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PTSD and COVID-19: A conversation we need to have

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A mask painted by a U.S. Marine who attends art therapy to relieve PTSD symptoms. Image credit: English: Cpl. Andrew Johnston, Public domain, via Wikimedia Commons
A mask painted by a U.S. Marine during art therapy to relieve PTSD symptoms. Image credit: English: Cpl. Andrew Johnston, Public domain, via Wikimedia Commons

“This assault on my mind. Please help me.”

Many experience ‘long COVID-19’, wherein they struggle with symptoms long after initial infection. While it is important to discuss the physical aftermath of battling COVID-19, it is also of great importance to discuss the mental health effects. An article published recently in The Wire draws attention to post-traumatic stress disorder (PTSD) and COVID-19 with some patients wracked with fear they will contract the disease once more.

The article by Dr Alok Vinod Kulkarni, a senior psychiatrist at the Manas Institute of Mental Health in Hubli, Karnataka, centres around the story of forty-year-old Bengaluru businessman Mahesh whose first visit to a psychiatric hospital came following his earlier experience with COVID-19. Kulkarni cites Mahesh’s remarks during a clinical examination, in which he expressed “the nightmares just won’t stop. I wake up every night shaking with this intense fear that I will contract COVID-19 once again. I wake up drenched in sweat. Worse still, I am unable to function and have stopped working. 

“Any mundane discussion remotely related to the virus sets off a series of alarming responses within me. Anything and everything can be a cue to further my anxiety. I have started drinking to cope with this assault on my mind. 

“Please help me.”

Kulkarni identified what Mahesh expressed as PTSD. In the COVID-19 context, it is a crucial area to explore.

142157361 - bengaluru / bangalore, india - march 4 2020: a hospital ward for testing covid-19 or coronavirus setup in bangalore, india. the infectious disease has over 93,000 confirmed cases worldwide, with india has reporting 28 confirmed coronavirus cases. COVID-19 case count concept. Image credit: Ajay Bhaskar / 123rf. Critical COVID-19 concept. COVID-19 tests concept.
A dedicated hospital ward for COVID-19 testing in Bengaluru, Karnataka. Image credit: Ajay Bhaskar / 123rf

Why we need to pay attention to mental health, PTSD and COVID-19

In 2013, the World Health Organization (WHO) estimated 3.6 percent of the world’s population to be affected by PTSD in the preceding year. PTSD, a 2017 study explains, results from “trauma exposure” which “is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognised.” Kulkarni delves into many of the specifics of PTSD at length in their article, which adds to the growing concern over mental health during this health crisis – one felt globally and painfully intimately. 

As previously noted by Health Issues India, the COVID-19 pandemic has taken a toll on Indians’ mental health. In May of last year, my colleague Nicholas Parry noted how “mental health issues and suicide rates have seen a notable increase in India since the beginning of the coronavirus pandemic.” The Indian Psychiatry Society at the time said a recent study showed a twenty percent rise in mental health disorder cases, affecting at least one in five Indians.

It is understandable why this is the case. In the earlier stages of the pandemic, India entered a strict lockdown for an extended period of time. Individuals coped with loss at a virtually unprecedented scale across multiple fronts: loss of employment and so loss of income, loss of social contact and, of course, loss of loved ones. There is then, of course, the anxiety. Fear of such losses and of becoming infected oneself can provoke anxiety. Even when one ostensibly recovers from COVID-19, there is the potential for reinfection. Even if reinfection does not occur, there is still the potential for lasting physical health effects. As Mahesh’s story shows, there is the very real potential for lasting mental trauma. 

Other countries have identified interrelation between PTSD and COVID-19 as a concern. In the United Kingdom, for example, the Royal College of General Practitioners (RCGP) wrote in June 2020 that general practitioners were “adapting the techniques they use to diagnose and care for veterans with Post Traumatic Stress Disorder in readiness for a ‘huge surge’ in patients with the condition as a result of COVID-19…[general practitioners] are already anecdotally reporting a rise in the number of patients with anxiety, depression and trauma symptoms, particularly in those who have pre-existing physical and mental health conditions – and they predict that this will escalate rapidly as lockdown restrictions are lifted and patients try to deal with their experiences.” 

mental health, suicidal behaviour illustration Copyright: silentgunman / 123RF Stock Photo
Nearly 200 million Indians suffer from mental health conditions — most do so in silence. The challenges of COVID-19 has only widened the mental health treatment gap, despite more people ostensibly being in need than ever. Image credit: silentgunman / 123RF Stock Photo

PTSD: The mental health dimension of ‘long COVID’

For those who have had COVID-19, the prospect of PTSD is a spectre which may loom large. Kulkarni writes, “at the beginning of the COVID-19 pandemic, I was half-expecting people to present with PTSD symptoms following recovery from COVID-19, and I wasn’t wrong. I have observed a steep increase in the number of patients presenting with PTSD in the last six months.” 

Kulkarni writes that “stories such as that of Mahesh tell us that a range of mental health problems are in the offing thanks to the ongoing pandemic. COVID-19 can verily affect the brain, and produce distressing neuropsychiatric symptoms. Early diagnosis and evidence-based treatments will help sufferers reintegrate themselves into society at the earliest.” 

Yet India faces a major challenge. The Government, acknowledging the pandemic’s likelihood of inducing mental distress among citizens, launched a helpline early on to help people cope and subsequently unveiled guidelines for mental healthcare during the pandemic. Nonetheless, it is worth remembering that India’s mental healthcare infrastructure has long languished from underfunding, underresourcing, and understaffing. Concerningly, during the pandemic, this has remained the case.

In December last year, Parry wrote “for those affected by mental health issues [in India], treatment is a practical impossibility.” The vicious circle of mental health issues among the population being amplified while treatment remains a distant prospect (if not more so compared to the pre-pandemic world) is one that portends to engender elevated rates of substance misuse, self-harm, and suicide unless the relevant authorities act. Addressing the mental health concerns of those affected by COVID-19 in tandem with any lasting physical effects is an imperative at all stages of the healthcare delivery system. 

As Parry noted, “even under normal circumstances, these individuals would be unlikely to avail treatment. Mental healthcare accounts for just 0.16 percent of the government budget for health. In addition, there is an acute shortage of psychiatric professionals in the country. Data indicates that there are 0.3 psychiatrists, 0.12 psychologists and 0.07 social workers for every 100,000 Indians.” While there has been legislative progress and meaningful steps in the right direction, more needs to be accomplished.

The pandemic has underscored the vulnerability of health systems everywhere and India has lessons to learn. Mental health is among those lessons – and addressing the very mental trauma of those who contract diseases such as COVID-19 in the aftermath must be incorporated into treatment. 

Contact details for mental health support in India can be accessed here. 

If you are suicidal or experiencing suicidal thoughts, visit your nearest hospital or contact AASRA on 91-22-27546669 or Sneha India on 91 44 24640050 helpline. A list of other suicide helplines can be accessed here.

Source: https://www.healthissuesindia.com/2021/01/20/ptsd-and-covid-19-a-conversation-we-need-to-have/

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Biden Praises Senate Passage Of ‘Desperately Needed’ COVID-19 Relief Bill

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President Biden speaks from the State Dining Room of the White House on Saturday, following the Senate’s passage of his COVID-19 relief package by a 50-49 vote. Samuel Corum/Getty Images hide caption

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Samuel Corum/Getty Images

In remarks after a divided Senate approved his $1.9 trillion coronavirus relief plan, President Biden praised lawmakers for securing the additional round of aid and thanked the American people for making it possible through their “overwhelming bipartisan support.”

The American Rescue Plan has been a priority of the Biden administration, and is poised to deliver a fresh round of financial assistance to individuals, families, schools and businesses hard hit by the coronavirus pandemic. Measures include $1,400 direct payments, an extension of supplemental unemployment benefits, an increase to the child tax credit and financial support for state and local governments, schools and public health efforts.

“When we took office 45 days ago, I promised the American people that help was on the way,” Biden said. “Today, I can say we’ve taken one more giant step forward in delivering on that promise.”

The Senate approved the package on Saturday afternoon by a 50-49 party-line vote that did not include Republican Sen. Dan Sullivan of Alaska, who was absent for a family funeral. Its passage there followed more than 24 hours of debate, and was met with applause by Democratic lawmakers.

The House will need to approve the final version of the bill before it can head to Biden’s desk to be signed into law. The House will meet to vote on an identical measure on Tuesday, Majority Leader Steny Hoyer, D-Md., said Saturday.

“It obviously wasn’t easy, it wasn’t always pretty, but it was so desperately needed,” Biden said in his remarks.

Biden stressed the urgency, noting the more than 500,000 American lives lost to COVID-19, hundreds of small businesses closed, millions of people out of work and families struggling to afford food and rent.

He said stimulus checks will get out the door “this month,” with more resources on the way for vaccine manufacturing and distribution as well as schools, local governments and unemployed individuals. Calling the plan “historic,” he also said it could potentially cut child poverty in half.

Biden acknowledged the effort and compromise needed to eke out Senate approval, and thanked a number of people including Vice President Harris, Senate Majority Leader Chuck Schumer and other Democrats. He also credited broad public support, saying, “your elected officials heard you.”

The measure passed with a simple majority using the budget reconciliation process and despite all present Senate Republicans voting against it.

Responding to a question on the lack of Republican backing, Biden reiterated that the support of the American people is “the key.”

“And that’s going to continue to seep down through the public including from our Republican friends,” he said. “There’s a lot of Republicans that came very close, they’ve got a lot of pressure on them and I still haven’t given up on getting their support.”

Biden also denied that progressives are frustrated with the series of compromises that led to the bill’s approval. Notably, House Democrats’ original version of the bill included a since-scrapped provision to raise the minimum wage to $15 an hour by 2025, while Senate Democrats agreed to lower the income cutoff for stimulus checks to meet the demands of moderate members of the party.

In a series of tweets on Saturday, Sen. Bernie Sanders of Vermont called it “the most significant piece of legislation to benefit working families in the modern history of this country.”

Biden referenced Sanders’ statement in defending the bill’s compromises, which Biden said did not substantially affect its substance.

“I don’t think any of the compromises have in any way fundamentally altered the essence of what I put in the bill in the first place,” he said.

Republican Senate Minority Leader Mitch McConnell on Saturday accused Democrats of “exploit[ing] the crisis by jamming through unrelated liberal policies they couldn’t pass honestly.” Among other criticisms, he said it does not include not enough money for vaccinations and “ignores the science on reopening schools.”

Senate Democrats took to social media to hail the monumental legislation on Saturday.

“The American Rescue Plan is one of the most popular bills in decades for a reason,” wrote Schumer. “It’s one of the most significant anti-poverty bills in modern American history that will help millions and millions who are struggling just to get by.”

Sen. Raphael Warnock, one of two Georgia Democrats elected in a runoff election earlier this year, wrote that “this bold legislation was exactly what Georgians had in mind when they sent me to the Senate.” Many social media users are applauding Stacey Abrams, who is widely credited with helping turn the state blue.

Former President Barack Obama congratulated the Biden administration and the American people on the relief package, which he said represents “the kind of progress that’s possible when we elect leaders across government who are devoted to making people’s lives better—and a reminder of why it’s so important to vote.”

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/03/06/974409402/biden-praises-senate-passage-of-desperately-needed-covid-19-relief-bill

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Senate Passes $1.9 Trillion Coronavirus Relief Package

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Senate Majority Leader Chuck Schumer, D-N.Y., speaks to the press Saturday at the Capitol, after the Senate passed COVID-19 relief legislation on a party-line vote. Tasos Katopodis/Getty Images hide caption

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Tasos Katopodis/Getty Images

Updated at 12:56 p.m. ET

The Senate approved President Biden’s $1.9 trillion coronavirus relief plan Saturday, securing additional aid for American families, workers and businesses — and a legislative victory for the Biden administration.

After more than 24 hours of debate, the evenly divided Senate voted 50-49 to approve the measure. Republican Sen. Dan Sullivan of Alaska was absent because he was in Alaska for a family funeral.

The package would deliver a new round of financial assistance to Americans grappling with the impact of the pandemic, including $1,400 direct payments, an extension of supplemental unemployment benefits and an increase to the child tax credit.

Individuals earning up to $75,000 and couples earning up to $150,000 would receive the full direct payments of $1,400 per person. But those payments would phase out for individuals and couples who make more than $80,000 and $160,000, respectively.

The income cutoff was lowered after moderate Democrats demanded that the latest round of checks target lower-income families.

Federal unemployment benefits would be extended through Sept. 6 at the current rate of $300 per week, and the first $10,200 of those benefits would be tax-free for households that earn $150,000 or less. That provision followed a lengthy debate Friday among Democratic senators.

Democrats were under pressure to get the bill to Biden’s desk before current federal unemployment benefits expire on March 14.

The budget reconciliation process allowed them to act without Republican backing, requiring only a simple majority to pass the bill.

Senate Majority Leader Chuck Schumer, D-N.Y., signaled Tuesday that Democrats had the support they needed to move forward with the vote. But debate on the Senate floor was delayed when Sen. Ron Johnson, R-Wis., indicated Wednesday that he’d require Senate clerks to read the more than 600 page bill on the floor, pushing the vote by several hours.

“We need to highlight the abuse,” Johnson said in a tweet. “This is not a COVID relief bill. It’s a boondoggle for Democrats.”

Senate Minority Leader Mitch McConnell, R-Ky., on Tuesday accused the Biden administration of trying to “jam” Republicans on the legislation.

“It is my hope that in the end Senate Republicans will unanimously oppose it, just like House Republicans did,” McConnell said to reporters.

House Democrats’ version of the bill originally included a provision to raise the minimum wage to $15 by 2025, but the Senate parliamentarian decided the provision did not fit the rules that govern budget bills in the Senate.

The House will need to revote on the final version of the bill before it can be signed into law. House Majority Leader Steny Hoyer, D-Md., said in a statement Saturday that the House will vote on an identical measure on Tuesday.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/03/06/973126199/senate-passes-1-9-trillion-coronavirus-relief-package

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The Dalai Lama Gets A COVID-19 Shot And Urges Others To Get Vaccinated

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The Dalai Lama leaves the Zonal Hospital in Dharmsala, India, on Saturday after receiving the COVID-19 vaccine. Ashwini Bhatia/AP hide caption

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Ashwini Bhatia/AP

Updated at 2:12 p.m. ET

The Dalai Lama, the exiled Tibetan spiritual leader, left his home on Saturday to receive his first dose of the COVID-19 vaccine and promote vaccination against the coronavirus, in what was his first public appearance in over a year.

The 85-year-old scrapped plans to receive the injection at home, opting instead to travel to a clinic in Dharamsala, India, where he’s lived since fleeing China after a failed uprising in 1959.

He was photographed exposing his right shoulder to receive a vaccine known as Covishield in India, which was developed by the University of Oxford and drug firm AstraZeneca. In a video message afterward, the Dalai Lama said, “I took [the vaccine] so I want to share [that] more people should have courage to take this injection.”

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This comes as India and other countries try to ramp up vaccination distribution to outrun the coronavirus and its variant forms. India currently has the world’s second-highest COVID-19 caseload, with over 11 million confirmed cases. To date, more than 157,000 people have died of the disease in India.

Globally, there are more than 116 million cases of COVID-19, according to Johns Hopkins University. A quarter of those cases are in the U.S., where more than 522,000 have died of the disease since the pandemic began.

On Monday, high-ranking government Indian officials, including Prime Minister Narendra Modi, publicly touted receiving their vaccines. Afterward, Modi tweeted: “I appeal to all those who are eligible to take the vaccine. Together, let us make India Covid-19 free.”

India, like the U.S. and other parts of the world, has seen its share of vaccine-related controversy, some of which relates to the speed with which the medicines have rolled out. Unlike the Dalai Lama, Modi and others received shots of a homegrown vaccine called COVAXIN, which the Indian government approved for use in January, even before clinical trial data on its efficacy was released. The decision to authorize early prompted concern from scientists and public health experts.

Some of that debate was put to rest on Wednesday, when Bharat Biotech, the company making the COVAXIN vaccine, released preliminary analysis of phase 3 clinical trials showing its doses 81% effective in preventing infection.

Globally, vaccination efforts are moving slowly. The U.S. has fully vaccinated the greatest number of people, at 28.7 million, which amounts to 8.6% of its population. In raw numbers, India ranks third, having fully vaccinated 3.5 million, but that’s a miniscule fraction of its population of 1.36 billion.

Still, India could eventually become a powerhouse in the world’s fight against COVID-19. It already makes most of the world’s vaccines, and companies are already ramping up manufacturing capacity. India is expected to make 3.5 billion doses of COVID-19 vaccine, second only to the U.S., which is expected to make 4 billion, according to Deloitte.

“India is in a much different position than most lower- to middle-income countries, in that they have the capacity to develop and manufacture vaccines,” said Andrea Taylor, an associate professor at Duke’s Global Health Innovation Center. Whether that will result in faster rollout within the country isn’t clear, she says.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/03/06/974356954/the-dalai-lama-gets-a-covid-19-shot-urges-others-to-get-vaccinated

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