coping with the emotional challenges of pandemic influenza an online guide for individuals and...

Coping with the Emotional Challenges

of Pandemic Influenza

An Online Guide for

Individuals and Families

Welcome

This Online program was developed to help individuals and families predict and prepare for the many emotional challenges associated with an influenza pandemic.

Emotional and physical preparedness are some of the most effective ways of addressing the anxiety and stress that may accompany a worldwide disease outbreak.

2New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

Strategies for Coping

The two primary strategies for coping with the emotional impact of a pandemic influenza are:

• Education: Factual information about pandemic influenza and its impact;

• Preparation: Personal and family readiness for health emergencies.


Program Overview

This program will provide individuals and families with:

1. Factual information about influenza and pandemics;

2. The emotional challenges that may accompany a pandemic;

3. Strategies and resources for managing the emotional consequences of an influenza pandemic.


Understanding Influenza and Pandemics


Working Definitions

• Epidemic:• From Greek “epi” (upon) and “demos”

(people)

• Pandemic: • From Greek “pan” (all) and “demos”

(people)• A worldwide crisis with

universal vulnerability across all boundaries

• Note: The term “pandemic” refers to the geographic distribution of the disease, not the severity of the illness or virulence of the strain New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

Pandemic Facts

Definition: According to the World Health Organization (WHO), viruses must meet three prerequisites to be called pandemics:

1. A novel virus subtype must emerge to which the general population has little or no immunity.

2. The new virus must be able to replicate in humans effectively.

3. The new virus must be efficiently transmitted from one human to another; efficient human-to-human transmission is expressed as sustained chains of transmission causing community-wide outbreaks.


How Real is the Risk?

On June 11, 2009, the World Health Organization (WHO) declared that a H1N1 (a.k.a. “swine flu”) pandemic had begun.


New Strains Develop by Reassortment• Like all influenza viruses,

avian and swine flu viruses change constantly

• Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses

• When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge

New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

The Historical Perspective

• Influenza pandemics are rare but recurrent events.

• There have been at least 10 pandemics recorded over the past 300 years (i.e., approximately 1 every 30 years).

• The last pandemic occurred in 1968 resulting in 1 to 4 million deaths worldwide.

• Each pandemic is unique, so predictive models can have great variation in estimates of fatalities.


The Historic Perspective: The Great Influenza (Continued)

• The “Spanish Flu” of 1918 is often called the “Great Flu”- The flu strain infected between 200 million and 1 billion people around the world.

• The Bulletin of Medical History estimates that between 50 and 100 million people died.

• From 1918 to 1920, nearly half of the world’s population was infected during three separate waves of disease.

11


Pandemic Timeline

• Based on patterns of past pandemics, it is expected that a new strain would circle the globe in three waves.

• Each wave could last several months, separated by as long as a season.

• It is important to note that different countries and continents may be in different phases at any one time.


A Global Health Crisis

• Once a pandemic emerges, its global spread is inevitable.

• Due to air travel, the pandemic can potentially reach all continents within three months.

• Some countries may attempt to prevent its spread by closing borders and restricting travel.


Pharmaceutical Options in Public Health Response

• Vaccination would be possible only after the onset of the pandemic.

• It is unclear if currently used antiviral medication, such as Tamiflu® (oseltamir) and Relenza ® (zanamivir), would be effective.

• There would not be enough vaccine or antiviral medication to treat the much of the world’s population.


Non-Pharmaceutical Options in Public Health Response

• For many countries, pharmaceutical interventions will not be an option.

• Non-pharmaceutical interventions can include:– Social distancing– Closing schools– Bans on mass gatherings: business,

cultural and religious – Bans on travel– Isolation– Quarantine


The Emotional Challenges of Pandemic

Influenza


Potential Emotional Responses

Foreseeable emotional responses to a devastating pandemic would likely involve serious mental health problems such as:

• Fear and anxiety• Sadness and depression• Increased rates of suicide• Traumatic stress reactions• Complicated grief and bereavement

Any and all of these mental health

problems may occur in both the diagnostic and sub-diagnostic range.


Emotional Challenges

There are many emotional challenges that may face individuals and families during a pandemic. These challenges are not limited to the medical impact of a disease outbreak, but include reactions to:

– Organizational and governmental response.– The impact on society.– Personal and social economic disruption.– Pre-existing medical or mental health issues.– Separation from natural sources of support.– Grief and loss of friends or family members.


Impact on Society

There are a multitude of ways in which a pandemic could affect society. These include the:

• Loss of workforce.

• Loss of social capital.

• Some people stranded when borders close and travel is restricted.

• Loss of personal connections during a heightened need for attachment.

Like other disasters and acts of terrorism, the pandemic will magnify preexisting social fractures related to cultural, religious, and economic differences. 19New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

Impact on Individuals and Communities

Many social responses revolve around loss. These losses may include the loss of:

• Control.• Income.• Privacy.• Autonomy.• Valued civil liberties.• Trust (i.e., in government, in humankind, etc.)• Beliefs or faith (i.e., patriotism, religious beliefs,

etc.)


Possible Economic Disruption

• High rates of illness and prolonged absenteeism in workplaces.

• Significant reduction in work productivity.• Drastic decline in retail, tourism,

entertainment, travel and many economic sectors.

• Escalating unemployment.• Impairment of essential services such as

utilities, transportation and communications.

• Disruption or closure of financial markets and banking.


Economics and Potential Panic

Economics is not just about the financial markets, it is by definition about how scarce assets are allocated.

• Vaccines, antiviral medications, hospital beds, and later perhaps basic necessities will be in tremendous demand.

• If supply chains are disrupted, other important goods, such as food, water, and power may be in short supply, as will critical medicines like insulin, heart drugs, and other prescription medications.

• Masks, gloves, antibacterial soaps, and other protective equipment will also be in high demand and low supply.

• There is a likelihood of price gouging and the development of a “black market” for essential goods.


Panic is related to the perception that there is a limited opportunity for escape, a high-risk of being injured or killed, or that help will only be available to the very first people who seek it.

Panic in Emergencies

Panic is unlikely in most emergencies


Denial

• Denial is more likely than panic in most emergencies

• “It appears that the major problem in an emergency is getting people to move, rather than preventing wild panic or disorderly flight “ (Quarantelli, 1972)


Personal Finances

Due to the possible closures of businesses, lost work time related to illness or caring for others, and many other factors, individuals and households may suffer increased financial difficulties, such as:

• Little or no personal or household income.

• Depletion of any available savings.

• Increased dependence on credit to replace income or cover large medical costs.

• Price gouging and elevated costs for many basic consumer goods.

• Risk of default on loans or mortgages.

• Potential for crisis-related financial exploitation.


Impact on Individuals with Pre-existing Conditions

Individuals with pre-existing medical or mental health issues may encounter increased levels of stress and anxiety related to disruptions of the health care delivery system. The pandemic may impact:

• The ability of consumers to travel to receive medications or treatment.

• The ability of community-based workers to travel to deliver medications or treatment services.

• Expedited triage and discharge from hospitals to make way for acute medical patients.

• Separation from natural care givers and community support systems.


Grief and Loss Several aspects of the pandemic and public

health response may complicate grief and loss reactions. These include the:

• Inability to see loved ones or say “good-bye” to those who may die in the hospital or while separated from family.

• Inability to retrieve the body for timely burial or funeral rituals.

• Shortage of caskets, burial sites or crematoriums.

• Mass stockpiling of corpses until burial or cremation can be facilitated.


Unique Challenges for Expatriate Employees and Students Abroad

For those individuals working or studying away from their home nations, there may be additional emotional stress associated with:

• Not being able to return home due to travel restrictions, even if loved ones are sick or have died.

• Disruptions in communications systems that prevent contact with loved ones.

• Coping with one’s own illness without the care and comfort of loved ones.


Ethical Issues

Political leaders must consider the emotional consequences of such unavoidable ethical issues as:

• Which groups to prioritize for vaccine or antiviral medications?

• How to ration medicines, healthcare services, equipment and basic supplies

• Whether to distribute the limited supply of antiviral medications to healthy people to reduce the risk of becoming ill, or to ill people to reduce their risk of dying?


Coping with the Emotional Challenges of Pandemic

Influenza


Normal Emotional Reactions

• It is normal and understandable to feel anxious and worried about a spreading disease, especially if there is not a readily available cure or enough medicine.

• Anxiety is related to the fear of the unknown, and all of us are vulnerable to this type of reaction at different times and in the face of different threats.


Everyone has different ways of reacting to emergencies or threatening events. It is quite normal and natural for people to experience stress reactions in many different ways, including being:

• Preoccupied with thoughts or interest in health-related news stories

• Unable to concentrate at work or school• Becoming irritable or tense with people• Having difficulty sleeping• Feeling hopeless or depressed• Feeling more distrustful• Worrying about personal and family safety

Emotional Reactions Are Phase-specific:Pre-pandemic Alert Phase


As the disease changes, news coverage and the word on the street may increase fears and people’s anxieties. It is understandable that emotional reactions may become more intense as well. In addition to the reactions discussed earlier, people may experience more:

• Difficulty sleeping• Difficulty communicating thoughts• Headaches/stomach problems• Feeling hopeless, depression or sadness• Easily frustrated• Poor work performance• Increased use of alcohol/drugs

Emotional Reactions Are Phase-specific:Prepandemic Phase


Emotional Reactions Are Phase-specific:Pandemic Phase

Once a pandemic begins, the virus can spread around

the world quickly. People in all nations are affected during the pandemic period. This phase of the disease can last for several months. Many individuals will also experience acute emotional reactions, as well as health risks during this time. These emotional reactions include:

• Physical aches and pain unrelated to the illness• Extreme fear, panic and dread• Inability to focus on work or school• Helplessness and/or hopelessness• Depression• Acute grief and sadness• Disorientation and confusion• Overwhelmed with self-doubt and uncertainty


With each passing wave of illness, fewer and fewer people get sick or die, but the emotional impact of the earlier waves remains. During the months and years that follow in peak of the pandemic, there are also many emotional challenges. These include:

• Ongoing grief and bereavement for those who have died• Financial and other daily life stressors created by the

disruption of the pandemic• Regaining a sense of trust and belief in the future• Fear that another wave of illness may begin• Restoring a sense of safety and security at home and work• Adjusting to changing roles and responsibilities at home and

work• Managing residual traumatic stress and other lingering mental

health issues

Emotional Reactions Are Phase-specific:Recovery Phase


Using Natural Supports

• Natural supports, as available, are essential in dealing with threats that do not pass quickly.

• Support from family, friends, clergy and others to whom people naturally turn should be encouraged.

• Schools, faith-based and civic/volunteer organizations also are part of this primary support system.

• It would be helpful to find support systems—people who are thinking about the same issues you are thinking about and to share ideas.


Tips for Coping

The following are some useful suggestions for coping with the emotional challenges stemming from pandemic influenza and other health emergencies:

• Limit your exposure to graphic news stories or images.

• Get accurate, timely information about the disease from credible sources.

• Seek out and follow the advice of experts.

• Maintain as much of a normal daily routine as possible.


Tips for Coping (Continued)

• Stay busy, both mentally and physically.• Communicate when possible with friends, family

and supporters.• Draw upon your spirituality or personal beliefs for

comfort.• Express yourself through writing, poetry, drawing

and other arts. • Talk and share your thoughts and feelings with

others.


Helping Children Cope

• Provide only age-appropriate information to children

• Be honest, but don’t vent your frustrations or overwhelm the child

• Provide children with opportunities to talk about what they are seeing or hearing in the news and the community

• Don’t be afraid to admit that you can’t answer all of their questions

• Allow children to discuss other fears and concerns about unrelated issues

• Monitor children’s television viewing. Limit your child’s exposure to graphic or troubling scenes. Watch news reports with your child so that you are available to answer their questions and to monitor their reactions


• Help children understand that there are no bad emotions and that a wide range of reactions is normal

• Encourage children to express their feelings to adults (including teachers and parents) who can help them understand their sometimes strong and troubling emotions

• In addition to the tragic things they are seeing or hearing, help children identify good things, such as heroic actions and the assistance offered by people throughout the country and the world

• Provide children with an opportunity to play and have fun. This is a healthy outlet for children coping with stress.

• To the degree possible while maintaining honesty, reassure children that you will be with them and it will be alright

Helping Children Cope (Cont.)


Staying Healthy

Practicing good health habits is another way of reducing the risk of all types of influenza in your home or family. To stay as healthy as possible:

• Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat dairy products, lean meats, poultry, fish, and beans.

• Drink lots of water and go easy on salt, sugar, alcohol, and saturated fat.

• Exercise on a regular basis and get plenty of rest.


Staying Healthy (Continued)

Take common-sense steps to limit the spread of germs. Make good hygiene a habit:

• Wash hands frequently with soap and water.

• Cover your mouth and nose with a tissue when you cough or sneeze.

• Properly dispose of used tissues.

• Cough or sneeze into your upper sleeve if you don’t have a tissue.

• Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.

• Stay at home if you are sick. 42New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

Limit the Spread of Infection

To limit the spread of germs and prevent infection:

• Teach children to wash hands frequently with soap and water, and model the correct behavior.

• Teach children to cover coughs and sneezes with tissues, and be sure to model that behavior.

• Teach children to stay away from others as much as possible if they are sick. Keep children home from school if sick.

43


Preparedness Facilitates Resilience

• Some of the emotional and behavioral consequences of a pandemic may be mitigated by preparedness efforts.

• Sources of useful preparedness for individuals, families and communities can be found at:


http://www.pandemicflu.gov

http://www.who.int/csr/disease/influenza/en/

Family Preparedness

To plan for a pandemic:

• Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them.

• Store a supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.


Family Preparedness (Continued)

• Have nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.

• Encourage family members to volunteer with local groups to prepare and assist with emergency response.

• Encourage family members to get involved in your community as it works to prepare for an influenza pandemic.


Changes in the Workplace

• Think about what information the people in your workplace will need if you are a manager. This may include information about insurance, leave policies, working from home, possible loss of income, and when not to come to work if sick.

• Meet with your colleagues and make lists of things that you will need to know and what actions can be taken.

• Find volunteers who want to help people in need, such as elderly neighbors, single parents of small children, or people without the resources to get the medical help they will need.

• Identify other information resources in your community, such as mental health hotlines, public health hotlines, or electronic bulletin boards. 47New Jersey Division of Mental Health Services – Disaster & Terrorism Branch

Anticipate Transportation Problems

Think about how you can rely less on public transportation during a pandemic. For example, store food and other essential supplies so you can make fewer trips to the store.

• Prepare backup plans for taking care of loved ones who are far away.

• Consider other ways to get to work, or, if you can, work at home.


Childcare Needs

Schools and childcare centers may be closed to slow the spread of disease or because a significant number of staff members are unable to come to work. It is advisable to consider alternative means of childcare and schooling during the pandemic period. You may wish to:

• Help schools plan for pandemic influenza. Talk to the school nurse or the health center. Talk to your teachers, administrators, and parent-teacher organizations.

• Plan home learning activities and exercises. Have materials,

such as books, on hand. Also, plan recreational activities that your children can do at home.

• Identify alternative care providers and make arrangements

prior to the onset of the pandemic.


Be Prepared

Build up a supply of water and food. During a pandemic you may not be able to get to a store. Even if you can get to a store, it may be out of supplies. Public waterworks services may also be interrupted. Stocking supplies can be useful in other types of emergencies, such as power outages and disasters. Store foods that:

• Are non-perishable (will keep for a long time) and don’t require refrigeration.

• Are easy to prepare in case you are unable to cook.

• Require little or no water, so you can conserve water for drinking.


Food Items to Have on Hand

During a possible prolonged health emergency, it is recommended that you have the following items on hand:

• Ready-to-eat canned meats, fruits, vegetables, and soups.

• Protein or fruit bars; dried fruits and nuts.• Canned juices, bottled water.• Canned or jarred baby food and

formula.• Pet foods, if necessary.


Medical, Health & Emergency Supplies

If possible, it is also recommended to have:

• Prescribed medical supplies or equipment, such as glucose or blood pressure monitoring equipment

• Soap and water; alcohol-based hand wash• Medicines for fever, such as acetaminophen or

ibuprofen.• Thermometer• Anti-diarrheal medication


Medical, Health & Emergency Supplies (Continued)

• Vitamins• Fluids with electrolytes• Cleansing agents/soaps• Flashlight and batteries• Portable radio• Manual can opener• Garbage bags• Tissues, toilet paper, disposal diapers if necessary


In Conclusion

• At present the risk of severe pandemic influenza cannot be eliminated, only managed or reduced by the behavior of governments, communities and individuals.

• The risks to our physical and emotional health may be serious, but they too can be managed.

• Management of these risks and the impact of a pandemic is a shared responsibility between governments and individuals, families and communities…

and attempts to manage the physical and emotional consequences must begin today.


For More Information

Please contact the

New Jersey Department of Human Services

Division of Mental Health ServicesDisaster & Terrorism Branch

Tel 609-777-0728E-mail [email protected]

Website www.disastermentalhealthnj.com


Online Resources• New Jersey Department of Health & Senior Services:

http://www.state.nj.us/health

• New Jersey Department of Health & Senior Services’ Pandemic Influenza Awareness Program:

http://www.state.nj.us/health/training/panflu/index.shtml

• Centers for Disease Control and Prevention, Pandemic Influenza Worldwide Preparedness: www.cdc.gov/flu/pandemic

• World Health Organization Epidemic and Pandemic Alert and Response: http://www.who.int/csr/en/

• The U.S. government Web site for information on pandemic influenza: www.pandemicflu.gov

• Center for Infectious Disease Research & Policy (CIDRAP) Academic Health Center -- University of Minnesota: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/


References

The information presented in this program has been adapted from three primary sources:

http://www.cdc.govhttp://www.pandemicflu.govhttp://www.who.int/csr/en/

Please visit these sites for more information and updates about pandemic influenza.


coping with the emotional challenges of pandemic influenza an online guide for individuals and...

Documents

new viruses

human influenza viruses

health emergencies

new strains

swine influenza viruses

great influenza

pandemic timeline

term pandemic