Saturday, April 18, 2020


Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania, HCFI and Past National President IMA

667:  COVID-19: Lessons learned

S: Service: same to everyone, presume every person to be COVID positive and every surface to be corona virus positive

E: Excellent: Anticipate (endemic, epidemic, pandemic; lock down; physical distancing, sealing, flexible to involve all segments of healthcare in emergency and watch what is happening globally)

R: Responsible: Provide the same standard of care to everyone to the people which you would expect for yourself

V: Value based: Team building, taking care of the health care providers. Treat and protect them as air lines treat their crew.  

E: Enthusiasm: Never lose hope, we shall overcome one day, with a hope for the better

668: Financial stress: what was the experience of mental health effects of unemployment by observing trends during the Great Recession of 2007 to 2009

For every 1% increase in unemployment in the United States, researchers observed an approximate 1% increase in suicide, and the approximate 4% increase in unemployment during that time was commensurate with a 4% increase in suicide.

669: Chronic stress impacts immune system, overall physical health

The pandemic viewed as a macroscopic chronic stressor,

Chronic stress can weaken the immune system, which needs to be functioning optimally during the COVID-19 pandemic. Stress can also inhibit healthy functioning of our digestive system, and it can lead to negative effects to the circulatory system through increased heart rate, increased blood pressure and even increased risk for heart disease over time.”

670: Which individuals with chronic medical conditions are particularly at risk for negative outcomes of elevated stress.

Those with diabetes may experience difficulty controlling their glucose levels. Among individuals with cancer who are immunocompromised, stress has been linked to more rapid tumor growth.

671: Is stress linked to ethnic groups

Chronic diseases also affect certain subgroups more than others. For example, diabetes, heart disease and obesity disproportionately affect people with mental illnesses and members of certain racial/ethnic groups, such as African Americans, compared with the general population.

672: Stress causes inflammation or inflammation causes stress

These chronic, noncommunicable conditions are not only causing inflammation, but they may be a consequence of it.

Perhaps one of the reasons why we’re seeing greater complications among African Americans, people of lower socioeconomic status and those with mental illness in response to COVID-19 is because these individuals already have an immune-dysregulated condition. Being mentally ill or having diabetes, for example, and then being confronted with the stress related to fear of the virus, of job loss or of financial insecurity only further dampens down the immune system, leaving these individuals at greater susceptibility to not only viral complications if they get it, but also complications from their medical conditions.

673: Managing stress in the era of COVID-19

Clinicians should be proactive in reaching out to patients who may be particularly vulnerable right now, especially those who live alone.

In speaking with patients, clinicians can explore what worked for these patients in the past when they’ve been under high levels of stress.

Further, clinicians can ask patients questions such as: What are some stress management tools that were effective for you in the past? Are you using those tools now during the pandemic? If not, would you be willing to consider reengaging them, or perhaps adding some new ones to your coping toolbox?

674: Which techniques can be used

Mindfulness meditation strategies are among the most effective strategies.

Simple initiatives, such as taking a walk outside, listening to music from a joyful period in one’s life or watching a funny movie also can help mitigate stress.

675:  How to manage sleep problems

Encourage people to take advantage of the opportunity to align their schedules with their natural circadian rhythms.

There may actually be some improvement in sleep durations given that most folks are working from home with more time with family and less work-related stress.

Although daylight has the biggest impact on regulating circadian rhythms, artificial light, meal times, diet, and amount of physical activity can also have an influence. Negative effects on sleep can result from both excessively high activity levels, such as stress and work overload, or excessively low levels, such as from depression or confinement.

676: How common will be PTSD

The current situation also opens the door to interactions between stress, sleep, anxiety, and risk of PTSD.

Those sensitive to stress-related sleep disruption are more likely to develop chronic insomnia, which, in combination with a major stressor, is a risk factor for PTSD.

7% of Wuhan residents, the city in China where the virus appears to have originated, particularly women, reported PTSD symptoms after the COVID-19 outbreak, and anxiety was highest in those under age 35 years and those who followed news about the disease for more than 3 hours a day.
Better sleep quality and fewer early morning awakenings, however, appeared to be protective against PTSD symptoms. The authors note the value of physical exercise, cognitive interventions, and relaxation techniques, including meditation, for reducing stress and milder symptoms of PTSD.

677: What are the sleep recommendations

  • Get up and go to bed at approximately the same times daily.

  • Schedule 15-minute breaks during the day to manage stress and reflect on worries and the situation.

  • Reserve the bed for sleep and sex only; not for working, watching TV, using the computer, or doing other activities.

  • Try to follow your natural sleep rhythm as much as possible.

  • Use social media as stress relief, an opportunity to communicate with friends and family, and distraction, especially with uplifting stories or humor.

  • Leave devices out of the bedroom.

  • Limit your exposure to news about the COVID-19 pandemic.

  • Exercise regularly, ideally in daylight.

  • Look for ways to stay busy and distracted, including making your home or bedroom more comfortable if possible.

  • Get as much daylight during the day as possible, and keep lights dim or dark at night.

  • Engage in familiar, comfortable, relaxing activities before bedtime.

  • If your daily activity level is lower, eat less as well, ideally at least 2 hours before going to bed.

The authors also offered recommendations specifically for families:

  • Divide child care, home maintenance, and chores between adults, being sure not to let the lion's share fall on women.

  • Maintain regular sleep times for children and spend the 30 minutes before their bedtime doing a calming, familiar activity that both the children and parents enjoy.

  • While using computer, smartphones, and watching TV more than usual may be inevitable in confinement, avoid technological devices after dinner or too close to bedtime."

  • Ensure your child has daily physical activity, keep a relatively consistent schedule or routine, expose them to as much daylight or bright light as possible during the day, and try to limit their bed use only to sleeping if possible. "Parents need to be involved in setting schedules for sleep and meal times so that kids do not get into sleep patterns that are difficult to change when school starts back.

  • Limiting screen time is also important especially during nighttime.

  • Reassure children if they wake up anxious at night.

J Sleep Res. Published online April 4, 2020. 

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