Keywords

As we close this volume, we must ask ourselves: perhaps there is no reason to raise the alarm? COVID-19 used to dominate the headlines, but now it’s virtually absent. Maybe there is nothing to be afraid of? “Those who are supposed to die will die, but the rest of the sick will get sick and then be fine,” some of us seem to be saying. Should we relax and accept that this book is historical, rather than one constructing scenarios for the future? In our opinion, it is very much a book about the future. In this chapter, we briefly review the effects of COVID-19, not in terms of mortality but rather of the impact the coronavirus has had and will continue to have on us. Why are we doing this? To illustrate the long-term effects and encourage better prevention in advance of future pandemics. There really is “something worth fighting for.”

The ongoing COVID-19 pandemic has reminded us of a truth that we have either actively repressed or simply forgotten: pandemics entail a massive serving of – often existential – anxiety for us and our loved ones, anxiety for our health and our future, in economic terms as well as psychological: well-being, stress, burnout, and depression. Thus, it is clear that the global threat to life and health resulting from the emergence of pandemics engenders a difficult-to-overestimate and analogous threat to our psychological and psychiatric well-being.

The paradox of the current threat is that, despite our own experience, we act as if we have none. On the one hand, an analogous pandemic took place more than a century ago (the so-called Spanish flu), and essentially – owing to censorship that shielded the public fear of the victims of World War I – it did not penetrate broadly into the consciousness of those living at the time, while reducing the risk of massive psychological and psychiatric effects caused by this fear. Only historians (of pandemics, of medicine) uncovered this danger by describing – in retrospect – the terrible toll it took. On the other hand, the less indiscriminate polio pandemic left its mark on those living roughly 50–70 years ago (and thus a small group of the readers of these words). We remember it faintly (if we were alive in those days, e.g., Dariusz Dolinski) or not at all (if we had not yet come into being, e.g., Wojciech Kulesza). Eyewitnesses to this tragedy (our parents, grandparents) who went through this tragedy in full consciousness are no longer alive or are nearing the end of their lives, so the experience of the psychological and psychiatric consequences does not have a place in our collective consciousness.

As a consequence of both these factors, analyses of the psychological results of pandemics are rather historical, with the present times visiting the first (and painful) lesson on a living social organism: ourselves. The current pandemic is creating a collective consciousness of mainly the medical effects just mentioned, without yet heeding the psychological and psychiatric effects. Before summarizing the discussed methods of self-deception for coping with the unpredictable future, anxiety, and stress resulting from the COVID-19 pandemic, we offer a momentary reflection on what psychological effects – both short and long term – the pandemic brings.

We will begin with the short-term ones, which are not only more intuitive (they are experienced directly by us and our loved ones; there is already a rich literature describing this time horizon) but, for obvious reasons, are better understood than the long-term ones. There is not yet enough research on the long-term effects of the ongoing COVID-19 pandemic, as the primary factor in solidifying knowledge from research findings is passage of the necessary time. For this reason, the following section references reasonably up-to-date knowledge as of the fall of 2022 (so only 2 and a half years after the COVID-19 pandemic was announced).

5.1 Psychological and Psychiatric Consequences

It probably will not come as a surprise that the COVID-19 pandemic was associated with an increase in anxiety and depression (Huang & Zhao, 2020; Prati, 2021; Prati & Mancini, 2021; Taylor et al., 2020; Vanderlind et al., 2021). What seems less clear, however, is the dynamics of these processes during the pandemic. This issue was the focus of a study by Debowska et al. (2022). More than 7000 Polish students were surveyed with various questionnaires during five phases of the pandemic: (1) March 1–15, 2020, i.e., immediately after the first cases of COVID-19 were identified in Poland; (2) March 16–22, after the first restrictions were introduced, e.g., closure of schools and universities, cancellation of mass events; (3) March 23–29, when regulations were introduced restricting direct human contact; (4) March 30–April 5, when a ban on entering forests and parks was introduced and it was established that people should not approach each other at a distance of less than 2 m; (5) April 6–30, when some restrictions were lifted but a mandate to cover mouths and noses was introduced. In addition to tools measuring anxiety and depression, they also examined levels of perceived stress and suicidal tendencies. As we can see in Fig. 5.1, the level of emotional dysfunction not only depended on the period in which the study was conducted but also on the sex of the subjects.

Fig. 5.1
4 line graphs. They exhibit 5 stages of value for suicide, depression, anxiety, and stress. The 2 lines illustrate a continuous and a dashed pattern. Other than the graph titled suicide the dashed line has a lower peak than the continuous line.

University students’ stress, depression, anxiety, and suicidality in the early stages of the COVID-19 pandemic

Source: Psychological Medicine, 52, p. 3746

Copyright: Cambridge University Press

Notes: Solid line = females; dashed line = males

Full size image

Another psychological disorder often reported following the COVID-19 pandemic is post-traumatic stress disorder (PTSD – Mak et al., 2009; Mazza et al., 2020; Parker et al., 2015), noted in almost one-third of COVID-19 survivors (Cai et al., 2020; Mazza et al., 2020). Chinese studies show that the mere information of a positive test result can trigger PTSD (Yuan et al., 2021), leading to the conclusion that it is not only the disease that produces psychological effects but also the mere fact of being diagnosed with it. The question may arise as to where the aforementioned consequences of infection come from. The answer may be provided by studies showing that the effect of the ongoing pandemic (affecting healthy people as well) is social isolation, which subsequently leads not only to the depression just mentioned (Clair et al., 2021) but to other disorders as well. Studies of the etiology of post-traumatic stress disorder commonly draw attention to the role of lack of social support (e.g., Gros et al., 2016). Limiting direct social contact, on the one hand, and people’s anxiety-driven focus on themselves, on the other, clearly promoted the development of PTSD.

Finally, it turns out that the pandemic makes its mark on us by not only infecting us per se but by exacerbating existing diseases or mental disorders. It has been shown, for example, that the aforementioned isolation (arising from the quarantine) caused people who had completed treatment for OCD prior to the pandemic to report an increase in hand-washing compulsions during the quarantine as a result of campaigns mandating frequent disinfection to prevent transmission of the virus (Davide et al., 2020; Kumar & Somani, 2020).

One community particularly affected by the COVID-19 pandemic and its psychological and psychiatric consequences is the school environment of students and teachers, starting from early childhood education. It has been shown, for example, that young children not only fear infection with the virus but also fear further transmission of COVID-19 to the elderly, who, as children know, should be especially protected (Idoiaga et al., 2020). In turn, older children (and teachers) have been noted – as a result of the COVID-19 pandemic – to experience increased fear and stress (Browning et al., 2021; USAID, 2021). In academia as well, a decline in various mental health indicators has been reported (Savage et al., 2020), indicating, for example, an increase in suicidal thoughts and depression (Wang et al., 2020).

Against the background of psychological effects in the school environment, we turn to consideration of the long-term effects of the ongoing pandemic. The group of outcomes discussed below is not only less intuitive (it is difficult to predict the long-term effects of something that is currently afflicting us), but for obvious reasons, research on this topic is still scarce.

5.2 COVID-19 Pandemic = School Closures = Longitudinal Social Disaster

In January 2022, the World Bank, Global Education Evidence Advisory Panel, UK Foreign, Commonwealth and Development Office (FCDO), and UNICEF Office of Research-Innocenti published an analysis titled “Prioritizing Learning During COVID-19: The Most Effective Ways to Keep Children Learning During and Post-Pandemic,” which captures the essence of the long-term psychological losses: children and adolescents were hardest hit by the pandemic. Pupils lost access to education and related services. The analysis was based on a broader perspective than the experience of people in Western Europe, developed Asian countries like South Korea and Japan, or North America. The report takes into account losses for underdeveloped or developing countries, the regions of the world that, after all, have the highest concentration per capita of the world’s children. In these countries, schools were either closed for longer periods during rising illness rates or did not open at all for months or even years. Children in these areas of the world did not have the opportunity for distance learning most often because teachers did not have access to computers either. Demonstrating the scale of long-term losses, it is sufficient to mention that the report indicates that the ongoing COVID-19 pandemic affected 1.6 billion children, who were kept out of school because of it.

Even at this early stage in the analysis of the report (and this chapter), the question may arise as to why distance learning, which has been introduced in some parts of the world, has not reduced the psychological costs paid by children. The report makes it clear that distance learning supports some aspects of education but cannot replace them. Those that remain irreplaceable introduce the extremely high costs we have already discussed. Distance learning as well is, in the main, less effective. The report in question, describing the long-term effects, showed a decline in the quality of education by an average of 1.5 grades in a given subject (see also Andrabi et al., 2021; Marcotte & Hemelt, 2008) and a 0.19 standard deviation of math score (compared to the same exam administered during non-pandemic times, Maldonado & De Witte, 2021). Experiments in Brazil have shown outright that a group receiving online – as opposed to classroom – instruction covered as much as 75% less material (Lichand et al., 2021). Of particular importance, as a result of the pandemic, some children “dropped out” of the education system and never reentered school, which has long-term effects on their entire future lives (Bandiera et al., 2020). After all, the detrimental aspects of being undereducated need no explanation: among other things, reduced chances of high earnings, which, in turn, will be reflected in the quality of life of the next generation conceived by the COVID-19 pandemic generation.

The aforementioned report also revealed that school closures lead to an increase in educational inequalities, where higher-income families were less affected by the consequences of the pandemic for their children, as their resources allowed them to pay for other forms of education. A striking result from a study in the Netherlands showed that 55% of the effects/costs (losses) of school closures were concentrated around the 8% least educated families. Using a similar example, one can analyze the costs of school closures that lead to the inability to provide other education-related services. The report mentions that 388 million students benefit from school meals (which in many areas of the world is itself an incentive to send children to school). The pandemic triggered a decrease in the availability of meals for 370 million children, magnifying the poverty and food insecurity already affecting lower-income families at the outset. Against this backdrop, other long-term effects of the ongoing pandemic are clearly positioned. After all, what are the effects of child malnutrition? For example, the level of children’s cognition and future school achievement drops (Fore et al., 2020). The COVID-19 pandemic particularly affects less privileged students who, in adulthood, will not be able to provide their children with the standard of living they would have achieved had there been no pandemic.

It has also been shown that 16% of girls and 8% of boys in Kenya did not return to school due to the COVID-19 lockdown (Presidential Policy and Strategic Unit and Population Council, 2021). Moreover, income projections show that schoolchildren affected by the COVID-19 pandemic will earn 17 trillion US dollars less over their lifetimes compared to what they would have earned had there been no pandemic (Abreh et al. 2021). Analogous losses are projected for preschool children at $308 billion (McCoy et al., 2021). This directly shows that the next generation – the children of today’s children – will be affected by the lower parental incomes that were reduced by the COVID-19 pandemic! So the effects of the 2020–2022 pandemic (ending as we are concluding the writing of this book) will be permanently, tangibly, and materially felt for decades to come!

The report also indicates the long-term impact of this and future pandemics in that 96% of highly developed countries and only 16% of underdeveloped countries have implemented online learning. When we contrast this result with the continued problem of access to the Internet in underdeveloped countries (e.g., via cell phones, highly and moderately developed countries report that nearly 90% have cell phones in their homes, while underdeveloped countries report 17%), it is clear that the chasm between the situations of children from underdeveloped and highly developed countries will widen.

A similarly unfavorable contrast is revealed in the fact that 85% of highly developed and moderately developed countries provided support for teachers working online, while less than 30% of teachers received such assistance in underdeveloped ones. As a result, millions of teachers have incurred serious costs, not only professionally but also purely psychological in order to adjust to new working conditions. And teachers, after all, have their own families, themselves affected by the pandemic in this way as well.

In conclusion, the report under discussion above showed explicitly that closing (often first; before businesses) schools will exert a long-term effect on 1.6 billion children (UNESCO, 2021) and their capacity to develop through education while reducing their well-being and, finally, dramatically degrading their productivity. These losses are estimated to last for years, or even decades, while it is estimated that the broader business sector will recover its lost revenue much faster. The report’s authors suggest methods to combat the psychological effects of future airborne pandemics: (1) prioritize the openness of schools (ahead of businesses; schools provide educational development but also, e.g., provide food); (2) focus on reducing infection in schools (e.g., by prioritizing vaccination of teachers); (3) support teachers in their ability and capacity to teach children. In short, the priority in pandemics should be to keep schools open at every stage of education for the reason that, in the long run, it is children who will be more affected by a pandemic than adults.

5.3 Neurological Impact = Years of Cognitive Dysfunctions

The last long-term change as an aftermath of COVID-19 is neurological changes leading to cognitive alterations. Let us note at the outset the multiplicity and breadth of brain areas that are affected by COVID-19 infection:

  • Insula, cingulate cortex (Kandemirli et al., 2020)

  • Olfactory nerve and gyrus rectus/straight gyrus (Petrescu et al., 2020)

  • Gyrus rectus/straight gyrus and gyrus rectus/straight gyrus (Fischer et al., 2020)

  • Thalamus (Fischer et al., 2020)

  • Frontal, parietal, occipital lobe (Anzalone et al., 2020), bilateral medial temporal lobe, midbrain (Virhammar et al., 2020)

  • Pons and corpus collosum (Zoghi et al., 2020)

  • Left lateral orbitofrontal cortex, amygdala, hippocampus (Douaud et al., 2021)

  • Cerebral peduncles and internal capsule (Zoghi et al., 2020)

  • Internal capsule (Egbert et al., 2020)

The list above does not exhaust the range of neurological areas affected, as early data indicate that the COVID-19 virus affects the central nervous system (Yong, 2021), which may be associated with functional impairments (Cheng, Yang, Gao, 2020) and neurodegenerative conditions (Heneka et al., 2020). In young people who are not, after all, in the risk group for COVID-19 infection, deterioration of short-term and semantic memory, attention, and verbal learning difficulties have been observed even up to 3 months after infection (Woo et al., 2020). Other reported impairments include difficulty processing commands to perform simple motor activities (Helms et al., 2020), verbal memory impairment (Almeria et al., 2020) and working memory impairment (Hampshire et al., 2021), and cognitive slowing (Ferrucci et al., 2021) referred to as “post-COVID fog.” Taken together, all of this means that the long-term neurological consequences will be very serious, permanently affecting the cognitive functioning of infected individuals.

In conclusion, it is clear that one of the few constant, unchanging features of the world around us is that in our perception it has threatened us, threatens us now, and will continue to threaten us. In addition to individual attacks from animals or other humans, we are menaced by weather disasters, volcanic eruptions, meteorite strikes, and, finally, disease. For centuries, these events have decimated not only Homo sapiens but all living creatures on earth. Therefore, it is safe to assume that in learning methods to avoid deadly threats, we have also evolved by developing the ability to cope with them. Unfortunately, the tools commonly applied in this struggle include the social cognition biases whose harmfulness we have written much about in this book. The following section is intended to illustrate the potential results of failing to respond to our deployment of these harmful mechanisms: the consequences of inaction will be felt for generations to come. And this, after all, is not the only threat facing us.