Stress, Anxiety and Well-Being in the Time of COVID-19

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By Leif Hass, MD |  April 4, 2020 | 

As the Chief Well-being Officer at Alta Bates Summit in Oakland, California, I was asked a few times to talk to staff to give them some tips on coping with the stress this pandemic is producing. After some reflection and research, I compiled some tips that I hope can be helpful to keep us grounded in these unprecedented times.

1.    Let’s keep the existential threat in perspective.

Let’s go to the big question that crosses all of our minds: Am I going to die?

We are used to the idea of pathogens surrounding us, but this threat is on a different level, and rising death tolls and worried families make it feel a lot worse. Doctors describe feeling “radioactive” and are making up their wills. It is important to look at the data and not the news stories of deaths without a denominator or circumstances (no PPE). First of all, we are not proceduralists, and we are taking universal precautions – all masks, all the time for those of us fortunate to have them. If we take the high number of 10% healthcare worker infection rate (it was much lower in Hong Kong) and a high death rate of 5%, the chance of dying from COVID-19 is 1/200. If the numbers are 5% infection rate and 2% mortality, the chances of dying from it is 1/1000. If I got on the bus to Cache Creek knowing my chances of winning was 199/200, I would feel pretty good about it. Something to keep in mind when your brain, like mine, starts spinning out of control in moments of worry.

2. Anxious? Stressed? Of course, we have good reason to be!

Anxiety can have this negative connotation of repetitive thought patterns and wasted energy, but when we have to process an unprecedented event and ever-changing data, anxiety is an appropriate response. There is a lot we need to learn, and there is new information daily! It takes time absorb it and then process it. However, we can slip from productive processing to unproductive ruminating pretty easily. Self-awareness can help us see the addictive nature of the computer and social media. When this happens, it is time to change the channel and utilize our social support systems to move our thoughts away from the news. We also need think about mindfulness and other self-care tools.

3. The answer? It starts with the breath.

The best way to quiet our minds through the breath. A single deep breath will decrease sympathetic tone. And if you take a few, focusing on the breathing as you do so, you can begin to calm the mind as well as the body. This is basis for most mindfulness practices. Research has shown that those who do even brief but regular breathing meditation get back to a calmer nervous system faster after a stressor than those who don’t. Part of this is just learning to pay attention to our bodies and thus notice and let go of the tensions that build up.

It is inevitable while working these days to have a mind racing with ruminations about PPE and testing and worries about what is next. For me, sometimes this happens to the point that I am not paying as much attention to what is actually happening right now, right in front of me. And that is how errors with doffing and donning happen. Even just a single deep breath helps! Practice makes it better; I have found that my 5 minutes of meditation most days. A practice of being in the present moment allows me, at least for a moment, to stop the fretting and see more clearly what I need to do right now. With a sense of calm, I then carry on.

4. “Never waste a good crisis!”

I am not sure who said this first, but crises can lead to change. For many of us, well-being practices have gone from feeling like a luxury we don’t have time for to a necessity. So, take this opportunity to start a practice which will benefit you a lifetime.

For those interested in a breathing or meditation practice, the Headspace meditation app is free to physicians for the rest of the year. I also like Insight Timer, and it is always free.

There are other easier well-being practices like gratitude, connecting with friends and looking for the wonder and beauty in our lives. There are many easy tools to develop these types of practices at the Greater Good Science in Action site.

5. Gratitude in the time of COVID-19

People who study gratitude talk about the idea of hedonic adaptation – you get used to stuff going well, so you take it for granted. Well, there is nothing like a pandemic to make you realize how good things have been. Now, I am saying thank you to those who grow food, make toilet paper, pick up the trash and ensure the internet and lights go on every time I open my laptop or flip that switch.  I am sure we all are taking stock of the important relationships in our lives and in so doing, feeling gratitude for them as they grow. And at work, we all appreciate the support we give one another and the incredible leadership we have. So be sure to deliberately count your blessings every day! We discuss “three good things” at the dinner table to share good things that have happened, even in a time of crisis.

6. “A Paradise Built in Hell”

In her fantastic book, San Francisco based writer Rebecca Solnit describes how disasters often allow people to be their best selves: to act with generosity and selflessness, to make community, to find courage and to act with purpose that can elude them in the day to day when we are lost in the routine and focused on ourselves. If we take a break from the grim statistics on Twitter, we can find much of this inspiring behavior on social media:

Here, you can watch people singing with their neighbors in Spain in solidarity. Some of the love is directed toward healthcare providers, like the people of Madrid cheering for healthcare workers:

The tension at work can make it hard to see, but there is heroic work being done every day – from the staff executing the COVID-19 testing, to our frontline hospitalists, to the outpatient providers who are making huge changes in the ways we connect with patients in order to keep them safe, to the leadership team that has changed workflows practically overnight!

7. The Science of Happiness: Concern for others ->Meaning -> Purpose-> Service-> Happiness?

We all need time on the beach with a margarita (or a Corona?!) in our hand, but the research compiled by my colleagues at the Greater Good at Berkeley come up with a surprising finding that is in line with religious traditions: concern for others is the key to a meaningful life and a sense of overall happiness with one’s life. The research suggests that finding meaning and acting with purpose are the keys to happiness. We intuitively know it having chosen this work, but we often fail to appreciate it. Now is time to take this in: We are dedicated to serving the most vulnerable members of our community. We save lives every day. 

8. Reasons for hope

While the hot spots rightfully are taking up the headlines, many places have yet to see a deluge. In California, good governance at the state and local level led to early shelter-in-place orders, and we might be seeing our curve flatten. Early warnings have given us time to get more PPE, more vents and prepare for “fever units” if need be need. Armed with some data and guidance from national palliative care leaders, we are prepared to have early conversations that make sure we are offering appropriate care to the critically ill. This disease will be with us for longer than we ever anticipated, and we hope that many of us around the country won’t end up in conditions similar to those that New York and New Orleans are experiencing now.

Despite our concerns, we understand we are privileged to be part of the solution to this crisis. Taking care of our community is what we do. We open our hearts to strangers and treat them like family. We live with purpose. Keeping that in mind may be the best thing we can do for ourselves in the time of COVID-19. Now is a time to feel pride in our work and to live life with a real sense of meaning.

If we take care of each other and learn to take better care of ourselves, we can and will find deep satisfaction in our work and our lives as we confront this pandemic.

Happiness = love+ fun + meaning and purpose! Of course, don’t forget to make time to be silly, laugh and express your love to friends and family!

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5 Comments

  1. Sean Moore April 5, 2020 at 3:20 pm - Reply

    Thank you for that grounded reminder of the ways to re-focus to a happier place. It is so hard to keep that perspective during the fray of shifts, meetings, planning and family responsibilities. Stay safe, and love to you and your family.

  2. Christina House April 6, 2020 at 7:55 pm - Reply

    Appreciate your words!!

  3. Nora Arakilian April 15, 2020 at 3:58 pm - Reply

    Well done Dr Hass ?

  4. Pat Gardner April 16, 2020 at 2:03 am - Reply

    Thank you Dr. Hass for your meaningful information and care and concern,

  5. Robert Pinsky May 9, 2020 at 5:34 pm - Reply

    Well done, Leif!

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About the Author: Leif Hass, MD

Dr. Leif Hass was trained in family medicine at UCSF after attending McGill University for medical school. He works as a hospitalist with Sutter Health in Oakland California. He is an advisor on health and healthcare for the Greater Good Science Center at UC Berkeley and clinical faculty at UCSF School of Medicine.

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