Flattening the Curve
Although various antiviral agents such as avipiravir, ritonavir/lopinavir and hydroxychloroquine and other therapeutics, e.g. steroids and vaccines, are currently being considered to reduce the complications associated with COVID-19, including SARI and cytokine storms (12–14), the most cost-effective methods remain the public health approaches of contact tracing, isolation and social distancing. The COVID-19 pandemic is predicted to run a protracted course, and available healthcare resources are likely unsustainable; hence, we need to flatten the curve with lockdown measures (Figure 4) (15). However, the imposition of a lockdown needs to consider the sociocultural and economic factors of each country.
Extreme measures, such as the Wuhan closure, will not work in many countries, including Malaysia. Instead, many countries may look to the South Korean model as a more suitable alternative. In South Korea, rapid testing to rule out COVID-19 has been the key to its success, along with using personal information to track the spread of the virus (16). In Malaysia, where social gathering is a norm, the initial days of the movement restriction order have been extremely difficult but necessary so that containment measures could be put into place quickly. The current mitigation phase is critical in order to create a small window of opportunity to break the transmission of the virus to the larger community. To do this, everyone should be transparent about their history of travels, mass gatherings and any new symptoms. It is also important not to spread fake news to prevent panic and anxiety among the public.
The most common psychological reactions to a pandemic are fear and anxiety-related symptoms, such as panic, worry and emotionally distress (17, 18). While these reactions are expected, they can be overwhelming to those with pre-existing mental health issues (19) and can lead the public to panic buy excessive amounts of food or health-related items, such as masks and hand sanitizer (18). According the most recent data on COVID-19 study among 1,210 respondents from 194 cities in China (20), more than half of the respondents suffered moderate to severe psychological impacts; of those, 28.8% had moderate to severe anxiety, 16.5% had moderate to severe depressive symptoms and 8.1% had moderate to severe stress levels. The majority were worried about their family members and they spent at least 20 h per day at home (20).
The psychological sequelae of the pandemic is the emergence of fear and anxiety not only due to the disease itself but also due to the disruption of daily activities, social isolation caused by the restricted movement order and financial burdens, especially among those with low-income levels (21). For healthcare workers, the pandemic is exposing them to long-term stressors, which could impact their wellbeing (22) and lead to burnout due to increased job demands (such as increased workload and role conflicts) and reduced job resources which lead to loss of workplace control and autonomy (23). Early mitigation and psychological crisis interventions are already in place in Malaysia. Several government and non-governmental agencies are offering psychological first aid to the public through tele-counselling and hotline services. These interventions should be continued even after the pandemic is over, as data has shown that those who are affected by a pandemic still have varying degrees of stress disorders even after the event ends or they recover from the disease (24). In addition, clear information about the disease and progress updates on the situation could reduce the psychological impacts of COVID-19 among the public (20).