A pandemic is an epidemic of disease that often spreads quickly across far-reaching areas, affecting many people. Few pandemics have affected as many communities around the world as the coronavirus disease 2019 (COVID-19) pandemic. Pandemics and other disasters involve physical danger and also stress that can overwhelm survivors’ usual coping strategies, both during and after the disaster. After a pandemic or other
disaster, people often notice changes in how they feel, think, and act, and they may not realize that these changes are reactions to the disaster.

Survivors may be at higher risk of intense reactions if they live in communities where many people got sick; they had the disease themselves; or they had health, mental health, or substance use conditions before and during the pandemic. Pandemics, unlike other types of disasters do not have a clear beginning and ending, sometimes leading to increased uncertainty and distress. This tip sheet describes common reactions after
pandemics and other disasters and suggests ways to cope. It also covers financial stress and signs of the urgent need for mental health assistance and lists sources of help and support.

Common Reactions to Disasters

Survivors often notice changes in their thinking, feelings, and behavior during and after a disaster, as well as physical signs and symptoms.

Changes related to thinking may include nightmares, confusion, trouble making decisions, trouble concentrating, difficulty with remembering things, and inability to listen to others.

Changes in feelings may include increased or overwhelming fear, anxiety, depression, irritability and anger, hopelessness, or guilt. Survivors may also experience a sense of disconnection, or not caring about things, as well as inability to feel joy or sadness.

Changes in behavior may include having an exaggerated startle response, trouble sleeping, or more arguments with others. Survivors may also notice that they are eating too much or too little, crying more often, having angry outbursts, or spending more time alone. Their substance use may increase.

Physical signs and symptoms may include headaches, stomachaches, or diarrhea; loss of appetite; sweating or having chills; tremors (shaking) or muscle twitches; higher or lower energy than usual; or being unable to relax.

Common Reactions in Children and Teenagers

Children and teenagers also experience reactions during and after pandemics and other disasters. In fact, because they have had fewer years to develop social, communication, and coping skills than adults, children may be at particular risk after disasters. Common reactions vary by age range.

Children 5 years and younger may have persistent fear and worry; become clingy; cry or whimper; scream; have problems sleeping or have nightmares; or return to former behaviors or fears (e.g., bedwetting, thumb sucking, or fear of the dark).

Children 6 to 11 years may withdraw from others and activities; have sudden outbursts; have difficulty concentrating; have fears; become irritable; feel sad or anxious; blame themselves for aspects of the pandemic and related stressors; become emotionally numb; or start performing more poorly at school.

Children 12 to 17 years may have similar reactions to those of 6- to 11-year-olds. They may also have flashbacks, or sudden, upsetting memories of especially upsetting events associated with the pandemic. They may engage in more risk-taking behavior, including misuse of drugs or alcohol.

If you are a parent or other caregiver, you can take steps to help your child or teenager cope with disaster reactions. Modeling effective coping skills that include a flexible routine with plenty of support, communication, and warmth will benefit the whole family.

Tips To Manage Distress After a Pandemic

Coping skills and strategies can help you deal with the distress that is common among disaster survivors. Modeling these strategies can also help your family through phases of disaster recovery.
Make and Use Your Connections. Build close relationships with others, especially with those who accept and understand your feelings, and take time to enjoy the close relationships you have. Socializing with others can reduce stress and create a sense of support and connection. Try volunteering, visiting family, calling a friend, or reaching out to a faith leader.

Find Purpose. After a disaster there may be time to reflect on what is important to you in life, and to make sure you’re spending the most time on things that matter most to you. Take part in activities you find enjoyable and meaningful, or create a plan to move in that direction.

Have a Flexible Routine. Create a routine or daily schedule. Have a plan to accomplish required tasks, and create a flexible routine to accomplish them. Routines provide a sense of control over your life and reduce stress and uncertainty. Flexible routines allow you to accommodate unexpected events or urgent needs that arise while also maintaining a degree of consistency.

Manage Thoughts. In challenging times, it is easy for your attention to focus more on the negative. To counter this tendency, remind yourself of transitions and challenges you have successfully navigated in the past. It may be helpful to remember coping methods that worked for you then, as they may also be effective now.

Engage in Practices To Relax. Try to meditate, or listen to music as a way to calm yourself. If you’re experiencing acute stress, you may want to try abdominal breathing

News Intake. Try not to over consume news. Doing so has been shown to increase stress levels and anxiety. It may be helpful to identify a few sources you trust and plan to consult regularly; stick with those sources; and set a daily time limit for reading, watching, and listening to news.

Sense of Humor. Use humor to reduce stress. Watch a funny movie or podcast, read a good book, or tell a funny joke to someone you know.

Physical Care. Eat healthy meals and snacks, drink plenty of water, and get enough rest. Avoid excessive amounts of caffeine and alcohol. Model these behaviors for your family.

Exercise. Set aside time for regular exercise or other physical activity, as research shows this reduces stress and anxiety while also boosting physical health. If your schedule doesn’t allow for long segments of activity, take a couple of 5-minute walks instead. Try to make regular physical activity a part of your everyday routine.

Get Outside. Visit a local park or other beautiful space. Find time to step outside regularly and move around. The fresh air will decrease stress while providing a boost to physical and mental health.

Write in a Stress Journal. Take 15–20 minutes each day to reflect upon stress and write down your thoughts and feelings. If you take time during the day to address stress, it is less likely at night to interfere with sleep.

Celebrate Successes, and Make Time for Activities You Enjoy. Know it is okay to experience joy in the disaster recovery process and have moments of success even after a pandemic or other disaster. Return to doing things you enjoy with your family and spending time with friends.

What To Expect in Your Financial Life

Pandemics may involve intense financial upheaval and stress linked to job loss and work disruption. The loss of a previous standard of living and professional identity, as well as the inability to pay monthly bills, may contribute to anger and prolonged stress and fear.

Seeking financial assistance may help survivors regain a sense of control and create a plan for moving forward. Please refer to the text box for online resources about how to manage finances after a pandemic.

For survivors in immediate need of food assistance, the U.S. Department of Agriculture National Hunger Hotline (https://www.fns.usda.gov/partnerships/national-hunger-clearinghouse) provides information on how to access local food resources such as meal sites, food banks, and other social services.

Personal Finance After a Pandemic
The Consumer Financial Protection Bureau has information on managing finances, finding assistance, and accessing support related to COVID-19:

ƒ Tools To Help When You Can’t Pay Your Bills: https://www.consumerfinance.gov/about-us/blog/tools-to-help-pay-bills
ƒ A Guide to COVID-19 Economic Stimulus Relief: https://www.consumerfinance.gov/about-us/blog/guide-covid-19-economicstimulus-checks
ƒ Protect Yourself Financially: https://www.consumerfinance.gov/about-us/blog/protect-yourself-financially-from-impact-ofcoronavirus
ƒ Dealing With Debt: https://www.consumerfinance.gov/about-us/blog/coronavirus-and-dealing-debt-tips-helpease-impact
ƒ Tips for Financial Caregivers: https://www.consumerfinance.gov/about-us/blog/tips-for-financial-caregivers-duringcoronavirus-pandemic

The Federal Trade Commission has provided information for consumers (https://www.consumer.ftc.gov/blog/2020/04/managing-your-bills-during-covid-19), as has the Federal Reserve (https://www.federalreserveconsumerhelp.gov/about/covid-19-resources), and the U.S. Department of the Treasury has highlighted resources for financial relief after COVID19: https://home.treasury.gov/news/featuredstories/your-money-and-coronavirusresources-for-financial-relief.

When To Seek Professional Support

Reactions to disasters dissipate in time for many survivors. However, some survivors may experience reactions that persist over time, cause them significant distress, and get in the way of their daily lives. Survivors with a recent history of intense stress or with health conditions before and during the pandemic may be at particular risk. Following are examples of more serious reactions after a disaster:

ƒ Disorientation or confusion, and difficulty communicating thoughts
ƒ Limited attention span and difficulty concentrating
ƒ Overwhelming guilt and self-doubt
ƒ Feelings of hopelessness
ƒ Frequent mood swings or continuous crying
ƒ Reluctance to leave home
ƒ Fear of crowds, strangers, or being alone
ƒ Increased use of drugs, alcohol, or prescription medication

If you or someone you care about is overwhelmed by stress and reactions to the pandemic, you may want to reach out for professional mental health and/or substance use services and treatment. Check out the Helpful Resources section for free, confidential help with crises and short- and long-term referrals to care and support.

Helpful Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
5600 Fishers Lane
Rockville, MD 20857
Toll-free: 1–877–SAMHSA–7 (1–877–726–4727)
TTY: 1–800–487–4889
Email: samhsainfo@samhsa.hhs.gov
SAMHSA Store: https://store.samhsa.gov

SAMHSA Disaster Technical Assistance Center
Toll-free: 1–800–308–3515
Email: dtac@samhsa.hhs.gov
Website: https://www.samhsa.gov/dtac

SAMHSA Disaster Mobile App
Website: https://store.samhsa.gov/product/samhsa-disaster

Helplines

SAMHSA Disaster Distress Helpline
Toll-free (English and español): 1–800–985–5990
TTY: 1–800–846–8517
SMS (English): text “TalkWithUs” to 66746
SMS (español): text “Hablanos” to 66746
Website: https://www.samhsa.gov/find-help/disaster-distresshelpline
Website (espanol): https://www.samhsa.gov/find-help/disasterdistress-helpline/espanol
National Suicide Prevention Lifeline
Toll-free (English): 1–800–273–TALK (1–800–273–8255)
Toll-free (español): 1–888–628–9454
TTY: 1–800–799–4TTY (1–800–799–4889)
Website (English): https://suicidepreventionlifeline.org
Website (español): https://suicidepreventionlifeline.org/helpyourself/en-espanol

Treatment Locator
SAMHSA’s National Helpline
Toll-free: 1–800–662–HELP (1–800–662–4357) (24/7/365
Treatment Referral Information Service in English and español)
TTY: 1–800–487–4889
Website: https://www.samhsa.gov/find-help/national-helpline


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