In this personal narrative, Dr Ahmed Khalafalla describes his experience of the Covid-19 pandemic as a general practitioner in Saudi Arabia. He describes new mental health issues that he has witnessed in his clinic as a result of infection prevention and control measures, and asks questions about the ongoing impact of the pandemic on the health needs and behaviour of the general population.
I have worked as a general practitioner in a family clinic for 11 years and have noticed a number of changes in patient presentation since the start of the Covid-19 pandemic. Since the outbreak of Covid-19, I have seen a significant increase in the number of seasonal flu cases compared to the previous three years, despite good coverage from the seasonal flu vaccine. I reviewed about 2,500 to 4,000 cases associated with seasonal flu and upper respiratory tract infections. These numbers would have been remarkable, before Covid-19.
The Covid-19 outbreak was reported in Wuhan, Central China in December 2019 and in March 2020 was classified by the World Health Organization as a global pandemic. Most countries began emergency infection control procedures to prevent the virus from spreading, which significantly restricted and changed daily life for much of the world’s population. These emergency measures were accompanied by extensive media coverage about the virus, with different and sometimes conflicting information about the disease being shared through multiple different media channels.
There was little scientific knowledge about the nature of the disease, how it affects patients and the epidemic trajectory. We also lacked specific treatments for Covid-19, did not understand the efficacy of preventative measures and at that point did not have vaccinations. Numbers of deaths were being shared around the world on a continuous basis. However, in our community we did not have a high death rate, so this information did not provide a helpful local picture for my patients. Many misunderstood the statistics and definitions.
All of these factors have produced a state of anxiety in society, which has had a direct effect on the cases I see in my clinic. I have already reviewed multiple cases of Covid-phobia, delusion about having Covid and Covid-related anxiety. These psychological symptoms are sometimes accompanied by behaviours that disrupt people’s lives such as obsessive disinfection and social divergence. These behaviours have grown from the infection-control culture that has developed during the crisis of the pandemic.
Medical systems have become a more significant power in decision making during the pandemic. We now need to use this influence to reassure people in the community and help them adjust to life on the other side of the pandemic. We need to offer psychological support to those who have suffered as a result of lockdown restrictions.
The question that preoccupies me is “What will life be like after the end of this pandemic?” Will people return to how they lived before Covid-19, or have there been fundamental changes that have occurred to their lifestyle? Have we moved further towards a life that is more virtual than real, with e-health, online education, online shopping and banking, and communication via social media?
What will the psychological and behavioural changes be for people? How do we treat the issues that will arise as a result? How will clinics look in the future, and what knowledge do we need to support this change? How will our health systems will need to change to accommodate this new way of living?
About the Author
Dr Ahmed Khalafalla is a doctor in family medicine at the Ministry of Health in Saudi Arabia. He has an interest in healthcare quality, patient safety and healthcare system transformation.