The first wave of infections from Covid-19 is beginning to gradually settle down and public health specialists in Pakistan are calling it 'the end of the beginning'. This is a realisation, of course, that the infection is here to stay and we must modify our lifestyles accordingly for the long run. One estimate, which most people seem to agree with, is that we should anticipate at least another two years of intermittent waves of Covid-19 infections before we see a permanent end to the disease.

Here in Pakistan, the mayhem started late. When the first lockdown was imposed nationwide in the third week of March, it was in response to 'imported' infections from neighbouring countries brought in by pilgrims, and for a while, nothing seemed to be happening. Today, close to four months later, we are now in the 'community spread' stage, meaning the disease is spreading freely from person to person.

While Covid-19 has posed enormous medical and public health challenges for a low income country like Pakistan, the mental health impact of the illness has so far received little attention. Mental health professionals have been warning people for months about the impending tsunami of infection and stress related conditions that are already mushrooming all over the country.

When the national lockdown was imposed, schools, colleges, universities, and workplaces were all shut down simultaneously in an effort to control the spread of the infection. For the first time in recent history, families found themselves locked inside their homes for an extended period of time with no clear indication of when things would go back to 'normal'. With three teenage children and two elderly parents, in addition to my wife and myself, my house suddenly became an interesting 'laboratory' in which to observe, at close quarters, what happens when people in 2020 are forcibly confined together with no indication of when the confinement might end.

My children, aged 19, 17, and 13, initially enjoyed the time off from school. After a couple of weeks though, we were all tired and irritable. Having to be around each other all the time with the threat of Covid-19 hanging on our heads meant that we were all getting, well, sick of each other.

So I decided to try another tactic which I had been experimenting with off and on for a while. In consultation with all family members, I requested that we all keep our cell phones away from meal tables and, if we are sitting together for a meal, that we talk to each other rather than staring at a screen.

Once everyone was on board with the 'no screens policy', we decided to extend the 'no cell phone' rule to all family interactions. Basically, if two or more family members are sitting together, no one can look at a screen. We have to talk to/pay attention to each other. In the beginning, it was an adjustment but as we got used to it, it got easier. To me, the best part was rediscovering the personalities of my children and learning to 'talk their talk' (while smiling and tolerating their snide references to my 'old age' etc). I also discovered that they all cherished spending quality time with me, since in regular life, I stay so busy that we hardly see each other. They are busy with their studies and friends and I'm busy with my patients and my teaching.

We pulled out an old carrom board and I taught them how to play. A table tennis table that I had bought last year also came in handy. It gave us an opportunity to get moving and get some physical exercise as well. Needless to say, screens are banned at all these activities.

Things have been harder with my parents. My father is retired and mostly at home but staying locked in led to him missing his walks in the parks and missing being with his friends there. He has also steadfastly refused to wear a mask, saying it suffocates him. But we have come to an agreement where he knows that in that case, he cannot be around people outside. My mother, a high-powered media professional with a very active social life has had a more difficult transition and particularly with the 'no cell phone' rule at meal tables. This means she occasionally forgets to turn her phone off and there will be a loud ring in the middle of meals and her immediate impulse would be to grab the phone and start talking. This is completely understandable since cell phones have been the lifelines of elders confined inside homes by anxious children and grandchildren to prevent them from getting sick. But cell phones have also been the conduits of the dreaded 'infodemic', the waves of misinformation and disinformation that have made the rounds world over about Covid-19, making the jobs of healthcare workers, including doctors like me, much harder.

When I tweeted about family relationships and how they have changed (in my family, generally for the better), someone responded saying their relationship with their family was 'toxic' and what they should do about that? At the risk of sounding facetious, the obvious answer is 'work on the relationship and make it healthier', whether on your own or with the help of a professional. It’s important to remember though, that the same family system that provides us support and succor during hard times and illness, can also grate on our nerves at other times. The hallowed 'extended family' (multiple generations living under one roof) is primarily an economic formation and almost unheard of in Western countries under normal circumstances. Adult children (sometimes with children of their own) living with parents generates its own unique set of challenges starting with not having enough living area for everyone to have their own 'space'. This, of course, is true in spades for low income families where physical living space may be extremely restricted.

Living in close quarters with another person, even a spouse, child or parent, can be interesting. The qualities, as well as the flaws, of the other person are magnified and one has to work harder to keep the good qualities in sight while actively trying to overlook the flaws. But it can be done, with some effort and a lot of love and compassion.

A whole other set of challenges may be added if there are young children at home (less than five years of age) and since screens are now default 'baby sitters', it may be even harder to reduce screen time for younger children without expending considerable energy and effort on part of the parents and/or grandparents.

Of course, I understand that everything I have written above is from my privileged, upper middle class point of view and may not apply at all to the vast majority of poor working class families in our cities and rural areas but one can argue that social distancing and 'screen-free' time may be much easier to achieve in rural areas.

Technology is a wonderful thing and our cell phones, tablets and apps have enabled us to be connected to friends and loved ones around the world but at the same time, they have heightened our expectations and distorted what we should realistically expect from those relationships. And they have, sadly, distanced us from the people who we sometimes are the closest to, at least physically and geographically.

So by all means, check in on your friends in other cities and other countries but don’t forget that the people that you live with, and those you see every day are also worth your time and effort. They may be harder to tolerate since you can see their flaws up close but they are also the ones with whom you are most tightly connected and rely on, whether you like it or not, for everything from a roof over your head to a shoulder to cry on. So put that screen down and see if you can get to know them again. It will be worth it.