The function of the immune system means that COVID-19 makes stress and anxiety more likely, and vice versa. Here’s how to break the feedback loop between them.

Understanding the biological link between COVID-19 and emotions. Despite its calamitous impact on the social and economic fortunes of the world, the COVID-19 coronavirus pandemic has also brought out some of humanity’s greatest qualities. It has transformed hospital rooms into bastions of bravery and has caused communities and nations to band together, often pooling resources in novel ways to reduce disease burden and increase treatment opportunities. On lab benches and in the pages of journals, scientific breakthroughs about combating the disease are occurring at breakneck speed.

But in addition to the death toll and financial losses, this progress has happened amidst a massive wave of human emotional damage. The presence of the pandemic, now a year old, has markedly increased stress, anxiety, depressed mood and grief, and has made excessive substance use alarmingly commonplace. Their persistence and their impact on society means that we have to understand how to manage them. 

There is a terrible irony in this situation, because this emotional fallout also weakens the body’s defenses against the very disease that has caused them. Here’s a look at how COVID-19 and the emotions that it creates influence each other through the brain and the immune system, and how getting back to the basics can help us reduce our risk for both COVID-19 and its emotional fallout. 

Neuroimmunology 101: Immunity and Your Emotions

To understand how your emotional state influences your susceptibility to COVID-19, it’s important to understand how your body‘s immune system works. Your immune system functions much like a military does. It’s responsible for your body‘s defense, as well as its internal repair. Just like the Armed Forces, your immune system has its own structure and hierarchy. It gathers intelligence and uses complex weaponry, along with a bevy of tactics and special operations. 

The immune system has a whole team of rangers whose job is to obtain scouting information on potential foreign invaders or a defective internal part. Those rangers share their information with their commanding officers, who decide on which types of tactics and weaponry are appropriate to fight off the threat. If the threat is one that the body has seen before, the immune system usually makes quick work of its potential enemy. If the threat is new, the body has to learn its strengths and weaknesses, and is thus more vulnerable to being infected. 

Biological Link Between COVID-19 and Emotions

That was the situation with the COVID-19 coronavirus, and it explains (at least in part) why the pandemic has persisted. Humans have no natural immunity to it and must rely on either seeing the infection (or a very similar one, like SARS) or getting a vaccine to get immunity to the virus. Vaccines work by allowing our bodies to see a new threat in a safe way, so that we don’t have to relearn the virus’s strengths and weaknesses and put ourselves in danger.

Even though immune cells patrol the body and can make some decisions independently, the brain acts as the immune system’s commander-in-chief. Much like a president and congress (or a prime minister and parliament), the brain is responsible for many other functions, too, but it determines how the immune system is going to best serve the body’s needs and what level of resources the immune system will get. Like a president listening to advisors, the brain makes these decisions based on the input and information it receives.

One of the major pieces of information the brain uses to make these decisions is our emotional state. When we are stressed or anxious, the brain gives the immune system—which is constantly fighting off potential invaders—a signal to tone the patrol activity down. The primary way that the brain turns the dial up or down on the immune system is through the creation of stress hormones. 

The primary stress hormones might be familiar names to you: adrenaline and cortisol. They are produced in large amounts when an animal (including a human animal like you and me) senses that it is under threat, allowing it to activate the “fight or flight” response. This temporary shuts the immune system down and preserves energy for other tasks that are more immediately important for survival, like running. For a little while, it makes us more susceptible to disease, but it keeps us from being some other animal’s dinner, too.

Once the threat has subsided, the body‘s immune system activity usually goes back to normal. But chronic stress has a lasting and profound effect on the immune system. If the stress and anxiety last for a long time, the body is constantly in fight-or-flight mode. In this situation, even though the stress hormones eventually start to burn out, the normal resources available to the immune system are never restored. The decreased production of normal stress hormones can create sluggishness, and can have emotional effects like depressed mood and an inability to feel excitement. The lack of normal immune system resources means there are fewer and less experienced troops to fight viruses, bacteria and other potential invaders. Your body is now more prone to both infection and to depression, and to worsened consequences from them. 

Managing the Link Between COVID and Emotions

Managing the Link Between COVID and Emotions

So how do we resolve such a dilemma, where our heartfelt emotions unwittingly betray our own bodies? 

We now have a full year of data on the emotional effects of the COVID-19 pandemic, along with suggestions from experts on how to manage them. Additionally, previous psychological research on the effects of emotion can offer helpful suggestions to us. The benefits of sleep and regular exercise—walking, biking, swimming and other safe activities that can be performed even with masks, hygiene and distance—have long been shown to counteract the destructive forces of stress. They support healthy immunity, and allow individuals to establish and maintain healthy routines. 

If you have struggled with maintaining these types of routines, you are certainly not alone. The COVID-19 pandemic has made access to mental health treatment and addiction recovery services more difficult. But the ability to find mutual aid and camaraderie has been shown to be protective against relapse, and even the isolation that current times have wrought does provide some opportunity to work on important aspects of individual recovery efforts.  

Despite these difficulties, the benefits of mindfulness, meditation and maintaining a positive outlook can reduce the immune system’s tendency to overreact. Meditation has been a staple of stress reduction for centuries, but it isn’t easy to engage in it when anxiety predominates. However, it is a skill that, like any other skill, gets more effective with practice. The more you try, the better you tend to get at meditation; the better you get, the more health benefits meditation confers.

It is important to ask for help if you are having any trouble managing mental health symptoms independently, and even if you’re doing fairly well managing them, it can be helpful to discuss how you feel with trained professionals. This is particularly important if there have been major changes in how you feel, or if you are having suicidal thoughts. 

Many foods and supplements have stress-relieving and/or immune-boosting properties. Valerian root has long been known for its ability to reduce anxiety and promote sleep. Lemon balm has been used as a natural sleep remedy for centuries. Foods that are high in vitamin C (like citrus fruits and broccoli), and vitamin D (like eggs and fish) are potent boosters of the immune system. Scores of experts have made lists of foods that help with stress relief or immunity boosting, and fortunately, many of these foods serve both functions. 

It didn’t take much to upend the world—just a few amino acids on a single spike of a virus that is about a millionth of a meter long. Fortunately, by the same token, small changes on the human end may be able to help us create the structures and routines that return us to emotional stability. Seemingly mundane management strategies like proper rest and meditation may end up rescuing us from the tortuous cycle between emotional distress and COVID-19. For the planet’s most fraught situation, it will be the small behaviors that will make big differences in our trajectory of emotional improvement. 

Jennifer Billings is the Medical Editor at National Coronavirus Hotline(NCH). She is an Integrated medical doctor who has been published on NCH Blog, and is a regular contributor at MedCity News, Physician Family, and Psychology Today.