We no longer refer to SARS-CoV-2 as “the novel coronavirus,” and the pandemic is still ongoing, so it might be difficult to look back on the early days of the pandemic. That said, reflecting on how Philadelphians reacted when the pandemic first hit may help us learn to be better prepared for changes in this pandemic, as well as other health crises down the road.
This is some of the motivation behind a new paper out this month in PLOS ONE from researchers at the Dornsife School of Public Health, which provides a much clearer snapshot of how Philadelphia residents managed through the “first wave” of the pandemic than what was previously known.
The paper’s authors analyzed and shared descriptions of the most difficult or stressful events from almost 800 Philadelphians — compiled between April 17 and July 3, 2020 – and found trends in how Philadelphia residents coped through things like anxiety, depression, worries and fears.
The survey found that more than a third of respondents experienced anxiety during this period. The authors also found that anxiety, depression and fear of infection increased as the first wave continued, but concern about hardships did not.
“Our analysis unsurprisingly found that most worries fell under fear of hardships and fear of infection,” said co-author Igor Burstyn, PhD, an associate professor at Dornsife. “I was deeply touched by the extent of suffering caused by shutdown orders last summer. People were anxious and depressed not just because of fear of infection but mostly because their whole lives were turned upside down by through government actions and withdrawal of deeply treasured liberties. It must be noted that the epidemic produced both positive and negative experiences for people, and the best way to understand this seems to be to listen to what folk have to say.”
The hardships were far-reaching.
On this psychological burden, one respondent wrote:
“being at home 99% of the time means my support/social network as shrunken immensely. I often feel I don’t matter.”
Some of the most striking comments about fear of infection came from those working in healthcare. Once such worker wrote:
“Some of us in the healthcare profession had to make the choice to stop working because of being high risk to covid-19 due to pre-existing conditions …, even though our jobs were up and running for business, we had to stop working, which left us feeling guilty and useless, on top of all the other feelings of fear and worry.”
Others expressed frustrations with government and organizations.
“I feel like no one has a handle on this situation at any level. … . I feel extremely let down by my government and my community, where I often see people without masks hanging out in close contact.”
The researchers found that those who reported having an “inner circle” – consisting of either family, friends, religious community – felt more protected from hardship and better equipped to cope, showing fewer signs of anxiety and depression. One such response:
“I enjoy more free time, more alone time, and more sleep. I’m not that worried about me or my family- vast majority who contract COVID19 survive. When are we not at risk of death?”
In addition, people who seem to have fared better took ownership on whatever freedom they had, creating a structure. For example:
“I am … not used to being home all of the time. … In the beginning one day blended into the next and I found myself feeling very depressed. I started making a schedule and I felt so much better. I highly recommend doing that and connecting with friends and family to keep your positivity in check! I will survive! ”.
The authors noted that they were grateful to respondents who completed the survey amid a pandemic, and hope the paper helps “validate the experiences that some people so far have kept private.”
“Their stories helped us see a clearer perspective of the psychological toll of the pandemic,” said Tran B. Huynh, PhD, an assistant professor at Dornsife. “When we understand our shared hardships, we can connect with our humanity even though we might not know each other.”
Although the authors said the feedback was from a convenience sample, and therefore not necessarily representative of residents of the City of Philadelphia as a whole, it does provide a broad range of detailed personal experiences during the early months of the pandemic in the city.
After studying the feedback, two main methods for minimizing consequences of the next public health crisis emerged. First, the authors cautioned about adding the threat of loss of income, as well as threats of food and medicine shortages, to those already in an unstable situation. (We all remember shortages of toilet paper in the early days of the pandemic in the U.S.) Second, the writers said there should be more focus on vulnerable groups who bear more of the brunt of public health crises, particularly those who are in poor health, low income, and younger in age. Younger respondents – who are statistically at lower risk of worse COVID-19 outcomes and tend to be lower income and less educated because of their age – were found to be at elevated risk of mood disorders, the authors reported.
“The data suggests that, when possible, it can be beneficial to empower families to look after each other and minimize anything that gets in the way of that happening,” said Burstyn. “We found that this is where most people looked for help, and those who had that support reported being less anxious or depressed than those who didn’t believe that they have a support network.”
The stories from respondents are included in the full paper, “Experiences of coping with the first wave of COVID-19 epidemic in Philadelphia, PA: Mixed methods analysis of a cross-sectional survey of worries and symptoms of mood disorders,” which is available here.