Mental health advice for worries about South Asian COVID genetic risks and new variants

A conversation with psychologist Anushka Phal

If I’m honest, the ‘South Asian gene increases COVID risk’ news stopped me in my social media scrolling tracks. 

I entered into this internal dialogue, like two characters from House, MD were having a debate in my head: 

Imaginary Doctor me: “What are your symptoms?” 

Me: “General freak out and Doom Googling about new research. It says South Asians have a gene that doubles our risk of dying from COVID, and about 60% of us have this gene. Should I freak out? Does it mean if I get COVID, it’s more likely that I’ll die?”

Imaginary Doctor me: “Don’t freak out, but yes. I’m a qualified, if imaginary, doctor and that’s what it means.” 

Me: “But, I’m double vaxxed and everything.” 

At this point, my television-drama fuelled brain had no solution and went into a meltdown. 

And that’s where I found myself when I reached out to SAARI writer and practicing psychologist Anushka Phal for some guidance. 

COVID and health information anxiety

Anushka starts with the first smart move of any good psychologist - normalising feelings. In other words, she tells me I’m not crazy for worrying. 

“When you hear something that’s major, as with articles like this, unless you’re super-interested and read the whole thing, you’re going to just read the first little bit - and be thinking ‘whoa, this is it’ because everyone is so fast-paced these days,” she says.  

“And the health anxiety that sets in is going to be super hectic.” 

This flavour of anxiety is defined not by actually having a condition, but instead by obsessive and irrational worry about having a serious medical condition. 

Health anxiety used to be called hypochondria, and sometimes you used to hear people say, “Don’t be such a hypochondriac” if you washed your hands a little too often or carried hand sanitizer with you. Gone are those days. Now we inhabit a different reality in a world awashed with COVID, one where everyone understands health anxiety, even as long-term lockdowns end across Australia and the threat of the new Omicron variant slowly rises. 

In her practice, Anushka has seen many individualised responses to the purported end of lockdowns, as isolation and anxiety have impacted people differently depending on their circumstances, coping mechanisms, genetics and culture. 

“I’m seeing it across the board - parents, adults, kids. Especially new mums; they are very conscious about their kids, as they should be.” 

“Just because we’re at a high rate of vaccination doesn’t mean we snap back into everything being ok,” she explains. Her words reflect the fragility of my own re-emergence, now even more shaky with this latest revelations about my biology and new variants.  

“But with this news of the new South Asian gene, the mental health implications are about watching our thoughts, and looking at how we see it as a restriction. We ask: what should I be doing? Can I go out - and then get really anxious about it.” 

Anushka breaks it down for me. The pervasive anxiety many of us are feeling has multiple dimensions: mental, emotional and physical. 

“With anxiety, especially health anxiety, the mental aspect plays out in overthinking, and then you have the emotional side where all of a sudden you feel down because everyone else is going out and you’re not and then you worry if you’re overreacting having those feelings. Then you feel alone and the loneliness hits in. And then there’s the physical aspect with an  increased heart rate, and sleep deprivation and other symptoms.”

In other words, she’s describing me - sitting awake in bed, doom scrolling, and feeling like a hot mess.  

But maybe that’s not a bad thing. 

“People don’t take time to sit and think about things. They end up with passive emotional responses. But sitting with it is the most important thing you can do,” Anushka suggests. 

So perhaps, allowing myself the time to be a hot mess can be a healthy start for processing my feelings about this new health information.  

Lightning fast word of mouth breeds fear 

Any dutiful South Asian on WhatsApp is greeted by good morning messages. Even John Oliver on his show Last Week Tonight on HBO highlighted this type of communication and how fast misinformation and memes can spread on social messaging apps. 

In the context of this new information about the South Asian gene, the risk is not just the actual risk, which we can’t yet quantify, but the perceived risk, one that snowballs in the panopticon of contextless and often unverified social media messages. 

Recently, WhatsApp even created an ad in India to let users know that there’s potential misinformation on their network and to fact-check their sources. 

Anushka Phal knows the world of WhatsApp forwards all too well. “If the risk is as high as the study suggests, the worry is that word of mouth travels really fast and people haven’t fully read the news or the research. With no context people will say, ‘have you heard about this new gene?’ and will then jump to their reaction, and information will spread like whispers without getting the whole story,” says Anushka.  

She is mindful in calling on us to be more media literate or face increasing fear. And like all fear, it’s home is our emotional, irrational side. 

“Sometimes it’s not until one person goes back and reads it in full that we really understand. But the media and most people will just lean into catastrophe - numbers, and statistics and facts. It just induces a lot of fear.” 

“If you’re already someone who’s anxious or worried about COVID, then it just adds to it.” 

“There’s so much information, and conflicting information, out there. First we were told to take Astra Zeneca, then we were told there were issues with a particular age group, and then it was - everyone get jabbed.” 

“My advice to people is: if you’re going to come across any health promotion information, take some time out. As part of this break, there are two steps.” 

“First, go do some of your own research. By yourself, so you have your own source of information.” 

“Second, take some time out. Just sit and process it. Ask yourself: What would it mean for you? What would it mean for your health? For your daily living? For your family? What changes and adjustments would you have to make?”

“And, assess the likelihood of that happening to you. And if concerned, [ask yourself] what next steps can I take?”

 

An intervention for ourselves, into our own thinking, can be a lifesaver. But we rarely do as Anushka suggests and work through it. 

Anushka Phal

“It’s better to take half an hour and hash that out instead of going into panic about it and then getting worried,” Asushka advises. 

Without this processing time, we can get lost in our thoughts. I see this pattern in my friends and family, and I even see myself falling down the rabbit hole. 

“I see people often going down a spiral, or like on a train,” Anushka reflects. “They’ll swipe their Myki and get on a train and keep going and going, until they get to the end and realise what they’ve done.” 

“By that time it’s already so debilitating to your mental health to have thought so much and felt so much.” 

“Rather than getting anxious about something that hasn’t happened yet, try pulling yourself back. And think - happiness isn’t your baseline. You’re allowed to feel worried and anxious and unhappy about things.” 

“But also be practical about it, because there is also information out there. You can go further by contacting people in the article directly, or your GP, or a different GP. There are resources out there. It’s just a matter of accessing them and being more proactive.”

“Go and get support from the people around you. Sitting and worrying about it is not going to do a lot of good for anyone,” Anushka says. 

A Communal Thought Train

In a communal South Asian culture, it’s not just our own worries we contend with. We are also on everyone else’s thought-train, constantly exposed to all the information and misinformation around us and the emotions and ideas of the family and close family friends within our circles. Those emotions can be contagious. 

“It’s like being on a packed train in India,” Anushka says.  

Anushka counsels us to exercise choice. “You don’t have to get on that thought train. You can acknowledge the thoughts are there - either yours or others - but you can choose to let them pass by and not engage with them.” 

On the flipside, some of the thoughts we carry in the communal space include the notion of our shared welfare. Culturally, with intergenerational family homes, many South Asians feel a duty to look after the members of our family, especially the elderly. In a COVID health context, this thought-train becomes a sense of urgency and obligation to help our family and community get vaccinated. 

In light of this newly manifested and heightened genetic awareness, that obligation to counteract the risks of the gene by encouraging vaccination, especially for those uncles and aunties and relatives who might be hesitant, resistant or lazy, takes on a new urgency. That urgency is born from a communal sensibility towards individuals, but it is also the only way we can combat the communal risk. If there’s one thing we’ve really learned from COVID, it’s that we literally live or die together as a community.

“We’re such a collectivist culture. We like to support each other, rely on each other,” Anushka acknowledges. “We like to convey that information to each other, to inform each other.” 

“But number one, you don’t have to have an obligation,” Anushka says. 

I ask her to say this twice because it’s so contrary to the thinking I have encountered culturally - even as far back as the ancient references to dharma, the idea of shared karmic duty. 

“Growing up in a collectivist culture, you feel like everyone’s problem is your problem. It’s not,” Anushka expounds. 

“That’s not easy. But also you might encounter resistance if you share information. That someone heard it from so-and-so who is a doctor.” 

“So if you want to help your family with information, it’s important to assess the best time and best way to introduce that conversation with your family.” 

Anushka’s advice is grounded in common sense - choose your moment and preserve the relationship. 

It’s ironic that many South Asian parents want their children to be doctors; but in contrast how many actually go see a doctor when they’re sick? Or believe the medical advice from their own children over gossip, a forwarded video, or the magical healing powers of turmeric? 

“My mum is case in point,” says Anushka. “She’s more likely to listen to my mental health advice as a psychologist if she pays to attend an event I’m speaking at than just hearing it from me firsthand or on a daily basis.”

“I’ve noticed in the South Asian community that citing third-party sources, from outside the community, actually makes a difference.”  

“That can help you if you frame it in a conversation with your family by saying ‘this is happening to both/all of us’ and having very generalised discussions around the topic, and then funnelling down to their specific circumstances,” adds Anushka. 

That sense of hierarchies of knowledge, ‘small g’ gurus in our community or the world-of-mouth South Asian version of an ‘influencer,’ are all important pathways to bridge understanding and meet your community where it is at without raising doubts about new authorities and sparking a ‘judgment hurricane.’ 

“What your family and community think are valid sources of information is really important to acknowledge, even if you know those sources may not be the most reliable.” 

“South Asians can be super dramatic, so sometimes the information has to be presented with matching drama, or urgency, as well.” 

What we can do

The genetic risk of death from COVID for South Asians is greater than the overall population, but as yet unspecified. Being vaccinated appears to be the best step we can take, even in the face of the emerging Omicron variant. 

In some people, this recent news about genes and variants generates a resignation, and in others it creates a desire to take action. I quiz Anushka about what we can do if we have this sense of energy that we want to use or direct somewhere, but have no specific way to channel the feeling of uncertainty.

She gives me six tips. 

1. Focus on what you can control

“Something everyone can do is to look at what is in their control and what is out of their control,” Anushka advises. “That is always helpful when dealing with uncertainty.” 

“Things outside your control include: COVID, your genes, and the external environment. You can control: your engagement with your family, part of your work, choosing to unplug, how you relax, and what you read or watch.” 

2. Match your self-care to your energy levels

“If you have this burning energy you need to get out - engage in different forms of high-energy self care like exercise. Sometimes calling up a friend to vent or have a rant can be great for you.” 

“Some people need to use that energy and others need to calm it down. That may be a lot of hours of Netflix. Let’s get real: no one watches Netflix for just one hour.” 

3. Declutter your space online and physically 

“One thing you can do is to reassess your social media. Unfollow a bunch of people, even the news if you have to. Declutter your social media, and you can declutter your physical environment as well, and even your computer desktop.”

4. Clear your mind to process better 

“Engaging in meditation, mindfulness or tapping can help to clear your mind. Everyone clears their mind in different ways, but when you have clarity you can think through things a little bit better.” 

5. Know it’s ok to seek help

“Whether it’s from your friends, your family, your community or a professional, if you’re really worried about this news, and it’s not going away, it’s ok to go have a conversation. It’s not about getting rid of the feeling, it’s about finding a way to sit with it, something beyond ignoring it and trying to be happy.” 

6. It’s ok to be uncertain

“If we knew everything that was going to happen, how mundane would your life be? Realise that uncertainty is not alway bad. You just need to give your thoughts some space,” Anushka says.  

If none of that works and you’re still spiraling into panic mode, Anushka offers a final piece of advice: 

“If you are worried about it right now and you’re getting anxious and you’re worried about something that hasn’t happened yet; on the off chance that it does happen in the future - you’re going to be panicked then anyways.” 

“You’re going to be stressed, worried, anxious - in the future, if something really does happen. So if you feel all those emotions now, before it does happen to you, then you’re living those emotions twice.” 

“Why would you do that to yourself actively?” Anushka says. “You’re saying I’m going to panic now and I’m going to panic when it happens.”

“If there’s an equal chance of something happening, you’ve panicked now for no reason,” she suggests. 

“If something does happen in the worst case scenario, eventually - in one week, month or year, ask yourself - will I be ok and will I be able to handle it? And what tools should I be working on right now to be able to deal with it in the future? That’s the question you should be asking.” 

“The mental preparedness of health consequences is really important for your physical health. Cultivating an open mindset is really important, as a life skill, and it can make a big difference to your health, especially if you can learn to not worry about something now if you might have to worry about it later.” 

While my worry isn’t fully gone, I take heart in postponing it until something bad actually does happen. In this rollercoaster of genetic uncertainty and variant possibilities, it’s the best I can do. 


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Sandeep Varma is the Founder of SAARI Collective.