Online Counseling during COVID-19:

Medical Perspective
Arlette Setiawan
and psychology
• The COVID-19 has led people to
engage social distancing as a
critical way to help “flatten the
curve” Many people overlooked the
implications of those
• Self-quarantine and social but strategies for people’s
distancing are deemed by mental wellbeing
medical experts as necessary in
reducing the spread of the virus
Key elements of mental health

• Autonomy
Social Isolation • Competency
• Connectedness
 Social isolation Adverse health consequences

• Depression • Emotional disturbance

• Poor sleep quality/ insomnia • Stress
• Impaired executive function • Low mood
• Accelerated cognitive decline • Irritability
• Poor cardiovascular function • Post traumatic symptoms
• Impaired immunity at every • Anger
stage of life • Emotional exhaustion
 • Leukocytes showed:
• Increase expression of genes
involved in inflammation
• Decreased expression of genes
involved in antiviral responses
Social Isolation • Long-term of “fight-or-fight”
stress signaling
• Negative effect on immune
system
Psychologists can take steps now to prepare
their practices, address patient concerns and
manage anxiety in their communities
 • News reports about COVID-19
Patient and and the possibility that it could
become more widespread are
Community making some people anxious
Fear/Anxiety • Help to quell fear by providing
credible information
 Considering what are the risks to
Properly fearful themselves and other people
associated with each of their
action
Aulia Iskandarsyah, Whisnu Yudiana –Informasi COVID-19, perilaku sehat dan kondisi psikologis di Indonesia
 • Centers for Disease Control and
Trusted Sources Prevention
• World Health Organization
of Information • Kemenkes RI
• Official website of COVID-19
(covid19.go.id)

Insulate the community from rumors that will help them get a clear picture and see how things are changed
 • Take care of your own health
• Provide yourself with credible
information
Prioritize • If you are ill or experience an
yourself anxiety during this pandemic,
you cannot provide effective
care to others who are in need
for your expertise
 • A large family of viruses which
Coronavirus may cause illness in animals or
humans
(CoV) • In humans à ranging from
common cold to more severe
diseases (MERS, SARS)

World Health Organization – Coronavirus Disease

 • Found in various animal species:
Where do CoV bats, camels
come from? • Transmitted from one animal to
another animal
• Viruses can evolve and infect
human (zoonotic virus)

World Health Organization – Coronavirus Disease

 • A new strain of coronavirus that
has not been previously
identified in human
SARS-CoV-2 • Epicenter of the outbreak:
Wuhan, China (Huanan Seafood
Wholesale Market)

World Health Organization – Coronavirus Disease

 • Positive-strand RNA virus
• Size ~0.02 µm
• The spike (S) protein of
coronaviruses facilitate viral
entry into target cells

Yan R et al. Structural basis for the recognition of SRAS-CoV-2 by full-length human ACE2. Science 10.1126/science.abb2762 (2020)
 • Angiotensin-converting enzyme 2
(ACE2) à cellular receptor for
SARS-CoV-2
• Virus infection occurred in well
differentiated ciliated epithelial
cells expressing ACE2 à the
mucosa of respiratory and
gastrointestinal tract

Yan R et al. Structural basis for the recognition of SRAS-CoV-2 by full-length human ACE2. Science 10.1126/science.abb2762 (2020)
 • Mainly from person-to-person
• Between people who are in close
contact (within + 6 feet/1,8 m)
• Through respiratory droplets
produced when infected person
Transmission coughs, sneezes, or exhales
• Contact from infected surfaces
or objects (fomites):
• Touching a surface or objects that
has the virus on it à touching
mouth, nose, or possibly eyes

World Health Organization – Coronavirus Disease

 droplets

• Respiratory infections can be

transmitted through droplets of
different sizes:
• >5-10 µm à respiratory droplets
• <5 µm à droplets nuclei
• Airborne transmission was not
reported

World Health Organization – Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations
Fomites

• Inanimate objects that can

become contaminated with
infectious agents and serve as a
mechanism for transfer between
hosts
• Indirect transmission
 • Most common: fever, tiredness,
dry cough
• Aches and pains, nasal
congestion, runny nose, sore
throat, diarrhea
Symptoms • Some people become infected
but don’t develop any symptoms
and don’t feel unwell
• 80% recover from the disease
without needing special
treatment

World Health Organization – Coronavirus Disease

 • In worst case, the virus not only
attacks and destroys tissue in
the lungs, but also triggers an
overreaction of immune system,
Symptoms creating dangerous levels of
inflammation
• Patients unable to breathe on
their own

World Health Organization – Coronavirus Disease

 • For milder cases, a hospital stay
might end without the need for
artificial ventilation
• Patients go home after being
Symptoms treated for pneumonia
• Many more are riding out this
illness at home, striving to
isolate themselves
• 25-50% of all infected feel no
COVID-19 symptoms at all

World Health Organization – Coronavirus Disease

 • Around 1 out of every 6 people
who gets COVID-19 à seriously
ill and develops difficulty
breathing
High Risk • More likely to develop serious
illness:
Group • Older people
• Patients with underlying medical
problems (high blood pressure,
heart problems, or diabetes)

World Health Organization – Coronavirus Disease

 80% mild or
asymptomatic

COVID-19

5% critical infection 15% severe infection

(requiring ventilator) (requiing O2)

WHO COVID-19 Situation Report 46

 • Rapid test à as screening test
• Swab test (PCR)
Diagnosis • Thorax photo à pulmonal
infiltrate

World Health Organization – Coronavirus Disease

 • Currently, no treatment available
yet
Treatment • Symptomatic treatment
• Isolation
• Adequate fluid intake

World Health Organization – Coronavirus Disease

Case definition
 A contact is a person who experienced any
one of the following exposures during the 2
days before and the 14 days after the onset
of symptoms of a probable or confirmed
case:
Definition of • Face-to-face contact with a probable or
confirmed case within 1 meter and for
Contact more than 15 minutes;
• Direct physical contact with a probable or
confirmed case;
• Direct care for a patient with probable or
confirmed COVID-19 disease without
using proper personal protective
equipment

WHO COVID-19 Situation Report 83

in children
 COVID-19 in children
• Children are less affected than adults
• Clinical attack rates in the 0-19 age group are low
• Preliminary data from household transmission studies in China:
children are infected from adults, rather than vice versa
• Coinfection is detected in COVID-19 case in children

WHO COVID-19 Situation Report 46

 Symptoms
• From limited reports of children with COVID-19
• Generally presented with mild symptoms
• Cold-like symptoms (fever, runny nose, cough)
• Gastrointestinal symptoms (vomit, diarrhea)
• Children should engage preventive actions to prevent the spread of
respiratory infection

Center for Disease Control and Prevention – Coronavirus Disease 2019

Infection control in
counseling setting
 Main Principles
• Be aware of asymptomatic individual
• Prevent potential transmission of infection to other patients/clients
and staff
• Create a safe office environment for patients/clients and employees

APA - COVID-19 and psychology services: How to protect your patients and your practice
Standard Precautions
To protect you and prevent you from spreading infections among
patients/clients
• Hand hygiene
• Use of personal protective equipment (e.g masks)
• Respiratory hygiene/cough etiquette
• Clean and disinfected environmental surfaces
 Environmental Controls
• Aim
• Reducing the spread of pathogens
• Reducing the contamination of surfaces and inanimate objects
• Include
• Providing adequate space to allow social distance or at least 1 m to be
maintained between patients and between patients and you
• Ensuring the availability of well-ventilated room

WHO. Rational Use of Personal Protective Equipement for COVID-19: Interim Guidance
Design of Counseling Office

• Use concepts that support

infection control
• Elements of office design for
effective infection control:
• Floor plan and traffic flow
• Materials
• Operatory design