Does Stress and Anxiety Contribute to COVID-19?

Stressful situations often cause a wide range of emotions and behaviors, such as anxiety, disturbed sleep, sadness, irritability, anger, and violence. There is evidence indicating that stress can increase the risk of several health conditions, including infectious diseases (viral, bacterial, and parasitic), childhood cancer, etc. (1-5). It also negatively affects the immune system. So that several studies reported that social stressors are associated with increased inflammatory cytokines, which highlights the central nervous system (CNS) signal to induce behavioral, neurological changes with psychiatric symptoms. Therefore, it can be argued that inflammatory cytokines are a major factor in the pathogenesis of stress, anxiety, depression, and other mental disorders (6, 7). Thus, the proliferation of T cells, which are responsible for cellular immunity and the most important arm of the immune system to fight viruses, is reduced in anxious patients. Moreover, it is well-proved that stress is associated with delayed response to the vaccine as well as exacerbated viral and bacterial pathogens. Stress hormones also disrupt the trafficking of neutrophils, macrophages, antigen-containing cells, natural killer (NK) cells, T and B lymphocytes, and produce the necessary cytokines to produceimmuneresponses (8). As a result of the COVID-19 pandemic, which has infected nearly 6.5 million cases and claimed thousands of lives, people are faced with stressful conditions (9). Many studies have shown that one of the best ways to deal with COVID-19 is to strengthen the immune system; Nevertheless, stress, anxiety, and fear, which have increased since the onset of the pandemic, weaken the immune system, which increases susceptibility to developing various diseases (10).