As we prepare nationally to reduce the spread of the latest coronavirus COVID-19 in Japan, it’s perfectly normal to feel anxiety about this emerging health crisis. COVID-19 is not MERS, and it is not influenza. It is a new virus with its own characteristics. 

Disruptions to work, living situations, schools, and daily routines have added additional strains and stressors to everyone. Our experience and research with PFA (psychological first aid ) have shown that people across the globe struggle to cope with their experiences of disasters and that this is a natural and normal reaction. A pandemic is an invisible disaster, yet its effects are just as real. Understanding how traumatic events affect us can help us to gain control over our lives again. So how should we respond when a pandemic happens? How do we stay centred? What is the best way to help children? How do you support those around you?

TELL has put together some information that can help you and your family manage a pandemic situation. This information will help you understand common reactions and offers suggestions on ways to deal with these concerns, while also maintaining a positive mental health outlook. 

The most common reaction to a pandemic is hyper-vigilance – feeling over-cautious and wary about things, such as the person coughing, or not wearing a mask. These feelings can be exacerbated by the fear of contagion. Some people may experience headaches, muscle aches, and stomach aches, and disruptions to their sleeping and eating patterns. Others may have trouble concentrating, thinking clearly, making decisions, or feel sad, overwhelmed, or angry. others may withdraw, and not want to discuss traumatic events. These are all normal reactions, and over time, as life gets back to normal, these feelings decrease. 

The three primary strategies for coping with the emotional impact of a pandemic are: 

1) Education: Factual information about COVID-19 and current guidelines for prevention.

2) Preparation: Personal and family readiness.

3) Understanding common reactions to pandemics.

Education & Preparation

Having accurate information makes us more confident and increases our coping skills. The World Health Organisation and the US Centres for Disease Control are two of the most accurate and reliable resources. 

In Japan, the Japanese government has issued a series of guidelines to prevent the spread of COVID-19.

1. Correct washing of hands & coughing manners
   • We’re not talking about a quick rinse. It should take 30 seconds, use plenty of soap, focus on washing between the fingers, fingertips, and under the nails, and include your wrists.
   • Wiping down shared surfaces regularly with disinfectant – for example, kitchen benches and work desks.
   • Please cover your mouth and cough or sneeze into your sleeve or use a tissue. Dispose of the tissue immediately into a closed rubbish bin, and then clean your hands.
2. Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. 
3. People with mild cold-like symptoms are asked to stay in their homes and refrain from visiting hospitals, to stamp out a possibility of mass infection and protect those who are most vulnerable, such as the elderly and people with pre-existing conditions.
4. If you have a fever of 37.5 C for four days or more and a cough or breathing difficulties, please contact the consultation numbers below.
5. If you have previous health conditions to wait two days with the above symptoms.
6. The government has asked for schools to consider closing until the end of Spring break.
7. Businesses are being asked to promote teleworking, encourage staggering commuting hours, and ensure that workers with cold-like symptoms can take sick leave.
8. The government has advised all people to stay away from large gatherings and for people in areas where there has been an uptick in cases to remain inside their homes.
9. The government has asked event sponsors to consider whether events are necessary. 

English language support and consultation numbers

1. Tokyo Coronavirus Support Center for Foreign Residents in 14 languages (0120-296-004) –  Available weekdays from 10 am – 5 pm
2. https://www.japan.travel/en/news/coronavirus/
3. https://webchat.bebot.io/JapanNationalTourismOrganization
4. https://www.fukushihoken.metro.tokyo.lg.jp/iryo/kansen/coronasodan.html
5. https://www.mhlw.go.jp/…/covid19-kikokusyasessyokusya.html
6. https://www3.nhk.or.jp/nhkworld/en/news/20200226_37/
7. https://www.metro.tokyo.lg.jp/tosei/tosei/news/2019-ncov.html
8. https://www.amdamedicalcenter.com/news

Preparations & Family Readiness

Preparing reduces our risks and our fears. Through family emergency planning, staying calm, and focusing on the well-being of others in the community, you can be certain normalcy will return to your life. Below are some tips to help you manage in a pandemic.

• Make a list of helpful email addresses and contact numbers: schools, doctors, etc. 
• Make sure you have enough of any prescription and non-prescription medication you need to last a couple of weeks. 
• Talk with friends and relatives who don’t live with you about how you can support each other if one household has to be quarantined due to infection. For example, you could agree to drop groceries or other supplies at the front door.
• Keeping your immune system happy and healthy is essential. A healthy immune system starts with a balanced diet and getting the amount of sleep you need to feel well-rested every night. 
• Avoid excessive amounts of caffeine and alcohol.
• Engaging in regular exercise is also essential.
• Limit your exposure to graphic news stories or images.
• Get accurate, timely information about the disease from credible sources. 
• Seek out and follow the advice of experts. 
• Keep your daily routines as normal as possible, such as meal and bedtimes.
• Stay busy, both mentally and physically. 
• Draw upon your spirituality or personal beliefs for comfort. 
• Express yourself through writing, poetry, drawing, and other arts. 
• Talk and share your thoughts and feelings with others.
• If you are currently seeing a physician, or if you have an existing psychological illness, you may experience an increase in symptoms. Find out how services will be provided during pandemic, flu, and consider or discuss how you might get needed support or assistance from family and friends.

Common Reactions To A Pandemic

Personal and Relationship Changes

• Changes to work, school, or income, may result in confusion and uncertainty about the future.
• Relationships may become stressed when everyone’s emotions are heightened, and conflicts with spouses and other family members may increase.
• Pre-existing problems, and previous losses, may resurface.
• Individuals and families may have had to live in confined spaces for a period of time. 
• Parents may be physically or emotionally unavailable to their children, or overprotective of their safety. Children may display a range of behavioral problems according to their age such as being extra clingy or disruptive and will take their cues from their parents.

Work Disruptions

• Fatigue and increased stressors can lead to poor work performance.
• Conflicts with co-workers may increase, because of added stress.
• Businesses may be forced to lay off employees, or company work hours and wages may be cut.
• Daily travel and commute patterns may be disrupted.
• Those who experience work disruptions may be unable to regain their previous standard of living, leading to financial concerns.

Possible Challenges to Personal and Company Finances

• Individuals & companies may suffer significant financial difficulties during this time and the Japanese government has promised subsidies and assistance to those who are experiencing difficulties.
• https://www.jfc.go.jp/n/branch/index.html
• https://www.metro.tokyo.lg.jp/tosei/tosei/news/2019-ncov.html
• Please reach out to your embassies as they may also be able to offer you assistance.
• The deadline for submitting tax returns has been delayed until April.

At-Risk Populations

The mental health impact of an epidemic is usually more severe in populations who have precarious living conditions, few resources, and limited access to social and health services. 

• The elderly may be more vulnerable as a result of chronic and disabling illnesses, nutritional deficits, and lack of family and social support; usually, they are less physically fit to face an epidemic. 
• Children have a limited understanding of what is happening and a limited ability to communicate how they feel. The setting created by an epidemic affects all aspects of child development (physical, mental, and social).
• Foreigners and students studying abroad may experience additional emotional stressors. Such as, not being able to return home due to travel restrictions, access to information & resources in their own language, disruptions in communications systems that prevent contact with loved ones. They may also have fewer friends or support to help cope with their own illness should they become ill. 
• Some people burn anxious energy by pacing, fidgeting, and other nervous habits. But some behaviors triggered by stressful events need to be stopped as they tend to make the situation worse. These things include increased smoking and drinking, blaming others, yelling, swearing, hitting, and throwing things. Unfortunately, it is often the people that we love the most are the targets of these behaviors. If others are in danger due to your stress reactions, please seek professional help.

How to Build Resilience

• The recent events have reminded all of us that we can’t control everything in our lives. But there are things we can do help us manage the emotional impact. Taking control and managing stress is key. Learning stress reduction techniques such as mediation and deep breathing can be good for everyone. Adults can help their children and others by creating an environment of safety and maintaining structure and routines in your life. Keeping a healthy diet, sleep routines, and exercise are all essential. Friends Make a Difference
• If you know someone who has the virus or is elderly reach out to them. Make some time to talk and check how they coping with the situation and the stressors in their lives. Watching out for others shows you care. It can be comforting and calming to both of you.  If anyone in your family has a pre-existing condition, call them to make sure they are doing okay. Even if you need to stay at home, keep in touch with all the people you know – family, friends, neighbors, from school, from your faith community, co-workers – by phone and email.Reducing Boredom While Staying At Home
  • Ask your child’s school to supply assignments, worksheets, and homework by online means if possible. 
  • Take everyone’s needs into account as much as possible when you plan activities. 
  • Remember, you don’t have to spend every moment together, and it is important to make sure everyone gets the opportunity to spend some time alone.
  • Don’t rely too heavily on television, social media, and technology. Treat this time as an opportunity to do some of those things you never usually have time for, such as board games, crafts, drawing, and reading. 
  • Involve your children in as many of the household chores as possible to help them feel they are contributing. They can help clean, or tidy, set tables or help with the cooking.
  • Accept that conflict and arguments may occur, and try to resolve issues quickly. Distractions may be a good option for young children.
  • It is also essential to pay attention to your own feelings and to take care of your own emotional needs. You are then better able to help friends and family members handle their concerns. 

“Together, we are powerful. Containment starts with you.

Our greatest enemy right now is not the virus itself. It’s fear, rumours, and stigma.

And our greatest assets are facts, reason, and solidarity.” 

WHO Director-General