In a hotel room in London on March 11, Penn State junior architecture student Gianluca Sanzone received three confusing phone calls from friends  in rapid succession.

President Donald Trump had just announced restrictions on entry to the United States from 26 countries in Europe because of the spread of COVID-19. The restrictions would go into effect on Friday, two days later. Sanzone and two friends, also students at Penn State, had flights scheduled to return home on Saturday.

After four hours of panic, checking flights and trying to figure out how to return to the U.S., Sanzone and his friends got clarification that the ban didn’t apply to the United Kingdom, yet. Three days later, Sanzone returned to the United States, landed in New York and returned home, but the stress of the seemingly off-again, on-again trip served as a vivid reminder of how the coronavirus pandemic has impacted nearly everyone’s life, placing a strain on mental health by creating anxiety and fear.

Since returning home, Sanzone and other students are dealing with yet another kind of mental strain: remote learning.

Things have changed drastically. As an architecture major, Sanzone is figuring out how to deal with three-hour studio classes twice-a-week – at home.

“I’m anxious to get back because it was fine working at home with a project that was already underway, but I’m not sure how it would work starting from scratch, especially without having different resources and tools,” Sanzone said.

But the worries don’t stop there. Sanzone is two years from entering the job market and he’s worried what the potential economic fallout could do to the job market.

“I’m obviously wondering where this is all going to head and how quick will companies rebound and be willing to hire, because it’s a field that’s heavily dependent on the market. If people don’t have money to build, architects can’t design, so that’s scary,” Sanzone said.

Dr. Sultan Magruder, a psychologist for Penn State Counseling and Psychological Services (CAPS), said having added stress and a little anxiety during this uncertain time is not unusual.

“Anxiety is a normal sort of emotional response to have, and if you didn’t have it, I would probably be like, ‘What’s wrong?’” Magruder said. “It’s okay that you may not have the motivation to do chores around your house. It’s okay that you may not be able to still be attending your classes. It’s okay that you may not have the emotional space to connect with your family or friends. That’s a normal response to what’s happening.”

“We can find some areas in our life that we can control, and it’s about really taking the time to figure out what those are and devoting more energy to those things than the things we can’t control.”

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Anxiety, in its simplest form, Magruder said, is a “basic fear or worry about something real or imagined.”

He said these fears can be rooted in reality. For example, if you don’t study for a test, you will fail. Or, the fears can be imagined. For example, if you fail a test, you are going to be a failure for the rest of your life.

During pandemics, Magruder said, heightened fear is a very common mental response, normally rooted in fear of the unknown.

“So when I don’t have control over whatever an outcome might be, that’s when you really see that fear increasing and then acting in ways that may not be as sort of helpful,” Magruder said. “So, you know, you see people going running to get toilet paper to load up on other different things that they may not need.”

“All people are trying to do is they’re trying to regain some sense of control and some sense of protection,” he said.

But it just isn’t fear that people experience during a pandemic, Magruder said. There is also a lot of grief – and not just for those who have died.

“Some people are grieving the loss of other people, but you can see a grieving of what my life used to be,” Magruder said. “So, going and hanging out with friends, being able to go play at the park, being able to engage in other sorts of activities – there’s a loss of a sense of loss … and the loss of that normalcy that we see.”

Magruder said the usual phases of the grief process come into play: anger, acceptance and sadness.

Sanzone, the Penn State student, said he’s experienced the grief, although he said he has been doing his best to move past it by doing his schoolwork and engaging in some limited recreational activities.

“Being forced in a space for a month or two is definitely straining on the mind and is tough to cope with, especially if you’re not used to being isolated or by yourself all the time,” Sanzone said. “I go on walks with my dog to get some fresh air … running, tennis by myself just hitting a ball against a wall or serving.” 

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Magruder said fear of the unknown impacts decision-making.

“We start acting in somewhat irrational ways,’ he said, “and I think that makes sense, because they’re sort of like the underlying physical processes, physiological processes that are happening with us.”

He said the brain changes how it works when experiencing these emotions. The frontal lobe, which is responsible for decision-making, planning and attention, among other things, shuts down for the more primal part of the brain to trigger a “survival mode.”

“Those parts of the brain are really focused on … ‘Let me sit down and think of the most complex ways to sort of navigate this particular issue.’” Those parts of the brains are more like ‘I need you to do something right now to protect yourself,’” Magruder said.

Magruder said this explains why some people tend to hoard things, such as toilet paper. Then when other people read about toilet paper shortages, it can create a snowball effect.

“Most people are aware of whatever the threat is. But they’re still getting through,” Magruder said. “They’re doing what they need. They’re not running out, stocking up on things.”

David Eckert, a senior journalism major and digital managing editor at The Daily Collegian, the independent student newspaper at Penn State, has been coping by continuing work at home, running the newspaper’s website and social media account remotely. For him, returning to State College after Spring Break in March wasn’t an option. He suffers from Lyme disease and has a compromised immune system. He said he has been very cautious, because coronavirus could have an even more significant impact on his health.

“I’m not as involved at the ground level of stuff, meaning working with reporters on stories and what-not, just because it’s not realistic virtually,” Eckert said.

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Magruder said people who naturally have difficulty regulating emotions have more spikes of anxiety and stress, simply because many things are out of their control.

Greg Eghigian, a history professor at Penn State, said differing reactions to pandemics is something that has been shown throughout history.

“One of the things you see with pandemics in general, looking at these going all the way back to the Middle Ages … is what you are seeing right now. The responses of people are quite varied. You get people who panic, who immediately [say] ‘We are all going to hang out together, look after ourselves.’ There are [other] people whose attitude is, ‘We are going to get out of here.’ You have people whose feeling [is] the way to deal with this is to party, to have a good time.”

Of course, not everyone reacts negatively or compulsively, Magruder said. Many people have positive responses, including an extra level of gratitude, because they still have jobs, are still healthy, are spending more time with family or are helping others. He noted, for example, the number of GoFundMe accounts that have been created to help people in need.

“I think that’s definitely important to focus on as well that people are actually also coming together despite the collective and individual sort of angst that are occurring,” he said.

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As Eghigian noted, previous pandemics, such as the 1918 Spanish Flu that hit the U.S. and the rest of the world immediately following World War I, triggered similar fears in people.

“There were four phases to [the Spanish Flu] and it didn’t just attack the very young or the very old. People between ages 20-40 were hit really hard,” he said. “So that makes it seemingly different than what we have now. But what it gets at [is] it created and was taking place in an environment where people were aware of its presence and aware that it was coming and going. That was creating a constant state of dread and anxiety in the population that lasted a good year and half.”

Eghigian said he is struck by what didn’t happen immediately after the Spanish Flu, when the world returned to normal.

“One of the most perplexing things about the Spanish Flu is that almost immediately after it was gone, people didn’t talk about it,” Eghugian said. “As far as I know there is not a single memorial to the victims of the Spanish Flu pandemic.”

(Editor’s note: Spanish Flu memorials appear to be rare in the United States. Where they exist, they are small. There’s one in Boston and another in Vermont.)

The answer to why America went silent on the topic is something that has Eghigian and other historians compare to times immediately following wars.

“People very quickly decided to get back to the normal and get back to the status quo before all of that started,” Eghigian said. “There is a lot of evidence to indicate this is a phenomenon that you see, not only with the aftermath of epidemics and pandemics, this is something you see in examples of modern wars. There is a great urge to get that past behind us and move on and I suspect you will see something similar about this once we get through the other end of this.”

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One major difference from the times of Spanish Flu and Covid-19 is the availability and accessibility of mental health services.

Magruder said CAPS, remotely, is doing everything now for students that it did before the start of the crisis and has even included some new services. It has something called “catch chat,” for example, which is similar to a drop-in visit.

“So we typically have Zoom links on our website, and we offer these drop-in webinars twice daily, so students can drop in. Basically, what they’re learning about are more concrete skills to manage stress, transitioning to virtual stuff, coping with COVID-19 and learning more concrete skills to sort of apply to their lives.”

And while it hasn’t been an easy transition, Magruder said he is proud of the effort that has been made to help students at Penn State in this uncertain time.

“I just wanted to convey that it is a huge undertaking to do that,” Magruder said. “And the speed at which we did it, I think is unprecedented and probably serves as a model to other counseling centers.”

Magruder said there are many things that people can do while at home to overcome this added stress.

“When I’m sitting across from a student, basically, the first thing that I say is, ‘You are an expert in your own life.’ And I say that because I only get 45-50 minutes with you out of a week,” Magruder said. “But you know yourself the other 23 hours out of the day.”

He said people know how to “soothe themselves” by listening to music, drinking some tea, connecting with friends or playing video games.

Magurder said that in times like these people often try to reach for a “magic pill or magical thing” to make them feel better, but just taking the time to engage in familiar activities is beneficial. He said people can sometimes lower stress simply by making lists of things that make them feel relaxed and calm.

Eckert joked that he’s been playing “an absurd amount of video games and I don’t even want to know how much Netflix I’ve watched.”

Sanzone has turned to household activities and work to distract himself.

“It’s good to get out of the house, but [I] like small projects around the house like cleaning and redoing my room,” he said. “[I’ve] stayed calm … by doing those small things to distract myself as well as the fact that I have a heavy workload, so it keeps me occupied.”

Magruder said simply “going back to basics” can really improve mental health – eating, sleeping, connecting with people, showing intimacy and just attending to the basics needs of being human.  Those “core foundational things,” he said, are so important.

“Attend those,’ he said, “and I can somewhat guarantee that things will start to feel a little better.”