Competing Risks: Infection vs Mental Health

The dilemma policy makers face in trying to deal with the COVID-19 pandemic is that while contracting the disease can be very bad for the physical health of an individual, social isolation is very bad for their mental health.

Many of the actions that reduce the risk of infection (social distancing, school closures, remote learning, partition into cohorts, masking, etc.) are likely to increase the risk of mental health issues, and vice-versa.

Finding the best tradeoff would be a challenge even if we had a complete understanding of the effects of the virus and an easy way to measure the mental health impact, but we have neither.

Quality research takes time and the virus is evolving too fast. So we have to come to a decision with incomplete, and sometimes conflicting information and expert opinions.

I have no doubt that the pandemic has significantly impacted the social-emotional development of children, and has had a serious impact on their mental health in many cases. I see this in my own students, who are young adults. I have a 21 year old advisee who quit taking courses even though he has nearly completed his degree. Of course I’m not privy to the details, but I would not be surprised to learn that he is suffering from depression.

Depression is a serious mental health issue

I worked for 12 years on a study of Body Dysmorphic Disorder (BDD) that established, among other results, that BDD and Major Depressive Disorder (MDD) are distinct maladies. When the original National Institute of Mental Health funding for the study ran out, it was partially funded by the American Society for Suicide Prevention, because so many of the study participants reported frequent suicidal ideation, and a number of the 200 original subjects are known to have committed suicide¹.

So I am well aware that depression is a serious, possibly life-threatening condition that is not to be taken lightly. There is nothing more tragic than a young person full of potential choosing to end their life.

Following Mainstream Science

As an elected official serving on a body that has the responsibility for setting policy, but having no qualifications whatsoever to make decisions regarding public health, I feel very strongly that those decisions can only be made by healthcare professionals.

Given that the rate at which reliable scientific evidence can be accumulated is considerably slower than the rate at which the virus can evolve², I can understand that recommendations can be expected to change.

For reasons noted in the competing risk section, I can also understand that there may not be universal agreement among healthcare professionals. I think the best approach for someone in my position is to go with the current mainstream scientific opinions.

In the current environment, these appear to be:

• Vaccines are safe and have been proven to reduce the incidence of the most severe effects of COVID-19, which is an important reason why we are now able to relax some restrictions.³
• At the moment, considerations mentioned in the competing risk section seem to indicate that the downside of masking outweighs the benefits in our current environment. Good evidence that masks reduce the spread of COVID-19 is emerging⁴, but controlling the spread seems less important right now than reducing social isolation.
• Guidance from public health organizations is moving quickly towards fewer mandatory restrictions.

As we enter a relatively quiet period in terms of COVID infections, the extraordinary effort that was required to keep schools open this year must be acknowledged.

While the plan was to open schools and keep them open, there was no guarantee that this was going to work. At one point, the Superintendent was having conference calls at 10 pm and 4 am to decide whether there would be enough staff to open schools the next day.

I believe the highest priority must be to keep schools open safely.

While I hope we never see it, we can't rule out the possibility that a strain as contagious as Omicron and as virulent as Delta evolves.

In that scenario, I believe our chances of keeping schools open and staffed are highest when all proven mitigation strategies are on the table, including a return to masking⁵. In my opinion masking is almost certainly less harmful than closing school.

The future behavior of the virus cannot be predicted with any certainty. Policies should have enough flexibility to adapt quickly, with the goal of keeping schools open and keeping students and staff safe.