How COVID could reshape mental health policy

The number of cases of COVID in the United States has reached over 29 million and the death toll has exceeded 534,000. This is almost certainly an undercount. The broader impact on the general health and quality of life of the survivors of the illness is unclear. Concern is rising over the emergence of a post-covid syndrome that insidiously affects the victims and leads to debilitating symptoms. Similar syndromes were encountered after SARS-CoV-1.

By far, most patients that get COVID only suffer mild illness, and many do not even know that they are infected. Nonetheless, even those who don’t know that they’ve had the virus can develop a long-haul syndrome with symptoms that can persist for weeks to months. The symptoms are vague and generalized, resembling chronic fatigue syndrome and similar conditions that present with depression, anxiety, fatigue, muscle aches and pains, and sleep problems. Similar effects have emerged following other viral infections.

Despite preliminary investigations and surveys of COVID patients by the CDC and other institutions, there is no clear picture about the post-covid syndrome. Moreover, medical professionals know very little and have no good treatments for the impact of inflammation and immunological responses on emotions and mental health that infections like COVID produce.

Our experience with similar problems over the past years, particularly Gulf War Syndrome following combat operations in 1990, causes us to worry that a large cohort of COVID patients will fall by the wayside again and be marginalized in the healthcare system.

We have observed that no reliable treatments have emerged for the multiple symptoms exhibited by the patients with chronic fatigue or Gulf War syndromes. The symptoms and complaints of COVID, like chronic fatigue and Gulf War illness, are the kinds of problems that typically defy conventional treatments and eventually get shunted to mental health practitioners for supportive therapy and counseling. The best accepted research recommends cognitive behavior therapy for the various complaints, and not much else.     

We take it for granted that mental health services get shortchanged. Despite our sense of 21^st Century sophistication, public attitudes toward some mental disorders are still locked in an historic tendency to stigmatize, or even moralize, about these medical problems. Thus while serious and disturbing disorders like schizophrenia are now the objects of basic brain science, the more insidious and less visible problems like depression and chronic fatigue are runners-up.

The evaluation and treatment of vague symptoms like fatigue, brain fog, muscle aches, etc. are not compensated nor promoted energetically across payers and healthcare systems. Once a problem has been labelled as “something in the patient’s head,” it is essentially downgraded in severity and attention.

No doubt these are frustrating disorders to treat — and are often written off as “problems in living” — but this inattention points to the larger failure to invest in a civilized and compassionate public mental health system that will in the end cost far less than the inestimable losses to the economy and to the life of a society.

President Biden’s focus on reviving confidence in our institutions is a first step. He has campaigned on “building back better.” That is a start to resetting and reinvigorating the confidence and commitment across to the country to regaining a normal life. Doing that requires an imaginative and energized campaign.

The standard disability programs are adversarial, and they generally disadvantage the working class — especially when the symptoms and impairments are vague and generalized, as they appear to be with the post-covid syndrome. The victims of COVID and suffering with long-haul symptoms should not be further victimized by deficiencies in the mental health services.

A different approach is to look at what has happened to our communities as if we all belong to professional sports teams that have been through a really hard season. Many players have been injured and still hurting, but the team is still committed to playing out the season and getting to the championship. Any good coach would acknowledge that the players are hurt and may not be playing at their best, but that they need dedicated rehabilitation and support to stay on the playing field. So, the challenge is keeping all Americans — the players on the field — healthy and working even though injured, having suffered COVID and living with lingering long-haul symptoms. Such approaches contrast sharply with the typical programs for assessing disability and compensating for healthcare.

The new stimulus package only has $4.5 billion allocated for mental health. That’s looks like quite a lot, but it’s only .05 percent of the total funding and falls far short of what is needed as the pandemic lingers on. So, let’s call it what it is — a down payment.

We need more, and it is going to be up to the president and Congress finally to make mental health and rehabilitation the priority they need to be. It will take a dedicated program for managing the after-effects and stress of the infection and getting everyone back to work and living healthy lives. Building resilience, learning to cope with stress, and getting treatment and support to the long-haul sufferers are as important to surviving the harm of the coronavirus as vaccines and antibiotics.

Jonathan D. Moreno teaches medical ethics and health policy at the University of Pennsylvania. His most recent book is “Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America.” Follow him on Twitter: @pennprof

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General, serves on the executive board of The Center for Ethics & the Rule of Law at the University of Pennsylvania. He directs the COVID Resilience Campaign at Silver Hill Hospital. Follow him on Twitter: @SteveXen