Hysteria

Yu Chengbo, chief physician at the First Affiliated Hospital of Zhejiang University School of Medicine in Zhejiang province, led the first group of medical responders from Zhejiang into one of Wuhan's worsthit coronavirus districts.

The team worked night and day, and Yu was surprised by the mental state of the patients, their hysteria and open hostility.

One 40-something had mild symptoms, but he was distressed about his elderly parents. Feelings of helplessness plagued him and he was inconsolable.

"He could barely stay in the ward. He demanded we let him leave," Yu said. "We couldn't, of course."

The man died after five days. "The disease didn't kill him," Yu said. "His emotional state killed him."

According to Samuel Ho, professor of psychology at the City University of Hong Kong, when people are confronted by a traumatic event caused by something invisible or intangible, they tend to project their fears and hostility onto something tangible as a way of coping.

In the case Yu cited, the patient could find no outlet for his fears. Like many patients, he seemed to regard the medics as somehow connected to his affliction, Ho said.

Moreover, the sight of doctors reminds some patients they are sick, and the medics come to embody the disease. The patients' natural response is "flight", he added.

Yu said it was excruciating to see the patients' displays of "apathy and indifference" toward the doctors.

He believes he can sense a visceral "distrust" of doctors among patients from his experiences. He noticed it in the first couple of days in Wuhan. "When we approached them (the patients), they ran away and hid," he said.

Mak said that is a natural response to potential harm, threat or danger－an evolutionary way of coping with an emergency, embodied in the "flight or fight" theory.

"When someone is in trouble, he may be anxious to the point that he avoids everybody," he said.

Lam, the psychiatrist, said the release of stress hormones, followed by physiological changes that raise the heart rate and blood pressure, are natural self-defense mechanisms that help people prepare for imminent threat and danger.

However, if an excess of stress hormone is released, allowing unpredictability and uncertainty to disturb mental preparations, the stress and anxiety can be unbearable.

"Eventually, the excessive anxiety will affect the immune system, doing no good in fighting illness," she said.

Given the slew of psychological issues that coronavirus patients experience, Mak said it may be too much for front-line staff to juggle providing treatment with offering psychological counseling.

Lam suggested that online psychological counseling could be helpful in situations such as the coronavirus outbreak.

Mak agreed. "Bringing patients' family members in－for example, allowing them to have video calls or bringing them up to date on family matters－could be the best antidote for emotional trauma," he said.