Dr. Shakel Henson, BSc, MD, MPH, MSc, MSc, MSBioethics, FRSPH, FRSTMH
The coronavirus disease (COVID-19), a newly emerging infectious disease, has severely affected morbidity and mortality rates on a global level. During this COVID-19 pandemic, the World Health Organization (WHO) released a report that noted mental health concerns. This column will use a specific case from St. Vincent to emphasize the need for a holistic approach to patients, and potential patients, as we continue to quarantine for COVID-19 and for future pandemics.
A Case of Quarantine in St. Vincent and the Grenadines
“Being in quarantine is not easy”. These were the words of a Vincentian male who also expressed that he felt lonely and on the verge of losing his mind while he was in quarantine. For him, the mental anguish was the worst part of the quarantine experience. On the 7th May, 2020, this 60-year-old mason returned to his home country, St. Vincent and the Grenadines (SVG), after being stuck in the British Virgin Islands. He had been working there in the construction field but work was suspended following the heightened COVID-19 situation. After being without work and an income for over two months, this father of six was excited to finally return home; border restrictions and unavailable flights had prevented this from happening earlier.
He was aware of the mandatory quarantine that was in effect and the necessary arrangements were made for him. His wife rented a house that was close to their home but positioned along the main road in the village with close proximity to shops. This was deemed ideal as it would permit him to see people in the village through the windows of the house. However, it turned out that even this was not sufficient to prevent the mental health issues that ensued while he was in quarantine.
A COVID-19 test was done upon arrival at the airport in St. Vincent and various documents had to be completed before he was permitted to leave that airport. Like others with whom he had travelled, this individual was told that he would be visited by a healthcare professional while he was in quarantine. Unfortunately, during the two-week stint in a house by himself, this hypertensive male never saw anyone from the COVID-19 team. He admitted that he had spoken to a member of the team a few times via telephone but had not been visited by any of them in person. This he found very concerning as he had expected someone to check on his health status particularly his blood pressure, which he assumed would be exceptionally high given the stressful and depressing situation. When this 60-year-old hypertensive male asked the nurse if someone was going to check his temperature and his blood pressure, he was told that there was no need to do so as the team was sure that he was “alright”.
On day 14 of his quarantine, he said that he was informed by the nurse, via telephone, that he had to remain in quarantine for one more day and thereafter he would be free to leave. His COVID-19 test was negative and no other tests were repeated while he was in quarantine so he found the request bizarre. Nonetheless, he complied. At 12:01 a.m. on the 15th day of quarantine, he walked out of the rented house. Incidentally, he had seen a police officer on the street close by. He approached him and explained the situation emphasizing that it was the 15th day of quarantine and he had previously been told that he would be free to leave on that day. Reportedly, the police officer did not object to him leaving. Weeks later, this Vincentian male who had no prior history of mental health problems and no symptoms of COVID-19 still believed that the worst part of his quarantine experience was the mental torture that was associated with being in quarantine.
Moving Forward
One issue that is not being given sufficient attention is that of the mental health effects of COVID-19, including the quarantine situation. COVID-19 is an infectious disease that affects the physical well-being of individuals. In an effort, however, to effectively prevent and control this infectious disease, mental health issues may surface that require counseling or other psychological support. Unfortunately, the mental health aspect secondary to COVID-19 may be easily missed due to its subtle nature. As efforts continue to combat this pandemic, it is essential to implement a holistic approach to the management of this deadly disease. Like many other countries, SVG is still learning about ways in which the problems associated with COVID-19 can best be addressed. Improvements can be made based on the lessons learnt from those who have first-hand experience of COVID-19, such as persons who have had to be quarantined mandatorily. Failure to do so may result in overwhelming cases of mental health issues that were missed during the COVID-19 pandemic and worsened over time as they were simply not treated. SVG can do its part in addressing these associated mental health issues. A great place for this country to start would be by gaining feedback from persons who were mandatorily quarantined due to COVID-19.