. Bats are able to maintain virus CoVs long-term
without showing clinical symptoms or diseases [2]. Common spreader of diseases,
the bat has been the inspiration for horror stories such as Dracula and
vampires which needs to find new blood to drink for spreading the undead
course. Many previous diseases such as Black Death, Spanish influenza, and
HIV/AIDS, were caused by zoonoses Lloyd- Smith [4]. Civets, horses, and great
apes have been found to be intermediate species for several coronaviruses
spreading and amplifying the virus, to subsequently infect humans [2,3].
However, where the fist bat was infected
to spill it over to humans remains unclear. How the virus survived outside of
it reservoir host to contaminate the recipient host is known yet. The virus
exposition had to be in sufficient quantity and time for generating an
infection and disease in some intermediate specie. Health authorities are not
able yet to accurately find and describe the Patient Zero in the Northern
Italian outbreak [3, 5]. Progresses in understanding and combating zoonoses
from Science would need a new generation of research schemas that addresses a
broader approach of research with including several animals host species to
study and several scientific disciplines all together [4].
Skepticism or Denialism
Cognitive skepticism is “an attitude of
doubt or a disposition to incredulity either in general or in a particular
object” . In 1980 Bertram Brookes published his pseudo-mathematical equation
which he was working on for several years:
K (S ) + ΔI = K (S + ΔS )
Where
K (S ) means knowledge structure to be known and ΔI the increase of information
about the structure. In his own words, the equation “states in its very
general way that the knowledge structure K (S )is changed to the new modified
structure K (S + ΔS ) by the information ΔI, the is indication the effect of
the modification” [6, 7]. According to the formula, the bigger
amount of information about the structure, the bigger change over the new
knowledge compared to its original. Skepticism might be happening with a small
bit of knowledge (ΔI ) which remains the original and new structure almost
identical. Concerning to the virus, skepticism might have happened at some
point, when curative resources were aimed at the beginning for exaggerated
cares to only a few first cases, without a clear perception of coming or
priority risks [8].
In
Spain there has been 27.135 deceases (6-6-2020), 52 were professionals
caregivers (Physicians, Nurses, Psychologist, etc.) from whom 40.961 have been
infected (data Red Nacional de Vigilancia Epodemiológica 05-29-2020)
(Figure 2). In the Netherlands due to the COVID-19 there was an excess of
mortality of about 8,600 people in the period March 9 - May 10 according to the
Central Bureau of Statistics (CBS). On the same day, RIVM announced that up to
28% of all registered contamination cases were healthcare workers, or about
8,000 cases. The risk of infection depends not only on personal risks factors,
but also upon the general state of the other individuals in the population [4].
During first period and concurrently, different tests for diagnoses where made:
positive antibodies tests (light green bars) and PCR, IgM (dark green bars).
Second period only PCR and IgM were apply (dark green bars). From Centro de Coordinación de Alertas y Emergencias Sanitarias.
Ministerio de Sanidad. Gobierno de España. So many Scientific
publications are in the air and some has been published without time to
contrast: experimental results are published within only 10 days of revision,
being this way of information more similar to the daily News reports than to
the rigorously procedure for Scientific texts. Publications based only in N=1
patient have been accepted when that would be unthinkable for Journals in any
other circumstances, when life is not under risk. Controlled experiments with
manipulated variables compared to control groups and reviewers work would be
desirable but were practically inexistent. However, difficulties of working
with any sort of mammalian virus hinders such experimentation [3]. That causes
contradictive information in a number of Scientific publications during
pandemic time, without a calm or quiet study and reading other papers
published.
However, Science still goes on and a promising treatment with a monoclonal
antibody compound against COVID-19 Figure 3 has been experimentally checked in
vitro with therapeutically efficacy in Thailand and Holland (Utrecht and
Rotterdam) [9,10]. Neutralizing antibodies can alter the course of infection or
protect against the virus [10], however large production of monoclonal
antibodies might not be affordable in labor intensity, expenses and time
consuming [9].
Likely a vaccine is going to be available
in 2021 or earlier, because not only massive disease has to be prevented, but
also some consequences for health and psychological sequels which are happening
in patients after the disease. Inappropriate perception of the facts, worries
about well-being of their families and irrational believes are some facts which
are causing excessive stress response [11,12]. Parallel clinical diseases have
been concurrently diagnosed in COVID-19 patients in relation to the stress,
anxiety, immune-depression and also related to disseminated intravascular
coagulation and blood coagulation alterations, leading to acral ischemia or dry
gangrene [1, 13]. Autoimmune diseases concomitant to the disease COVID-19 or
even to the lockout have been found: dermatological no specific reactions in
children and adult were described, being unknown yet or remaining unclear
whether they come up in response to an infection for the virus or to an
emotional/hypersensible reaction [1, 13], in some cases without hospitalization
required. To an accurate diagnose, a number of reverse transcription polymerase
chain reaction (RTPCR) kits with different primers and probes have been designed
to detect SARS-CoV-2 presence genetically. Thermocyclers, incubation
temperatures and times have been optimized to get the faster results: in the
one-step assay, reverse transcription of SARS-CoV-2 and PCR amplification are
happening into one unique simultaneously reaction [14].
Circulation of blood and changes in its
coagulation pattern (thrombus, skin deceleration) were found, but no clarity
whether they were a cause concurring with the infection or a consequence for
the medication. Urticaria, morbilliform rash, vesicular eruptions, acral
lesions (“COVID toes”), livedoid eruptions appeared in patients infected.
Further microscopically analysis of the skin reveals groups of apoptotic
keratinocytes in the epidermis, suggesting a viral exanthema [15]. Symptoms
related to the loss of olfaction and taste during the infection COVID-19
(anosmia or hyposmia) were found in a few patients, likely due to the lower
respiratory track diseases in uncomplicated early stage (fever, dry cough,
weakness) [16-18].
A majority of Androgenetic Alopecia (79%)
in male patients and 42% in female patients has been coincident among patients
hospitalized due to severe COVID-19 (“Gabrin sign”), suggesting a possible
influence of the Androgen Receptor through its effect over the enzyme angiotensin-converting
enzyme 2 (ACE2), both genes (AR, ACE2) located in chromosome X [17,18]. Some
patients infected with SARS-CoV-2 showed neurological signs such as headache
(about 8%), nausea and vomiting (1%) and in severe patients, acute cerebrovascular
diseases and impaired consciousness. Patients with acute SARS-CoV illness had
evidences of the virus in their cerebrospinal fluid (Figure 4) [16]. In this
brief revision we are exploring new emotions caused by several unpredictable
situations due to the pandemic, irrational thoughts and we are including one
psychological test for a better approach to a relocation of the locus of
control.
New Emotions
Ideas and believes might have a really
huge impact over our health and metabolism: for instance, consumption of meat
of wild animals has become a sign of social status in some areas of the world
[22] and it seems the COVID-19 has been mainly caused for that rare habit.
Education on these ideas with empirical data and contrasted information might
be of great necessity to avoid further zoonoses. The strategies for preventing
spread of outbreaks are mitigation (isolation plus quarantined plus social
distancing) and suppression (isolation plus quarantined plus social distancing
and closing schools, Universities and businesses). Those measures of isolation
of confirmed and suspected cases and the rapid and effective contacts tracing
of clinical cases have been succeeded for the majority of scenarios: with a R0
= 2.5 the 70 % of contacts were possible to be traced and isolation was assumed
to be 100 % effective at preventing further transmission [23]. The word
quarantine was firstly used in Venice, year 1127, when leprosy and later on
with Black Death happened [24]. United Kingdom 300 years later established the
quarantine as an imposition in response to a plague. All these measures imply a
serious restriction for people´s free will and their personal decisions,
imposing the necessity of changing their routines, habits and lives till that
moment. Some keys to deal with these hyper-protective measures to the subdued
population were provided to the population, especially in order to prevent
rebellions and for controlling the intensity of relief of de-escalated
measures. Stigmatization and negative feelings, some of them negative against
affected persons, also happened before in History (Spanish flu, bubonic plague,
etc.). Even health care workers have suffered from a greater stigmatization and
rejection from people in their local neighborhoods than the general public
[24].
Post-traumatic stress symptoms, confusion, anger, exhaustion, mass hysteria,
obsession of contamination, detachment from others, anxiety, indignation,
irritability, frustration, boredom, financial loss, annoyance, fear, isolation,
helplessness, loneliness, less happiness, etc. are some consequences described
which have an impact over our psychological state and the general population
[11, 24, 25]. Stigmatizations causes damage in psychological health and common
coexistence, that is why the World Health Organization (WHO) have tried to
prevent it from the very beginning, renaming on February the 11th the disease
as COVID-19 [16], with no link to the area or region where it firstly showed up
to avoid discrimination against Chinese population.
The enemy is the virus, but many unreasonable behaviors might have happened because
our inertial reactions to blame something else and because our psychological
necessity of visualizing the hated target. Worries of people changed to be
mainly focus on their health and family instead of in leisure and friends [11].
Victimization is an approach that patients with severe sequels might apply
themselves, because in some cases posterior to the infection a long time has to
be dedicated to rehabilitation therapies. Social distancing together with
barrier methods (facial masks) and respiratory hygiene (washing hands and good
breathing habits) are some keys suggested to avoid disease and improve general
health [25]. In children a relative resistance to SARS-CoV-2 has been
described, however the reason why is not clear yet [26].
But
as human spirit uses to do, also good emotions and feelings happened: for
instance an increase in faith for Science and its curative labor during these
months, because a vaccine would be a very efficient measure and perhaps the
only one, to reduce anxiety and fears on general population. Messages about
death and religion became salient to comfort tense moods and bring more
positive emotions, after January 20th when Dr. Zhong Nan Shan made a public
announcement of this virus in CCTV [11, 18]. Music, routine games, allowed
recreational activities and generous musical and artistic performances have
been shared between common people and neighborhoods every day. King of the
Netherlands Willem- Allexander comforted and warned people to avoid
loneliness: “Alertness, solidarity and warmth: as long as
we keep those three, we can handle this crisis together, even if it takes a
little longer.” King said. In Spain admiration and respect have
been shown everyday with applauses toward the caregivers and their current
difficult work. As Sir Ludwig Guttmann said, “this is especially the time we
need to “love our paraplegics” [27].
Irrational Thoughts And
Behaviors
Our common enemy is a virus which is a
target not visible. Understanding about that fact is not an easy goal. The lockout
has reduced social interactions or hobbies to be distracted, then an increase
in bad, harmful, and toxic habits (alcohol, drugs) and thoughts through
rumination has happened. Under these unexpected circumstances with any or few
psychological tools to deal, people are more likely to develop negative
emotions (aversion, anxiety) and negative cognitive assessment about
self-protection, life satisfaction or social risks, which may result in
excessive avoidance behaviors and blind conformity [11].
Some behaviors as repeated washing hands like an obsessivecompulsive disorder
(OCD) might be “normalized” and even socially rewarded in the middle of the
pandemic [25]. The OCD and specifically its compulsive nature is clinically
defined by the DSM-5 (300.3) as: “1. Repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g. praying, counting, repeating words
silently) that the individual feels driven to perform in response to an
obsession or according to rules that must be applied rigidly.” However, the
temporal criteria makes the diagnoses more restrictive: B. The obsessions or
compulsions are time-consuming (e.g., take more than 1 hour per day). About the
prevalence: The 12-month prevalence of OCD in the United States is 1.2%, with a
similar prevalence internationally (1.1%-1.8%).
The frustration related to quarantine goes to several psychological problems
including depression and post-traumatic stress disorder. Post-traumatic stress
disorder is typified by recurrent, extremely vivid memories of traumatic events
and the avoidance of everything that brings them to mind, along with
depression, addiction, increased watchfulness, aggression, shame, nightmares,
flashbacks, feelings of guilt, raised heart-rate, shallow sleep, frequented
waking and excessive irritability (“having a short fuse”) [28, 29]. Moreover
this environment pushes people to consume high sugar foods (chocolate, soft
drinks, saturated fats) to boost their mood and release dopamine in the brain,
which increases obesity. Sleep disturbances also increases food intake and
physical activities has been reduced because to the lockdown, to the point some
countries should be prepared for the upcoming epidemic of “depreobessed
patients” [30]. Anxiety, depression, indignation and other negative cognitive
indicators were wildly described in an affected population [11]. Physical
exercises might be a good solution to prevent obesity, to a better sleep and
healthy breathing space habits and for our immune system [31, 32].
Locus of Control Internal
Vs External
The concept of locus of control was
firstly described by Julian B. Rotter in 1954, referring to a personality trait
based on the degree that people believe to have about their own control over
the outcome of events vs the power of external forces beyond their particular
influence (Figure 5). Attributional styles and self-efficacy concepts are built
upon this trait, which may lead to neuroticism, poor self-efficacy or low
self-esteem. In Figure 5: Metaphorical representation of an external locus of
control, being the subject unable to freely move or to think without
instructions coming from their ties. In order to restore our confidence and
start new fresh acting on our internal locus of control areas and to learn from
our mistakes, we suggest to read and answer this inventory elaborated by
Rotter, to improve our knowledge about differences in loci of control and to
get a better perspective of our own power over the events [26-31]. Many
external places are suggested in this questionnaire as “common areas to blame”
as responsible for our own decisions and paths taken: politicians, teachers,
leaders, mates, friends, parents, genes, conflicts, luck, accidents, few
trials, etc (Table 1).
During the lockout and because of
pandemic restrictions, locus of control of people has been dramatically changed
to be almost completely external to their will, with the sudden imposition of
new rules which changed their control over their routines and lives. No chance
of choosing about where to be or what to do, because suppression measures
closed every places people used to go. Under this extremes circumstances, the
locus of control might be relocated and focused on smaller areas where the
person has a real control, such as the time of their days, the space of their
homes, the few indoor activities, etc. Much more creativity and imagination are
required from population, who is asked to keep calm and be patient while their
range of maneuvering is considerable limited and restricted. Uncomfortable
forced coexistence might lead to many conflicts that might be avoid: confusion
about who is the enemy, the easily spread of fake news, rumors or even magic
cures about the disease, passive and victimizes attitudes in healthy people,
personalization of the information given by media or newspapers about the
pandemic.
Conclusion
With this virus and at a very high cost
we have learned several important lessons. Among them, the humble assumption
that a tiny creature without superior intelligence or brain is capable of
putting us in check and making us tremble at the foundations of our
civilization. For the virus itself it is not a matter of ideology or power, or
right or wrong, or races nor colors, or amount of military arsenal. Another
lesson would be the fact that every person has its own immune system and reacts
differently to the same virus. Every disease each people has suffered makes the
history of his/her immune system which allows a particular fight against the
virus. Among all our immune systems, the virus is mutating and we are working
in a team against the common enemy. We, as a specie with brain and higher
intelligence, will find hopefully soon safe vaccines for everybody according to
their body weights and metabolism
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