COVID-19 and the Pandemic of Stress

“There cannot be a stressful crisis next week. My schedule is already full.” Henry Kissinger

If you haven’t reached, or by now breached, your limit of psychic stress, you’ve either lost touch with reality or you’re one of the rare lucky ones. When COVID-19 emerged in early December 2019, most people already had a full plate of things to worry about be they personal, national or global. Then in the space of just four months, COVID-19 rapidly escalated into what U.N. Secretary-General Antonio Guterres declared on April 1, “the world’s most challenging crisis since World War II.”

There’s no need to review the evidence that supports Guterres’ claim. Articles and news releases detailing the impacts of COVID-19 on global health and on the world economy dominate the news media. We are told: “bad news sells.” But, we’re all thirsting for unmistakable signs of recovery. And in the meantime, everyone is searching for ways to deal with the unrelenting stress following in the wake of the COVID-19 pandemic.

I’ve had a career-long interest in host defenses with a focus on how the immune system defends us against pathogens. A good deal of this time I was influenced by research coming from studies in psychoneuroimmunology. Researchers in this multidisciplinary field investigated, among other things, bidirectional interactions between the brain and the immune system. And many investigators focused on the effects of psychological stress on the immune system.

Collaborations between scientists in our University of Minnesota Neuroimmunology Research Laboratory and colleagues in neuroendocrinology and veterinary medicine involved studies of the effects of stress on the pathogenesis of infectious diseases. (Of course, COVID-19 didn’t exist at the time, but I believe many of our findings and those of other teams of investigators are pertinent to the pathogenesis of this new coronavirus infection.)

What is stress? In 1936, McGill University endocrinologist Hans Selye coined the term “stress.” He explained stress as “the non-specific response of the body to any demand for change.” One of the first things I learned about stress, however, was that none of the authorities in the field at the time (the 1980s) dared define the term. It was just too complicated. (A more popular definition referred to stress as a condition arising from an overbearing boss. This usage was consistent with a description I found pinned by the desk of the secretary of the Chief of Psychiatry: “STRESS: The confusion created when the mind must override the body’s basic desire to choke the living shit out of some asshole who desperately deserves it.”)

A second thing I quickly learned when we began our studies of stress was that our colleagues in Veterinary Medicine were way ahead of those of us in Human Medicine. As one example, I learned from the director of the University of Minnesota Raptor Center that aspergillosis, an invasive fungal disease that kills immunocompromised patients, is also deadly to hawks and owls when they’re brought into the Center. Veterinary research had shown the increased risk of this infection is due to “captivity stress,” with an associated impairment of the function of the same kind of immune cells that defend us against this fungus.

Suffice it to say that evidence from the field of psychoneuroimmunology supports the notion that psychological (emotional) stress impairs immunity, which in turn can interfere with the body’s ability to defend itself against pathogens—hypothetically, this includes the coronavirus that causes COVID-19.

Stressors. Things that trigger stress are called “stressors.” Ordinary life is full of stressors and each one of us figures out how best to deal with stressors through coping. But, as all physicians know, each patient is unique. Something that is a stressor to one person may not be a stressor at all to another. And a coping mechanism for one person may not work for another.

Strategies to relieve stress. Dealing with COVID-19-mediated stress, however, is different. We can’t get away from it. As a stressor, it is experienced not only at an individual level but it has become a global Public Health crisis. It’s everywhere—it’s in our communities, it’s palpable. It has the capacity to provoke distress—an emotional state in which the hope of returning to “normal” is shaken or, at worst, lost.

So we all await news that the tide of COVID-19 is ebbing, which based on past experience with pandemics and the rapid advances of science, is definitely going to happen. We just don’t know when. I also believe that invaluable lessons are being learned (sadly, many from our mistakes) that can be applied in confronting future pandemics. Behavioral changes, such as social distancing, wearing masks, etc., are likely to slow the pandemic (the so-called “bending the curve”). This gives time for development of medicines and a vaccine.

So what should we do in the meantime? As a doctor of internal medicine, I recommend that if you feel so overwhelmed by COVID-19-mediated distress that you are having trouble coping, seek professional help. For the rest of us, we must draw on our past experiences in dealing with stress...our coping mechanisms.

My veterinary medicine colleagues convinced me that pets are great stress-relievers. Social contacts are important: stay in touch with family and friends (even if it isn’t in person). Enjoy music and the arts (mostly on-line these days). Seek connections, spiritual and otherwise, that offer hope. Practice kindness and gratitude, especially for the heroes delivering not only healthcare but also those who are providing essential services for us.

As Hippocrates, the founder of Western Medicine, said, “Walking is man’s best medicine.” To lift my spirits, I walk with my wife around the lake near our home almost every day. On sunny days, I enjoy the extra benefit of vitamin D. Moreover, even while I am practicing social distancing, seeing young children playing made-up games and dogs proudly carrying a stick for their owners is unexplainably joyful at these times and uplifting.

Finally, remember that even during these challenging times (and perhaps especially so) humor sometimes is the best medicine. It’s a good antidote to the barrage of bad news that can take a toll on your psyche, and on your immune system. As a Minnesotan and the grandson of Swedish immigrants, I’m partial to “Ole and Lena” jokes; if you’re unfamiliar, Ole and Lena are an old married Scandinavian couple who are sometimes a bit slow on the uptake. Hope the one below provides a smile and a brief respite for your day.

Lena says to Ole "I found dis pen, is it yours?"

Ole replies "Don't know, give it here"

He then tries it and says "Yes it is!"

Lena asks "How do you know?"

Ole replies, "Dat's my handwriting"