IF the novel coronavirus was the enemy, or an opponent, one would have to marvel at the simplicity and effectiveness of its strategy and execution.

It has the potential to eliminate its host, or opponent, at its own expense. If it had a mind, it would be admired as single-minded, resolute, absolute in its quest for domination and victory.

The covid-19 pandemic has resulted in a bio-psycho-sociocultural crisis not experienced by humankind since the Spanish flu Influenza outbreak of 1918.

 

BIOLOGY

The covid-19 virus belongs to a family of coronaviruses, which have wreaked havoc on humankind before. At its core is a strand of RNA, its command centre, its genetic material. This is surrounded by a protein shell, itself protected by two layers of lipid.

The outer membrane has protrusions of glycoproteins, like multiple points for anchoring to its prey. Resembling a corona, hence its name.

Simply put, the virus has to breach the host cell’s walls, infiltrate its territory, before hi-jacking its cellular machinery to replicate itself. It needs to do this with stealth, before the inevitable detection and mounting of an immune response.

It does this by attaching to a cell’s membrane, primarily those lining the respiratory tract, given its mode of transmission via droplets by sneezing, coughing and touch to another host. The spike protein binds specifically to ACE2, an enzyme, before splitting in two and entering the cell.

Once inside, the virus has to build an army of proteins to assist it for reproduction. These polyproteins have various functions, ultimately to copy its RNA and assembling new viruses to be shed into the respiratory tract for further proliferation.

The effectiveness of the covid-19’s spread is attributed to the fact that in can reproduce in the body for days without triggering the immune response, by producing “non-structural genes” that interfere with the response. A type of an advanced special forces unit.

Inevitably, the fight back by our immune system is what causes the initial symptoms of cough, fever and breathing difficulties, before possibly ending in pneumonia, respiratory failure and death.

Only seven coronaviruses have been identified as infecting humans. Four cause symptoms like the common cold. Three are much more pathologically destructive than the others: SARS-CoV, identified in 2002 causing Severe Acute Respiratory Syndrome; MERS-CoV identified in 2012 causing Middle East Respiratory Syndrome and now the SARS-CoV2 that began in Wuhan, China.

It is likely the original source of the virus is from bats, spreading to humans through an intermediary host. This was the case for both SARS and MERS. For covid-19, the exact incubation period is uncertain, although it is thought to be from one to fourteen days.

The initial fatality rates vary from country to country and reflect a number of variables, although the elderly and immune-compromised are more susceptible. It seems to lie anywhere between 2 and 10%. This is less severe than SARS (10%) and MERS (35%), although it is the lower mortality rate that has allowed its infection to proceed more rapidly globally.

Much of the damage caused to our bodies is ironically, due to the veracity of our immune system fighting the invader. Cells die, slough off and filling the airways with mucus and debris which is then expelled loaded with virus. An extreme response is called a “cytokine storm” – proteins that coordinate the immune response. This can lead to hyperinflammation and increased mortality in the young adult population as was the case in the Spanish flu of 1918.

The human response to a pandemic is both rational and scientific. Based on cause and effect, a deterministic approach. It uses the primary, secondary and tertiary prevention paradigm for health.

Primary prevention is aimed at reducing incidence, or anyone contracting the covid-19 virus. Secondary prevention is the early detection and treatment of the disease process, while tertiary prevention aims to limit the long term consequences of the disease.

Primary prevention approaches include an understanding of the transmission of the virus, its replication and infectivity. Biological weaponry would attempt to interfere with how the virus attaches to its host cell and manages to invade and use its genetic material to replicate. At least until a vaccine is readily available, to hone the immune system for early detection and prevention.

In this regard, laboratories around the globe are frantically working on a vaccine, but all estimates suggest at least it is 12 to 18 months away.

Otherwise, the main thrust for primary prevention is not to become infected in the first place.

Despite its impressive machinery, the covid-19 virus is not indestructible. The outer lipid layer means it is easily destroyed by detergents and alcohol, making regular hand washing for 20 seconds vital. The virus also struggles to survive in the elements without a host cell or in droplets to be transmitted at the peak of its infectivity. Wiping down of objects of potential infection such as door handles is imperative, as is coughing and sneezing kept to one’s own immediate vicinity rather than catapulting millions of viruses air-borne.

The other main focus by governments around the world is to limit social interaction, a term now known in the vernacular as “social distancing”, and its more extreme version, “social isolation.”

Certainly, the more extreme the limitation, such as total “lockdown,” the probability of spreading and contracting the virus is significantly reduced, if not eliminated. Especially if it can be done absolutely by everyone on the planet for 14 days of incubation. Impossible, but the closer to 100% the better our chances. This has been the method behind the “flattening the curve” model that has been communicated to everyone.

From a global perspective, limiting physical contact between peoples has meant shutting down modes of transport: airlines, railways and ships. Ocean liners have been difficult to manage if they are carrying infection. They are isolated and prevented from disembarking, at risk of becoming floating morgues as the morbidity accelerates.

They present a moral dilemma for those countries where they are refused docking and disembarking. Perhaps more vigorous testing and the implementation of medical teams to treat those on the ships is the answer, before any decision is made.

Countries have taken the measures of closing their borders, allowing access for citizens only, and then be subjected to a period of quarantine upon entering.

Within a country, further restrictions regarding contact have led to the closures of any place or situation leading to group gatherings, with the total number allowable frequently diminishing. The number varies amongst countries, their infection rates and social infrastructures.

How long these strategies remain in place is an ongoing question, since we are dealing with a new virus. Epidemiological models can use past infections as a template, as well as the progression of the disease in China, the original epicentre.

In any case, the extreme measures are likely to be in place for several weeks, if not months, with some easing depending on the rate of recovery and other measures to deal with the pandemic.

The secondary prevention strategy is to limit the progression of the disease. This is difficult for a virus. It involves early detection, isolation and then treatment to keep the individual alive who is under severe respiratory distress, such as ventilators to take over the job of breathing when the lungs are unable to perform adequately. Until recovery occurs, or not.

The availability of ventilators has been a major concern for hospital and health systems under siege around the globe.

Otherwise, the main thrust for secondary prevention has emphasised early detection, isolation, treatment and identifying contacts and repeating the process. This has been shown to be most effective in controlling the spread of the virus.

The impetus now is to produce an inexpensive and simple test that can be given en masse to the public that they can do themselves, such as a blood test similar to diabetes. This would detect those who have developed antibodies to the virus, but not identify those who remain contagious. This would be in addition to the traditional testing sites using nasal and pharyngeal swabs for individuals to access who meet the recommended specified criteria.

For the elderly and others, minimising the impact also means the management of co-morbid conditions that affect the general health such as chronic illnesses. Including diabetes, heart disease, bronchiectasis, leukemias and other conditions. As well as the treatment of any secondary bacterial infections which could occur opportunistically.

There has been some suggestion of treatment with anti-malarial agents and other anti-cancer medicines. To date, these have been unproven. Unfortunately, it also presents an opportunity for all forms of claims to be presented without any evidence of therapeutic efficacy.

The tertiary prevention model aims to limit the impact of the disease on an individual. Once again, the data to examine this is still limited and being assessed. It is unknown whether there are any lingering effects of the virus, in particular lung conditions secondary to scarring, the effect on those pregnant especially in the first trimester, and transmission to infants.

Programs will certainly have to deal with the psychological consequences of the pandemic as much as the physical realm.

 

PSYCHOLOGICAL

The type of psychological problem experienced will depend on a number of demographic variables as well as the presence of pre-existing physical, psychological and social problems.

There is likely to be a new term such as “pananxiety” and “pandysphoria” to reflect the psychological equivalent of the global biological pandemic.

There will be immediate, short and long term disorders largely associated with symptoms of anxiety and depression.

The uncertainty of the virus and its progression understandably leads to significant stress or anxiety amongst the population. This leads to a sense of vulnerability, lack of control over one’s reality and those within the immediate family and friends. Especially from an enemy that is physically unseen and not understood.

Much anxiety can be ameliorated with the spread of information that allows our minds to make sense of our new reality that is being challenged daily by a potentially silent assassin.

The information must be concise, consistent, simple and practical. Otherwise, it may lead to confusion and uncertainty and add to the collective anxiety, not diminish it.  Individuals must also be careful not to saturate themselves with information, as this also has the potential to overwhelm.

Anxiety will occur as people wonder if they will contract the disease, or whether loved ones do, whether they will survive and the impact upon their family. They will seek solace from statistics, from government policies, from the efficiency of their health system and other social infrastructures.

The experience of dying alone in a makeshift hospital bed, surrounded by hundreds of others is terrifying for both patient and family.

Immediate reactions will follow the recognised phases of Grief: denial, anger, bargaining, depression and acceptance. The enduring presence of the stressor will then lead to more recognised anxiety disorders: Adjustment Disorders, Acute Stress Disorder and Post-Traumatic Stress Disorder. Given the time frame involved of the pandemic, cases of the latter are inevitable for individual, family and those health care workers who are dealing with life and death decisions on a daily basis.

The occurrence of panic attacks in the context of a respiratory illness such as asthma and COPD is already well established. There is no reason to assume that this will not be the case with covid-19, both acutely and chronically.

Agoraphobia, a behavioural consequence of Panic Disorder, is also likely to flourish as a traumatised public will be cautious to congregate in numbers in the future.

Those with existing disorders such as Obsessive-Compulsive disorder are likely to worsen as their fears of contamination is proven and heightened. Ironically, those with Social Phobia will probably cope best with the social isolation. Generalised Anxiety Disorder and Post Traumatic Stress Disorders are likely to worsen. As is Panic Disorder.

Cases of depression will follow for a number of reasons. Either acutely, by contracting the virus, or a result of the impact of the government enforced changes on their day to day livelihood. This includes multiple losses: work, income, recreation, exercise, homes, accommodation, social gatherings and social communication. Bars, cafes, restaurants, schools, weddings and funerals, local parks and playgrounds will have a severe effect on the collective psyche.

Many children will develop anxiety about their uncertain future, feeding off the anxiety of their parents as they seek guidance and reassurance. There will be a sense of catastrophe and doom. Separation anxiety will inevitably emerge as children seek reassurance from attachment. The long term effects of school closures, then resumption, will likely see an increase in behavioural disorders.

The absence of social interaction for children removes an important psychological process for bonding, sharing and the formation of relationships.

The elderly may well adopt an approach of “giving up” on their lives as they are isolated from family, friends and social activities. Especially those who have recently lost loved ones, are alone and struggling with a variety of chronic medical conditions.

There may well be an increase in the suicide rate as a reaction to severe depression if contingency plans are not put in place. Alarmingly, some religious groups in particular may interpret the current pandemic as a plague and sign of the “End of Times” or apocalypse to justify their belief systems and a call to arms of their followers similar to the Heaven’s Gate and Jonestown tragedies.

There is also likely to be a rise in the somatoform disorders such as Abnormal Illness Behaviour, Hypochondriasis and Somatisation Disorders as a result of fear of having the covid-19 disease or the belief of its inevitable contraction. At its most extreme, there may be the delusional belief the virus has affected other internal systems irrevocably.

The psychological impact of social isolation is of particular concern. The stress upon the occupants of the household is severe. This will exacerbate problems of domestic violence, especially where drugs and alcohol are compounding factors.

Indeed, Substance Use Disorders, such as illicit drugs and alcohol, are likely to escalate as people find their own way to deal with their anxiety, depression and isolation, in turn leading to an increase in the crime rate.

The mental health of those working or residing in institutions will be affected. Nursing homes, prisons, correctional facilities and hospitals. In particular healthcare workers: doctors, nurses, administration staff, emergency workers and paramedics are likely to be at risk of exposure. They are acutely vulnerable and must be offered as much protection as possible to do their job, which has been a problem in some countries overseas as they try to contain those affected.

They are prone to the chronic forms of mental health problems such as Post Traumatic Stress Disorders, Dysthymic Disorders and Substance Abuse.

Social communication is paramount to maintain some semblance of cohesion and support, at least virtually. This is one of the main differences to the Spanish flu of 1918. The presence of the internet, smartphones, access to facetime and videolinks and other forms of social media provide some protection against the psychological effects of isolation.

Humour, as a psychological defense mechanism, is also important in a crisis. Trying to find something amusing on line or talking with others can lift a mood. As can social events at a distance, such as singing in the terraces or sharing an experience.

Accessing YouTube videos on meditation and other anxiety and depressive oriented apps also can be of immense comfort. As is story books and cartoons for children to ease their fears of covid-19 virus as an unknown enemy that could harm them and their family.

Governments must prepare now for the mental health of their people. Access to mental health professionals must be a priority, including changes in the way health care is delivered.

Indeed, there should be a summit before the end of the pandemic, by government departments and officials, as well as mental health professionals to foresee the mental health problems of its constituents.

Otherwise the incidence of depression and anxiety will have a protracted effect on the economy, unemployment and social cohesion for years to come.

 

SOCIOCULTURAL

Perhaps the most profound effect of the pandemic has been on existing social structures and social norms.

The rapid reduction and eventual cessation of a number of social activities has been largely adhered to, as people come to grips with the potential severity of the pandemic. But there has also been dissent and outright protests, opposition, disbelief, as well as some egocentric, survivalist behaviour.

The young have also been slow to heed the message, presumably due to a general stance against any form of authority, but also a belief that they are invincible.

The hoarding of toilet paper and handwash, canned food and pasta can only be interpreted as a social regression to a primitive state of survival of one’s most basic bodily functions in the face of fear of loss of control over existence. A siege mentality, previously adopted by doomsday preppers, who now no doubt feel vindicated for their paranoia.

Broadly speaking, locations where large groups of individuals gather have been stopped. The larger the group, the quicker the response. Sporting events were first to go. Initially played in an empty stadium, then ultimately as the infection spread to players and officials, abandoned completely.

Next was Formula One, international tennis tournaments, local and global football and ultimately, the postponement of the Tokyo Olympic Games. Major organisations are claiming massive financial losses as they pare down their staff to skeletal proportions if not completely shutting down, as well as reducing the wages of their sportspersons.

Other places of congregation soon followed. Bars, cafes, restaurants, churches, some schools, universities, gymnasiums, cinemas, public swimming pools, art galleries, museums, amusement parks, wineries, hotels, many retailers and more.

Indeed, movement has been restricted to essential services for medical conditions, to visit those at risk, brief exercise and garnering food supplies.

The economic impact of these rapid social restrictions has been unprecedented. Massive unemployment, loss of income, fears of eviction, welfare recipients have resulted in government intervention with various stimulus packages to save the economy and livelihoods.

Just how effective these interventions are time will tell, given it remains unclear how long they will remain in place. The lingering effects will probably last for several years.

Other social problems will impact on those living in poverty, the homeless, not for profit organisations relying on donations and more.

The loss of any police force due to the pandemic will lead to a loss of enforcement of new social requirements as well as an inevitable increase in crime, specifically looting. The sale of firearms in the United States has also accelerated as a result.

The overall impact will be reflected in the pre-existing sophistication of the society, its wealth and its capacity to effectively take care of those in need in times of crisis.

The loss of social cohesion and social interaction has been seen before.

The Spanish flu of 1918 was a particularly destructive influenza pandemic. It infected 500 million people, or a quarter of the world’s population. Mortality estimates are up to 50 million, perhaps double that. Young adults were particularly vulnerable, as well as the elderly and infants. But most died because of malnutrition, overcrowding, poor hygiene and bacterial superinfections. World War I troop movements also likely hastened its progression globally.

In some good news, the second wave of 1918 new cases dropped quickly, almost ceasing. The rapid decline either due to improved management or the mutation of the virus into a less lethal strain. It will be seen whether covid-19 can hopefully follow this path, especially given 100 years of improved medicine with vaccine and drug availability and bio-containment.

As well as the co-operation and understanding by a fearful humanity who remain united against a common enemy.

 

THE ROLE OF SPORT

Sport in its various guises has been of significant importance in the healthy functioning of an individual, family, the community and broader society.

Sport is a bio-psycho-sociocultural phenomenon. For those who play, it brings physiological rewards and advantages as the need for competition is embraced. A signature of our primeval instincts mimicking aggressive impulses for physical domination, territory, and sexual propagation of the species.

Sport has since evolved into our civilised, socially more acceptable version of aggression. It offers other individuals in a society the opportunity to vicariously share and be a part of the physical success of the sportsperson or team. Through a process in psychoanalysis known as projective identification and introjection. Mirroring the athlete by wearing similar clothing, sometimes the name and number. As well as chants of primitive vocal support.

Sport, either directly or indirectly, is recognised as a psychologically mature defense mechanism for the resolution of inner conflicts. The opportunity to vent aggression, abuse at authority, and to experience the highs and lows of success and failure.

Sporting organisations are a powerful part of the fabric of any society. Coaches, players, administrative staff, owners, board members and others are a collective collaboration, embracing the ethos and culture that is idealistic and noble.

Traits that are often missing in the personal life and reality that is confronted on a daily basis otherwise.

Not surprisingly, sporting organisations across the globe resisted the temptation to abandon their sporting competitions as the covid-19 pandemic gained traction. This in part may have been driven by altruism, to continue to provide an outlet for a community under increasing stress, but also by the impending crippling financial losses resulting from imminent collapse.

Teams around the world tried to adapt to a situation crumbling around them. At first, games were played in empty stadiums. Presumably to offer some diversion for its constituents, but also a last ditch attempt at revenue.

It became obvious that the product, without the fans, was inferior. This highlights the importance of the relationship between the team, the sport, and the fan base in terms of the total experience for both athlete and audience.

Eventually, even the Olympic Games, the pinnacle of sporting competitions and solidarity, had to abandon the 2020 games in Tokyo.

In past crises, such as war, sport has largely survived as a social distraction and necessity for improving the morale of both the armed forces and a society. It has been immune because humanity was split into factions, warring against each other.

But as we have seen, sport is not immune to the global threat to all humanity posed by the covid-19 virus. That is because the virus is easily disseminated by close contact, so the numbers in congregations and gatherings have plummeted close to zero.

As sporting competitions stop, so does the income from the paying fans, corporations, sponsors and television and streaming platforms. Organisations are no longer able to continue to function. Massive cuts to staff have occurred, as well as massive reductions in the wages of coaches and players.

Some vulnerable competitions such as women’s sport may not be able to survive the financial fallout, especially if they do not make a profit. Those sports catering for athletes with disability and other social problems are also likely to be severely affected.

On the contrary, we can expect a proliferation of esports and other virtual platforms.

The livelihood of thousands of people has been affected in a very short space of time. The psychological and financial ramifications profound. The effect filtering down to other community clubs and grass roots.

Without sport, there is likely to be an increase in psychological and social problems. That is because one of the main ways to deal with emotional conflict for an individual is no longer available.

The problem is compounded by the added stress of other effects of the pandemic. Unemployment, social isolation, loneliness, family discord, domestic problems, fears of eviction, an increase in the crime rate.

That is why governments must plan ahead for the psychological impact of the covid-19 pandemic, which may persist for months with its social restrictions.

That is also why sport must find a way to survive the crisis. All sport, at all levels. The importance to children cannot be overemphasised, in terms of development, social morals, self esteem, team ethos, respect and valour.

Assistance must be given by government, private investment and the banking sector. Including loans and subsidies to allow organisations to not only survive, but expand their participation and supporter base in an uncertain future.

When sport resumes, and it will, it is likely to be in a very different format. Organisations will have to reboot, some starting from scratch. The new financial landscape appreciated. Coaching staff and administrators pared back. Frugality will be the new norm, as those in wider society would have been expected to adapt to without complaint.

Members and supporters who are now unemployed and struggling may seek a monetary return of their club fees, if no sport is being played.

It may well be time to review the fees charged for those who participate at all levels as well as the dedicated fan. It must become easier for people of all ages, race, gender, religion, disability, social status and mental health to access.

A decision will be made regarding the return of crowds to sporting events. Caution and some fear is to be expected, guided by medical experts and government policy. Slowly but surely, some semblance of normality will attempt to return.

Covid-19 has thrown down the gauntlet. It is up to society, including sport, to take up the challenge.

A new normality with a new equilibrium.

Whatever that may look like, sport must and will be an important part of the recovery process to a collectively damaged human psyche.

Ludo Aequitas – Equality Through Sport – welcomes your opinion.

 

Image via South Shore Health

« Back to Articles