Since 8 December 2019 and the onset of the first cases of coronavirus disease (COVID-19) in China, the disease rapidly spread around the world, with hundred−thousand cases and thousands of deaths (Dutheil, Navel, & Clinchamps, Reference Dutheil, Navel and Clinchamps2020). Post-traumatic stress disorder (PTSD) is a severe mental health condition caused by a terrifying event outside the normal range of usual human experience (Belrose, Duffaud, Dutheil, Trichereau, & Trousselard, Reference Belrose, Duffaud, Dutheil, Trichereau and Trousselard2018). Exceptional epidemic situations also promoted PTSD in the past (Cénat et al., Reference Cénat, Mukunzi, Noorishad, Rousseau, Derivois and Bukaka2020; Xu et al., Reference Xu, Zheng, Wang, Zhao, Zhan, Fu and Cheng2011). Considering that humanity is undergoing the most severe pandemic since Spanish Influenza (Morens, Daszak, & Taubenberger, Reference Morens, Daszak and Taubenberger2020), the actual pandemic of COVID-19 is very likely to also promote PTSD. Moreover, COVID-19 was renamed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) on the basis of a phylogenetic analysis of related coronaviruses (Jiang et al., Reference Jiang, Shi, Shu, Song, Gao, Tan and Guo2020). The SARS in 2003 was very traumatizing for populations, with a poor understanding of viruses and spreading mechanisms (Koralek, Brown, & Runnerstrom, Reference Koralek, Brown and Runnerstrom2015; Wendlandt et al., Reference Wendlandt, Cowling, Chen, Havers, Shifflett, Song and Thompson2018). The evocation of SARS is thus generating a great anxiety and biased responses to threat, which can both promote PTSD (Bo et al., Reference Bo, Li, Yang, Wang, Zhang, Cheung and Xiang2020; Mekawi et al., Reference Mekawi, Murphy, Munoz, Briscione, Tone, Norrholm and Powers2020). Despite a vaccine that was quickly found for SARS 2003, the prevalence of long-term PTSD was high (one-fourth) among hospitalized SARS survivors (Mak, Chu, Pan, Yiu, & Chan, Reference Mak, Chu, Pan, Yiu and Chan2009). The handling of the SARS-Cov-2 crisis evolved through different stages, that can all participate to future PTSD. First, cases were quarantined in hospitals to avoid spreading. Patients were surrounded by healthcare workers in hazmat suits recalling some disaster movies about pandemics. As media lay a great emphasis on the SARS-Cov-2 mortality, the fear of dying adds to the terror initially felt. Then, worldwide authorities started by promulgating quarantine status of ‘infected’ towns or popular districts. Finally, because of the continuous worldwide spreading, authorities promulgated massive quarantine status of entire countries (Parmet & Sinha, Reference Parmet and Sinha2020). In Europe, as in most developed countries, this blackout period has not happened since the dark moments of the World War II. In similar extreme distressing situations, some individuals discontinued social bearings and traditional values, to seek in wrongful acts, asocial behavior or civil disobedience, aggravating the sense of insecurity. Furthermore, in the families of cases, the brutal death of family members involved a spread of fear, panic, anger and a loss of certainty (Wang et al., Reference Wang, Pan, Wan, Tan, Xu, Ho and Ho2020), which can contribute to PTSD. Moreover, healthcare workers could also develop acute stress disorders, potentially degenerating into chronic PTSD. In a context of disaster medicine with a lack of human and technical resources, emergency teams had to separate SARS-Cov-2 cases from others, and contagious from non-contagious (Wong et al., Reference Wong, Goh, Tan, Lie, Tay, Ng and Soh2020). In routine clinical practice, life-and-death emergencies are already a major stressor for medical doctors (Dutheil et al., Reference Dutheil, Boudet, Perrier, Lac, Ouchchane, Chamoux and Schmidt2012, Reference Dutheil, Trousselard, Perrier, Lac, Chamoux, Duclos and Schmidt2013). In the context of the SARS-Cov-2 pandemic, choosing which patients may benefit from assisted ventilation – and thus live or die – is an additional major factor of stress. In countries where the death is a social non-common fact, filtering the patients is a shocking and violent picture for the entire society. Globally, WHO estimates 30–50% of the population affected by a disaster suffered from diverse psychological distress, experiencing injury or death of family members (Brooks, Amlôt, Rubin, & Greenberg, Reference Brooks, Amlôt, Rubin and Greenberg2020). PTSD symptoms involve chronic severe anxiety with re-experiencing the traumatic event, flashbacks, nightmares, increased arousal, and reduced social life. PTSD individuals are more at-risk of suicidal ideation, suicide attempt, and deaths by suicide, in huge proportions (2–5 times) (Thibodeau, Welch, Sareen, & Asmundson, Reference Thibodeau, Welch, Sareen and Asmundson2013) – considering that healthcare workers are already at-risk occupations (Dutheil et al., Reference Dutheil, Aubert, Pereira, Dambrun, Moustafa, Mermillod and Navel2019). This is particularly preoccupying considering that people suffering from PTSD are prone to not seek care, because of barriers such as lack of information and cost of mental health care, being afraid of stigmatization, or beliefs that symptoms may decrease with time (Fuhr et al., Reference Fuhr, Acarturk, McGrath, Ilkkursun, Sondorp, Sijbrandij and Roberts2019). We draw attention toward PTSD as a secondary effect of the SARS-Cov-2 pandemic, both for the general population, patients, and healthcare workers. Healthcare policies need to take into account preventive strategy of PTSD, and the related risk of suicide, in forthcoming months.
Conflict of interest
The authors of this work declare no conflict of interest.
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