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As Society Reopens, Not Everyone is Ready

photo of hand opening blinds

May 5, 2020 -- The restaurants have tables ready. The malls are open. The barber is taking appointments.

But as some states start relaxing their coronavirus stay-at-home guidelines, are people ready?

While scenes of crowded parks and beaches show that some people have quickly embraced these restored freedoms, others aren’t budging from the safety of their homes. Or if they are, they are doing it slowly.

Cara Blair is a pregnant mom of four in Atlanta, the capital of one of the first states to relax restrictions in late April.

Blair has followed strict shelter-in-place guidelines, leaving home only for doctor’s visits. She made an exception this weekend when her family gathered with her parents, 6 feet apart, in a mall parking lot to watch the Navy’s Blue Angels and Air Force’s Thunderbirds perform in honor of essential workers. But that will be it, for now.

“Reopening is causing me a lot of anxiety. Not because I’m not ready, but because I don’t feel we, as a society, are ready,” she says. “I’m anxious to get out, I wish I could, I just don’t feel comfortable. I don’t trust anyone else to tell me when it’s safe.”

Blair’s anxiety is shared by others. A poll of more than 3,100 WebMD readers found that 26% said they felt a sense of trauma from COVID-19, with 25% afraid to go to the store and 15% afraid to leave their house. The poll, which ran May 3 and 4, also found that 77% had not sought counseling.

The roller coaster of emotions the world is experiencing right now, as businesses and communities reopen and families cease sheltering in place, is “normal and expectable” for a disaster, including a pandemic, says Joshua Morganstein, MD, chair of the American Psychiatric Association Committee on the Psychiatric Dimensions of Disaster. “It will improve over time. Most people will find ways to cope and move forward.”

He says sheltering in place may be more likely to add to distress and challenges. “But everyone’s experience is different,” he says. “The more concern someone feels as they begin to participate with other elements of the society again, the less likely they may want to engage in it. But if not having to stay home means once again being able to put food on the table, it might be a very welcome change."

Morganstein cautions against labeling COVID-19 worries and concerns as posttraumatic stress disorder (PTSD), or “right now” stress disorder, as some have now labeled it.

“Some people will have anxiety. Most people will experience concern,” he says. “Then there will be a small percentage of people who may develop, as a result of other things they’ve been exposed to, PTSD, but that’s not the case simply by virtue of coming out of one’s home after being homebound or following stay-at-home orders.”

In Dallas County, Texas, which has the second-highest number of reported coronavirus cases in the state, quinceañera dress shop manager Juan Balderas fears a consecutive 2-day spike in coronavirus cases over the weekend could prompt another shutdown.The 40-year-old father of three says the financial strain combined with shelter-in-place orders have taken a toll on his family’s emotional health. His children fear going outside when they see people wearing masks. And he finds himself more cranky and quicker to get annoyed -- a symptom that’s common during times of disaster, including pandemics, according to the American Psychiatric Association.

“Last month, we had everything -- well, not everything -- figured out, we knew we were doing well,” Balderas says. “And now we don’t know if things are going to continue like that or not. We prefer not to talk about it so that we don’t get sad.”

Jordan Griffith was among a handful of visitors Sunday afternoon at NorthPark Center, an indoor mall in Dallas known for its art collection and luxury retailers such as Neiman Marcus, Versace, and Louis Vuitton. The 19-year-old college student felt comfortable visiting stores because businesses were limiting the number of customers inside and carefully disinfecting cash registers and counters. He said the outing was a welcome break from staying at home and feeling isolated.

“There were some periods of loneliness,” says Griffith. “Zoom and those online platforms are good, but it’s better to see people in person.”

COVID-19 and Mental Health: A Call to Action

Many Americans entered the COVID-19 pandemic already feeling anxious or depressed. In 2018, about a third of adults said they were worried, nervous, or anxious about something every day, week, or month, according to the Kaiser Family Foundation. Add a pandemic and uncertain future, and experts see a potential mental health crisis on the horizon.

Another KFF survey, done in late March when restrictive measures were still in their infancy, found that nearly half (45%) of adults in the United States had stress, worry, or anxiety due to the COVID-19 pandemic. A call-for-action article in the April 15, 2020, issue of The Lancet has urged international collaboration to evaluate the impact of COVID-19, especially social distancing, on our mood, behaviors, and overall mental health.

But the mental health impact or reactions related to COVID -- or any traumatic event -- may be mixed and may not appear for some time. When approaching the idea of ending your family’s shelter-in-place time, be realistic about expectations and “keep them super low as you start,” says Leigh Ellen Watts, a private practice play therapist in Athens, GA, and mom of two balancing telework and homeschooling. If you or your child has anxiety about catching the coronavirus when venturing out, Watts suggests recognizing the things that protect you and the people who keep you safe: the doctors, nurses, and the essential employees sanitizing the stores.

While her family is still sheltering in place and sticking to social distancing, she encourages those who are in mental health crisis or having thoughts of suicide to go out and see a loved one or supportive friend. The health benefits may outweigh the risks.

“You know how you should go and get groceries for the week because you need those things? I think if you aren’t OK as a result of this pandemic, especially if you are suicidal, you need to go out and get your socialization for the week, too,” says Watts. “That needs to be an essential that is as important as medication and food.”

If you are having stress, anxiety, or depression-like symptoms due to COVID-19 or the reopening of communities, the Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people having emotional distress related to natural or human-caused disasters.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 800-273-8255.

WebMD Health News Reviewed by Michael W. Smith, MD on May 05, 2020

Sources

National Suicide Prevention Lifeline.

Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Helpline.

WebMD poll of 3,101 readers, May 3-4, 2020.

CDC: “Stress and Coping.”

American Psychiatric Association: “Coping After Disaster.”

Kaiser Family Foundation: “The Implications of COVID-19 for Mental Health and Substance Use.”

Simon: “Reopening Update.”

Institute for Health Metrics and Evaluations: “COVID-19 Projections.”

Johns Hopkins University of Medicine Coronavirus Research Center: “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).”

United States Air Force Thunderbirds: “Blue Angels, Thunderbirds to Salute Maryland, Washington D.C., Virginia, Georgia COVID-19 Responders.”

Georgia Department of Health: “Georgia Department of Public Health Daily Status Report.”

Office of Georgia Gov. Brian P. Kemp: “2020 Executive Orders.”

Texas Health and Human Services: “Texas Case Counts COVID-19.”

Dallas County, Texas: “Dallas County Reports 187 Additional Positive 2019 Novel Coronavirus (COVID-19) Cases.”

Facebook: The Forum at Harvard T.H. Chan School of Public Health, May 5, 2020.

The Lancet: “Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.”

Joshua Morganstein, MD, chair, American Psychiatric Association, Committee on the Psychiatric Dimensions of Disaster.

Leigh Ellen Watts, licensed clinical social worker; co-owner, Athens Center for Counseling and Play Therapy, Athens, GA.

Cara Blair, Atlanta.

Jordan Griffith, Dallas County, TX.

Juan Balderas, Dallas County, TX.

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