Own Your Fear; Don’t Capitulate to it
A total stranger sent me this note on social media. I’m posting it here with permission because it captures so many people’s feelings right now: the shame, guilt, and fear associated with avoiding—and getting—COVID-19.
This mother, naturally afraid for her unvaccinated child, realized that she’d unwittingly let her anxiety overtake rational thought. As a result, she deprived her child of much-needed normalcy. The antidote to her fear wasn’t ongoing avoidance of risk; it was facing her fear, trusting the facts about COVID in kids, and appropriately balancing the harms of the virus with the harms of more missed school.
Maybe you’re not anxious at all. Maybe you never were. But after I posted this screenshot on Instagram and Twitter, my mailbox was flooded with private messages from people saying: “This is me!” “Reading this makes me feel less crazy” and “I feel seen!”
I was on-call this weekend for my group medical practice and spoke to many vaccinated patients with COVID-19. They reported cough, sore throat, headache, body aches, fatigue. Their other top symptoms? Guilt, shame, and fear. “I did everything right.” “I feel like a failure.” “Doctor, I’m terrified.”
So when I’m talking to a newly-diagnosed COVID-19 patient, we don’t only go through their symptoms; decide whether or not they need emergency care; discuss various treatment options from Ibuprofen to monoclonal antibodies and oral antiviral medications (the latter two for high-risk patients); and how to monitor themselves at home. I also help tamp down patients’ (natural!) anxiety. I remind them how very well the vaccine continues to work against death and severe disease.
Exactly how good is good? The CDC’s newest data on vaccinated people is incredibly reassuring. Take a look at their graph below and you can see how incredibly low risk vaccinated and boosted people over 65 years old are for hospitalization (it’s ZERO per 100,000 people at some points!)
The same is true for people ages 50-64, though people in this age group are generally at lower risk for severe outcomes and therefore have less to gain in the first place from added protection from boosting!
I also remind sick patients with little ones at home that Omicron seems to be less severe than Delta—even in unvaccinated children under the age of 5—which seems to quell parents’ natural anxiety.
The bottom line is this: The vaccines continue to be wildly effective against serious consequences of COVID-19. Kids remain at relatively low risk for poor outcomes. Yet anxiety is high. It’s clear that the pandemic has done a *number* on our brains.
It makes complete sense! It has not always been clear who to trust. We’ve been bombarded with information, ever-changing guidelines, and conflicting opinions on risk. Moreover, we’ve been marinating in stress hormones since March 2020 and the moment we watched, aghast, TV images of refrigerator trucks full of bodies outside overwhelmed hospitals in New York City. For almost two years, we’ve been managing our everyday lives (which weren’t stress-free to begin with!) on top of the medical, logistical, and emotional challenges of getting sick.
To say that some of us are anxious is not to suggest we’re crazy; it’s that we’re HUMAN.
Fear is normal. It’s how we run from danger. It’s how we flee from the proverbial tiger in the wild. Fear can be our rocket fuel. Without stress hormones coursing through my veins, I might not have made it through my medical training! I might not have studied so hard for the test; I might have forgotten how to resuscitate a patient during a code red.
So if anxiety is part of the human condition, when is worry “too much”? When does the appropriate fear accompanying a global disaster become a problem in and of itself? And how would we even KNOW? Who is the judge of our feelings anyway??
Well, I’ll tell you how I talk to my patients about anxiety. We discuss the “normalness” and survival benefits of anxiety. We talk about how anxiety lives on a continuum. I explain that anxiety is considered a medical condition when worry takes on a life of its own—that is, when it’s interfering with a person’s quality of life, causing physical symptoms, and/or medical harm.
For example, my patient who is constantly worried about her teenage son’s depression symptoms doesn’t necessarily have an anxiety disorder; she’s appropriately worried about a struggling child. My patient in remission from breast cancer who’s worried about her upcoming mammogram doesn’t have an anxiety problem per se; she’s appropriately anticipating a nerve-wracking test.
But let’s say my patient’s son gets the treatment he needs, emerges from his depression, and starts thriving at school. If my patient continues to find herself worrying excessively about his condition, if she experiences surges in her blood pressure, and/or she gravitates to drinking more alcohol to help tamp down her fears despite the absence of evidence that he’s struggling, then we’d consider her anxiety an actual problem and talk about various strategies to help.
Or let’s say my breast cancer patient repeatedly has normal mammograms, yet the fear of getting recurrent cancer starts bleeding into her regular life—causing emotional symptoms like irritability, anger, or depression; physical symptoms like sleeplessness, jaw tension, or migraines; and/or behavioral symptoms like avoiding social occasions, stress-eating, and/or over-using sleep medications, then I’d want to help her manage the anxiety like I would any other medical problem.
In other words, anxiety is a problem when repetitive “what if” thoughts, worry, and/or ruminations occupy too much brain space.
Similarly, if we find we’re worrying excessively about COVID risk when we’ve been fully vaccinated, it may not be COVID that’s the problem; it may be that our intrinsic worry barometer has been thrown out of whack. I’ll say it again for those in the cheap seats: having anxiety during a global crisis makes you NORMAL. I’m simply suggesting that it’s time to make sure we’re calibrating our fear and everyday decisions to the level of actual risk. (I realize this is easier said than done—and is one of the main reasons I’ve been writing this COVID-19 newsletter for almost two years!)
I invite you to do the very first thing I do myself when I’m feeling anxious: fact-check your thoughts. Is the internal narrative you’re playing on repeat rooted in reality? Is the amount of time you’re spending thinking through the issue commensurate with the facts? Or has that nugget of worry hopped on a hamster wheel, distracting you from solving the problem head-on?
These are not always answerable questions. Subjectivity abounds when we’re talking about thoughts and feelings! Which is why I suggest talking out your thoughts—the good, the bad, the ugly—with a friend, therapist, pastor, or other trusted guide. Self-awareness can be hard—particularly when we’re in a tizzy—but reflecting on our interior worlds is ultimately the birthplace of health.
Next week I’ll talk in more depth about how we treat anxiety and prevent it from taking on a life of its own in the first place. For me at least, it’s a daily work in progress.
I will see you next week. Until then, be well.