How to Manage Fear, Anxiety and Panic During a Pandemic (Or Any Acute Event), Specifically Related to the Current Coronavirus (COVID-19)

The world is currently riveted in fear of what is known as COVID-19, a new type of coronavirus that has put a lot of people at risk of getting ill or potentially dying. I understand that this situation can be frightening, and we should take all necessary precautions, following the WHO and CDC guidelines. However, it is also important to recognize that if you have ever had the flu in your life, it was probably the result of a type of coronavirus infection, and the risk of death for most people is a lot less than many other viruses.

We need to bring balance to the fear, because the fear can be more dangerous than the virus. First, it is important to research what is true and what is false, so that we do not inevitably spread false information about the pandemic. Even though current statistics suggest around 2% of the population may get really ill and potentially die from this coronavirus, the health of almost all the deceased was already compromised before they were infected. This means we have to take extra precautions if we or people we know have pre-existing conditions or are seniors, while still keeping a straight head on our shoulders.   

We cannot afford to give into our fear and cause more panic. Toxic, fearful thinking shifts our bodies into toxic stress, which can cause the blood vessels around the heart to constrict, and this means there will be less blood flow and oxygen to the brain, and 1400 neurophysiological responses can work against us instead of for us, potentially making us more vulnerable to viruses. When an individual is in toxic, unmanaged stress, a few of the things can happen are: 

• The neuroendocrine system responds and the DHEA/cortisol ratio is reversed, which means your prolactin and ACTH levels increase, which, in turn, affects the HPA axis, that is the stress balancing axis. This can potentially compromise or shut down the immune system.
• The brain produces a pattern of too much high beta activity in the dorsolateral prefrontal cortex (DLPFC), an area that becomes active when we are making judgements, which can lead to emotional reactions that can cause more fear and panic.
• Anxiety shows up in the brain as a lot of high beta over the amygdala region in the brain, an area that we use to respond to and process emotional perceptions. If there is too much activity here, we can overreact, over-generalize, and even catastrophize situations, which often leads to miscalculations and more fear.
• This overactivity across these two areas is reflective of a disconnect between the amygdala and DLPFC, which means that the perceptions in the perceptual library of the amygdala cannot be drawn on by the DLPFC, which can lead to ineffectual reasoning and the inability to deal with emotions. This, in turn, affects our decision-making capabilities.
• Staying in this state for long periods of time can potentially lead to brain damage, which will affect both our mental and physical health in the long term.

Indeed, toxic, fear-based thinking can lead to the nocebo effect, which is the opposite of the placebo effect: fearing something may just make it come true. If you make efforts to stay healthy by following the latest CDC and WHO guidelines, and try to avoid the toxic “panic-of-the-virus” thinking, even if you do get infected with the virus, it will in all likelihood feel like you have the flu (dry cough, fever, shortness of breath and so on)-as far as we can tell based on the evidence. If it is worse than that, then, if most people remain reasonable, the people who need help the most have a greater likelihood of accessing that help. If we all just panic, however, we will cause more chaos and confusion, which can lead to more people getting sick and potentially more deaths. 

We are learning a lot about this virus in real time, so always check your updates and the CDC!

So, what can you do now about the virus?

1. We encourage you to follow ALL the standard precautions outlined by the WORLD HEALTH ORGANIZATION and the CENTER FOR DISEASE CONTROL AND PREVENTION.
2. Practice good hygiene: wash hands for at least 20 seconds, use sanitizer, avoid large crowds, and make sure you are stocked up on your medications and necessities like shelf-stable food. Think: what will I need if I am self-quarantined for around 14 days?
3. Avoid touching your eyes, nose, and mouth with unwashed hands.
4. Avoid close contact with people who are sick, if possible, and stay home when you are feeling unwell.
5. Put some distance between yourself and other people if COVID-19 is spreading in your community. 
6. Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. Please consult with your health care provider about additional steps you may be able to take to protect yourself.
7. Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
8. If you are feeling under the weather, think before you rush off to the hospital or doctor. If you have a runny nose and sputum, you probably have a common cold. Coronavirus mostly presents as a dry cough and fever with no runny nose. However, the new Coronavirus may not show sign of infection for many days.
9. If you feel unwell, you should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.
10. Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
11. I can't emphasize this enough - drink plenty of water! I personally love drinking teas like green tea and herbal tea when I am feeling under the weather, or hot water with lemon and ginger.
12. If the virus drops on a surface it can live for at least 12 hours and up to 3 days—so, if you encounter any surface, wash your hands as soon as you can with a bacterial soap, or wear gloves/use wipes when touching public surfaces. You can also disinfectant public surfaces with a small spray bottle you have on hand. On fabric, it can survive for 6-12 hours; normal laundry detergent will kill it.
13. Eat healthy and avoid processed junk foods to help keep your body strong. Foods that can boost the immune system are:

• Vitamin C foods: Citrus fruits, red bell peppers, broccoli, kale, strawberries, kiwi, guava
• Garlic: It does this by stimulating the cells in your immune system, including your natural killer cells and other white blood cells. Natural killer cells are a type of white blood cell in your body, known as lymphocytes, that are responsible for your body’s initial immune response of killing off a virus or pathogen. The body is more susceptible to illness and disease when immune function is low, so consuming garlic is a food-based way to keep the body’s immune system strong.
• Probiotics and probiotic rich foods like yogurt, kefir, miso, bone broth and so on.
• Herbs that are helpful are: ginger, echinacea, ginseng, myrrh, oregano, astragalus, turmeric. 
• Foods rich in vitamin D like wild caught salmon, mushrooms.
• Raw honey-  Honey has high levels of antioxidants. This is important because free radicals contribute to illness, disease, and aging in the body. The antioxidants in raw honey help fight the free radicals that harm the immune system. Honey has also been reportedto have high levels of antibacterial properties, which was shown to be an alternative therapy for urinary tract infections in pregnant women.
• Elderberries (they contains antiviral properties).

MOST IMPORTANTLY, practice good mind-management:

1. Take precautions like those mentioned above, while avoiding the toxic “fear” of what the virus may do. Chances are even if you do or did get infected with the virus, you will likely only end up with something resembling a flu. My new app SWITCH is a great tool for helping people deal with the root of their fear and overcome toxic thought patterns and behaviors through the mental process of reconceptualization, that is facing and dealing with what is causing them distress and unease, before it takes over their lives and affects their mental and physical health.

2. Recognize that change and stress are certainties  in life. In the midst of an acute crisis, we can become hypersensitive – this is an integrated reaction that includes the mind, brain and body. What happens in your mind is going to affect the functioning of your brain and body, and vice versa. When an acute stressor, like the current coronavirus pandemic, is added to your daily chronic stressors, and the world feels increasingly out of control, it takes a toll on every aspect of your humanity. We need to have mind-management strategies in place for these acute stressor situations. One good mind-management strategy is to reconceptualize the timeline of acute stressors, recognizing that most things in life work in ebbs and flows. This means that when multiple challenges land in our laps, rather than fighting them (which has the boomerang effect of coming right back at you with more energy and power), we need to learn how to accept, deal with and tolerate them, and think of ways we can learn from the situation at hand. This decision will create a positive feedback loop between brain and mind, elevating your coping strategies to a whole new level – something much needed in a crisis! You will increase gamma activity flow from the front to the back of the brain, increasing your integrative ability, high-level learning and creative insight, while engaging higher levels of cognition. When this happens, you will already be thinking with more wisdom and be making better decisions! You don’t want to stamp out or suppress inner feelings, you want to embrace, process and reconceptualize them– this is true mind-management.

3. BUT...the coronavirus is here and you are on hight alert. Chemicals are flushing through your body and the energy waves in your brain are going ballistic, and you rush to the store to get toilet paper.... Stop. Think. Don’t just react. When you react to something in your environment, research shows there’s a 90 second chemical process that happens in the body; after that, any remaining emotional response means you are choosing to stay in that particular emotional loop. This means that for 90 seconds you can watch the process happening, you can feel it happening, and then you can watch it go away. After that, if you continue to feel fear, anger, panic and so on, you need to stop and look at the thoughts that you’re thinking, as they are re-stimulating the same circuitry, which means that you are having the same physiological response over and over again. Mind-management is needed to control this, so start timing your reactions to the next COVID 19 news release, the next social media post and so on, and think of what I have said above. Observe and think about the emotional and physical warning signals you are experiencing. Now, choose to direct your mind – you own it after all! You can choose how you react to a situation. You are in control, even if the world around you feels like it is falling apart.

 4. Manage your stress through practices like the 90s rule above, meditation, yoga, breathing techniques (for example, breathe in for 3 seconds, hold for three seconds and exhale for 3 seconds), taking a long walk in nature if possible, reading a good fiction book, maintaining your usual routine as far as possible, doing something fun that makes you happy (such as watching your favorite silly show), talking to a therapist (if you are looking for a therapist we recommend BetterHelp, an online counseling platform that offers affordable and accessible mental health care tailored to your individual needs. Visit our sponsor here https://betterhelp.com/drleaf for more details and to find a therapist), talking to your friends and family over text, over the phone or in person!if possible, practicing gratitude, limiting your exposure to the news media, and making sure you are getting news from reliable sources and are thinking about, not just reacting to, the facts.

For more information on mind-management and COVID-19, listen to my podcast (episode #138).

*While we make every effort to broadcast correct information, we are learning about the virus in real time. We welcome any comments, suggestions, or correction of errors.  This podcast is not medical advice. If you are feeling unwell, contact a medical professional immediately. By listening to this podcast or reading this blog, you agree not to use this podcast or blog as medical advice to treat any medical condition in either yourself or others.