Stress, Trauma, Resilience, and COVID-19

As we finish day 3 of schools being closed early, and libraries and other facilities following suit, it is important to press pause and take a moment to explore some of the stress/trauma-related implications for the unfolding dynamic with COVID-19. While the serious infection rate continues to stay relatively low, panic and extreme measures abound. Panic and a sense of “loss of control” are inherently tied to mental health, which impacts our immune systems, our creative adaptability, and our tolerance for any additional stressors (i.e. loss of income). Various resources are starting to come out about protecting mental health amidst this crisis. This post is intended to expand a bit on other resources.

How do we know that this situation impacts our trauma response systems? All we have to do is look at the fear-related words being used: crisis, emergency, pandemic, isolation, shortage... They are words primed for survival responses (which activate our trauma response system). Secondarily, when we note the measures being taken, which our society has never previously seen, including the closure of predictably open services (like schools), it is clear that “alarm bells” will go off inside of our bodies that “something is wrong.” And when we are primed for something being wrong, our stress-responses and survival modes activate. This is not a surprising trend, especially knowing what we know about how prevalent trauma is in our society (see ACEs study). Since much of those traumas and chronic stressors have gone unaddressed, and even been stigmatized, fear-based reactions are more common. But they don’t have to be.

Social, emotional, medical, cultural, and economic/financial factors are all affected by the decisions being made by government officials and administrators. By virtue of how they highlight the “unknown”, interrupt a sense of predictability, and are outside of most of our control, these decisions have a role in how stress and trauma arise in our society and in our programs. As stress increases, so do trauma triggers, and dysregulation. Simultaneously, as stress increases, we are given innumerable opportunities to practice resilience. Let’s break down a few examples.

Social Considerations:
1) The 6-foot rule and “social distancing”, as well as isolation and quarantining can exacerbate stereotypes/bias, chronic loneliness, and paranoia. Tip: Be creative with how you express affection and seek out social contact. Be curious about and challenge your own fear-based reactions to others.
2) While schools are rapidly adapting to provide online education for students, we know this could exacerbate already existing loneliness, and cyber bullying. Children who do not have access to reliable internet will be especially impacted. In particular, children will miss out on much incidental learning (what happens when you “overhear” other dynamics, like why someone else is being punished, or an explanation to a question). This type of learning happens best in peer dynamics with adult leadership, so be prepared to narrate dynamics and explain things directly to children. Tip: Patience is key here!
3) Childcare is suddenly a big issue. Many of the organizations that usually care for children are closing their doors for now. Families will likely rely on neighbors or other community members for childcare needs while schools and programs are closed. Tip: Ask for help and offer help!
Pro Tip: Humans are capable of experiencing social connection to some degree via technology. However, we are even more capable of experiencing inter-species social connection through relationships with pets, wildlife, plants, and even natural environments. Take time to connect with the more-than-human natural world.

Emotional Considerations:
1) Even for people who are not familiar with anxiety, the collective level of anxiety is rising as a result of large-scale measures being taken by local, state, and national government. This could be particularly triggering (or normalizing) for some folks. Tip: Check in on those you know to have anxiety, OCD, germophobia, etc. It’s okay that heightened stress might cause an increase in symptoms.
2) Pay attention to how you, or someone else, may become fearful of other people. This is more likely to be true if they are immuno-compromised, or have close contact with someone who is. Caution and awareness are valuable and warranted, while fear will exacerbate secondary consequences of the virus. Tip: Offer to pick up necessities for community members if you will be going out anyway.
Pro Tip: Express your emotions! Write, create art, or get active. One of the best ways to move anxious energy is through movement. Exercise and let yourself breathe! Notice how each of your emotions is temporary and remind yourself that “this too shall pass.”

Medical Considerations:
1) The majority of the large decisions being made are with the intention of slowing (not preventing) the spread of COVID-19 so that we have an ample medical response. Still, doctors may see an increased number of people presenting with anxiety attacks, domestic violence, and/or community violence issues. Tip: Practice basic first aid skills. Learn who has these skills in your local community. Be proactive in preventing interpersonal violence.
2) People with chronic illness, compromised immune systems, and older bodies are more likely to be seriously affected, both from COVID-19 itself, as well as from the secondary stressors occurring from decisions that are being made. Tip: Practice good health measures (go for walks outside, eat as healthy as you can, take your medicine and/or vitamins, get good sleep) and support others in doing the same.
Pro Tip: Did you know that when tuberculosis was widespread, and people had to set up “TB Camps”, the people who were in the camps (exposed to sunshine, fresh air, and nature), had a better recovery rate than people treated in hospitals? Nature is good for our immune systems. Get outside and get fresh air often.

Cultural Considerations:
1) Some social/cultural groups are more likely to be seriously impacted by the domino-effect of COVID-19. For example, stereotyping and racial aggression towards Asians has amplified, undocumented immigrants currently do not qualify for unemployment benefits or some of the proposed health benefits associated with the pandemic, and people living in multi-generational homes and/or community living arrangements may have different implications than the dominant recommendations indicate. Tip: Do not assume that “staying at home” is feasible or stable for everyone. Interrupt acts of bias and prejudice when you witness them. We are all in this together.
2) Access to quality interpreters has always been an issue, especially in urgent medical situations. This is going to be even more true as providers are trying to figure out systems for tele-medicine and may face several issues with a) being able to confirm that a patient is in a private/confidential setting, b) has reliable internet or cell service to complete a tele-visit and/or get follow-up services, or c) will understand how to navigate the online health systems in written English. Tip: Be proactive in getting interpreter services set-up. Start now with making Electronic Health Records (EHS) accessible for multiple languages and literacy levels. Develop culturally-competent policies to navigate various living arrangements.
Pro Tip: A sense of urgency causes us to cognitively revert to ingrained biases, whether we believe in them or not. Take the time to slow down, breathe, and clarify information when working with diverse clientele.

Economic/Financial Considerations:
1) Not everyone has, or can afford, or logistically has access to internet or cell-phone service where they live. With social distancing and quarantining, it could be easy to assume that people will still be able to have technological access to others. But that may not be true, especially if families lose substantial income from businesses being closed. Tip: Remember to use multiple modes of communication. If you have not heard back from someone, call, text, email, write, or even go visit.
2) Not everyone can afford to “stock up” on supplies or has a vehicle to transport large quantities of supplies. When mandates come out to “stay home as much as possible” and you see people regularly visiting the grocery store, do not assume that they are being reckless. Tip: Greet people. Ask friendly questions. Offer transportation if you feel like you can.
3) Collective living spaces (i.e. shelters) and other settings could be seriously impacted, especially if someone tests positively for COVID-19 or if they are mandated to close. Without libraries, restaurants, and bars open, many of the places that people seek refuge are unavailable and access to food has become more difficult. Tip: Consider food distribution options for people.
Pro Tip: Become aware of unemployment applications, and food distribution sites and services (i.e. many schools have set up free breakfast/lunch locations). Even if you don’t need these services, someone you know will. Again, some families and children will not have access to transportation to get them to and from meal programs—find out if there are ways to pick up meals for families who cannot drive themselves.

Want some other tips? Keep using stress-management tools for yourself, your staff/team, and your family. Consider using some of the worksheets developed by Wisconsin Hawthorn Project participants. Additionally, consider taking the time to plan a personal, community, or organizational garden and take solace in the fact that new growth is coming with spring.

Remember, a pandemic in general and the unique circumstances around COVID-19, is another version of stress on our systems and bodies. Take the time to notice your own sleep quality, irritability, heart rate, jumpiness, etc., as well as those of the people around you. Don’t judge—just notice. It is useful information about the individual and collective toll this stress is taking on us. So much of what is happening is outside of our control, so taking the time to control the things you can (i.e. breath, conscious relaxation of your own muscles/jaw/etc., spending time in nature, offering kindness, etc.) will be of added benefit. Let the little things be big wins.