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COVID-19: What we should all being do to protect ourselves, physically and emotionally.

Updated: Jul 3, 2020

President Franklin Delano Roosevelt famously said in his inaugural address on March 4, 1933, “the only thing we have to fear is fear itself.” He was addressing the dire economic situation during the midst of the Great Depression, but his words ring true today.


In contemplating the COVID 19 outbreak, these words of FDR come to mind. In searching for timely links that might be relevant, I stumbledupon an article in the American Psychological Association’s Monitor from March 2015. “An Epidemic of Fear” (https://www.apa.org/monitor/2015/03/fear) was written in response to public anxiety about the Ebola outbreak. The author cited research that showed that “novel threats provoke anxiety, while people often under react to familiar threats.” For example, while influenza sickens as much as 20% of the population annually, and thousands die, fewer than 50% gets vaccinated for the flu each year. The author writes about the importance of disseminating accurate information and the roles that not only government administrators but the media has in doing this, even if the information is acknowledging the unknown. One of the examples brought up in the article concerns the response of media in different markets, and how that affected outcomes. The author notes that during the 2009 H1N1 influenza outbreak, Australian and Swedish media both did an admirable job at getting word out about that new strain of flu. However, while Australian news outlets focused on the negative in how health care agencies were handling the situation, Swedish media reported the facts, acknowledged what was not known, and gave clear and concise information from public agencies as to what individuals could do to decrease risk. In Australia, 18% of the population ended up getting vaccinated for H1N1, while in Sweden, 60% were vaccinated that year.


While there is currently no vaccine for COVID 19, there are still actions that individuals can take to minimize risk. First and foremost is getting some sense of what that risk is. While much remains unknown, it appears that basic public health methods that are being implemented in China and elsewhere seem to be slowing the rate of new infections. It appears that not everyone who gets exposed gets infected, not everyone who gets infected develops symptoms, of those who develop symptoms only a subset get very sick and of those who get sick, anywhere from 1 to 3% die. That rate seems to vary drastically with very low rates of symptoms among minors who were exposed v. mortality rates of up to 7% among the frail elderly who become ill with COVID 19.


Basics of every cold and flu season, such as washing your hands thoroughly and frequently (one of my nurse friends shared a post that read, “wash your hands like when you were a teenager with a club stamp from the night before that you don’t want your mother to see”), cough/sneeze into your elbow and don’t go to work/school if you have the sniffles are very reasonable protocols to follow. Hoarding mass amounts of toilet paper and hand sanitizer are not. Stigmatizing people from different ethnic backgrounds is also not a helpful response. Buying up M 95 respiratory masks may due more harm than good, as hoarding these may result in the frontline health workers caring for those who are ill with COVID 19 may then lack access to protective gear. If significant numbers of health care workers fall ill, who will care for you if you do?

Certain segments of the population may need to follow different protocols. While children, at least as of this writing, appear to be at lower risk of becoming symptomatic, they may still be carriers, so closing schools in localities with clusters of illness might make sense, not so much to protect the children, but to protect their grandparents. Changing travel plans might not be necessary for an otherwise healthy 27 year old. That may not be the same for a 72 year old. NIH director Dr. Anthony Fauci has advised older adults not to travel on cruise ships till this has passed. He might not advise twenty something newlyweds in the same way.


What is much more in my lane, as a psychiatrist, is the mental health consequences of COVID 19. Some people react to stressful situations with denial, and that is not particularly helpful if you are in a position of authority and have to make timely decisions to limit harm. Others may react with increasing anxiety and even panic, and that can lead to behaviors that result in greater harm as well (see above, re: mask hoarding and health care worker risk). Another article, this one specifically related to mental health and COVID 19, in Psychiatric Times (https://www.psychiatrictimes.com/psychiatrists-beware-impact-coronavirus-pandemics-mental-health/page/0/1), addresses the effects that the current situation may have on mental health symptoms. Individuals with certain mental health conditions, such as obsessive compulsive disorder, may experience an increase in symptoms due to anxiety. Those who already have distrust of medical systems may see that intensify. Being alert to this can help if you have loved ones suffering from anxiety.


So it would seem that either on and individual level or a societal level, reacting to COVID 19 to either extreme may do more harm than good. As Buddha would certainly advocate, the middle path is best.


In closing, I would like to share a light hearted video that gives you some helpful things that you can do to keep healthy. One of the most important things is to smile.https://www.youtube.com/watch?v=4mzThYPuzs4


Celia Woods, M.D., Sterling Care Psychiatric Group

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