With the worsening COVID-19 pandemic, people are faced with illness anxiety in the context of social isolation, economic pressure and political instability.
Given that anxiety can be adaptive or maladaptive, let’s first look at how anxiety can be helpful for coping with COVID-19 and why we have anxiety.
Adaptive anxiety serves a purpose: to motivate us to deal with potential threats.
If you are realistically worried about COVID-19 and are problem-solving effectively, you are coping well. Practically, this means that your worry has led to adaptive work/school practices, social distancing and mask use. It also means that you are coping with all the near-COVID-19 misses that require multiple viral and antibody tests.
“If you can plan for the best, most likely and worst-case scenarios, panic is replaced by realistic optimism.”
Research shows that moderate anxiety helps us address potential threats such as illness. So, if you are worried about COVID-19 but your head is above water, keep going!
Pathological anxiety is more serious and requires treatment. Here people are paralyzed by COVID-19 anxiety. Sleep is disturbed, work/school function is poor and home life is stressful. Exhaustion and over-worrying are ubiquitous.
Medications are often helpful, but psychological approaches should be the first step. The most useful tool, in my opinion, is the de-catastrophizing tool. It’s a way to manage medical uncertainty.
The de-catastrophizing tool has three initial questions:
1. What is the best-case scenario?
2. What is the most-likely scenario?
3. What is the worst-case scenario?
However, the fourth question is most important:
• If the worst-case scenario comes true, what is my plan of action, even if it means dealing with an ICU admission or death and dying?
Let’s examine these three potential COVID-19 outcomes in greater detail.
1. In the best-case scenario you are never infected or if you are, it is an asymptomatic infection.
2. In the most likely scenario, if you contract the virus, the most likely outcome is about an 80% chance of mild disease (no or mild pneumonia) and about 15% chance of severe disease (shortness of breath, low oxygen saturation or more than 50% of lungs infected, based on imaging).
3. In the worst-case scenario, you have a 5% chance of developing “critical disease”, which involves hospitalization and isolation. It can mean an Intensive Care Unit (ICU) admission on a breathing machine.
According to Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, the COVID-19 case fatality rate is about 2.5% overall but about 1 in 4-5 ICU-admitted, critically ill patients will die. So, the worst-case scenario is an ICU admission with mechanical ventilation where the chance of death is about 20-25%.
Psychologically, to cope with the worst-case scenario, ask yourself:
• What is my plan of action for dealing with the potential of death?
• How did other family members such as grandparents approach death and dying before me? What went well and what could be improved? If I die, how can I best support my family and ensure their survival?
• What are my chances of surviving an ICU admission?
By flipping Dr. Fauci’s mortality data, you can see that about 3/4 (75%) of critically ill patients admitted to ICUs are in fact discharged. ICUs do excellent jobs of treating patients and treatments are getting better.
So, the worst case-scenario, does not sanitize the possibility of death and dying but rather invites us to consider it as a possibility. Discussing the risk of death does not increase its likelihood.
Additionally, new antiviral medications and vaccines will improve the odds. Consider how the AIDS epidemic was turned around by the invention of antiretroviral medications.
Staying healthy will also improve the odds of survival. Keep your lungs pristine – if you vape, smoke or inhale nicotine, cannabis etc., now is a good time to stop. Maintain exercise even if the gym is closed. You don’t have to train for a marathon. Seven minutes a day will get your diaphragm working and open your air passages.
It’s helpful to actually write down the four de-catastrophizing questions and your answers. Research shows that writing things down helps psychological processing.
So, the idea of the de-catastrophizing tool, is to develop a plan of action that covers all your bases. If you can plan for the best, most likely and worst cases, panic is replaced by realistic optimism.
One additional thought: marching around without a mask, thinking you are invulnerable to COVID-19, is known as denial or avoidance coping. Puffing out your chest with a false bravado is a way to avoid anxiety about possibly dying. It’s helpful if you are a general sending soldiers to war (or a soldier going to war) but detrimental to public health planning. My recommendation is to follow federal safety guidelines for wearing masks, social distancing and avoiding crowds, as Dr. Fauci plainly states.
If you need more help with COVID-19 related anxiety or other related problems, please call to schedule an appointment.