key: cord-0732425-tykc6a45 authors: Shi, Wei; Hall, Brian J. title: What can we do for people exposed to multiple traumatic events during the coronavirus pandemic? date: 2020-04-08 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2020.102065 sha: 31e7d5686db98cbb18fed0bd31dc188e19c0c367 doc_id: 732425 cord_uid: tykc6a45 nan As the world increasingly deals with the COVID-19 pandemic, other natural disasters (e.g., earthquakes, floods, fires, and tornadoes) or public health emergencies (e.g., influenza in America) have simultaneously occurred in some countries. These events pose serious threats to people and have resulted in a great loss of people's lives and property. For example, by March 21, 2020, 15 earthquakes had occurred in China during the COVID-19 outbreak, increasing the fears, concerns, and anxiety of more than 1.4 billion Chinese people about natural disasters and public health emergencies (China Earthquake Administration, 2020). Flash floods, bushfires, and dust storms have occurred in Australia, killing at least 33 people and more than a billion animals, and destroying nearly 11 million hectares of land and thousands of homes (British Broadcasting Corporation, 2020) . In America, more than 19 million people contracted severe flu, resulting in more than 10,000 deaths and 180,000 hospitalizations (Bursztynsky, 2020) . Furthermore, tornadoes have killed at least 25 people across 4 counties in Tennessee (Wadhwani, Bliss, Alund, & Tennessean, 2020) . Essential trauma care should be implemented for people exposed to multiple traumatic events during the COVID-19 outbreak. The WHO's guidelines for essential trauma care states that to minimize the negative effects of trauma on survivors, essential aspects must be considered in the treatment process (WHO, 2004) . First, to minimize the mortality rate, life-threatening injuries should be properly and promptly treated as a priority. Second, potentially disabling injuries should be rapidly detected and treated to reduce functional impairment and ensure a quick return to normal life. Third, experienced health professionals should be assigned to provide trauma health care for people in need, which could increase the effectiveness and efficiency of treatment. Finally, the management models of disaster or public health emergencies should be developed focusing on the phases of mitigation, preparedness, response, and recovery, which could better ensure the various measures and assistance to victims conducted in an efficient, well-sequenced and coordinated manner. After experiencing multiple traumatic events simultaneously, many people may feel great dread, loneliness, and frustration from losing their family, or as a result of injuries, fatalities, and broader financial burdens (WHO, 2004) . Appropriate psychological support should be implemented for people exposed to multiple traumatic events during this period. Some approaches used in the Severe Acute Respiratory Syndrome (SARS) outbreak could be considered to resolve psychiatric distress emerging during COVID-19 (Maunder et al., 2003) . As trauma-related mental care system remains underdeveloped and incomplete in many countries, some areas could be considered for improvement to ensure appropriate professional help for people with mental disorders. Previous researchers recommended (1) expanding training and education of health specialists in different cultural contexts (Fang, J o u r n a l P r e -p r o o f coordinating with various stakeholders and social network supports to strengthen, early identification of mental disorders (Zandifar, & Badrfam, 2020) ; (3) further encouraging helpseeking behaviors to reduce the stigma and marginalization via social media resources, such as TV commercials, Wechat, and Facebook (Banerjee, in press ). By February 27, 2020, 852 academic publications on COVID-19 had been published globally (WHO, 2020), but few focused on the influence of other traumatic events on populations. As the world is highly concerned with COVID-19, the additional influences of other traumatic events could be overlooked. Thus, research should explore the impact of these traumatic events occurring during the outbreak. Epidemiological surveys on mental disorders, trauma-informed care, professional help-seeking, and related barriers should be conducted among various populations affected by multiple traumatic events during the COVID-19 outbreak. These findings may contribute to coordinating and aligning response programs and treatment models beyond national priorities. Finally, health authorities should consider the research and treatment programs used in previous public health emergencies e.g., SARS in 2003) and traumatic events (e.g., the 2008 Great Wenchuan Earthquake) to improve the response to the challenges due to traumatic events occurring contemporaneously with the COVID-19 outbreak. The author(s) received no specific funding for this work. The authors have no conflicts of interest. J o u r n a l P r e -p r o o f Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults In press). The COVID-19 outbreak: Crucial role the psychiatrists can play Australia floods: Fire-hit Australia faces "dangerous" downpours. 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