Remote Working during the Pandemic: A Second Q&A with Gillian Isaacs Russell

On the first anniversary of the beginning of the Covid-19 pandemic lockdown, Gillian Isaacs Russell, author of the influential Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy, returns to respond to a second set of questions from the BJP. In this interview by email, she considers the challenges and issues that came up for clinicians and patients during the last year of working remotely. Looking back at the year as a whole, she explores the impact of ongoing trauma on the therapeutic couple. She discusses the creative ways that clinicians have found to navigate the losses and differences between co-present and distance treatment, including holding an internal paradox of immersion in telepresence and the maintenance of a reflective distance, to be shared and explored with the patient. She examines the effects that differing hardware such as telephone or computer screen have on our intimate communication, how the intrusion of the personal environments of both clinician and patient may have affected the dynamics of the therapeutic couple, and the personal and global experience of loss and bereavement for both therapist and patient, particularly when it has to be processed remotely. Finally, the BJP asks her to give her thoughts on the future and whether the 'new normal' will include more hybrid forms of training and treatment.

Older people at the beginning of the COVID-19 pandemic: A scoping review

This scoping review focuses on evidence gaps regarding the effects on health, social participation and life contexts of older people at the beginning of the COVID-19 pandemic. It is based on a systematic search strategy of the international literature covering a period between December 2019 and June 2020. The review is supplemented by a search of the websites of selected organisations in Germany (cut-off date: 29 June 2020). Search hits were differentiated by types of publication (empirical study, review, discussion paper). The contents were summarised in tabular form according to topic. The publications mainly discussed the high risks of suffering severe courses of COVID-19 faced by older people, specifically those belonging to certain subgroups. In addition, further main topics were the pandemic’s indirect impacts on physical and mental health, physical and cognitive functions and participation in society. Social isolation, loneliness, reduced levels of physical activity and difficulties in maintaining care were discussed as major health risks. Ageism was an issue that was addressed across all of the identified topics. The publications highlighted the need, but also the opportunity, for raising public awareness of the needs of older people in various life contexts. Publications pointed to the urgent need for research into the biological and social causes of older peoples’ high infection risk and how measures could be adapted in a differentiated manner (infection prevention and control measures, social support, medical and nursing care).

Disease severity of the first COVID-19 wave in Germany using reporting data from the national notification system

As of December 31, 2019, initial reports circulated internationally of an unusual cluster of pneumonia of unknown cause in China. By the end of January 2020, the virus affected Germany with the first case confirmed on January 27, 2020. Intensive contact tracing and infection control measures contained the first two clusters in the country. However, the dynamic of the first wave gained momentum as of March, and by mid-June 2020 over 190,000 laboratory-confirmed cases had been reported to the Robert Koch Institute. This article examines these cases as part of a retrospective descriptive analysis focused on disease severity. Most cases (80%) were mild and two thirds of the cases were younger than 60 years (median age: 50 years). Severe cases were primarily reported among men aged 60 or over who had at least one risk factor (particularly cardiovascular disease, diabetes, neurological disorders and/or lung diseases). Cases between the ages of 40 and 59 years had the longest interval between symptom onset and hospitalisation (median: six days) and - if admitted to an intensive care unit (ICU) - also the longest ICU stay (median: eleven days). This analysis provides valuable information about disease severity of COVID-19 and particularly affected groups.

Health behaviour and COVID-19: Initial findings on the pandemic

The COVID-19 pandemic poses new challenges to both individuals and societies that impact health behaviour in many ways. This narrative review brings together initial findings for smoking, alcohol use, nutrition, physical activity and obesity. Smoking and obesity are potential direct risk factors for a severe course of COVID-19, and alcohol abuse, physical inactivity and an unbalanced diet can be indirect risk factors. The constraints of public life to contain the COVID-19 pandemic reduced the opportunities for physical activity and sports, although the initial results on physical activity during this period for Germany do not reflect this assumption. While a part of the population reports making healthier diet choices than before the pandemic, others do not. For smoking and risky alcohol use, data at an aggregate level for the general population do not indicate any behaviour changes. However, different trends appear to be emerging for different population groups pointing to the fact that social inequalities in pandemic-related changes to health behaviour must be assumed. Should further studies confirm these results, this would indicate a need for pandemic-specific prevention measures. Furthermore, specifically during the pandemic, prevention and health promotion measures directed at changes to health behaviour should continue to be implemented and adapted to the restrictions due to the pandemic. Equity in health should be promoted in particular.

REMOTE WORKING DURING THE PANDEMIC: A Q&A WITH GILLIAN ISAACS RUSSELL: Questions from the Editor and Editorial Board of the BJP

In this interview by email, Gillian Isaacs Russell, author of the influential Screen Relations: The Limits of Computer‐Mediated Psychoanalysis and Psychotherapy, responds to a set of questions from the BJP. The interview focuses on the impact of remote working during the coronavirus epidemic, starting with the question of whether an effective therapeutic process can occur without physical co‐presence. Isaacs Russell shares her immediate thoughts about the virtually overnight changes to our practice that came with the epidemic, and the work of the American Psychoanalytic Association's Covid‐19 Advisory Team, on which she sits. Her responses are informed by recent cross‐disciplinary and neuropsychological research on the digital age. She considers what happens to free association, evenly suspended attention and reverie when working by phone or online; the loss of the consulting room as a containing physical space for both clinician and patient; the relationship between place and time; and whether (and how) we can maintain a focus on transference and countertransference in the presence of the threat of death. The interview ends with her thoughts on whether we should assume that the landscape of analytic therapy will be permanently altered by Covid‐19, and with her hope that general awareness of the impact of trauma on our mental health has been raised.