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.
