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With around a million people dead, it seems abundantly clear that COVID-19 affects our physical health. And yet, as scientists analyze the data around this virus, a hidden and concerning theme has also become apparent. COVID-19 seems to expertly exploit our psychology. Our psychological status, especially the experience of chronic stress, may present a major vulnerability for severe COVID-19 complications. Even more worrisome, COVID-19 may be worsening the very mental patterns that are contributing to our current predicament.

In order to understand the connection between our mental state and this virus, we need to know who is suffering the most from the complications of coronavirus. At the start of the pandemic, it was commonly said that the virus “does not discriminate.” We now know this statement is incorrect. People who experience severe disease and higher rates of death from COVID-19 tend to be those with pre-existing health issues like heart disease, diabetes, high blood pressure and cancers. A large body of evidence demonstrates the connection between stress and the development of these health conditions.

Generally speaking, up to 90% of human diseases are linked to activation of the stress system. The diseases with the strongest connections to stress include diabetes, cancer, heart disease and high blood pressure, virtually mirroring the list of the diseases associated with worse outcome from COVID-19 infection.

Scientific research also sheds light on the strong tethers between chronic stress and immune dysfunction. This is a central focus of the growing field of psychoneuroimmunology. Psychological strain seems to impact our immunity by way of the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. It’s thought that chronic stress has two major influences on the immune system. First, it leads to a general suppression of our immunity, making it harder for us to mount a response to an infection. For example, it’s thought to decrease the function of our natural killer cells, damaging a part of the immune system that helps fight off viruses.

In addition to this more widespread immune suppression, chronic stress also appears to induce a state of low-grade inflammation. At face value, this seems paradoxical, as one of the principal effects of stress hormones is a lowering of inflammation. However, when stress transitions from acute to chronic, levels of inflammation begin to rise, potentially as a result of changes to the stress hormone receptor. Elevated inflammation itself is considered a contributing factor to many of the diseases conferring a higher risk for COVID-19 complications. It’s also notable that an intense inflammatory reaction called the “cytokine storm” is implicated in deaths due to COVID-19.

With these ideas in mind, chronic stress may represent one of the most under-appreciated risk factors for worse outcomes from COVID-19.  Unfortunately, this means we may be especially susceptible to the virus right now. That’s because modern day humans experience a lot of chronic stress. A 2019 Gallup poll showed that Americans reported more stress, anger and worry than they had in the last decade, and over half of them said they’d experienced stress during much of the day prior. This means that our poor preexisting psychological status likely rendered us especially vulnerable to the effects of the virus.

As if this weren’t bad enough, mounting research suggests that the virus may only be further exacerbating our poor psychological health. Americans on average rated their stress levels higher in 2020 than in 2019, and, unsurprisingly, reported that COVID-19 was a significant source of that stress. In an age of widespread lockdown protocols, there’s concern that already elevated rates of loneliness have worsened, and recent research suggests a global uptick in stress, depression and anxiety. It’s also notable that these effects may disproportionately affect minorities.

This picture seems bleak. Yet there are several reasons to be encouraged. First, some data indicate that loneliness may not have worsened all that dramatically, and that many actually perceive increased support from others. Additionally, from April to July, American stress levels may even be declining.

What can we do to further improve our psychological state? First, we can decrease our contact with unnecessary and unproductive exposure to stress. To this end, we can empower ourselves and others to take a break from speculative, sensationalized, and unhelpful fear-laden conversations around the virus. Following researchers’ suggestions, we should consider limiting our exposure to repeated media coverage of the pandemic, especially when it provides minimal new information. Pandemic-related social media exposure may also be an issue, with data from multiple countries indicating a connection between stress-related symptoms and excessive social media use.

We should also remember the value of more typical stress-management strategies. Meditation, exercise, getting adequate sleep and even nature exposure are readily available to most, and may help to dampen an overactive stress response. Fostering social connection, even from afar may help blunt the negative effect of stress, potentially by increasing brain oxytocin. Working with a mental health professional may look different when compared to pre-pandemic times, but the increasing availability of options like tele-health makes this a valuable consideration for those needing extra help.

In describing COVID-19, the primary focus has been on its physical health effects. Yet on closer review, we see the critical role of our psychological state in this story. Chronic stress, an epidemic in its own right, appears to play a major role in our risk for COVID-19 complications. By acknowledging and working to improve the burden of stress on our mental health, we may well be taking a significant step forward in fighting this virus.

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