Epidemics were, are and will be unexpected and frightening events that have been present since the beginning of time. They highlight the fragility of man and the vulnerability of his social structure. These epidemics are caused by the greatest murderers in history: microorganisms, capable of sneaking surprisingly into different scenarios, whose mission is to infect and continue to survive, for which they mercilessly attack anyone who crosses their path, producing, in the infected, multiple ailments, including death. In some communities, these epidemics become a relevant cultural and religious dimension that can negatively impact the population. Thinking about the possibility of the emergence of a new disease capable of spreading rapidly, with high morbidity rates and high mortality in certain sectors of the population, is frightening. In addition, leaving significant sequelae in many survivors and the lack of clear evidence of their pathophysiology, which makes proper treatment difficult, increases this feeling. All of this can cause a feeling of helplessness and can generate feelings of fear and anxiety. Does this make us stronger or weaker?

According to Otto Fenichel, fear is an alteration of the state of mind, the product of a situation of risk or damage that can be real or imagined. Fear is an essential alarm and protection mechanism for human survival and it is impossible not to be exposed to it ¹. When there is a disturbance in the psychic apparatus, due to an external stimulus due to the presence of sudden overwhelming events, such as the COVID-19 pandemic, the body looks for mechanisms to restore emotional stability. When we fail in the attempt to control the situation, the individual enters a state of emergency that produces an extremely painful tension that can lead to blockages or diminished capacities of the "I" and/or uncontrollable emotions such as anxiety, anger and helplessness.

In the world, millions of people watch with amazement, concern and sadness how rapidly the social structure has changed since the arrival of COVID-19. The WHO declared this disease a pandemic on March 11, 2020 ², having, to date, an exponential growth in cases. It also directly affects health personnel who are on the front line and security and cleaning personnel who provide services in health centers. These dangers are caused mainly because they did not have all the necessary biosecurity elements to face the threat, and because of ignorance regarding the propagation strategies of this virus. This fear of the lack of biosafety elements also hinders quality care.

The speed of contagion of COVID-19 causes collapse in health services, because the cases exceed the installed capacity of the health care institutions, which translates into a dramatic death toll, due to lack of care. In the same way, the economy was affected in all production areas, mainly in small and medium-sized companies. It also impacted the purchasing power of households, which limits the possibility of accessing goods and services. At first, food was scarce in stores and supermarkets and then there was an increase in its cost. The mandatory isolation and social distancing prevented many families from having access to food and basic necessities, a fact that caused protests in different communities because government entities had not covered these areas with food aid. This caused public order disturbances.

Fear grows silently and permanently. On the one hand, it feeds on the gap in knowledge that persists, despite the large amount of free and easily accessible scientific and non-scientific information available to all audiences. Sometimes, the proper interpretation and verification of the veracity of the information is not performed before socialization, creating more confusion. On the other hand, there are inaccuracies in epidemiological reports regarding the course of the epidemic at the national level. Additionally, there are limitations regarding the logistics, processing and analysis of the information, due to the centralization of the tests. All these factors are the cause of this opinion of insecurity and low credibility that the population has regarding government entities. Add to this the fact that corruption has also been involved, taking advantage of the contingency and the mobility of large resources by the government.

In short, COVID has brought us multiple feelings, most of them negative. The main ones are: stress, anxiety, fear, sadness and loneliness, due to compulsory social isolation. Disbelief for some sectors and fear of the possibility of being infected and dying, Concern for family and loved ones who are exposed, distrust of the neighbor, of the passer-by who may be infected and anger towards those who do not take care of themselves and do not follow the social norms to avoid contagion. All of this can be summed up as: “We have lost that feeling of certainty, that sense of security, that sense of predictability, and that is why it is logical that all this leaves us feeling disengaged and unsure about what is going to happen now” (Kosminsky, taken from ³. Or “I think we are not riding in the same boat, maybe we are going through a similar “storm”, but we are going in different directions. For some, it has been a positive moment, of being with the family and perhaps even “on vacation”; for others, there has been a feeling of unease. Others struggle to find food to eat and there are those of us who live on a roller coaster of emotions between uncertainty, fear and moments of calm” ⁴. As we can see, there are many emotions involved and they appear with different magnitudes and combinations in each individual. The way of dealing with them is also individual and unpredictable.

What does this bring as a consequence? Daily life has been disrupted and the complexity of decision-making increases and judgment is altered, leading to mistakes, guilt and depression. Exposure to this reality is not just biological: in fact, the virus not only makes our body sick but also our mind, because it generates concern, mistrust and human fears of the future and of death; the psyche is also affected, that abstract but very human dimension - and in that sense, also very real - the psychological.

While this occurs in the general population, another consideration is the situation of health professionals who are on the front line. Unlike the rest of the population, those who are on the front line, including health professionals, logistical and professional support personnel, are aware of these elements that affect health and well-being, being more vulnerable to fear and stress. These individuals must identify possible cases, limit contagion for others and for themselves, determine the most effective therapy and delimit an area of independent management, and many more strategies that arrive day after day. Add in the arduous working hours, where there are not only physical but also mental demands, the rigor that must be observed when placing and removing the biosafety elements, the body disinfection: all of these elements add up to increased emotional problems.

Another scenario is the return home where there is uncertainty as to whether or not the virus is carried to the home, the possibility of being judged by their neighbors and the risk of infecting their relatives. Many of them have had to separate from their family because it is safer not to live together at this time in order to avoid contagion. Exposure to risk factors that are dangerous and which professionals are in permanent contact with, results in a high psychological cost translated into severe symptoms of depression, insomnia, anxiety and anguish⁵. In Colombia, a survey of medical personnel showed feelings of anguish about the possible collapse of the health system, the lack of protection elements, and unsatisfactory working conditions ⁶.

With all this comes the anguish. As Freud said ⁷, anguish is an affective state known as one of the most horrible ailments that human beings can experience, motivating the individual who suffers from it to face extreme and irrational situations, depending largely on our knowledge and power regarding what we face on the outside: the greater the knowledge, the greater anguish. Despite the above, anxiety is underestimated and even ignored on some occasions, without taking into account that its identification would shed light on understanding emotional behavior, therefore offering the potential for an adequate intervention.

With this large list of negative feelings, the question is: how should we face them without having a similar experience in the world at hand? From a mental health point of view, we are facing a new cause of deteriorating mental health. Do we have answers to this? NO. But there are many recommendations from psychologists that we can follow to minimize the impact on our mental health.

For this reason, it is essential to work to acquire an open and objective mentality to understand this new reality, which for the moment we cannot change, but which is driving social, economic, scientific and health structural changes from all angles. This new situation must be exploited. Other strategies are based on taking advantage of time for self-care, using this time as an ideal occasion to carry out activities that for many reasons have had to be postponed, organizing your time, allocating schedules not only for work activity, but also for sports, culture and leisure or simply taking a break from the daily pressures and resting. Both options are adequate and you should not feel guilty about choosing one over the other. Adequate nutrition is necessary, since anxiety induces eating disorders, either hyporexia/anorexia or hyperphagia, which affect the person who suffers physically and emotionally, worsening the feelings of disability.

To conclude, humankind has faced different threats throughout its history, forcing himself to acquire skills and abilities to perpetuate the species. Today, we are facing a fatal pandemic where we are currently largely ignorant about this new microorganism and its physiopathogenesis. Diagnosis and management irrefutably leads us to be fearful and to feel anguish which, when properly addressed, has driven scientists and health professionals to develop new knowledge that can be used to fight the invisible and silent killer called Coronavirus.