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Our Mental Health

Has it happened to you too? More than once in the last few weeks, I’ve woken up in the middle of the night questioning whether or not all of this is real. Is there really a pandemic virus claiming tens of thousands of lives around the world? It’s like a movie plot. Scratch that. It IS a movie plot. I’ve seen it. And I’ve seen it again. (I also read it when I was a kid and I think that’s what got me interested in public health in the first place).

Who would have though that something like the COVID-19 outbreak is even possible in this day and age, given our advancements in medicine and knowhow. Yet here we are. Confined to our homes. Watching the numbers rise. It’s difficult to comprehend. Even for an epidemiologist.

I never thought, when studying in school, that I would one day be living through a communicable disease pandemic. That was something for the history books. Or maybe the rare and short-lived emergence of something like Zika or swine flu. In fact, I’ve made my career mostly as a non-communicable disease epidemiologist, focusing primarily on mental health.

If I’ve learned one thing, however, it’s that physical health and mental health are inextricable intertwined. I fear we will see this play out loud and clear with the COVID-19 crisis. This infectious disease pandemic could result in one of the worst mental health pandemics in history.

Fear and anxiety

One thing this virus is particularly good at is scaring people. The endless media coverage certainly contributes to that, but many news outlets and health officials are simply telling it like it is. It is a frightening virus. It is highly contagious and has the potential to be fatal. This makes us fearful and anxious. We are concerned about our health and the health of our loved ones.

Fear itself is also contagious. People can become fearful of one another in times of uncertainty. COVID-19 has led to an outbreak of stigma and prejudice, mainly aimed at those of Asian ethnicity due to virus’ origin in China and some people calling it the “Chinese” virus. Even wearing masks in public has been highly stigmatized and can be anxiety provoking, (though that may change with the CDC’s new guidance).

How do we overcome fear? With the the facts. We know how to protect ourselves. We know how to slow the spread. And we are learning how to treat COVID-19 and prevent it from spreading in the future.

Social distancing and isolation

Part of our new reality is distance. Distance from the person in front of you at the grocery store. Distance from your neighbors next door. Distance from your family in another state. It is difficult for many to simply cut-off their social networks (the real-life ones). Having close friends and family is known to promote better overall health. Social isolation is known to have the opposite effect, particularly on our mental health.

The good news is that we are all just a video call away. It’s not the same as grabbing drinks with friends or dinner with the family, but video chat happy hours can be fun too.

Loss and bereavement

Millions of Americans may suffer the loss of a loved-one over the course of this pandemic. Worse, many individuals may not be able to mourn appropriately, due to social distancing. We are hearing heartbreaking stories of so many who have lost someone to COVID-19, who were unable to be by their bedside. Some people who may have been healthy just a few weeks ago, have succumbed to the virus. This is sad and can be shocking, especially for a close relative. Death is difficult and the grieving process can be complicated; made even more complicated by our current situation.

If you or someone you know is dealing with a loss, the American Psychological Association has provided guidance on grief amidst COVID-19.

Stress and depression

All of these experiences and perceptions can feed our anxiety and lead to stress. Chronic stress can have serious mental health consequences. It can lead to substance abuse. It can lead to major depression. It can provoke thoughts of suicide. Individuals with preexisting mental health conditions are at even higher risk.

Chronic stress can also lead to inflammation in the body which can negatively impact our overall health and weaken our immune system. This, in turn, can put us at greater risk of severe COVID-19 symptoms and other conditions like cardiovascular disease.

Exercise and meditation are two at-home ways to address and overcome stress. Headspace is offering a free “weathering the storm” meditation and movement program for anyone struggling.

Lasting impact

Unfortunately, we are only about a month into this new reality, the effects of which may be felt for many more months ahead. The recovery process will be difficult for many. On top of the growing numbers of cases and deaths, the severe economic downturn due to COVID-19 has led to a record-breaking loss of jobs. Our children have been out of school for a month and may be out for the remainder of the school year. We may be able to protect our kids from the virus, but how do we protect them from the emotional and psychological challenges they may be experiencing. And how will this experience shape our future generations?

What do we tell our kids about COVID-19? Here are some ideas.

Mind your mind

Never has it been more important to take care of our health. We must treat mental health as seriously as we are treating our physical health. Now and always. There is no health without mental health. Don’t ignore it if having difficulty sleeping. If you need help, reach out to someone. Just because you are home doesn’t mean you are alone. If you are struggling with a mental health condition, be in touch with your primary physician, and have a plan should you need urgent attention.

Even if you are coping well, someone you know may be having a tough time. We can still be there without being there, so stay in touch with your friends and loved ones. Don’t forget, we are all in this together.

The CDC has put together an excellent resource focused on mental health and coping. It includes information on reducing stigma and stopping the spread of misinformation. It also provides tips on how to care for the emotional well-being of children.


If you are are experiencing thoughts of suicide,
contact the National Suicide Prevention Lifeline

1-800-273-8255

Text “HOME” to 741741 to chat with a crisis counselor
Connect with a counselor over Facebook Messenger

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Perspectives Resources

What to Tell Our Kids

I am slapping a disclaimer on this one. I am far from an expert on how to educate our kids about COVID-19. I am just a dad, along with a mom, trying to figure out what our kids should know about the current state of the world and how to explain it in a way that makes sense to a couple of toddlers. Fortunately, there are a lot of great kid-friendly resources out there. And it turns out that our kids already know quite a bit. So lets not underestimate their ability to understand the situation, or their desire to help.

Fist off, kids already know that getting sick is a bad thing. Nobody likes a tummy ache. They also already know the single most important thing we can do to protect ourselves from getting sick, be it from coronavirus or any germ for that matter – WASH YOUR HANDS! And just in case anyone needs a refresher, Pinkfong has us covered (by planting that incessant earworm, more infectious than the coronavirus itself, do do doo do do…)

Another video my 3-year-old cant get enough of is this cute little animation from the WHO (no, not The Who) on how-to protect yourself from COVID-19.

Kids also already know the importance of chicken wings. Chicken wings, you ask? (Its OK, I didn’t know either). “Chicken wings” is how kids these days learn how to sneeze into their elbows. You know, like they have a chicken wing.

What about how to explain what a virus is? This is where we’ve turned to some good old fashioned Netflix. There is a really good Ask the Story Bots episode that answers the question, “How do people catch a cold?” It is a great lesson in germs, personal hygiene, and how your immune system works to kick some viral butt. More great news; the episode is free to watch on YouTube!

For the super science-loving kid (what kid isn’t), LiveScience has created an “ultimate kids guide to the new coronavirus” and an amazing infographic that I posted below, because it’s too cool not to post.

It seems the hardest part of all this for our kids to understand is why they cant go to school, see their friends, go to the playground, go bowling, etc. And this is where it gets tricky. We don’t want to frighten them, but the whole idea of not being able to leave your home is scary, even for adults. We’ve told them that stores and playgrounds are closed, and families are staying home, just to be safe. Of course, with the news constantly on in the background, our 5-year-old is quick to point out that “we know… its because of the virus.”

Maybe for some of the older kids, it might be worthwhile explaining that most children and mommies and daddies wont get too sick if they catch the virus. But that we have to be extra careful not to get our grandmas and grandpas sick. Like I said, its tricky.

I know this post has been a bit of a departure from the rest of the site, but hey, its been a long few weeks and everyone can use a little Baby Shark right now. It is a difficult situation but it also happens to be an incredible learning opportunity for everyone, kids included. After all, they may very well be the ones preventing the next pandemic. And since our kids are not in school, us parents have an even bigger role to play in teaching them about this. So lets make the most of it. Go squeeze yourself in between the kiddos on the couch and enjoy some Story Bots together.


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Community Considerations

With more test results coming in, our city is now up to 27 known cases. Our task force continues to respond to the immediate needs of the community, and prepare for those to come. The following provides a general idea of the types of questions we are asking to help inform the city’s COVID-19 response strategy, and why they are important.

COVID-19 Response Plan Considerations

Health System Preparedness

The ability of the health system to handle the surge of COVID-19 patients is paramount. It is the primary reason for our social distancing efforts to mitigate the spread of the virus. How do we gauge the capacity of our city’s healthcare system?

  • How many hospital beds does the city have?
  • How many ICU beds?
  • How many ventilators?
  • How many healthcare staff?
  • What is the existing supply of personal protective equipment?
  • How is the city procuring more of all of the above?
  • What is the plan should hospitals exceed capacity? (Are there temporary treatment facilities)?
Testing Procedures

As the virus (and awareness of the virus) spreads, the demand for testing will increase. Having an appropriate protocol in place will help ensure organized and efficient testing procedures while, importantly, adhering to the necessary safety and social distancing guidelines. What are some of the key testing considerations? (These apply to non-hospitalized suspected cases).

  • Testing locations – ideally situated away from hospitals to avoid congestion and unnecessary exposure
  • Drive-up/mobile testing when possible
  • With a physician’s prescription only – physician will determine if symptoms and medical history meet COVID-19 testing criteria
  • By appointment only
  • Priority testing and/or separate testing site(s) for healthcare workers and first responders
Persons Under Investigation

Persons under investigation (PUIs) include individuals with symptoms whose test results are pending, and asymptomatic individuals who may have been exposed to a lab-confirmed COVID-19 case. How do we manage and instruct PUIs to prevent the further spread of virus?

The CDC has developed health department guidelines for (1) how to evaluate PUIs, (2) how to report PUIs and confirmed cases, and (3) what preventative measures a PUI should take based on their risk of exposure.

Confirmed Cases

What is the course of action once a persons’s test comes back positive for COVID-19? If he/she does not require hospitalization, the CDC has developed guidelines for self isolation and home care. This includes guidance on when it is safe for an individual to discontinue home isolation.

First Responders and Emergency Medical Services

How do we ensure the safety and preparedness of our first responders? Police, Fire, and EMS departments will play a crucial role during the COVID-19 crisis. The CDC has developed EMS guidelines for patient assessment and transport, the use of personal protective equipment, the cleaning of vehicles, and other important steps in responding to an emergency.

High Risk Groups

This includes seniors (primarily those in senior housing), individuals with disabilities, low-income households, and the homeless. What procedures are in place to ensure the health and safety of these individuals, including access to healthcare services, food, essential services, and housing/shelter? What state and federal aid programs are available to further support these individuals?

Continued Social Distancing Measures

How do we maximize our efforts to slow the spread of COVID-19 in the community?

  • “Stay-at-home order” for all non-essential employees
  • Non-essential travel restrictions
  • Non-essential retail businesses closed
  • School closures
  • House of worship closures
  • Public library and offices closed
  • Cancellation of all public events and gatherings
  • Restaurants open for take-out only
  • Essential businesses (eg, pharmacies, grocery stores) recommended to limit the number of customers to maintain social distancing guidelines (ie, 6 feet between individuals)
Communication

How is this information being conveyed to residents and businesses clearly, concisely, in a timely fashion, and with the utmost consideration for the angst and uncertainty that many individuals may be experiencing at this moment in time?


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