In Denmark, schoolchildren sit again in classrooms, but at desks almost two metres apart. In Germany, small shops are open again but masks are required when shopping in almost every state. And in the Czech Republic, people are allowed to travel abroad again, but they must quarantine for 14 days after returning.

While the first signs of life after COVID-19 lockdowns are starting to appear in some European countries that seem to have brought new infections under control, it’s a very different kind of life than anyone could have imagined just a few months ago.

Canada’s Chief Public Health Officer Theresa Tam told reporters this week that although we’re not quite there yet, the eventual “new normal” in this country will have to include measures for stopping the spread of the virus until there’s a vaccine, which is 12-to-18 months away under even the most optimistic timelines.

Don’t expect mass gatherings like concerts or sporting events any time soon. And while public health experts can provide guidelines, they can’t make the judgment calls for you.

The onus will rest more on individuals to make the decisions, with all the fears and anxieties that come with that.

Desks are spaced six-feet apart in classrooms at the Korshoejskolen in Randers, Denmark after schools began reopening on April 15 after a month-long closure amidst the coronavirus outbreak. BO AMSTRUP

Laura Hawryluck, an associate professor of critical care medicine at the University of Toronto and ICU physician who has studied the mental health impacts of quarantine during the 2003 SARS crisis, said people might underestimate their feelings once they finally “get out.”

“We’ve never lived through something like this before. I think it will be a bigger impact than what anybody really grasps right now,” she said.

“It’s so not over.”

We’re not going to just snap back to our old lives, at least without a vaccine or treatment. We might be asked to wear masks in public, which will have it’s own “psychological impact” of not being able to see faces, for example. There will still be the fear of infection. And we will need to clamp down if there are surges again.

Hawryluck and U of T colleague Rima Styra, an associate professor of psychiatry, co-authored a 2004 study, which found longer quarantines were associated with more post-traumatic stress (PTSD) symptoms, as was knowing someone with SARS, or severe acute respiratory syndrome.

And several studies have found that after disasters, from 9/11 to the Deepwater Horizon oil spill, there’s a bump in anxiety, depression and PTSD that can persist over time.

A sign marks A beach closed due to the Deepwater Horizon oil spill in Grand Isle, La., Thursday, May 27, 2010. (AP Photo/Jae C. Hong)

“We’ve all had this very sort of traumatic event” of extensive community spread of COVID-19, added Styra. Unlike SARS, which in Canada mainly impacted health-care workers, this time “all of us have been involved in it in some way.”

As we move towards a reopening, there’s going to be a lot of anxiety. An extended “hypervigilance, where people are going to be very much aware of other individuals and their surroundings, because there’s still going to be concern regarding getting infected,” Styra said.

Decisions that during the lockdown were made by officials, will now be up to us. For example, whether or not to visit an older family member.

“I think what’s going to happen is there’s going to be a lot of feelings of guilt, and then probably blame also from other individuals, even within the family,” she said.

“So a lot of stress, and I think it’s important to validate these people.”

But there are ways to cope, Styra added, including seeking out information and guidelines from public health experts, even if there are no clear answers for many questions because the virus is new and the science is still evolving.

People tend to obey advice from authority figures because of “something called diffusion of responsibility,” said Steve Joordens, a professor of psychology at U of T Scarborough. “Where you can basically say, ‘Well, they’re the ones making the decisions and therefore they’re responsible for any consequences.’” It will be more stressful for some to have to make their own day-to-day decisions about whether certain activities are worth the risk.

There will be some people who will run right out into restaurants as soon as they open, said Joordens. But the vast majority of people who took public health guidance to stay at home seriously will be more cautious.

“Once the bear’s kind of wandering in the other direction, it does become less of a threat,” he said.

Anxiety might dissipate a bit “as we come towards something that’s a little more familiar, a little bit more normal.”

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But this follows what for some has been almost a “disgust reaction” around other people, with the inclination to move away from others on the street or in a grocery store, during the height of the pandemic.

“We’re all becoming germaphobes, we’re all worried that other human beings could infect us,” Joordens said, and that fear could linger for some.

They may not be comfortable, in say, a small meeting room with a group of colleagues, for a long time, even if that becomes safe. Employers should respect that and make accommodations, he added.

Galina Hooge opened her stationary and toy shop in Berlin this week for the first time after a month of closure during the coronavirus pandemic. Customers were required to wear masks while shopping in almost every state. Markus Schreiber

Health-care workers, COVID-19 survivors, people with existing mental health issues and older people, will be particularly vulnerable, said U of T’s Styra.

“So we’re going to have to really ramp up our mental health services to make sure that these individuals get a lot of support.”

Another way to do this, she said, is through telemedicine. FaceTime-type therapy sessions have already been used for people struggling with mental health issues in self-isolation, and should continue.

Lu Dong, a psychologist with the U.S. think tank RAND Corporation who has studied mental health and the coronavirus in China, said officials in that country deployed mental health support to Wuhan, the epicentre of the outbreak. They also implemented crisis phone lines, and created a mental health handbook for COVID-19.

“Something similar might be helpful for local departments of health,” said Dong, and could include tips on self-care, coping strategies and warning signs of more serious issues.

The “psychological impact on people’s lives and mental health” of this kind of event is so unprecedented that it hasn’t been studied, she added.

“We’ve never been through anything like this.”

Dong, now in her 30s, lived through the SARS partial lockdown in Beijing as a teenager in 2003. That disease was contained within a few months. But there will be no flick of a light switch this time.

“There was an outbreak, people’s lives were temporarily disrupted, and then we went back to normal,” she said.

“It’s pretty clear that this is going to be a more chronic stress for everyone, for a pretty long period of time.”

Another way to cope with that might be for people to temper expectations, said U of T’s Hawryluck.

“So that they actually celebrate the freedom that you do gain as we start to open up,” she said.

“It’s time to check that hope, or make sure that hope is realistic and appropriate.”