key: cord-269970-tnnpo6hu authors: Musa, Hassan H; Musa, Taha H.; Musa, Idriss H.; ELBingawi, Haitham M.; Musa, Ibrahim H; Campbell, Michael C. title: L’impact psychologique silencieux de la pandémie de COVID-19 au Soudan date: 2020-10-14 journal: Ethics Med Public Health DOI: 10.1016/j.jemep.2020.100604 sha: doc_id: 269970 cord_uid: tnnpo6hu nan Coronavirus disease-2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, has spread to almost every region of the globe and has affected more than 24,299,923 people worldwide, resulting in 894,476 deaths as of September 7, 2020 [1] . The clinical manifestations of this disease include headache, fever, dry cough, and atypical pneumonia that lead to life-threatening acuterespiratory distress [2] . Although patients generally present with mild symptoms, more acute disease can lead to hospitalization, intensive care unit admission, and/or death, particularly in seniors (> 65 in age) and individuals with comorbid conditions [3] . The current pandemic has also complicated treatment for chronic diseases and has led to delays in the management of emergency cases [4] . Additionally, COVID-19 has entrenched a number of individuals across the world in an unprecedented level of depression and anxiety [5, 6] . Thus, the COVID-19 19 pandemic has had a large impact on people's lives from the perspective of physical and mental health [3, 5, 7] . In Sudan, the first SARS-CoV-2 positive case was confirmed in March 13, 2020, and since then a number of mitigating measures was initiated by the federal and state governments to combat onward transmission of the virus. For example, on April 18, Khartoum State was under lockdown; more explicitly, bridges were closed and people were only permitted to access neighborhoods shops, bakeries and pharmacies between the hours of 6 AM. and 1 PM daily. Furthermore, all public gatherings were banned, including religious activities in mosques and churches (e.g. weddings, celebrations, and Ramadan Iftars). The borders between states also were closed except to commercial vehicles carrying strategic commodities such as food, medicines and fuel etc. These measures were eventually implemented in all states in Sudan [8] . Social distancing, self-isolation, and mandatory quarantines togethers with the adverse economic impact due to the pandemic have affected every aspect of daily life in Sudan. Because of population density, social structure, cultural norms, reduced healthcare capacity, and poverty, it is challenging to place millions of people in Sudan under lockdown, including those living in some of the largest refugee camps in the country, without impacting their mental health. From the first reported cases to September 7, 2020, 13,437 confirmed COVID-19 cases, and 833 deaths have been reported in Sudan [1] , though it is possible that these numbers are underestimates of the true counts. Indeed, it is reasonable to deduce that the effect of the COVID-19 pandemic has extended beyond the physical illness in a large proportion of people in Sudan. When the COVID-19 cases reached the community transmission stage, and the confirmed positive cases and the death rate rose, Sudan entered into quarantine experience which led to distress in the form of fear, panic, anxiety, anger, stigma, depression, xenophobia, confusion and symptoms of post-traumatic stress [9] . In Sudan, when the first coronavirus positive case was reported, Sudan faced critical challenges, such as the identification of positive cases through testing, insufficient number of health care workers to treat confirmed COVID-19 cases, and implementation of treatment plans in response to COVID-19 [8] . [10] . In addition, fears of transmitting the virus to family members also exist among healthcare workers [11] . Recent studies also have reported an increase in depression, stress and anxiety within families due to the pandemic [12] . Moreover, the fear of contracting SARS-CoV-2 has led to suicide events. For example, it was reported that a 50-year-old man in India-who feared that he had been infected by the novel coronavirus-committed suicide to avoid spreading COVID-19 to his family and village [13] . More generally, social isolation, susceptibility to stress, and economic recession have been cited as contributing factors to COVID-19-related suicides globally [14] . In the end, the pandemic has broadly affected people's well-being in multiple ways [15] . Mental health clinicians expressed their concerns about the psychological effects of the COVID-19 pandemic [10] . To date, anxiety and fear of becoming infected have grown with the risk of exposure to SARS-CoV2. In addition to the prevention and treatment of disease, it may be prudent to perform mental health assessments of confirmed COVID-19 patients, suspected patients, quarantined family members, and healthcare personnel to ensure that individuals are coping well during the pandemic [16] . In particular, health care providers should be employed to address social stigma, fear and vulnerability in the general population. Moreover, government officials need to work towards increasing the public's confidence in the mitigating measures undertaken to combat the spread of SARS-CoV-2 and encourage communities to act together to further reduce infection. Equally as important, we advocate for minimizing the propagation of fake information in the media and on social network platforms, which can adversely influence people's state of mind and behavior [17] . Finally, it would be highly beneficial to broadly disseminate information about the possible psychological effects of the pandemic and the ways to access support for emotional distress during these unprecedented times. World Health Organization. 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