MEASUREMENTS AND RESPONSES

Resilience of affected and/or infected individuals
Psychological resilience is generally defined as “the ability to sustain or recuperate, psychological well-being during or after facing the stressful conditions” (S5). In the current scenario of the COVID-19 outbreak in Wuhan, China, resilience can be achieved by ending the vulnerability to psychopathology and mental dysfunction when exposed to the viral infection or at-least living in the regions under threat. People of Wuhan may experience unusual stress, anxiety, and even serious mental health issues in response to minor stressors that people during normal conditions would cope with readily (S5-S8). Resilience is mediated by the presence of distinct molecular adaptations to promote normal behavioral function and the absence of molecular abnormalities that occur in susceptible individuals that impairs the coping ability (S6). Thus, prevention from the stress and mental impairment requires building resilience in people as a whole. Different strategies including biological, social and psychological mechanisms are associated with increasing resilience (S5-S9). While combating the impact of COVID-19 pneumonia (Figure 1), the health care regulatory authorities should communicate the people that the risk of being infected may sustain for a long time, but the government will protect the nation. In addition, it should further be communicated that serious measurements will be implemented at hospitals and communities. Moreover, people should be given a hope that everything will become normal and controlled with the passage of time. The scientists and health care workers should communicate the affected population about their progress regarding developing treatment and prevention strategies and improving facilities.

Regions under secondary threat
The regions and areas other than the originating region of COVID-19 infection will be considered as the regions under secondary threat. In these regions, the stress and fear of infection along with other above-mentioned factors will likely generate moderate to major behavioral and psychological abnormalities (S10-S12). The overall impact of infection on mental health will be associated with the rate of infectiousness and mortality.
The most common impacts of such an outbreak or epidemic could be anxiety, panic behavior, sleep disturbances, disrupted daily biological rhythms, anger, and disappointment (S10,S13-S15). In most cases, infected people make their utmost effort to avoid the spread of the virus in community however, some people don’t cooperate. It has been generally observed in several cities of China that foreigners (mostly students) find ways to flee. It may be due to the higher stress or fear; however, such actions may cause the viral spread in countries with no facilities for combating coronavirus. It will ultimately increase the burden of mental abnormalities in the respective population. To avoid the negative outcomes of such practices, the relevant forces should communicate people who can help them identify such individuals. It may be possible through facilitating the community by electronic and social media. Individuals who have moderate psychological disturbances can be handled by mental health professionals through relaxation and cognitive behavioral techniques, and/or medication if needed (S11,S16). Furthermore, people must be educated or made aware of the development of clinical depression, and suicidality related symptoms followed by the outbreak. Professional clinical psychologists or psychiatrists should come forward and communicate through media to encourage individuals for life and healthy activities. In addition, communities with certain beliefs should be benefited from spiritual education. Nevertheless, media can play a critical role by broadcasting instruction regarding relaxation, meditation, and advice to not focus on rumors and forged news from unauthentic sources.

Regions under primary threat
The area of novel coronavirus origination (Wuhan) will be considered as the region under the primary threat. The outbreak of COVID-19 pneumonia imposed a serious threat to the residents of the city by infecting thousands of people and killing hundreds of them [11] (S2,S4,S7). Similar outbreaks were observed in past caused by the coronaviruses namely, SARS-coronavirus and MERS-CoV, however the transmission rate in those cases was significantly lower as compared to 2019-nCoV of Wuhan [3,10,11] (S17). MERS negatively impacted mental health up to a higher extent and in some cases, the impacts imposed were long term and severe (S18-S22). Comparatively, the COVID-19 may have strong negative effects on health and can cause serious mental problems including acute stress, insomnia, severe anxiety, and chronic depression. MERS and SARS induced serious psychological problems majorly in health care workers (S22), however, the COVID-19 infection may cause such abnormalities in the general public as well, because it is more intense in terms of infecting and killing the individuals [11]. To overcome serious problems in the future, all of the recommendations that we have discussed in the previous section of regions at secondary risks should be implemented here. Furthermore, the people should be provided with counseling and guidance at specified public centers, equipped with psychologists, and psychiatrists.