Additional Disruption to Normalcy by COVID-19

"It's long overdue that the economy should be opening up in areas that are less affected than others."
"We have to move to a more smart containment ... You cannot actually protect someone's physical health, and just go ahead and destroy their mental health. That makes no sense to me."
“We're seeing some of the highest unemployment rates in this country since the early 1980s, we've seen the loss of 15 years of job creation in Canada in only two months,”
"The labour contraction, the unemployment, and the income insecurity has resulted in an increase in the number of suicides projected in our country."
"These are significant numbers of people who are at risk, but the important point is this is not a done deal,.This is something that can be prevented by getting access to treatments. The treatments are very good. We need better psychiatric first aid, and treatments that can deal with the distress that people are experiencing. We need to have a national strategy implemented locally that can prevent the increase in suicides."
"What I'm especially concerned about is the ongoing situation in Canada, where there remains uncertainty as to when the economy will fully open up. This creates ongoing chronic stress, increasing the risk, not only for suicide, but also mental disorders that are associated with suicide, like depression and drug and alcohol misuse."
Dr.Roger McIntyre, professor of psychiatry, University of Toronto

"There has been unprecedented focus on mental health ... as well as unprecedented financial accommodation."
"So there is no comparison ... The modelling focusing on one factor could send a misleading message that it's inevitable."
Karen Letofsky, Canadian Association for Suicide Prevention

"If your livelihood is being threatened -- a business you built up -- if your ability to provide for your family is taken away from you, that's incredibly painful."
"If things don't get better, you do lose hope."
David Konsky, psychologist, University of British Columbia

The COVID-19 pandemic has brought so any closures to our lives with scant opportunity, experts note. Peter J. Thompson/National Post

"In addition to having more calls, [the agents are] also saying that in some cases, up to 100 per cent of them are either calls that are the result of issues from COVID-19, or are made worse by COVID-19."
"About 25 per cent of the centres that we surveyed recently said that more than 75 per cent of their calls either related to COVID, or were because of worsening conditions due to COVID."
Stephanie MacKendrick, CEO, Crisis Services Canada

A new study, produced by researchers at University of Toronto, published in the journal Psychiatry Research, predicts an additional two thousand suicides in 2020 and 2021, owing to the effects of COVID-19 among people vulnerable to mental health problems brought on by stress. Based on historical evidence that indicates every one percent rise in joblessness is associated with a matching rise in the number of people who die by suicide, the study authors urge the federal government to focus on getting the country working again to prevent that suicide spike.

The millions of Canadian workers who found themselves unemployed by the lockdown are largely those among whom the suicides will occur. As time passes since the initial phase of the lockdown, stress builds and expectations waver. Safety measures such as social distancing and face masks in public spaces were valuable at a time when the results of a hugely infectious, unknown new coronavirus stormed into the country, laying waste to the economy, sending people to hospital, devastating old-age and nursing homes.

There are always those in the field of science, human psychology and other disciplines dealing with human activity and health outcomes who will support or dismiss such studies and their conclusions, and this one is no different. Some, in the field of mental health doubt an epidemic of self-harm is in the offing, referring to the government support programs rolled out to mitigate against psychological fallout of the lockdown among the general population.

The correlation between unemployment and rates of suicide was the focus of the study analysis. And the researchers' finding that between the years 2000 and 2018 in Canada a one percent increase in suicide rates equated with every one percent rise in unemployment, an association, not a cause-and-effect, stresses Dr. McIntyre. Suicide, he points out, is never the result of one factor alone. Evidence of the link between employment and suicide however, is irrefutable.

Dr.McIntyre, head, UHN Centre, Mental Health’s Mood Disorders (Photo: UHN)

Two scenarios were contemplated by the researchers; where unemployment rises to 8.3 percent this year and 8.1 percent the following year; the second, "extreme" case where rates weigh in at 13 and 14.9 percent. That one percent correlation saw the first scenario resulting in 418 additional suicides this year and 2021, while the second scenario saw 2,114 additional deaths by suicide -- additional to the 4,000 average of recorded annual suicides under normal conditions.

Income replacement and wage subsidy programs proffered by government represent a laudable response, along with the $240 million the federal government allocated for online mental health services along with other recent mental health investments in service to the needs of Canadians, but it would only be the enabling of a return to work that would relieve the financial pain being felt by the ordinary Canadian, where the Canada Mortgage and Housing Corporation cites up to 20 percent of mortgages may shortly move into arrears.

"When a suicide happens, it’s multiple things that lead up to that point. You can't say it's just COVID, but could it be a contributing factor? Absolutely. Could it be the point that tipped it over? Absolutely. There's never just one reason."
"All the things that made him [her husband] super happy, that he enjoyed doing, that just made life what life is, was all being taken from him and then they were coming out saying it was going to be 18 months to two years of this and I think the thought of 18 months to two years of living in such restrictions was just too much."
"If you don't sleep for even two days, your mind does strange things, it doesn't operate properly. There was an element of the fact that he wasn't sleeping, the added stress, the added business, just the dynamics of having the whole family at home."
"Whether you can't go to work, whether you can't go to school, all of a sudden having everybody together, that is a contributing factor."
Vanessa Leslie, May suicide widow, mother of six, Oro-Medonte, Ontario 

Defying Illness and Death for Life-as-Usual

"What we see is that in many states, you see an increase in influenza-like illnesses, and then a week or two later, you see an increase in deaths due to pneumonia and influenza."
"It provides some confirmation that what we are seeing is related to coronavirus."
"We decided to look at all deaths from pneumonia, or all deaths overall, and see how those numbers were changing,"
Dan Weinberger, epidemiology of infectious diseases, Yale University

Protesters demonstrate against safer-at-home orders at the Colorado Capital in Denver on Sunday. Some counties there have implemented stricter measures than the state, which had announced an easing for some businesses starting Monday. (Jason Connolly/AFP/Getty Images)

"In New York City, this discrepancy [between numbers forecasted and numbers realized] was even more stark, with three to four times as many excess all-cause deaths as pneumonia and influenza deaths."
"For instance, California had 101 reported deaths due to COVID-19 and 399 excess pneumonia and influenza deaths."
"Many states experienced a notable increase in the proportion of total deaths due to P&I (pneumonia and influenza) starting in mid-March through March 28 compared to what would be expected based on the time of year and influenza activity."
"In some states, such as Florida and Georgia, the increase in deaths due to pneumonia and influenza preceded the widespread adoption of testing for the novel coronavirus by several weeks."  

"Given the lack of adequate testing and geographical variability in testing intensity, this type of monitoring provides key information on the severity of the epidemic in different geographic regions."

"It also provides some indication of the degree to which viral testing is missing deaths associated with COVID-19 directly or indirectly."Research report, published in MedRxiv

The United States has been hit by one of the globe's worst epidemics of novel coronavirus. The death toll is approaching 58,000, increasing at a steadily rapid rate. Despite this, a growing number of state governors appear to be defying reality, in lock-step with the president anxious to see a return to normal life, in particular that business as usual would resume. The economy has been put to a standstill. From a situation of full employment and more jobs than people to fill them, suddenly mass unemployment has struck the country. On Saturday alone, there was an additional 2,404 coronavirus deaths reported.

Yet, a belief born of desperation appears to be informing decision makers, that the worst of the outbreak could have passed, matching pressure from the corporate community that the devastated U.S. economy must see some relief from the imposition of lockdown. Across the country anger and frustration have seen protests erupt, with citizens decrying the unneeded security steps, that their liberties have been abridged, that the American way of life has been upended for no good and reasonable purpose.

As evidence of that looming distrust in government action in response to the advice from their top expert medical advisers, Americans are demonstrating their penchant for ignoring stay-at-home orders in a demonstration of quarantine fatigue. A team led by the University of Maryland, with the use of mobile-phone data, discovered that Americans have been leaving the confines of self-isolation in increasing numbers.

Operating manager Barry Lennon cleans up the table of customer Duke Scott in the empty dining room of the J. Christopher's restaurant on Monday in Brookhaven, Ga. As of Monday, restaurants around Georgia are allowed to offer dine-in service. (Jessica McGowan/Getty Images)

In California, thousands of people have gone to the beaches amid soaring temperatures on the weekend, choosing to entirely ignore the state governor's orders. Demonstrations have been reported in Springfield, Ill and Baton Rouge, La. Demonstrations in Michigan, where one of the worst breakouts has occurred in Chicago, have been supported by conservative groups. In response the governor agreed to ease some of the imposed curbs allowing some businesses to reopen.

In Georgia, Governor Brian Kemp is allowing hairdressers, nail salons and tattoo parlours to re-open their premises; hardly the essence of 'essential' services for a population in lockdown against a dread disease. There have been guidelines issued that clients and staff wear masks and customers be asked questions of their health conditions; with no way to monitor compliance. A raft of businesses will be permitted to operate over the coming week in around 20 states.

According to the director of the Johns Hopkins Center for Health Security, Tom Inglesby, he believes the country is "at the end of the beginning" of the crisis. As for President Trump, he has stated that his daily White House briefings are to be scrapped, "not worth the time and effort".

Some health experts and local politicians are concerned that restrictions put in place to slow the spread of COVID-19 are being lifted too soon in some U.S. states such as Georgia.