When the SARS outbreak reached Hong Kong in 2003, it hit hard and fast.
Case one emerged in a hospital worker from China who had been treating SARS patients in Guangzhou.
He arrived in Hong Kong to attend a family wedding and despite feeling ill, he visited family and travelled around the densely populated region. The virus spread to hundreds of people.
Over the next three months, more than 1,750 cases were identified and nearly 300 people died of the disease - the SARS fatality rate in Hong Kong reaching a terrifying 17 per cent.
The Princess Margaret Hospital became a dedicated SARS response facility and Dr Lily Chiu was the facility’s chief executive.
She says at its peak the hospital was admitting up to 100 patients a day, with the number of beds in intensive care tripling in the first week.
Dr Lily Chiu was chief executive at the Princess Margaret Hospital in Hong Kong. Source: Supplied
“Everything happened really fast, really it was like a Tsunami. We had not before been exposed to such a huge onslaught of a very infectious disease.”
Staff worked around the clock, many not returning home for weeks at a time.
It was their mental health that became a foremost concern for Dr Chiu.
She arranged accommodation for staff members at risk of contracting the disease, organised for groceries to be delivered to their families, and set up mental health support programs for those working on the front lines.
Staff at the Princess Margaret Hospital show hearts on their hands as Hong Kong overcomes SARS. Source: Supplied
“To make them feel they don’t need to feel lonely, isolated, that they were just put in the front line to fight and die,” she says.
Studies later found more than 10 per cent of those who worked in the SARS outbreak or were affected by the disease showed signs of post-traumatic stress disorder several years after the event.
'It's traumatising'
Dr Chiu says there was supportive camaraderie during the relatively short SARS outbreak, a camaraderie she fears has been missing during the COVID-19 pandemic.
And health experts in the field agree; COVID-19 is a much bigger beast when it comes to mental health impacts.
Professor Richard Bryant is the director of the Traumatic Stress Clinic at the University of New South Wales. He says the length of the COVID-19 pandemic, with its recurrent lockdowns and financial strain, means the toll on mental health will be widespread.
Professor Richard Bryant is working on an accessible mental health treatment program with the World Health Organization. Source: SBS
“If we look at countries who are ahead of Australia in terms of vaccinations and easing restrictions, even there we see anxiety and depression are actually increasing as well as suicide rates.”
Melbourne resident Spiros Vasilakis says he deals with surges of anxiety every time he hears the daily COVID-19 case numbers.
“Mind-wise, it really sets you back. It’s traumatising, it is traumatising, it just doesn’t let up, you try to move forward and you just can’t do it.”
He lost his mother to COVID-19 early on in the pandemic, in July 2020, when the virus infiltrated her nursing home.
In the weeks following, he also contracted COVID-19, along with his wife and sister.
They all now live with ongoing health impacts of the virus and the trauma of being impacted by COVID-19 on multiple levels.
“Mentally though, it’s drained me. I tried to go back to work. I just wasn’t in the frame of mind to actually participate,” Mr Vasilakis says. 
Spiros Vasilakis. right, lost his mother to COVID-19 and contracted the virus himself. Source: Supplied/Spiros Vasilakis
Psychiatrists in demand
Melbourne GP Stacey Harris says before COVID-19 she would see a handful of patients seeking mental health support each week, but now she says it’s almost every appointment.
“I can’t refer anyone to a psychiatrist; most of them have closed their books. So the cases that are really borderline, the only option is to go to hospital.”
Figures from the Australian Bureau of Statistics (ABS) show one in five people in Australia are reporting high or very high levels of psychological distress linked to the pandemic. In Victoria, the statistic is even higher with 27 per cent of the population struggling to cope.
Melbourne GP Dr Stacey Harris fears the scope of COVID-19 related mental health is being underestimated. Source: SBS
A recent survey by the ABS showed each surge of COVID-19 leads to greater mental health impacts, with the recent Victorian outbreak leading to almost one-third of people reporting feelings associated with depression and anxiety.
Those most affected are women (23 per cent), younger Australians (30 per cent) and those with pre-existing mental health conditions (48 per cent).
Dr Harris says in her experience, the mental health impacts of the virus don’t decrease when the case numbers drop.
“Things sort of got back to normal January or February but I was still seeing people who didn’t get help last year with the lockdowns and saying, 'I know it’s after the fact but I’m really suffering, I really suffered last year in the lockdowns and that just kept going.'”
Mental health experts predict a significant proportion of Australia’s population will be left with psychological impacts from COVID-19, with some estimates putting the figure as high as 20 per cent.
Professor Bryant says Australia has the benefit of observing countries such as the United Kingdom that are further along in assessing the mental health legacy of the pandemic.
“One in four people still report marked loneliness and it will be an issue because people won’t go back to the life they had before COVID. We're still going to have a lot of restrictions in place, a lot of people’s plans have been disrupted; schooling, university, careers, relationships - these won't bounce back overnight.”
He recommends people should try to learn new skills and new mechanisms to cope moving forward.
UNSW in collaboration with the World Health Organisation has created a consisting of group video-conferencing sessions with a clinical psychologist, covering skills to manage stress and worries resulting from the pandemic.
The approach focuses on boosting positive moods, with trials showing positive results for improved mental health outcomes.
Professor Bryant says now is the time to establish sustainable and accessible mental health programs, to ensure Australia has a psychological roadmap out of COVID-19.
World Mental Health Day is marked on Sunday 10 October.
Readers seeking support with mental health can contact Beyond Blue on 1300 22 4636. More information is available at . supports people from culturally and linguistically diverse backgrounds.
