Those days when mental health treatment was so easy/Craig Medred photo

Few know better the dangers of enforced isolation than old-time Alaskans. Tales of “cabin fever” among those locked into the wilderness by the onset of winter are the stuff of legend in the 49th state.

Thus none should understand better the latest report from the U.S. Centers for Disease Control (CDC) warning that government-ordered lockdowns aimed at slowing the pandemic spread of the SARS-CoV-2 virus coupled with a fear of the unknown have been pushing many Americans to the brink.

“CDC Details COVID-19’s Massive Mental Health Impact” is how Medpage Today headlined its summary of that report. COVID-19 is the disease caused by the SARS-CoV-2 virus.

The report itself said that when researchers polled Americans in the last week in June, just shy of 41 percent of them said they were struggling with a “mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9 percent), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic (26.3 percent), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3 percent).”

In other words, this has reached the point where we are approaching half the country going nuts.

The situation is so bad, the report said, that better than one in 10 of those surveyed reported contemplating suicide in the previous 30 days.

Thoughts of suicide were especially prevalent among the young, who are at the least risk of suffering severe or deadly consequences from developing COVID-19, and those caring for an elder or already health compromised family member, the ill and elderly being the most likely to suffer severe or deadly consequences if they contract COVID-19.

“The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7 percent) was significantly higher among respondents aged 18–24 years (25.5 percent), minority racial/ethnic groups (Hispanic respondents [18.6 percent], non-Hispanic black [black] respondents [15.1 percent]), self-reported unpaid caregivers for adult  (30.7 percent), and essential workers (21.7 percent),” the report said.

Alaska history would indicate this should come as no surprise.

Nature’s lockdown

Su Lum, a columnist for the Aspen Times, in 2014 wrote about her own mental health experiences circa 1963 when she was homesteading in a Susitna Valley that was nothing like the suburbia it is now.

For reference, the George Parks Highway from Anchorage, the state’s largest city, through the valley and on to Fairbanks, the largest city in Central Alaska, wasn’t completed until 1971, and for years after that parts of it remained a gravel road.

The Matanuska-Susitna Borough did not yet exist in 1963. Wasilla, the strip-mall city made famous by polebrity Sarah Palin, was a wide spot along the road consisting of Teeland’s Country Store, a railroad station, and not much else.

Alaska itself was home to only about 226,000 people and about 62 percent of them – some 140,000 – lived in rural areas, according to the 1960 census.

Today, the Anchorage Metro population is approaching that of twice the entire statewide population of 1960. Alaska in the ’60s was still very much the American frontier.

Back then, Lum wrote, “nobody knew a thing about anxiety attacks. We were familiar with cabin fever (“Moose stew again?” Blam, between the eyes!), but we didn’t know squat about anything like this.”

Anxiety attacks, it should be noted, are related to cabin fever in that both have connections to social isolation. “Long-Term Isolation Elicits Depression and Anxiety-Related Behaviors by Reducing Oxytocin-Induced GABAergic Transmission in Central Amygdala,” according to neuroscientists.

“Isolation stress is a major risk factor for neuropsychiatric disorders such as depressive and anxiety disorders,” they wrote in a 2018, peer-reviewed study that outlined the chemical pathways to those disorders.

Yes, mental illness is all in your head, but as with all other diseases, there are physiological reasons linked to human biochemistry making it every bit as hard to control as most other illnesses.

Winter’s plague

“We went to the doctor in Palmer, who probably had seen hundreds of cases like mine but didn’t have the energy or wisdom to explain it,” Lum wrote. “He just gave me a prescription for what I presume were tranquilizers. I was so ignorant, I didn’t even think about asking if those pills were OK for nursing mothers.

“The pills didn’t help. Anxiety attacks lurked like assassins behind every corner. I might wake up feeling that the witch was dead only to be felled later while stirring a pudding on the stove, feel that dreaded engine bearing down on me without warning or mercy. It was so physical, I wondered (wished) that it was caused by gases from the propane stove or the logs in our wood furnace.

“The condition gradually abated with relocation (homestead to Anchorage, Anchorage to Aspen), a three-year process, and eventual divorce. But, like a recovering alcoholic, I would never dare think ‘cured.’ That cursed thing is, at best, at bay.

“So when people ask, ‘Don’t you miss Alaska?’ and ‘Do you think you’ll ever go back?’ my reply is vehemently negative.”

Thankfully, she didn’t murder her husband of the time. Too many of these cases of anxiety or cabin fever were once known to end that way. In Anchorage, this was commonly referred to as the “Spenard divorce,” for an area of the city where there was a high frequency of, as Lum put it: “blam, between the eyes!”

Positive changes

Most of the peopled portion of Alaska is, of course, a vastly different place today than it was almost 60 years ago. Humans being inherenlty social animals, or at least most of them, this is a good thing.

The Anchorage Metropolitan Area, which has grown to include the Mat-Su Borough, is today home to more than half the state’s population, ranks among the top 150 U.S. metro areas in size and population, and is in many ways a more urban and less isolated area than Aspen, a ski resort community of 7,000 or so more than a mile high in the Rocky Mountains about 40 miles south of Glenwood Springs, Colo.

Or at least this was the case before the SARS-CoV-2 pandemic brought to Anchorage, as to the rest of the country, a human-induced version of those isolating Alaska winters of old.

In some respects, experienced Alaskans, who to this day suffer through the light-short, seeming isolation of the far north winter, were probably better equipped to deal with stay-at-home orders than most Americans.

Not only because of their experiences with the dark side of the seasons, but because of the blessings of wide-open space, lots and lots of wide-open space in which to get away from internet-fueled worries.

See “Ultimate Isolation.”

While the huddled masses of New York and New Jersey couldn’t get far enough away from each other to slow the spread of the disease in the spring, Alaskans were taking advantage of the state’s lockdown to tour the  vast and unpeopled backcountry on snowmobiles, fat bikes and skis.

Though their social distancing might not always have been perfect, all of the fresh air surrounding them likely helped disperse any SARS-CoV-2 viruses anyone emitted.

As a result, the state in March, April and May saw fewer cases of COVID-19 than in a just a few weeks in July, and the Alaska death rate for the disease – 4 per 100,000 residents – remains about 2 percent of that of New Jersey and New York.

New Jersey is a world leader in COVID-19 deaths with a rate of 179 per 100,000 and New York is closed behind at 169 per 100,000, according to the latest Statista rankings.

Most of the deaths have come in densely populated areas where people are squeezed together almost everywhere they go and live stacked in buildings with sometimes questionble ventiltion systems.

Poor building ventilation has been known to be a contributor to pandemics since the Spanish flu, but it is only now beginning to get the attention it warrants. 

Worst places

Given the staggering death toll in New York, New Jersey and some other East Coast states, it’s valid to ask whether locking people into buildings with questionable air was the best solution to slowing the pandemic.

But it may be there was and is no perfect solution as embattled Swedish epidemiologist Anders Tegnell has observed.

“‘It will be very difficult to achieve any kind of really clear-cut answer as to what was right and what was wrong,’ he said. ‘I think we’re talking years into the future before we can get any kind of consensus on how to deal with this in the best possible way.'”

Sweden’s more restrained responses to the disease, which allowed life to go on more like normal and reduced as much as possible the mental strain on Swedes, has been under attack for months but is looking better to some by the day.

“It’s the country that was heavily criticised for deciding to do things differently when it came to coronavirus – to ignore lockdown and keep bars and schools open,” the New Zealand Herald reported last Saturday.

“And it paid a price with at least 5,700 deaths, putting it in the top 10 of nations in terms of coronavirus deaths per million. But, as time goes on, Sweden’s controversial approach to tackling Covid-19 is winning over some skeptics.

“The Swedish economy has shrunk less than other nations and cases have fallen dramatically, deaths have essentially dried up and no significant second wave has occurred. In fact, right now, Sweden looks better than Australia.”

New Zealand, for its part, looked to have beaten the disease. It went more than 100 days without a community spawned case of COVID-19 and then an outbreak erupted in Aukland, the nation’s largest city.

The country is now in lockdown, France 24 reported, and there are discussions of postponing the national election becuase of the spread of the disease.

Meanwhile, the Swedish death toll of 57.05 per 100,000 isn’t looking as horrific as it once did. The John Hopkins University tracker shows seven countries doing worse, including Spain and Italy which locked down hard only to now be facing new outbreaks. 

And the U.S. – led by New York, New Jersey and Massachusetts death tolls that make Sweden look like a safe space – is quickly closing in on the Swedish tally at 53.60 per 100,000 not counting any of those people who were thinking about suicide and then might actually have done it.

Simply put, the SARS-CoV-2 virus has put many states and countries in that classic and difficult position of being “doomed if you and doomed if you don’t.”

There are no doubt that mitigation efforts – lockdowns, social distancing, hand washing, face coverings – help, but the devil lives in the details

Sweden reported 27, COVID-19 deaths in the last week, according to John Hopkins. That was 64 less than Massachusetts with 91, 14 less than New York with 41, and 11 less than New Jersey with 38.

Those are U.S. states where the death toll is thought to be easing. Texas, which is among the states where the disease is surging, witnessed 1,340 deaths; Florida, 1,027; and California, 798.

Those states still trail New Jersey, New York and Massachusetts by significant margins in death rates per 100,000, but the numbers are going up.

Though the disease may be weakening, it is clearly not going away as New Zealand illustrates, and the questions of what to do next to keep economies from collapsing and protect everyone from going nuts are not getting any easier.