Mitigate Risk
MEDICAL AND MENTAL HEALTH UPDATE
It’s decision time. We’re facing reentry as the novel coronavirus continues to tear through the country. Summer is beckoning us, yet it’s hard enough planning what’s for dinner. Kids and teens are bored, restless, and looking down the barrel of a hot, unstructured summer. Parents crave routine, their day job, and passing the baton of full-time schooling, caregiving, and family mood jockeying to the pros. Older adults worry about their reported high risk from COVID and a future of fear.
And indeed most calls from my patients today (and over the past few weeks) involve questions about risk, decision-making, and venturing past the front door. Am I high risk just because of my age? When can I fly? What about visiting my children and grandchildren? Is it safe to socialize outside? Can I play tennis? Hire a housekeeper? How can my city/state be opening up when the case rates are going up? Who is in CHARGE?!
Here’s the deal: THE RISK FOR GETTING COVID-19 WILL NEVER BE ZERO. And until we have a vaccine (which I suspect likely won’t be this year though I’d LOVE to be proven wrong), we will be living with risk every day.
So the questions we should be asking are not “Can I do this or that?” but rather “What are my risks, and how do I mitigate them?”
This week I’ll talk even more about R naught, the reproductive rate of coronavirus, “superspreaders,” herd immunity, and making smart decisions (see my post from last week here as a reminder.)
But TODAY I’m thrilled to unveil my handy-dandy way to remember the KEY ELEMENTS to mitigate risk. By joining the MOSH PIT, you’ve automatically earned an A+ in safety, smarts, and suffering my dumb humor.
M = wear a Mask
Masks are essential for reducing community spread by asymptomatic or presymptomatic carriers of the virus. They also show respect for others by not risking infecting them. We’re all in this together, literally!
O = being Outside is safest and good for our mental health
Being outdoors reduces transmission of coronavirus. Closed, poorly ventilated spaces are less safe than being in nature (unless, of course, you are crammed onto a beach towel like we saw people this weekend!)
S = Socially distance
Remember that most community spread occurs by person-to-person spread from people who don’t have symptoms. We must remain vigilant staying 6 feet apart to keep ourselves and others healthy. The more we distance, the less we transmit virus.
H = Handwashing
Handwashing and wiping down high-touch surfaces are critical, even though we know that environmental transmission of virus is LOW relative to spread via respiratory droplets.
P = Personal and public responsibility
When states are opening despite warnings from public health officials, it’s hard to know whom to trust. My advice: trust yourself (when you follow the rules) and BE trusted. When a virus is this contagious and MOSTLY is spread by people who don’t even know they have it, we’re obligated to protect our fellow citizens (aka the public).
I = Information and facts
Figure out who you trust and where you get information. Know the curves and case rates in your city, town, state, or district. You can make smarter decisions when you’re armed with facts. Just because your state is open doesn’t mean it’s safe to be out.
T = Talk to your doctor
You need to know your personal risks and unique medical situation. You need access to a doctor should you get sick or need medical advice. Elected leaders, public health officials, and the media can provide general (and often misleading) information. And no one knows you like your own doctor.
Note that while NO SINGLE MEASURE alone will eliminate the risk of infection, putting ALL of these elements together can essentially shut down the virus. We can do it—together.
Also note that as much as I, for one, miss my days slamming against other people at rock concerts, a mosh pit is NOT a recommended place to be right now. In fact, I can think of nothing less safe (or frankly less pleasant) at the moment. For now, it’s just an oddly-chosen yet strangely effective mnemonic device.
I hope you’ll print out MOSH PIT and tuck it in your back pocket to remember the rules. Heck, laminate it! Post it! Share it widely! If we MOSH PIT together, we’ll be back to a new “normal” much sooner!
Pictured here are my tireless, essential lab workers, Wendy and Marion, strutting their (safe) stuff six feet apart. They joined the MOSH PIT back in March and continue to be role-models for me. If they can do it, so can you!
I will see you tomorrow. Until then, be well.
P.S. Upcoming events this week:
Join me and BBC’s Katty Kay on Instagram Live TOMORROW at 11:15 am EST for a news roundup! We’ll talk about vaccines, COVID in kids, blood clotting due to coronavirus, and other medical updates.
Join me and teen psychologist Julie Baron, MSW, of Julie Baron and Associates on Facebook Live on THURSDAY at 3 pm EST to discuss the emotional challenges our teens are facing. Specifically we’ll discuss managing an unstructured life, navigating uncertainty, and resisting our culture of hyperfunctioning—now and in the future.
Let’s talk about loss. Not because it’s sexy or particularly fun but because we have to. We are all experiencing loss. And understanding the process of grief can help us create a roadmap to ease pain—and even find meaning.
While pain comes in varying orders of magnitude, whether you’re losing a loved one to COVID-19 or losing your senior spring of high school, we all are losing important parts of our lives.
Even small things like your Saturday morning yoga class, your regular haircut, your spontaneous spring happy hour with friends—they’ve vanished.
We can’t hug, snuggle, piggy-back ride, leapfrog, close-talk, or slow-dance at prom like we used to.
And it hurts.
We are hurting together—and apart.
The collective trauma of COVID-19 is its own pandemic, and we need to talk about it. Our health and wellbeing depend on it.
GRIEF GROUND RULES: Please know that you’re entitled to grief no matter WHAT you’ve lost. I’ve heard many times from patients this spring, “This seems so silly when you’ve got patients with COVID, but I’m really sad about missing my grandson’s baseball games” or (quite a lot from my older patients) “At my age I can’t stop thinking about all the time I have lost this spring.”
As trauma expert and my new friend Dr. Roxane Cohen Silver would say, “You can’t compare grief across traumas.” (We actually wrote an article together about collective trauma.)
And Roxy (she lets me call her Roxy) is right. There’s no contest on sadness, no loss too small, no lost moment unworthy of mourning. Apologizing for our own grief makes as much sense as apologizing for being human.
Experts agree there are SIX STAGES of grief that most people move through, whether they know it or not. Of course every situation is different, and no one reacts to loss in exactly the same way. But understanding these stages can help us make sense of losses that can feel overwhelming, confusing, and just plain sad.
STAGE 1: DENIAL. Boy, does this come in handy. It’s like nature’s way of buying us time. We are numb. But we’re actually pacing ourselves. We are processing and preparing, too. And as we start to question our new reality, we’re actually moving forward with healing.
STAGE 2: ANGER. Anger is a necessary part of the healing process. It anchors the pain, and expressing it helps diminish it. We often see anger as something to suppress, to shove down, to silence, when actually acknowledging it, feeling it, and working through it is good for our health. Sometimes this stage, like others, requires added support, and grief counselors (and/or your doctor) can help.
STAGE 3: BARGAINING. You’d do anything to have that part of your life, that person, that experience back. We try to negotiate with the pain. Our mind becomes filled with “what ifs” and “if onlys” as we live in the past. Guilt can compound the suffering as we often blame ourselves.
STAGE 4: DEPRESSION. When we start to face our new reality, we enter a state of natural sadness. We can feel lost and overcome with emotion. But this is part of the healing process, too. And while the depression component of grief is normal, it’s important to talk with your doctor about moods—to help distinguish between the natural depression from grief from a true mood disorder. We can help.
STAGE 5: ACCEPTANCE. This is not the same as “being okay.” It means finding peace with the loss, forging new pathways forward, and making sense of a new normal. It’s when we start to listen to our feelings, take care of ourselves again, and have more good days than bad days.
STAGE 6: FINDING MEANING. This is when we notice silver linings, unexpected joy, and new hope. It is not “closure;” but rather it’s about new beginnings and finding peace. It’s the birthplace of hope, strength, and resilience. It’s what some people call “post-traumatic growth” (a term I don’t love because it implies that something is wrong with you if you’re not stronger after loss—and indeed sometimes we AREN’T ANY BETTER OFF.) But if you’re fortunate enough to find meaning, savor it, use it as your rocket fuel, and write it down for when you slip back into other stages.
It’s important to note that these steps are not “requirements” for coping, nor do we enter and leave each stage in order. These stages are responses to natural feelings. And just as feelings can last minutes or hours, we can move in and out of one stage and back into another.
SO! On this chilly spring day (here in DC), we’re looking down the barrel of a very NEW normal. And we’re mourning the loss of our OLD normal, warts and all. School, work, and social life will invariably be different in the future. How will that look? And how will we FEEL?
I, myself, miss a lot of things. In particular, I LONG for my Saturday walks with Courtney, my Tuesday morning yoga class in my kitchen with neighbors and Alice, browsing at Ella Rue, deal-hunting at TJ Maxx, and simply being with my patients in person. I miss traveling. I miss eating out. I miss kiss-kissing and laughing at loud, crowded parties wearing high heels—and regretting it later. I miss hugging my parents and brothers and nieces.
Will it ever come back?
I have hope. We’re getting smarter about this virus every day. Vaccine trials are underway. People who are following the rules (see Tuesday's post) are not getting sick and not infecting others. And, thus far, ALL of my patients who’ve recovered from COVID-19 have tested positive for antibodies (suggesting, but not proving, immunity). They can even donate plasma by clicking here! People are looking out for other people. Kindness is in fashion. My kids did the dishes tonight.
ONWARD!
This WILL be over. We WILL be back to normal—even if it looks different. Change is hard, but change can be healthy, too. Let’s breathe, be patient, and know that the universe has our back.
I will see you tomorrow with a report from the FRONT LINE: my interview with friend and colleague Jen Abele, MD, Chief Medical Officer and ER physician at Sibley Memorial Hospital. She has some great info to share with you! Until then, be well.
P.S. Tomorrow join me and BBC’s Katty Kay on Instagram Live at 11:15 am EST for a news roundup!
P.P.S. Yesterday I interviewed my colleague, friend, and medical partner Dr. Clay Ackerly. He’s an internal medicine doctor and geriatrician—and a generally wonderful human being. We discussed the unique challenges of our older patients, AGE (and its relativity), and assessing our unique risks during the pandemic. We had great fun, bloopers and all! If you missed it, check it out here!