A Review on Lockdown and its Effects on Mental Health Due to Corona Pandemic

The Covid-19 pandemic is affecting society in various aspects of life. This outbreak was initiated in a laboratory accident centered in Wuhan, China. People are suffering from psychiatric disorders due to the disturbance in several sectors of the society which includes the most important “socializing”. The abrupt step of lockdown taken by the government authorities has led to a severe social distancing. This social distancing has a direct impact on their psychosocial thinking. Due to this lockdown people have started to overthink on daily normal issues which were not completely dealt with. Now due to the increase in time and isolation from society, the various problems associated with this quarantine have been highlighted. The government has enforced lockdowns from time to time. These lockdowns have created not only mental health issues but also physical and social health problems. Along with health issues, the country suffered economical losses and the GDP went to negatives. Many people suffered losses. There were shortages in food and other day to day facilities. With only the essential services going on, people were in a lot of trouble. But listing down the cons of lockdown, we have to believe that this very lockdown was one of the perfect measures by the government. This very lockdown is the reason that the cases have declined to a great extent.


INTRODUCTION
Covid-19 came in to picture by the fall of 2019, December when WHO was informed about a few cases in Wuhan (China) who were suffering from pneumonia with unknown cause, this disease travelled across the globe leaving behind imprints of a virus named 'SARS-CoV-2'.By taking strict measures, the government has implied national lockdown in many countries [1]. Coronavirus disease (COVID 19) is a lifethreatening disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus is contagious in nature which means it spreads through contact and is one of the fastest modes of transmission. After the first case detected in china the word covid 19 never went off our memory. It has shaken the world entirely, not only physically but mentally also. Months after the lockdown started, psychiatrists had a bunch of patients with one or the other mental conditions which included anxiety attacks, behavioral changes, depression, and many more.
Hospital staff who are serving the covid positive patients are always at a high risk of coming in contact with the virus, although there are guidelines as to how to protect yourself but the risk still remains. The front-line workers are fighting this disease for the people without caring about their own lives.
Many people lost their jobs because of the financial crisis due to coronavirus spread, also creating havoc in not only the young entrepreneurs but the top ones as well.
Even such common symptoms like fever and cough, tend to do a lot more inside the body. The virus mainly infects the sinus, nose, and throat and then spreads to the windpipe and finally lungs. The virus after entering the body attaches itself to the ACE2 enzyme and enters the host cell. ACE2 is present in the alveolar cells of the lungs. The virus also infects the gastrointestinal system. This virus tends to attack the myocardial tissues as well and thus some covid positive patients are seen with thrombosis as well as venous thromboembolism. This virus in some cases has also been associated with kidney failures in patients with no kidney problems. It is said that the novel coronavirus cannot enter the central nervous system but low levels of this virus are found and confirmed in some patients who died of covid. Even though the virus has been found in the cerebrospinal fluid but how it has reached there is still unknown. The virus is also thus extracted in the blood samples, feces samples, and adipose tissue [2].

LOCKDOWNS IN INDIA
On 23rd march 2020, the PM of India Narendra Modi had announced a lockdown nationwide for 21 days limiting all movements due to the surge in covid cases in India. A voluntary Janta Curfew was held on 22nd march, which was followed up by various rules and regulations to be enforced in the country. When India had reached approximately 500 cases, lockdown was made mandatory in most states. Maharashtra and Kerala were the first two states to impose lockdown as the maximum number of covid cases were contributed to India by these states. It was observed that cases were declining due to this lockdown and hence Punjab and Orissa had extended their lockdowns till the 1st of May. This was followed by Maharashtra, Karnataka, and West Bengal as well. On the 14th of April, the PM himself extended the lockdown till 1st May throughout the country which was further extended till 17th May. The National Disaster Management Authority had divided all the districts into three main regions-orange, red, and green this authority further extended this curfew up to 31st May. This major lockdown led to a decrease in cases nationwide but created a lot of problems. the people were not allowed to step out of their houses. Transport services such as trains, flights and ships were stopped and only transport of essential goods were allowed. Educational institutions were suspended and all students were sent home. Online courses started and students as well as parents were not allowed to go out. Offices were shut down and work from home was made mandatory. ATMs, Petrol pumps, shops were also allowed for limited time periods [3].

Phase 1 (25th March-14th April)
On 24th March, all services were suspended. In some parts of the country, people were hurrying to stock up goods and products because they had no idea how long this lockdown would last. The government held meetings with e-commerce websites and ensured that there was continuous delivery of essential goods throughout the country. Many states arranged for relief funds for the poor and the affected individuals [4].
26th March, the finance minister contributed Rs.1,70,000 crore to all those who were affected due to the lockdown.
On 31st March, for the first time in 167 years, Indian Railways were suspended. The Railways also announced plans to convert coaches into isolation wards for people suffering from covid. The 5th of April showed a new respect for health care workers where every Indian switched off their lights for 9 mins from 9 pm to 9:09 pm, they even flashed torchlights and lit diyas.

Phase 2 (15th April-3rd May)
14th of April, the PM of India announced that lockdown has been extended till 3rd of May. He also said that some relaxations will be given in those states where the cases had declined. Every town, police station and every state were to be evaluated carefully to see if the cases had decreased. On 16th April, there were three zones identified. They were "red" zones which indicate infection hotspots, "orange" zones for infection, and "green" zones for free from infection.
The government allowed agriculture, dairy, aquaculture, plantations as well as shops that sell farming products. Public works were open along with institutions with specific social distancing rules and regulations [5].
On 25th April, small retail shops with fifty percent staff. were allowed. States were particularly told to screen, quarantine, and do periodic health check-ups.

Phase 3 (4th-17th May)
There were 130 districts in the red zone, 284 districts in the orange zone, and 320 districts in the green zone. Those with high cases of covid and a very high doubling rate were put in red zones. the districts with fewer cases than red zones were put in orange zones. The green zones were the ones that were completely free of the infection since the last twenty-one days. Movement was permitted in the no infection that is green zones with buses which were limited to half capacity. Public transportation was not allowed in orange zones, in these areas, only private or hired vehicles were permitted. This classification was to be revised once a week.

Phase 4 (18th May -31st May)
The National Disaster Management and Ministry of Home Affairs had extended the lockdown to 31st May. The red zone was classified into a buffer and containment zone.

RULES AND REGULATIONS DURING COVID LOCKDOWN
Until the 3rd of May the following activities were banned: All international and domestic flights were cancelled, only flights supplying essential goods were permitted. All train passengers were not allowed. Buses and public transports were not allowed. Coaching institutions, training and educational houses were also suspended. Industrial and commercial businesses were not allowed. Auto rickshaws and cycle rickshaws were not allowed. Malls, cinema halls, shopping complexes, theatres, entertainment parks, water parks, assembly theatres, auditoriums as well as clubs, bars were suspended. All cultural, political and sports activities and rallies were not permitted.

Guidelines in Red Zones-Hotspot Areas
Large covid 19 outbreak areas were called hotspot areas. The Ministry of Health had demarcated containment zones and buffer zones. Strict perimeter control had to be established to control the people coming in and out of the areas. Only essential services were allowed.

Rules to be followed in Workplaces
The workplace should be clean and hygienic. Surfaces must be disinfected instantly after use. Promoting handwashing among employees was made mandatory. Maintaining good respiratory hygiene. Face masks were made mandatory all the time. Fines were imposed if masks were not worn. Social distancing was particularly specified in every corner. If people developed a fever that is more than 98.6, then they should be quarantined and reported to the nearest doctor or health care facility.

Problems Faced During Lockdown
One of the major issues which should be addressed is Mental Health. This is a very serious problem which people don't talk about.
This part of health needs to be looked after as soon as possible.

Mental Health
People are suffering from psychiatric disorders like anxiety issues, anger management issues, stress disorders, depression, anticipation, fear, and concentration issues.
Consequent lockout due to coronavirus ultimately impacts the mental health of one and all. However, while there are plenty of recommendations and tools to treat mild and moderate symptoms of depression, stress, and anxiety during the COVID-19 pandemic, it can be more difficult to know where to approach in case of a mental health crisis [6].
Not only the people who are under lockdown in their own houses are suffering from this change of mental state, but the doctors, nurses, researchers, and other staff are also experiencing a kind of change in their routine behaviour [7].
They are expected to work highly efficiently and result of the work is expected to be high, moreover it is always in their subconscious to stay safe from the disease as they also have a family to protect, they have decreased their social interaction and their leisure time to concentrate on the work they are doing [8]. They are also keeping aside their personal life so as to serve the needful. People with developing or existing mental health and substance use disorders have started experiencing relapses and negative outcomes because they are avoiding health care facilities or unable to access their care providers. People are afraid to discuss any kind of respiratory problem with others like normal cough and cold as they think they are being judged and discriminated against [9].
Dealing with suicidal thoughts has always been distressing and disturbing, and lockdown is making us feel more disconnected from our emotions, understandably. Collectively, we face confusion and anxiety about the future, social isolation, our limited movements, and the difficulty of adjusting to new routines. There are millions of tweets, posts, shares on social media about covid-19, of which a few convey wrong information about covid-19. And because of this, people are more worried and anxious about the situation than people who do not have contact with social media. And when those posts and shares are being trolled on social media, several words like "hate", "sadness", "negativity", "fear", "disgust" are often felt by the people who are locked down in their homes [6].
People who are quarantined and are being either tested or treated for Covid along with their family members are also facing many problems as the patients are in very much pain to deal with this situation, these patients themselves want to get out of the quarantine bed but they cannot, the family of those patients and other family members are worried if their patients will return home healthy. More over due to covid-19 lockdown, the daily cycle of people is disturbed to such an extent that the people have stopped taking their medications or missing out on their doses which will affect their physical health and will give rise to plenty of existing infections or will increase the emergence of new infections at an individual level.
School and college going students are facing a lot of problems as their classes are online, and staying at a place and accessing major work through a screen leads to undoubtful stress on eyes and mind which can change their way of interaction with people during adolescent age and make multiple teenagers independent and not asking for help, by which they will lose the ability of working in a team environment and thus result in not being productive. Now being in a limited environment, the students have started adapting to a comfort zone and work in that zone only, because of which, when they will have to get out, and travel to their schools and workplaces, there will be a mismatch of competencies among students and thus result in lack of productivity. This will also lead to discomfort in the social gathering atmosphere and thus many will face the problem of socializing again.
Students of final year or who have had got their placements earlier, and have not received the joining letter of the respective jobs are dealing with anxiety issues and are seeing themselves as equivalent to the unemployed and due to the on-going recession they have fears of not getting a job sooner, and currently due to high expenses and low or no income, people are at a fear of getting short on food and money, thus leading to having anxiety disorders.
Due to frustration on a personal level, domestic violence has increased significantly in the household of those who are facing problems in basic amenities, along with an increase in drug consumption, which in an Indian household is usually monitored and controlled by the female partners by applying restrictions on them. This has increased the psychological difference in partners and thus family integrity is at stake [10].

Economic Impact
There is a progressive slowdown in the economy. The Gross Domestic Product fell from 8.2% to 3.1% during this period. The Gross Domestic Product for April-June fell to negative that is -23.8%. Manufacturing, hotel industry, travel, tourism and construction also showed a very specific decline. Trade and hotel businesses fell to -47%. Construction fell to -50% [11].

Food Supply
The Home Ministry issued an order on 24th March which allowed the shops with food items to function. The policemen used to stop all the trucks and workers who were going to their factories. Food places and industries were facing shortage in labourers because people could not reach their places and many places were scared of legal actions. All these resulted in shortage of food and prices were increased.

Migrant Workers
The ones who were most affected were the labourers. These workers lost their jobs due to this virus and were affected economically and mentally. All factories and workplaces were shut down, millions of workers became homeless. These workers dealt with shortages in food, incomes. They were not paid anything. They were uncertain of their future. Families had to remain hungry. Many people lost their lives due to these shortages rather than the virus. With no work, many workers wanted to go back to their native villages but were arrested on the way back due to violating rules enforced by the government during the lockdown. Around 1st of May, the Indian Railways announced a new special train called the shramik special train which was specifically for the labourers and workers.

CONCLUSION
Nationwide lockdown was imposed by the Prime Minister of India in March. This lockdown had several impacts on people and the country. This lockdown is the reason that the cases have declined but this very lockdown has also created various problems. The economy was greatly affected. People have lost their jobs and many have died due to these reasons and not the virus. Lockdowns have also led to depression, people have suffered from mental health issues. With these rules and regulations, cases came down. This led to relaxations. Mental health is one of the most highlighted leading issues globally. The Covid-19 lockdown has impacted this area of healthcare the most. People are facing depression and anger issues during this period of time .Different sectors of the society in India are facing mental health issues due to their respective roles in society. This department needs maximum support and should not be neglected. This article mainly aims to list down all the pros and cons of lockdown and its impact on people, society, economy and health. Falling economy, loss of income, loss of occupations, depression, work from home, essential services, violation of rules and regulations, all these were a part of lockdown. The government has taken all steps and measures to reduce the covid cases in the country. Lockdown was proven to be the perfect decision taken by the government.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.