Millions of people in North America watched helplessly as the coronavirus epidemic rolled over first Asia and then Europe. And when that inevitable tide hit North America, fear and anxiety levels across the continent shot through the roof.

And as those anxiety levels rise, so too does the mental health toll on both victims and those untouched by the virus.

“In the entire month of February, we had maybe 25 calls come in that had something to do with COVID-19,” said Stacy Ashton, executive director of the Crisis Centre of B.C., an emotional support and crisis intervention hotline based in Vancouver. “In the last two weeks, we’ve seen that just explode. We’re seeing hundreds of calls come in where COVID or coronavirus is one of the things that people want to talk about, or are worried about.”

Ashton said her volunteers have been getting an extraordinary number of first-time callers, who, frustrated with their isolation and the absence of their usual social support network, are reaching out for help to deal with their fears and anxieties.

“We’re keeping the lines open specifically because we know when there’s more stress in society, more people want to reach out and we want to be there for that,” said Ashton.

According to Steve Joordens, professor of psychology at University of Toronto, Scarborough, a lot of those reactions have to do with the fact our brains feel most comfortable with familiar things.

“We kind of have a script of how things will play out. And for a lot of the things we do on a regular basis in our daily life, that’s how our brain is operating — it’s going into every situation with expectations about how things will unfold and what your role will be in that. So that gives us great comfort,” he said.

“Right now, it’s like that ability has been ripped away from us.”

That uncertainty is viewed as a threat. And when we feel threatened, said Joordens, our bodies kick into a threat response.

Generally, when we’re relaxed, our bodies have engaged what’s called the parasympathetic nervous system — often known as the “rest-and-digest” system, which is more concerned with our long-term survival.

But when the body feels threatened, it kicks in its sympathetic nervous system. This is the “fight-or-flight” response. It makes the heart beat faster, increases respiration and pumps adrenalin into the system. It’s a very primitive system, meant to keep us alive in the short-term by preparing us to fight — or to flee — a perceived threat.

Normally, the threat is perceived, the “fight-or-flight” response is engaged, the threat is dealt with, and the body returns to its “rest-and-digest” mode.

But in the case of the pandemic, said Joordens, the threat is continual, and there’s no obvious thing that can be done about it, and there’s little chance to escape the coming outbreak.

So there’s nothing to fight, and nowhere to flee.

“All of us, I suggest right now, are kind of feeling like our bodies are a little energized all the time and we feel compelled to do something but we don’t really know what that thing is,” said Joordens.

In the presence of a continuous threat, and no obvious timeline as to when that threat might end, our bodies remain in a “fight-or-flight” mode. And that has consequences.

People begin to feel chronic stress and chronic anxiety. And if those last too long, immune systems become compromised. Which in turn makes people more susceptible to things like viruses.

That’s due in part to a hormone released by the adrenal glands called cortisol. In normal “fight-or-flight” responses, cortisol helps get energy to your body, and helps your heart pump harder and faster. It’s also involved in temporarily suppressing the immune system, which the body considers low priority for its short-term survival.

With continued stress however, cortisol levels remain elevated and the immune system remains suppressed. And that has the effect of making the body more vulnerable to, for example, a coronavirus.

When people are under this kind of stress for an extended period, their body is telling them to take action. In lieu of anything effective to do, they seek out anything they can control, whether it’s relevant to their situation or not. Hence, the toilet paper hoarding situation.

Tempering the situation, especially when people are in self-isolation, has a lot to do with perspective, said Joordens.

“One way of thinking about that is that we’re all hiding from this horrible virus and cowering in the corner and waiting for it to pass. That’s a very sort of depression, anxiety, helplessness, kind of way of thinking,”

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The other way of looking at it is that isolation and distancing are positive, self-motivated acts that are performed for the benefit of the community and for those more vulnerable.

“So what we are doing, we are doing out of a sense of community responsibility, and we are doing this as a very active thing to do to help those people who are in danger.”

If there is a silver lining, it is that people tend to rebound relatively quickly after a crisis is over, said Dr. Simon Sherry, a clinical psychologist and professor in psychology and neuroscience at Dalhousie University.

“If we look at SARS and we look at H1N1, we can also have some confidence that for the majority of people, this distress will subside,” said Sherry. “People should rebound within weeks to months following the conclusion of this crisis.”

But there’s a caveat. That applies to the general population. There were two subgroups that were found, following the SARS epidemic, to be especially vulnerable post-epidemic.

“In the wake of SARS, there was a lot of depressive symptoms reported by individuals sufferers (of infection),” said Sherry. “We saw that, even months to years later, people were reporting lower levels of vitality and lower levels of social functioning, lower levels in terms of quality of life, and they were also accessing and using mental health care at a higher frequency.”

Health-care workers are also particularly vulnerable because, in times of epidemic, they are overworked, heavily burdened and chronically exposed to the virus. On top of that, they have the same fears and anxieties as the general population.

Both groups were found, months after the crisis had passed, to be showing symptoms of post-traumatic stress disorder.

“These would be elevations in PTSD-like symptoms, like intrusive thoughts, nightmares, tension, irritability … or being upset by cues related to coronavirus memories, experiences that keep coming back in an unwanted way,” said Sherry.

Mitigating the effects of the fear and anxiety caused by the coronavirus is no mean feat, given our situational uncertainties and biological penchants. But Sherry believes the first steps are to avoid hysteria, look rationally at the situation and spread that rationality to others.

“Right now there’s a sort of digital distortion that’s occurring whereby people are being inundated with negative information,” he said.

“Every headline and every click is feeding a steady diet of panic and anxiety to us. So people need to consider the idea of there being too much information and to limit their exposure to things like social media, because in social media in particular, panic sells.”

“Caution is indicated here, but panic is not.”

“Just like a virus can be spread from one person to another, fear can be spread from one person to another. So there’s such a thing as emotional contagion. If all you’re doing is talking about COVID-19, you become a source of transmission of fear yourself.”

Joordens has some recommendations to help quell those fears, and weather the storm, including limiting news consumption to a couple of hours a day, and never right before sleeping. Instead, he suggests watching a light sitcom, or a mindless reality show, or even karaoke with the family before bed.

In addition, he suggests listening to guided relaxation recordings as you go to sleep. The idea is to teach your body how to relax again, and re-enter that mellower “rest-and-digest” mode.

“I’m recommending to people just before they go to bed, put one of these things on. It’ll help you sleep better, because you’ll be relaxed before bed,” he said. “And if you do this every night, you can start to have this as a skill that you just carry around with you in your back pocket.”