key: cord-0926683-s8xkh671 authors: Werneke, Ursula; van Der Feltz-Cornelis, Christina; Löwe, Bernd; Ventriglio, Antonio; Bhugra, Dinesh title: Editorial: Outbreak Investigation: Mental Health in the Times of Coronavirus (COVID-19) date: 2022-02-18 journal: Front Psychiatry DOI: 10.3389/fpsyt.2022.854388 sha: dfd0e11587344f4b1202979b8fc1731386dc9c64 doc_id: 926683 cord_uid: s8xkh671 nan The most predictable thing about the pandemic in the new year is its utter unpredictability. Three factors may become game changers in 2022: vaccines, anti-COVID medicines and economic performance. Globally, more than 9 billion vaccine doses have been set (7) , however, COVID-19 vaccine coverage remains patchy. In richer countries, anti-vax influencers, including conspiracy theorists, populists, and some vocal celebrities, continue to undermine the confidence in the vaccines, driving down vaccination rates. In poorer countries, vaccine supplies continue to be limited. Incomplete vaccination coverage, though, increases the likelihood of further mutations. Vaccine developers may not be able to keep up with the speed of mutations, unless they manage to predict mutations before they occur and decide to mass-produce vaccines based on their predictions. As with Omicron, future COVID-19 strains may turn out more transmissible but less virulent than previous ones. But this may not invariably be the case. For instance, a future mutation could cause the virus to replicate in people's airways at higher levels than the immune system could clear. This would also lengthen the time an infection persists (8) . Antiviral medicines such as Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) and Lagevrio (molnupiravir) may become the next movers in the equation. Approved for emergency use by the US Federal Drug Administration (FDA) on 22 and 23 December 2021 (9, 10), both medicines can be taken in the convenience of one's home. However, the tablets are not a substitute for vaccination (9) . These anti-COVID medicines are expensive and most likely out of reach for many countries. Poorer countries may acquire supplies through donations and subsidies, often ad hoc and one-off. Under such circumstances, securing steady supplies may be economically unviable. Finally, how well the world fares in terms of mental health will depend on economic performance as well. Fiscal stimulus packages have been one way of taking people through the economic fallout of the pandemic. But fiscal stimuli together with labor and supply shortages have driven up inflation (11) . Soaring energy prices add further inflationary pressure. Compensatory rises of interest rates may put pressure on indebted countries and households alike. The longer the pandemics persists, the more economies will become vulnerable. It is indeed difficult to predict where the world is heading in 2022. Much of the uncertainty we have experienced since the beginning of the pandemic will prevail. Other uncertainties will emerge. Uncertainty makes people anxious. Uncertainty that does not go away makes people depressed. Mental health impact of pandemic can be seen as occurring due to anxiety, loneliness, and isolation but also grief due to loss of friends and family without likelihood of being able to attend funerals in early days and survivor guilt. Furthermore, long COVID brings with it certain mental health factors into play. Understanding and documenting the early impact of the COVID-19 pandemic on mental health can help us to manage the challenges lying ahead. Early experiences, frozen in time, provide a unique historical account of the unfolding pandemic. This Research Topic is an investigation into the early impact of the COVID-19 pandemic on mental health. It has covered nearly all aspects of mental health during the pandemic. Most of the studies came from China and Italy, two countries particularly hard-hit in the early days of the pandemic. Many of the studies published here were based on online surveys. The discussions of their strengths and limitations leave a vivid testimony of epidemiological research during the lockdown, replacing fieldwork on the ground with fieldwork in cyberspace. Some findings were expected. Undoubtedly, the pandemic has precipitated psychological distress, trauma, anxiety and affected quality of life as depicted in several contributions in this collection ( . Admittedly, women are more likely to participate in surveys. Thus, some selection bias may have been at play. Yet, this gender difference is not entirely unexpected. In many parts of the world, women carry a higher burden of caring for families. They tend to be more isolated and run a higher risk of economic hardship and insecure employment. Individuals with pre-existing mental health problems may also have run into more physical problems during the pandemic. A Swedish register study showed that the odds of COVID-19 associated death was double in people with psychotic or bipolar disorder (Maripuu et al.) . Further work has shown that this increased mortality may not be specific to COVID-19; similarly increased odds arise with other lung infections (14) . As judged by increased hospitalization rates (15) , the higher mortality risk may be more likely linked to an increased risk of an adverse clinical course of a COVID-19 infection than to an increased risk of infection per se. Efforts to prioritize people with serious mental disorder for vaccination must continue. Several (16, 17) . Intriguingly, face masks may also have an impact on mental health. One study comparing the impact of face mask use in two countries showed that use of face mask was associated with less anxiety, depression, and stress (Wang et al.). Possibly, taking control by using a mask reduces feelings of stress, anxiety, and depression. Although this finding can at best be considered preliminary, it is still noteworthy. Finally, right from the beginning of the pandemic, there was a proliferation of COVID-19 related health apps, providing news and information, contact tracing, and self-assessment, or diagnosis (Zhang, Chow, et al.). Such apps may facilitate infection control and help to stay connected in periods of quarantine. However, there are caveats to the current "infodemic" (18) . Civil liberties may become infringed when there is comprehensive control of movements. At the same time, a constant flow of information may increase stress, particularly in people who are intolerant to uncertainty. Besides, not all apps are equally reliable. They may be used to spread misinformation and conspiracy theories. The verdict is still out whether such apps do more harm than good. Virtual reality applications generating positive emotions to may take self-help to the next frontier. A randomized trial is planned to test whether such a virtual reality protocol can be used to improve wellbeing and preserve social connectedness through the beneficial social effects (Riva et al.) . The economic impact of the COVID-19 pandemic may play as much of an essential role as the infection itself in short, medium, and long-term. Strict lockdowns, implemented almost globally, have brought economic insecurity and poverty for many. Job and income loss, as well as the fear of it, add to anxiety and depression. A statistical modeling exercise based on longitudinal data from 38 countries showed that unemployment might increase suicide rates, particularly in middle-age. Loss of national income might even have a higher impact on suicide rates, particularly in the older age groups (Brenner and Bhugra). Currently, in many high-income countries, vaccination programmes are being implemented at an exponential rate. At the same time, our ability to effectively treat severe courses of COVID-19 infection has substantially improved. The subsequent reduction of mortality will invariably shift the focus to economic and social recovery, even if new outbreak waves and mutations lie ahead. Such may then precipitate further mental health problems in an already primed population. At present, it remains unclear whether the detrimental effect of COVID-19 on mental health is transitory or lasting. A global study estimated an additional 53.2 million cases of depression and an additional 76.2 million cases of anxiety due to COVID-19 for 2020 (19) . But depending on data sources and circumstances, there is scope for over-reporting and observation bias. For instance, according to that study, Sweden should have experienced a 22-25% change in the prevalence of major depression after adjustment for COVID-19 (19) . Data extrapolated from the Swedish Board for Health and Welfare suggest otherwise. Depression requiring specialist services and suicide rates have not gone up in 2020 (20) . Prescribing for antidepressants has increased by little more than one percent (21) . This is consistent with suicide trends observed in 21 countries or areas within a country during the beginning of the pandemic. Suicide numbers remained largely unchanged or even decreased in same countries or areas (22) . However, it remains unclear whether these findings from high-and uppermiddle-income countries can be generalized to lower-middleand low-income countries. The pandemic is not over yet. COVID-19 related mental health problems and their consequences are likely to be with us for a long time. Neither is the direct impact of long-term COVID-19 on mental health fully understood. Some survivors of COVID-19 are even at risk of psychiatric sequelae, which may either be caused by the virus itself or the immune response to it (23) . Ultimately, it is early days. And it may not take another 100 years until the next pandemic. We hope that the lessons learnt in these early days of the COVID-19 pandemic and documented in this Research Topic can be used in preparation for the next one. UW initially proposed and set up this Research Topic and led the editorial introduction. All authors acted as guest editors, managed the submissions, and worked collaboratively to decide which manuscripts were accepted or rejected. All authors contributed to the article and approved the submitted version. Worldometer: Coronavirus. Available online at Early assessment of the clinical severity of the SARS-CoV-2 Omicron variant in South Africa Investigation of a SARS-CoV-2 B.1.1.529 (Omicron) Variant Cluster-Nebraska CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population South Africa recalls new isolation and quarantine rules Führt die Omikron-Variante zu Schulschließungen? Available online at WHO coronavirus (COVID-19) dashboard Beyond Omicron: what's next for COVID's viral evolution Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19 Coronavirus (COVID-19) update: FDA authorizes additional oral antiviral for treatment of COVID-19 in certain adults The way things were. The new normal is already here. 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Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and metaanalysis World Health Organization (WHO) Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic Swedish Board of Health and Welfare (Socialstyrelsen) Swedish Board of Health and Welfare (Socialstyrelsen) Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.