Author

Lane McKenna and the BeWell staff


Date of Publication

March 2020

Guide to self-care: Coping with coronavirus

As Stanford works to reduce the spread of COVID-19 (novel coronavirus), it is also important that we each take care of ourselves while we assist in individual and community efforts to prevent further spread of this virus.

See also HIP’s response to COVID-19 for specific information on remote program options.

Staying calm, managing anxiety

Even on a “normal day” in history, emotional stress can prove very challenging. So add in COVID-19, and it’s really tough. How can we stay calmer and make wiser choices?

Firstly, bear in mind that as COVID-19 news spreads, it has created heightened stress for many of us. (For others, it has added to existing anxieties.) As James Kendall, LCSW, CEAP, of Vanderbilt University states, “sensationalized stories add to our angst and panic. The stock market has responded with a downturn, and many are unsure whether to travel or attend social gatherings. It may be similar to our response to other stressful world events: HIV, H1N1, SARS, mass shootings and 9/11.” It may therefore be wise for some to limit news overexposure: sensational news stories can perpetuate unnecessary anxiety.

On the other hand, staying educated means something more than just watching TV news:

To help your state of mind as you process current events, employees may access our free archived webinars on such topics as stress, resiliency, mindfulness and many more. We are also offering a free webinar on reducing anxiety relating to COVID-19 on April 10.

We also hope the following advice from Stanford experts will prove helpful:

Sheltering in place: A BeWell Coach’s perspective
Tips for coping with anxiety
Even if you are virus-free, COVID-19 is affecting your health: Here’s what to do
Self-care: The gift that keeps on giving
Rough day: Be grateful

As was summed up in an article published by The Greater Good Science Center UC Berkeley:

“One way is to use whatever tools you have at your disposal for keeping a cool head — like practicing mindfulness, which has been shown to both lessen emotional reactivity and help us make better decisions. We might take a walk in the park or nearby woods and let nature soothe us. Or we could talk to a friend — a calm friend, that is — who can help us reduce our anxiety. Of course, our normal ways of connecting socially — like singing together at a concert or going to large parties — may have to change. But whatever we can do to maintain an air of calm, and to spread it to those around us, the better. After all, our emotions tend to be contagious in our social circles, and we should do our best to keep fear and panic contained.”

Solo outdoor exercise and “fitness-in-place” at home

Lastly, we have long advocated that each of us carve out “alone time” — enhanced even more when combined with fresh air and exercise. Simplistic as this may sound, now more than ever, this strategy is a useful tool. Take yourself away — both physically and mentally — from coronavirus for at least a while by going out for a run or long walk, alone.

Runners on running at Stanford
Why walk?

Note: All entrances to the Stanford Dish will close at 5 p.m. on Friday, April. 3. The Dish website will be updated if conditions change.

Or, if it’s a rainy day, exercise at home. See:

Still having difficulty with emotional stress?

  • Faculty, staff, and postdocs can contact the HELP Center at 723-4577.  All scheduled sessions are being held remotely (Zoom).
  • Santa Clara County maintains an anonymous crisis line that is available 24 hours, 7 days a week, at 1-800-704-0900 (Mental Health Services).
  • SAMHSA’s Distress Helpline (related to any natural or human-caused disaster) is accessible 24/7 at 1-800-985-5990 or via text (send TALKWITHUS to 66746; Press 2 for Spanish).

Do what you can to help prevent the spread of the virus  

Within the healthalerts.stanford.edu website, Stanford has a list of preventative strategies that include:

Get a flu shot. We strongly recommend that everyone obtain seasonal flu vaccination. Members of the Stanford community can contact the SU Occupational Health Center (Stanford employees) or go to Vaden Health Center (Stanford students) to get a flu shot.

Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.

Avoid touching your eyes, nose, and mouth with unwashed hands.

Don’t share food and drinks.

Clean and disinfect shared surfaces and objects that are touched frequently (e.g. door knobs, desks, phones).

If you can, avoid close contact with anyone with cold or flu-like symptoms.

On “social distancing”: Take that as far as you can

Expanding on the recommendation to “avoid close contact with anyone with cold or flu-like symptoms,” it is now strongly urged that everyone  abide by “the 6-feet rule,” otherwise known as social distancing — the strategy of maintaining a minimum of 6 feet between yourself and any  other individual. Why?  When someone coughs or sneezes, they spray small liquid droplets from their nose or mouth, which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease. Most commonly, viral transmission occurs when you touch someone who has the disease, or you touch something they have touched — and you subsequently touch your face with your hands. Transmission levels are compounded by the fact that when someone gets COVID-19, they may be contagious 1-2 days prior to symptom onset. (They are, thus, COVID-19 positive, but asymptomatic.) Data also suggests that, while less common, the virus can be spread through feces/stool/bowel movements. The virus can also survive for many days on surfaces, especially metal ones.

Information about transmission is evolving and is being closely investigated by CDC and WHO. See healthalerts.stanford.edu for updated information.

Going well beyond social distancing

Sheltering in place first become a legal ordinance in Santa Clara and six Bay Area counties on March 16, 2020. An Updated Order allows for certain designated activities to continue, but otherwise requires people to remain and work in their residences and stay away from others as much as possible.

“This Order clarifies, strengthens, and extends certain terms of the Prior Shelter Order to increase social distancing and reduce person-to-person contact in order to further slow transmission of Novel Coronavirus Disease 2019 (“COVID-19”). Violation of or failure to comply with this Order is a misdemeanor punishable by fine, imprisonment, or both.” (California Health and Safety Code § 120295, et seq.)”

The CDC and WHO organizations both emphasize that this “shelter in place” community strategy is the key to flattening the curve of growth in new COVID-19 cases in California and eventually throughout the U.S. and the world. Data from Taiwan, Singapore and China points strongly to the positive impact of containing family units at home. In other words, it is highly inadvisable to invite over a distant Aunt, a neighbor, or any other adults that do not need to be in your family residence. See Stanford’s Self-Isolation Guidelines and our report, Home caregivers: Meeting the COVID-19 challenges.

Breaking news (April 3, 2020): CDC now recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission — which is a reversal of its earlier position that only the sick should wear a mask. CDC explains that the use of simple cloth face coverings may slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Read more.

News as of April 17, 2020: San Mateo County announced a new order (the “Face Coverings Order”), which generally requires that you wear a face covering when around other people outside of your residence, including at work unless you are in an enclosed, private office. The order does not require a mask, but any kind of cloth face covering, such as a bandana, is sufficient. Importantly, the Face Coverings Order does not  change the shelter in place orders (including social distancing requirements) that are already in place; while face coverings are a tool for reducing the spread of the COVID-19 virus, they are not a substitute for sheltering in place, physical distancing of at least six feet, and frequent hand washing. See complete details in Stanford Health Alerts.

COVID-19 symptoms and who is most at risk

The current evidence is that most cases (~80%) of COVID-19 appear to be mild. The most common symptoms include fever (38°C/ 100.4 °F) and respiratory complaints such as cough and shortness of breath. Runny nose, sore throat, vomiting, and diarrhea — as reported in the landmark Feb. 7, 2020 JAMA analysis — are less commonly present. In more severe cases, infection can lead to pneumonia, severe acute respiratory syndrome, kidney failure, and even death. Read more about COVID-19 Symptoms.

Those with chronic underlying medical conditions appear to be at considerably higher risk for serious complications, including:

  • Those people with diabetes, chronic lung disease, and heart disease have endured the most severe complications with COVID-19, according to data published on March 26, 2020 by The Centers for Disease Control (CDC).
  • People who are immunocompromised, including those who have had cancer treatment; who smoke; or who have had bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.
  • People with severe obesity (body mass index [BMI] of 40 or higher), chronic kidney disease undergoing dialysis, or liver disease are also at higher risk.
  • Lastly, certain (but not all) people over 60 could face a more difficult course of COVID-19, simply because a person’s immune system starts to gradually decline in function and speed of response around middle age, with a sharper decline at 65.

However, except for those individuals 14 and under, it’s increasingly clear that even healthy, under-60-year-old people can become severely ill with COVID-19. Their recovery rates are better, but they may still require hospitalization, and some may require ICU hospitalization (including time on mechanical ventilation) before they make a full recovery. That is why it has become vitally important for people of all ages  to shelter in place during this pandemic — both to curb the spread of the disease and ultimately to curb mortality rates.

If you get sick

Stanford employees should follow the guidelines compiled in healthalerts.stanford.edu.

What to do if you’ve been in contact with a COVID-19-positive individual

See this Stanford guide if this applies to you.

By Lane McKenna and the BeWell staff
Originally published March 13, 2020; last updated April 22, 2020