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Erin Finnegan is a 41-year-old single mother trying to focus on how lucky she is to be spending every day at home with her toddler. But she can’t help fretting over the financial fallout from losing her bartending job to the coronavirus pandemic that has drastically reshaped her daily life.

“I’m oddly optimistic for someone without a savings account,” said Finnegan, who lives in Hanalei on Kauai. “That’s just kind of the spirit of who I am. But in the moments where I have kind of crumbled, it’s because I’m concerned about making sure my son is okay. As a single parent, I certainly didn’t go into this having a backup plan for job loss.”

As Finnegan and her 2-year-old son Declan comply with the state’s mandatory “stay at home, work from home” order to curtail the spread of coronavirus in Hawaii, she’s trying to avoid the temptation to succumb to sloth and complacency — or worse yet, panic over money worries. So each morning she maps out a daily routine. 

Get out of bed. Take a shower. Put on makeup — at least some mascara. Go to the beach and play with her son in the sand.

In the difficult moments when she’s on the brink of tears, Finnegan returns to an old stress coping mechanism.

She pauses and asks herself, ‘Is this going to matter in a half hour? Is it going to matter next week? Is it going to matter in five years?’”

The exercise, however, is not as effective now as it has been in the past.

“This is truly the first time where the answer to, ‘Is it going to matter in five years?’ is ‘Yes,’” Finnegan said.

As the coronavirus outbreak spreads across Hawaii, the restrictions on daily life that aim to stall it are putting enormous stress on people who find themselves worried about financial losses, emotionally disturbed from being isolated at home or panicking as they witness friends and family members becoming sick.

Worries are widespread over derailed income and the health of loved ones especially vulnerable to the virus. For those with preexisting mental health conditions, anxious thoughts, feelings of despair and compulsive behaviors are flaring up even among people who had been managing these symptoms.

“If you’re already thinking about worst-case scenarios and thinking about what-ifs, then this is taking it to the next level,” said Dr. Darryl Salvador, a psychologist at Schofield Barracks and Molokai Community Health Center.

“And if you don’t have anxiety, you’re still feeling pretty rattled in a lot of cases because you can’t go to the movies, you can’t get together with your friends, all the gyms are shut down and there are a lot of unknowns that create stress.”

Anisa Wiseman, program director at the , said she has a history of anxiety. But she didn’t think the rush of uncertainty brought into her life by the coronavirus pandemic would trigger it. 

Sure, she was worried about her 79-year-old grandmother continuing to work her job at a Laie grocery store alongside colleagues and customers who might be unknowingly infected with the virus. 

But the 29-year-old North Shore resident said she felt generally grounded. As she watched her friends get laid off from work, she was thankful to still have a dependable paycheck.

Then she vomited.

“I went into this instant, ‘Oh, my gosh, what if something’s wrong with me? What if I have the virus?’ and I retraced all my steps,” Wiseman said. “My anxiety was giving me all these different scenarios of how I could have contracted it and the most ironic thing is that my anxiety is probably the reason I threw up to begin with.”

In the past, Wiseman said she has vomited in the midst of a panic attack.

“I felt like I wasn’t panicking, but I guess my body is feeling otherwise,” she said. 

Recently Wiseman said she’s also felt urges to hoard groceries and supplies, fearing the possibility of a disruption to Hawaii’s supply chain. 

“There’s moments where I’m like, ‘Oh, my gosh, do I have enough potatoes?!’” she said. “Just strange thoughts that I never thought I would have.”

Earlier this month, Timothy Quick was dealing with a great deal of uncertainty as he prepared to transition into a new job and living arrangement. Then the coronavirus hit, unwinding all his plans. 

A pair of job interviews he had scheduled at clothing stores were canceled when the businesses closed because of coronavirus. Another work opportunity fell through because he didn’t meet the qualifications. And he couldn’t find a landlord who would rent him a house because he didn’t have any wages comings in.

Now the 27-year-old is eating up his limited savings on Airbnb rentals while he tries to acquire a paycheck and a place to live.

“I have anxiety and being in this vulnerable situation, wanting to protect yourself but not being able to, it definitely makes me feel more anxious,” Quick said.

Honolulu psychiatrist Sonia Patel has made several adjustments to her practice to accommodate the growing needs of her patients. She had never used telemedicine before the coronavirus appeared in Hawaii, but over the last week she has converted all her patient appointments to virtual meetings.

Medicare and Medicaid have temporarily around telehealth coverage to allow patients and health care providers to connect remotely from their homes. Previously either the patient or the doctor was required to connect from an approved health facility.

With telemedicine, Patel is learning that it’s harder to detect subtle cues from her patients’ body language that might give her insight into how well they’re doing.

But by meeting patients virtually in their bedrooms and living rooms, she said she’s gaining access to a whole new set of environmental cues: art on the wall, clutter in a room, a pet cat slinking across the screen.

“The positive things that took some of my patients a lot of time to get in place are now completely thrown off and they’re backsliding.” — Psychiatrist Sonia Patel

In the last two weeks, she’s taken on several new patients, including a few who had been discharged from the emergency room where they were treated for coronavirus-related anxiety. Some of those people have a history of anxiety while others are experiencing it for the first time, Patel said.

Heightened levels of anxiety, depression or suicidal thoughts in some of Patel’s patients have prompted her to increase their medication dosages or see them more often.

“It’s not just because of all the coronavirus stuff but everything else that stems from it, including being isolated at home with a dysfunctional family and not having face-to-face connection to other people,” Patel said.

”I have some patients who are pregnant and dealing with a lot of panic about possibly being exposed,” she said. “The worst is spiraling into more of a depression because their social connection had been very important for them and now it’s gone.”

Panic and anxiety brought about by job loss and insecurity have been the top issues for Patel’s adult patients, whereas her child and adolescent patients are struggling more with loneliness from not being able to go to school or gather with friends. 

Some of her teenage patients are passing the long, lonely hours on social media, which can reinforce their preexisting problems with negative body image, insomnia or cyberbullying.

“Social media can be a very detrimental thing if you’re in the middle of depression and anxiety, especially if you’re a teenager,” Patel said.

“In some cases you maybe were doing OK and staying away from it, but now you’re isolated at home without your friends and so you’re back on it, but you don’t want to be on it, and then it draws you back into this negative thing that you fought to get out of, which includes comparisons and feeling pressure to post things.”

Patel said many of her stable patients are also having a difficult time because their normal coping strategies, whether it’s hanging out with friends or playing a group sport outdoors, are no longer available to them.

“The positive things that took some of my patients a lot of time to get in place are now completely thrown off and they’re backsliding,” Patel said.

Some services have been suspended for people with serious mental illness and their caregivers, including and the state’s rehabilitation , where members meet for daily group activities, services and meals. 

Philip Enomoto, who leads a support group in Pearl City for people with serious mental illness, said his regular attendees are feeling abandoned and alone.

A few nights ago he got a phone call from a man in his 50s who has schizophrenia and normally attends his support group.

The call came in at 10 p.m.

“There wasn’t any stated purpose for the call,” Enomoto said. “I think he just needed to be reminded that we will eventually meet again.

“I think he was emotionally reacting to the need that he has for human contact, relationships, acceptance. These are forgotten people, people that don’t have much of an identity in regular times. Right now it’s an especially harsh time for them.”

The phone call has prompted Enomoto to check in on all of his regular support group attendees, many of whom live in group homes that are reducing or eliminating outside programming and visits from family members.

“I’ve been thinking, ‘What can I do to help these people?’” Enomoto said. “What I’ve decided is I can call them and just have conversations with them and pray with them and just let them speak and know that they are still thought of and cared about and not forgotten.”