How to Cope with Anxiety During a Pandemic?

In December 2019, a new virus, Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-Cov-2 was discovered in China.  This virus causes a disease named Coronavirus Disease 2019 or simply COVID 19.

COVID 19 has an incubation period of 2 to 7 days, most commonly 5 days, with an upper limit of 14 days.

Most cases present symptoms of fever, dry cough, fatigue and shortness of breath. Some cases may develop into pneumonia, and in the most severe cases, acute respiratory distress syndrome (ARDS).

Based on a study conducted by the Chinese Center for Disease Control (China CDC) on the first 44,600 confirmed cases, more than 80% had mild presentations, 15% were severe, and 5% were critical. Mortality has been highest among persons over 80 years old and among people with multiple chronic illnesses, such as asthma, diabetes, and chronic heart or lung diseases.

Transmission occurs from person-to-person, via droplets when an infected person coughs or sneezes, or if somebody touches a contaminated surface or object, and then touches the eye, nose, or mouth. Because most cases are mild, it is possible that a large number of infected people might not seek medical attention, and continue spreading the virus to their contacts.

There is also evidence that patients in the incubation period, before symptoms begin, can transmit the virus, imposing a greater challenge to contain this infection.  For this reason, it can be said that, “a virus that poses a low risk on the individual level can pose a high risk on the population level”.  (ref 2)

On January 23^rd this year, China implemented movement and travel restrictions, and on January 30^th, the World Health Organization (WHO) declared COVID 19 a public health emergency of international concern.

The Public Health measures implemented in China were:

• Isolation: the separation of ill persons from those that are healthy, to protect non-infected persons.
• Quarantine: movement restriction of persons who are presumed to have been exposed to the disease but are not ill, either because they did not become infected or because they are still in the incubation period.
• Social distancing such as closure of schools, office buildings and commerce (except food and essentials), and cancellation of gatherings.
• Community-wide containment: an intervention applied to an entire community, city or region, designed to reduce personal interactions, except for minimal interaction to ensure vital supplies. A community-wide quarantine was imposed in China in an order of magnitude that mankind has never witnessed before. (ref 6)

Although these extreme measures have now been taken worldwide, as of March 27, 2020 the virus continues to spread, and the world is facing an expanding pandemic.

Nobody knows how long the pandemic will last, or how it will impact the economy and our jobs.  There are many uncertainties.  With more and more countries shutting down their borders, we fear for our children and relatives in parts of the world that get more inaccessible by the day.  Anxiety, worry and a sense of helplessness and hopelessness are very common, and are a normal reaction to such a crisis. We may even have insomnia, fatigue, and sadness.  However, there are ways to cope with the stress.

What can we do to cope with anxiety in the current health crisis?

1. Cooperate with the health authorities by protecting yourself and your family. Stay home if this is the recommendation. Only go out if really needed.

2. If you go out, keep a distance of 2 meters from other people, and don’t touch your face.

3. Hand Hygiene. Wash your hands thoroughly when you return home. This involves washing the palms, back of the hands, between fingers, the nail area and the wrists. It should take about 20 seconds. Clean your cell phone and keys. There is no need to wash the hands all the time if you are at home; washing too often can cause inflammation of the skin.

4. If you are working or studying at home, try to keep the same regular schedule as before: wake up, eat and go to bed at the same time. This helps you to have a sense of normality and control.

5. Keep your immune system in good shape by eating healthy and exercising. You can download an app to learn and practice exercises, for example, tai chi or aerobic exercise. Physical activity is an effective way to reduce anxiety and improve sleep quality. It is also important not to stay awake too late at night. Sun exposure is important for your body to create vitamin D from direct sunlight which is essential for healthy bones.

6. Limit your internet time. Avoid reading too much about the virus by limiting reading / viewing time to 15-20 minutes per day. Excessive and especially incorrect information is unhelpful because it can increase anxiety.  Be careful with data sources and avoid ill-informed opinion pieces.  Look for facts on official sites (WHO, CDC, John Hopkins, etc.).

7. Observe your behavior: shaking, difficulty in sleeping, tension, fear of going out, excessive washing of hands or sanitizing, restlessness, persistent worrying. All these symptoms can be signs of anxiety.  If you think you might need help, talk to your doctor or mental health specialist (psychologist or psychiatrist). They will be glad to help you.  Observe your family member’s behavior as well as your own.

8. Staying at home for long durations of time can be stressful. Create quality time with your family: play games together, share in the house chores, use creativity to cultivate a better and meaningful relationship. You can learn a new instrument, a new language, a new skill such as culinary arts, read a new book.

9. Support and encourage one another: It is a good opportunity to connect with your friends through internet (WeChat, Facebook, etc.) to keep in touch and encourage one another.

10. There are things we cannot do at this time (maybe we cannot travel as we wanted to or go to school as before) but there are many things we can do. Focus on things you can do. Not everyone is able to go to the frontline to help now but staying home and being safe is a great contribution. You can also consider helping in other ways such as blood donation for example. There is currently a huge need for blood. (WeChat: BloodlineFamily). This is a great way to help save lives.

As the whole world is fighting against this new virus, let’s stay safe and support one another.

1. https://coronavirus.travax.com/library/coronaviruses/events/coronavirus-disease-2019
2. A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment, Vincent J. Munster, Ph.D.,Marion Koopmans, D.V.M., Neeltje van Doremalen, Ph.D., Debby van Riel, Ph.D., and Emmie de Wit, Ph.D. January 24, 2020, at NEJM.org.
3. Potential for global spread of a novel coronavirus from China, Bogoch II, Watts A, Thomas-Bachli A, Huber C, Kraemer MUG, Khan K, Journal of Travel Medicine, Rapid Communication, 27 January 2020, taaa011,  https://doi.org/10.1093/jtm/taaa011/5716260
4. Novel Coronavirus 2019 Considerations:Johns Hopkins live outbreak update:  maps.arcgis.com/apps/opsdashboard/index.html#/…
5. Geographic distribution of 2019-nCov cases in Asia, as of 11 February 2020: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases
6. Isolation, quarantine, and social distancing and community containment: pivotal role for old- style public health measures in the novel coronavirus (2019-nCoV) outbreak. Wilder-Smith A. MD1,2, Freedman DO. MD3 https://doi.org/10.1093/jtm/taaa020
7. Dr Wei Chang, Chair of Psychological Health Center of United Family Hospital, How to Cope with Stress During the Outbreak of Coronavirus?
8. Julia Huang, Tips on how to cope with anxiety during the covid-19 outbreak
9. CDC.GOV