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As US reaches one million COVID deaths, how are Americans coping?

An estimated 8.5 million Americans have lost a close family member to COVID-19 [Justin Hamel/Handout via Reuters]

Warning: The story below contains descriptions of suicidal thoughts. The National Suicide Prevention Lifeline is available at 1-800-273-8255.

Los Angeles, California, US – In spring 2020, COVID-19 hit the Kaiser Permanente Fontana hospital outside Los Angeles. As the sick poured in, Liz Marlow, a registered nurse in the emergency department, saw fear in the eyes of her normally stoic colleagues as they had to choose which critical patients to help first.

“Seeing that blow-by-blow of continuous death every single day would debilitate anyone,” Marlow told Al Jazeera.

More than two years into the pandemic, the US on Tuesday reached 1 million COVID-19 deaths, according to Johns Hopkins University data. An estimated 8.5 million Americans have lost a close family member to the coronavirus.

Marlow is among countless people who have suffered trauma from the pandemic. Many in the healthcare field have had to come to terms with a torrent of unexpected deaths, while society at large has collectively grappled with social isolation, financial insecurity and the loss of loved ones.

Marlow herself developed symptoms associated with COVID-19 – including a fever, chest pain, searing headaches, insomnia and brain fog – early in the pandemic. She tested negative for the disease, but her psychological symptoms intensified to the point that she spent a week in a psychiatric hospital.

After her release, she experienced flashbacks and memory gaps, and she lost her sense of time. One doctor thought she might have post-traumatic stress disorder (PTSD), while another said she was showing symptoms of long-haul COVID-19. While she never received an official diagnosis for either, she sank into depression.

“What I was most afraid of was losing my mind. That scared me because I had no control over it,” she said, choking up.

Marlow did not want to get out of bed, shower or eat. She felt like a burden to her family, and began struggling with suicidal thoughts, asking herself: “What do I have to live for anyway? They’d be better off without me.”

And she is far from alone: the collective stress, grief and trauma of the pandemic has had an undeniable effect on mental health, with the American Psychological Association citing a huge increase in demand for the treatment of anxiety (up 82 percent) and depression (up 70 percent) since it began. California’s former surgeon general, Nadine Burke Harris, called the pandemic “probably the greatest collective trauma of our generation”.

Spectrum of mental health

The pandemic’s mental health toll exists on a spectrum, according to Debra Kaysen, a behavioural scientist at Stanford University. Stressors range from losing relatives or watching extreme levels of death, to being isolated from friends and family, to worrying about health or finances. Those working in the healthcare field have been among the hardest-hit; in a survey last year, more than two-thirds (PDF) of nurses in California reported anxiety and burnout.

According to the Pew Research Center, 72 percent of American adults know someone who was hospitalised or died because of COVID-19. In Black communities, that number jumps to 82 percent. “When you have discrimination, overt and covert racism, compounded with economic insecurity and tremendous rates of death, that makes it much more difficult,” Kaysen told Al Jazeera. “You have people [who are experiencing] loss on top of loss on top of loss.”

A technician cleans a room after a COVID-19 patient was transferred to an intensive care unit at Providence Holy Cross Medical Center in Los Angeles [File: Jae C Hong/AP Photo]

Alison Holman, a psychology professor at the University of California Irvine, told Al Jazeera that for some, the pandemic has become a major collective trauma: “It has hit the entire country, it has hit the entire world, with the threat of death … Never in my life have I seen a worse disruption in our collective sense of time.”

Social isolation has also led to an increase in substance abuse among people who were already at risk, Kaysen said – something that will “lead to more downstream problems, and it won’t fix the depression or PTSD”.

At the same time, some will come out of the pandemic in a better place mentally after taking time to reconnect with loved ones and prioritise what is most important in their lives.

“For many people, they are going to go back to finding happiness and joy, and making social connections,” Kaysen said. “My guess is that we will see some uptick in rates of PTSD, depression, anxiety [and] insomnia globally, because of the scale of the pandemic. But not everybody who is showing those symptoms now is going to stay where they are now.”

Coping mechanisms

Those with better access to resources are more likely to recover, while the poorest communities will face the most devastating mental health effects, Holman said.

To build resilience and coping skills, experts suggest a number of basic practices: reaching out to loved ones, getting enough sleep, eating nutritious food, exercising and practising meditation.

Body movement can be an excellent way to process trauma and stress, Holman added, while “doomscrolling” can worsen mental health. Instead, she advised limiting news consumption to a couple of reliable sources, for a maximum of 20 minutes a day.

For Marlow, there are good days and bad days, and she has been coping thanks to a combination of medication, therapy and social connections. She keeps a regular sleep schedule, meditates and volunteers at a local church.

“This pandemic has definitely messed with people’s normal routines and their minds,” she said. “The whole world was basically on lockdown. For some people, it felt like the end of the world. But the reality is, you’re living right here, right now, in the present moment.

“You’re not alone in this.”