The outbreak of COVID-19 has shocked the world. The number of confirmed cases and deaths continues to increase, causing people to be nervous, anxious and uneasy.

Harvard President Lawrence S. Bacow issued an open letter to teachers, students and the world, emphasizing in particular that the new coronavirus is a test of the kindness and kindness of human nature in difficult times. Caring, I hope everyone can show their best character, help confirmed patients, support those in isolation, and also care for the vulnerable groups in society.

Liao Junzhi, President of Academia Sinica, also posted on Facebook in the early days of the epidemic. He believed that people who disclosed or concealed confirmed cases had blind spots, and hoped to show the brilliance of humanity and Be sincere, patiently communicate, coordinate, and explain to those with objections or objections, and provide the greatest care, support, and tolerance to those diagnosed.

According to big data statistics from the Central Health Insurance Agency, among the top 20 diseases with the most outpatient visits from January to June this year, the first one was acute upper respiratory tract infections such as colds, which was less than the same period last year. 3.83 million items, a decrease of approximately 31.7%, while anxiety and insomnia surged rapidly. According to expert analysis, this year's epidemic has made people deeply anxious, and anxiety can be divided into two waves. The first wave is the early stage of the epidemic, when people are afraid of being infected by the new coronavirus or unable to buy masks or alcohol, and they worry too much, causing anxiety; The second wave is concerned that the epidemic will seriously affect economic development, leading to layoffs or salary cuts, which also causes public anxiety. It can be seen that before the epidemic is resolved, people's anxiety and tension will inevitably linger.

In addition, home quarantine or isolation will also cause severe psychological impact. Other disadvantaged groups such as poverty, confirmed cases, young children, elderly people, and front-line medical staff will suffer more severe psychological effects than normal people. The well-known medical journal "Lancet" recently published an article in its special issue on mental illness, calling for the urgent need to provide timely mental health care during the epidemic. The following is about how to pay attention to human care and care during the period when the COVID-19 epidemic has not yet slowed down and has fallen into stalemate and chaos. How to balance human rights and epidemic prevention, and how to protect privacy are discussed with readers ***.

(1) The psychological impact of quarantiners

Isolation and quarantine, the English name is "quarantine", this word originated from the Italian "quarantina" in the 17th century. It means 40. At that time, the plague was spreading in Italy, and ships entering Venice had to be quarantined for 40 days before being released, hence the name.

According to a review article by Brookset et al., a scholar from King's College London, in the journal "Lancet", 24 articles on SARS, H1N1, Ebola, MERS and other epidemics were collected. Below, a survey of quarantined persons.

The report found that most people will have negative psychological effects. The more common one is post-traumatic stress disorder. Symptoms include low mood or instability, depression, anxiety, Irritability and insomnia, etc.

In addition, it may also cause isolation, fear of infecting family members when going home, and fear of being discussed, ostracized and stigmatized by neighbors or relatives. Some quarantined individuals who have been tracked for a long time still suffer from post-traumatic stress, depressive symptoms and alcoholism even 3 years after the incident.

From a political, medical and public health perspective, after an epidemic occurs, isolation can curb the spread of the epidemic, protect people's health, and avoid exhaustion of medical resources.

However, it is undeniable that under the premise of actively fighting the epidemic, the situation and physical and mental impact of the quarantined people are also the focus of public attention. If the handling process is improper or too rough, it will cause personal and collective trauma in isolation. The solution is and There are 6 ways to relieve the stress of isolation:

1. First, shorten the isolation time as much as possible

2. Provide correct information

3. Daily necessities Instant replenishment

4. Reduce boredom and increase friendly communication

5. Provide sufficient contact tools such as mobile phones, charging cables, sockets, etc.

6. Create 24 Hourly online service hotline.

In short, letting the quarantined people feel people’s care, social support, and government protection, and letting them realize the love from all directions is their greatest "Self-healing ability" and "spiritual support".

(2) Psychological impact on children

According to Professor Li Sixian of the National Normal University, an online survey on the epidemic found that 47% of the people can remain confident about the epidemic. Calm, 22% to 27% feel quite nervous and worried about the epidemic. In particular, the psychological state of children is different from that of adults. The emotional reaction of children is not worry, but disgust and anger because they want to play but can’t. .

According to the "SARS Safe Epidemic Prevention Manual" issued by the Chinese Mental Health Association in 2003, it is also applicable to new coronavirus pneumonia. In summary, the following points should be noted:

◎Keep calm, adults should make children feel safe.

◎Be empathetic and do not shy away from talking about the current situation, but when the epidemic spreads, you must restrict them from watching TV reports, etc.

◎Let them feel that they can maintain their own health.

◎Maintain a normal schedule and provide correct information to your children.

◎As for children who are quarantined at home, classmates can be encouraged to take turns calling to express their concern or write cards of concern instead of ridiculing or avoiding them.

◎If the situation worsens, seek help from professionals or a psychiatrist.

(3) Concern for high-risk and vulnerable groups

According to statistics, the older you are, the higher the mortality rate. The mortality rate for those over 70 years old is 8%. Above, the mortality rate for healthy groups is only 0.9%. In addition, those with chronic diseases such as cardiovascular disease, diabetes, hypertension, chronic respiratory diseases and cancer have higher mortality rates, ranging from 5.6% to 10.5% on average. Before these patients are infected, we need to pay more care and attention than in the past, and we must be more strict with epidemic prevention measures. We also try not to let them go out or go to places where people gather. Regular examinations and daily medication cannot be interrupted. (As shown in Figure 1 and Figure 2)

In addition, we generally treat disadvantaged groups such as poor people, unemployed people, migrant workers or people with disabilities. It is said that these groups have low incomes, few job opportunities, unstable diets, poor nutritional intake, and poor physical condition. They are often more susceptible to virus infection and neglected to take care of them. We should pay special attention to this group of vulnerable groups and must show empathy. , illegal immigrants will not be held accountable for the time being, so as to ensure that they do not panic and dare not report the epidemic, but they must also be given due care. This will actually help control the epidemic and give them a better economic foundation in dangerous situations. people, have the opportunity to learn dedication and compassion to help them. At present, the Domestic Immigration Department is actively promoting the "Expanded Self-Report Project", adhering to legal principles and humane care, and providing assistance. *** This good charity policy has indeed helped new immigrants and migrant workers.

Microsoft founder Bill Gates also emphasized that vaccine research and development are public funds and should be used on the groups that need vaccination most, rather than on those who have the resources. Only in this way can we demonstrate the universal value of supreme human concern.

(4) Concern for medical staff

Medical staff on the front line facing the epidemic are at high risk due to increased workload areas, they will show fatigue and irritability. What they look forward to most is the support and encouragement of hospital supervisor colleagues. They also hope that they will not be criticized or disturbed when working. They also hope that all medical and epidemic prevention supplies and equipment will not be in short supply. Of course, they are also urgently needed. Safety in the workplace is fully guaranteed. It was pointed out in the journal "The Lancet" that in the face of a cruel epidemic, these front-line workers will show more love and enthusiasm, and actively participate in saving lives with their professionalism in the workplace. Instead, they hope that psychiatrists Or social workers should spend more time and energy dealing with patients' anxiety, fear and other emotional problems.

In addition, the World Psychiatric Association also put forward some suggestions for medical staff: To realize that mental health is as important as physical health, it is necessary to relieve stress and take appropriate rest

? Colleagues should support each other and stay in touch with relatives and friends

The above three items are also applicable to the general public.

(5) In preventing and fighting the epidemic, privacy and human rights must still be taken into consideration

During the raging spread of COVID-19, in addition to isolation, other epidemic prevention measures Including the 3T mode: Test, Trace and Treat are also very important. The so-called tracking mainly involves tracing the past contacts of infected patients and placing them in quarantine and isolation to cut off the patient's infection path and reduce the chance of infection, so that the R0 value (basic infection number) is reduced to less than 1. The traditional epidemic prevention tracking method is "epidemic investigation", which means epidemic prevention personnel use questionnaires and interviews to discover or find the patients' past contacts. This often has shortcomings such as time-consuming process, unclear records, or concealment of the epidemic.

Nowadays, since everyone has a mobile phone, they can use mobile phone positioning tracking technology to find people’s past activities. Currently, Taiwan’s epidemic prevention mainly uses mobile phone signal base stations In addition, the "entry quarantine system" also builds an "electronic fence system" to facilitate the use of epidemic prevention personnel for 14 days of home care.

However, technology must still be based on human nature and must be regulated by personal information laws to protect personal privacy. Currently, there is the "Severe Special Infectious Pneumonia Prevention, Treatment, Relief and Revitalization" The Special Regulations have more flexible regulations on personal privacy and human rights, but we should also be concerned that epidemic prevention measures must comply with the principle of proportionality and not excessively infringe on people's personal privacy. Otherwise, although epidemic prevention is very successful, privacy protection will be violated. It’s not what everyone wants to see.

(6) Ethical considerations in vaccine research and development and vaccination

Countries around the world have invested a lot of manpower, finance and resources to accelerate vaccine research and development. So far, , 27 have entered clinical trials, and 6 have entered clinical phase 3. The world is accelerating research and development with moderate relaxation of regulations. Of course, we hope that a sufficient number of vaccines will be available at a reasonable price, so that they can be applied to the groups that need them most. In addition to the above, we sincerely hope that the following ethical considerations will be taken into consideration:

◎The effectiveness and safety of vaccines should be included as the highest priority and most rigorous consideration factors .

◎Have the induced effective antibodies and T cell immunity been fully confirmed? Is it suitable for all ages? In addition, the duration of effectiveness of the vaccine must also be taken seriously.

◎Whether there are strong or even fatal side effects, such as Antibody-Dependent Enhancement (ADE) or Vaccine-Associated Enhanced Respiratory Disease (VAERD), all Handle with extreme caution.

◎Vaccines are the world’s public property. They should have fair opportunities for vaccination (such as vaccine distribution and vaccination sequence) and the price should be affordable.

Conclusion

The COVID-19 epidemic has been spreading since the end of last year. It cannot be denied that when humans face any major epidemic, they will inevitably have psychological reactions of panic and uneasiness; therefore, , how to appease people's hearts and provide timely psychological consultation and related treatment is particularly important.

Generally speaking, the stress and worries caused during the epidemic include: fear of getting sick, fear of infecting others, changes in sleeping and eating habits, fear of worsening of existing chronic diseases , instead develop the bad habit of smoking or drinking to relieve boredom, and increase the dosage of sleeping or sedative drugs. Everyone's psychological condition is different, but in summary, the following points are absolutely worth following:

(1) Abandon utilitarianism, replace suspicion, selfishness, and self-interest with trust, care, and altruism, and realize the importance of "existence and prosperity."

(2) While using self-isolation or reducing going out to participate in public activities, learn on your own, self-reflect, and learn more about tolerance and respect.

(3) Use empathy, cooperation, communication, coordination and care.

(4) Actively use self-relief techniques, such as mindfulness-based stress reduction, breathing pranayama, exercise or reading, etc.

Cooperate with *** to implement and practice the five steps of safe epidemic prevention (PEACE)

Patient: Cultivate patience and empathy

A ccept: Accept emotional ups and downs and try to calm your mood

Change: Improve bad habits and establish epidemic prevention New life

E ngage: Return to normal life and engage in a diverse and beneficial way of work and rest

Currently in Taiwan, the COVID-19 epidemic has gradually slowed down but is still in an unpredictable and confusing situation. In a state of chaos and uncertainty, as long as we maintain crisis awareness and alertness at all times, value humanity (humanily), show care (care), and be united as one (solidarity), we believe that the fight against the epidemic will be successful.