Ever since Ontario enforced closure of non-essential businesses to curb the Coronavirus pandemic, Lester Fernandez found himself denuded of a job overnight, as well as stranded in his apartment, painfully aware of the time ticking past and money running out. Being an expat student, his job at a restaurant was the only way to stay afloat. “I have money left just to buy groceries one more time,” he said with a resigned sigh. Anxiety and loneliness have been gnawing at him, making it difficult to sleep for more than 4-5 hours.

As the world grapples with this monstrous, insidious virus, the psychological scars it can inflict on people - especially because of the social distancing measures and disruption of normalcy it brings in its wake - can be just as gruesome.

Lester, a 25-year-old from Bangalore, has been cooped up in his rented apartment in Canada for more than a week now, and classes have also shifted to online. Apart from the crippling loneliness of being stranded in a foreign country, the possibilities of his course getting indefinitely delayed looms large, which would mean more money down the drain. “If this prolongs for a long time, I don’t know what can be done,” his voice trailed off.

Closer home, a nationwide lockdown has been enforced in India to tackle the spread of the Coronavirus, and people find themselves enmeshed in varying degrees of quarantine - either self-isolation at home or mandated quarantine to prevent contagion. A recent review of research published in The Lancet found that quarantine is linked with post-traumatic stress disorder (PTSD) symptoms, confusion, and anger - the effects of which can be long-lasting.

While a negative psychological effect is unsurprising during the period of quarantine, what is more troubling is that the psychological effect of quarantine can still be detected months or years later, The Lancet review further stated.

Now that the coronavirus crisis has clawed its way into almost every continent, as well as our collective consciousness, it will have unfathomable mental health implications, affirmed all the mental health experts BusinessLine spoke to.

“I don't think there is a single human being who is not feeling some degree of stress or anxiety. It’s a question of degree and it's a question of vulnerability to it,” said Shyam Bhat, Psychiatrist and Physician.

Those with pre-existing depression and anxiety are at a greater risk of it becoming worse during this time, whilst many new cases of depression and anxiety can also occur, said Bhat. Any signs of worsening depression such as suicidal thoughts should be taken seriously and one must consult a mental health professional, he cautioned.

“I would not be surprised if more people go for therapy after all of this is over and we can resume a normal life,” said Omar Bazza, a Toronto-based clinical therapist.

Needless to say, the toll on the mental health of Coronavirus patients is particularly of concern, because being the first ones in the world to contract a virus we still don’t know much about can trigger a lot of anxiety, said Bazza. People are also hoarding resources all over the world leaving many items out of stock and such a scarcity can also lead to the general population being more anxious, he said.

Nervousness, fears of contamination, constant reassurance seeking behaviors, panic attacks, sleep disturbance, excessive worry and feelings of helplessness are some of the other possible ramifications, said Venkatesh Babu G M, Consultant Psychiatrist, Department of Mental Health and Neurosciences, Fortis Hospitals, Bangalore. Aggravating this is the probability of an economic slowdown, potential job losses, financial burden, uncertainty about future possibilities etc, he added.

“It’s almost like the world just stopped for a moment, and we are caught unawares - we don't know what to do,” remarked Bhat.

Lockdowns and quarantines have become the norm in most affected places, grinding life to a standstill.

Formerly-bustling cities now resemble ghost towns. Without its characteristic bustling, boisterous crowds, Mumbai’s local trains and stations are eerie in its cavernous emptiness. Previously chock-a-block highways now glisten in the sun with no person or vehicle in sight. A deafening silence pervades tourist meccas with its jarring dearth of life.

Such a new, unprecedented reality induces existential angst, said experts, for it is a reminder of what once constituted normalcy having been hastily rendered null and void.

It is also a time that confirms our worst dystopian fears. Cops are deployed to ensure people do not step out unnecessarily, every cough or sneeze draws accusatory glares and sometimes, ostracisation too, and the prospect of stepping out to get even basic necessities comes saddled with dire consequences. Fears of running out of food and necessities also weigh on people.

Meanwhile, people continued to engage in avoidance behaviours even after the quarantine ended, the Lancet Review stated. A study of people quarantined during the time of the SARS outbreak because of potential contact noted that 54 per cent (524 of 1057) of people who had been quarantined avoided people who were coughing or sneezing, 26 per cent (255) avoided crowded enclosed places, and 21 per cent (204) avoided all public spaces in the weeks following the quarantine period. A qualitative study in the same review reported that several participants described long-term behavioural changes after the quarantine period, such as vigilant handwashing and avoidance of crowds and, for some, the return to normality was delayed by many months, it added.

The review also said that hospital staff showed symptoms of depression even three years after quarantine, with nine percent (48 of 549) of the whole sample reporting high depressive symptoms.

Though combating the pandemic through social isolation is what countries across the globe have been harping on, it’s not to say that persevering through the resultant chronic loneliness will be an easy task. Apart from its obvious psychological repercussions, its effects on the overall health is also grave.

For instance, loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity, found a 2018 study conducted by Cigna - a global health service company - in the U.S.

The Coronavirus induced social isolation and loneliness is further fraught with zero clarity on how long the situation will last or if it will indeed cease to exist in the near foreseeable future, which makes the matter all the more disconcerting. Although the infection is not extremely fatal, factors like rapid rate of spread of infection, airborne mode of transmission, lack of definitive treatment, non-availability of vaccines as well as the healthcare gap in society is causing a huge degree of fear, threatening the survival of humans worldwide, Babu pointed out.

This crisis is an unprecedented one, unlike any that the world has been subjected to in the past 100 years, wherein it is facing a collective threat to its well being - physical, social, and economic, said Bhat. “It needs a lot of resilience from individuals, communities and countries, societies to learn from this, get through this and do better and get something positive out of it.”

As memes and discussions burgeon on social media about the quirks of social distancing, it’s pertinent to pay heed to some of its repercussions. For instance, if the home environment was what triggered mental health issues in the first place, the current crisis can certainly aggravate it, said Bazza. “I am thinking about abusive parents, partners, etc…Being stuck with them in a quarantine situation is a nightmare situation for those people and can lead to worse trauma and other mental health issues,” he explained.

Stress and anxiety can decrease immunity, and managing one’s mind and emotions helps maintain immunity. "Leaders, decision and policy makers should maintain their equanimity, it won't help if they act out of panic and fear or apathy and denial,” said Bhat.

Even as all this is happening, social media platforms like Twitter throws up disconcerting anecdotes of people from the Northeastern part of the country being spat on and being subjected to varying repugnant forms of stigma and accusations, pointing fingers at the larger malaise of moral decadence that this health crisis is wreaking.

Take the case of Ayesha (name changed), a 24-year-old with a bad case of cold, who was alone at her Ahmedabad apartment. She turned to her neighbours for help with groceries, only for her to be shunned with closed doors and barely veiled suspicious glares, aggravated by hushed instructions to their kids to steer clear of her. A phone call was also swiftly made to Ayesha’s elder sister to inform her on the probability of her being a coronavirus patient, hinting that she be taken away. Stung by their utter lack of sensitivity, Ayesha is now bogged down by the prospect of the entire apartment society ostracising her. "Until this happened, I was coping just fine though I was alone and hadn’t stepped out at all. It took a toll on my mental health," she said.

People are largely resorting to self-survival mechanisms and engaging in protective behaviours which are less likely to be guided by social responsibility and civility, affirmed Babu.

To be sure, when human beings are collectively threatened, one of the two things can happen - in the worst case, you will see anarchy, looting and chaos, said Bhat. But, even as things get murkier and uncertain, hope persists. “But, in its best, human beings can support and help each other altruistically even when they are hurting,” continued Bhat.

It can even be a wake-up call of sorts.

"We have seen this time and again, during natural disasters and wars, where people come together. It can also remind us of some of our priorities, and reprioritize as a society, as a globe,” said Bhat.

In light of this, hopefully, people will see that religion and other divides don't make sense as such a health crisis affects everyone, irrespective of where you are in the world and what your beliefs are, explained Bhat. “At the end of the day, everyone feels threatened by this because it is potentially going to affect everybody. We all want safety, and we all want security, and we all want peace for our loved ones. So, that basically reminds us of our collective humanity. So, hopefully, it will do that.”

It is also possible that in the face of an existential threat like this, the stress induced by this can take precedence over other stresses as this is more primal and immediate, said Bhat. “So, it will divert attention from other issues - other stresses fade into the background as most people start contemplating the effect of coronavirus on their lives,” he explained.

What is more, the Coronavirus crisis can also be a blessing in disguise in the sense that it can bestow on us a new and refreshed perspective.

“I see this a lot with patients who have been diagnosed with terminal illness. Most of them go through panic and many will continue to feel upset and depressed. But, for many, their lives are filled very positively after they are diagnosed - more than they have ever done before because they are aware of the preciousness of life,” said Bhat.

When we are faced with an existential threat, either as a planet or individually, it will help us to become more spiritual, in the sense of connecting with a higher power or a larger purpose, added Bhat.

But, even as these positive implications remain, it is important for people to be prepared and for authorities also to help assuage the mental health ramifications of such a crisis.

The Lancet review cannot emphasise enough on this. Since suicide and lawsuits have been reported following the imposition of quarantine in previous outbreaks, the potential benefits of mandatory mass quarantine need to be weighed carefully against the possible psychological costs, it warned.

But, this is not to suggest that quarantine should not be used; the psychological effects of not using quarantine and allowing disease to spread might be worse, it added.

“However, depriving people of their liberty for the wider public good is often contentious and needs to be handled carefully. If quarantine is essential, then our results suggest that officials should take every measure to ensure that this experience is as tolerable as possible for people. This can be achieved by: telling people what is happening and why, explaining how long it will continue, providing meaningful activities for them to do while in quarantine, providing clear communication, ensuring basic supplies (such as food, water, and medical supplies) are available, and reinforcing the sense of altruism that people should, rightly, be feeling,” the review said.

Boredom and isolation will cause distress, hence, people who are quarantined should be advised about what they can do to stave off boredom and provided with practical advice on coping and stress management techniques, it added.

On a more individual level, there is plenty we can do to insulate ourselves from the ramifications of being restricted within the walls of our homes. Every expert BusinessLine spoke with reiterated the importance of regular sleep, healthy eating practices, yoga and meditation. Limiting engagement in social media to access important information and updates about the virus, whilst ensuring that only authentic sources are relied on is also another indispensable factor, they said.

People can also use this time to introspect and reflect about their priorities in life and its direction, said Bhat. “It's also the time to be with yourself and your loved ones. Use this time to grow in some way - learn a new skill, learn a new language, read, draw, learn the guitar, write the book you have always wanted to write.”

To be sure, Sir Isaac Newton made some of his greatest discoveries, including gravity, when he was sent home from Cambridge when the Great Plague hit London.

Acknowledging the distress and ensuring communication with family and friends is important, said Babu. “Making communication with family members about the disturbing thoughts would give clarity in thinking and help in making a better strategy,” he said.

Routine building is another strategy he pointed out. While working from home, it is important for the family members to build a productive routine, engage in activities like music, meditation, playing indoor games, watching movies together etc., said Babu. “Keep up good connectedness with friends and distant family members through digital platforms. Practice social distancing but not emotional distancing,” he added.

The silver lining could also be that, given the technology we are equipped with, this is probably the best time in history to be quarantined, a sentiment echoed by experts.