BUENOS AIRES — The situation is extreme. It's an economic, social and a healthcare crisis that exempts nobody and will leave its mark on all. It is a global emergency. And even in the coolest of heads, anxiety is creeping in as people struggle to navigate these uncertain times.

So far, those with the emotional tools to manage their feelings are riding the wave of events without succumbing to undue fear or disproportionate concern. But for those who struggled with anxiety even before the epidemic, people who had trouble leaving their homes even in the best of times, or hypochondriacs who struggle against a constant obsession with disease, the coronavirus has become a double threat. It may or may not attack their physical health, but is most definitely harming their emotional state.

"The generalized stress this pandemic is generating has resulted in a 20% relapse rate," says Gabriela Martínez Castro, head of the Argentine Center for Specialized Studies in Anxiety Disorders (CEETA).

Like other mental health professionals in Argentina, Castro says there's been an uptick in recent weeks in patients seeking help. Many people being treated for anxiety disorders and phobias and who were gradually recovering are now relapsing, she explains. And what's triggering them, the specialist adds, are the restrictions being put in place.

"Many patients have become much worse, to the point of provoking symptoms again, in spite of the progress we were making," she says.

Gustavo Bustamante, president of the Phobia Club Foundation, says that among patients who already had a phobic framework or specific disorders like Generalized Anxiety Disorder (GAD) or Obsessive Compulsive Disorder (OCD), panic attacks or agoraphobia, anxiety levels have risen considerably.

"These are people who were already stressed about money and the pandemic's consequences," he says. "Even before the government began issuing guidelines, most of my patients had abandoned their daily routines and were in self-confinement. Some had to move up their appointments or seek closer attention, as the level of anxiety and worry the illness is generating is making them feel vulnerable."

Virtual platforms have become essential in providing emotional support. "We are implementing a strategy to give them support through online services," Bustamante says. Among other things, his foundation is offering more after-hours or night night consultations.

The Argentine anxiety disorder center has also adopted remote consultations for those who need them most. Patients are being encouraged to continue their therapies, says Martínez Castro. "Not only are they not stopping but we have people who are consulting more than once a week," she adds.

OCD patients with cleaning-related rituals are convinced their longstanding fears were not baseless after all.

Specialists say that for patients with GAD and OCD and forms of hypochondria, behavior patterns are now even more intense. Rossana Speranza of the Argentine Association of Anxiety Disorders (AATA), says patients "overestimate the level of danger." People overly concerned about health show a "heightened observation of the general state of the body, and you have to work to make sure they won't go to night pharmacies," she adds. "With OCD, patients with cleaning-related rituals boost this kind of behavior, convinced that their longstanding fears were not baseless after all."

Susana Dagos, a 63-year-old podologist and agoraphobic, is familiar with a lot of this conduct. She had managed, since 2012, to control her fear leaving her home. She'd been attending workshops and even managed to travel abroad. She was "well enough," she says. But with the pandemic, she's struggling once again.

"There is fear, which is what makes the phobia reappear," she says. "I decided not to travel on public transport. I took the precaution two weeks ago. I don't want to be with people all packed together... I'm much more afraid."

Liliana Traber, coordinator of the Trauma and Anxiety clinic at INECO, a public research body, points out that there are different kinds of fears and phobias, and that to treat them it's important to distinguish one from the other. "Fearing the illness or its contagion is not the same as being really worried about the future, about what will happen with the economy, for example, or your family," she says.

What many patients have in a common is a fear of death — of their own death and the death of others. And the panic over the pandemic, says Martínez Castro, "can arouse and trigger latent disorders, as it can work as an unleashing factor."

Bustamante of the Phobia Club says the coronavirus outbreak will also impact people who hadn​"t previously sought mental health advice. He says there is precedent for this in Argentina, where there 2001 financial crisis prompted a 300% increase in therapy visits. For many, he says, the trauma of the crash soon became a "constant worry" about falling into poverty that "became chronic, and changed the way daily lives developed."

The pandemic will have a similar effect, Bustamante says. "It will alter many habits in society generally," he adds. "And many people who previously had no history of mental illnesses or disorders, or thought they were less at risk, will from also be living in a heightened state of alarm."

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