CORONAVIRUS ADVISORY

Life during the coronavirus pandemic has created an emotional maelstrom across the world. For people with older adult loved ones, either at home or quarantined in a senior living community, these emotions can be felt exponentially as families are bombarded with news reports of the devastating toll the virus is taking on older people. Being shut off from loved ones, family members may experience unbearable uncertainty, fear, anxiety, despair, and guilt. As social work clinicians, we have helped our clients navigate the emotional fallout of the pandemic, and we have also been privileged to share in their astonishing ability to find a sense of hope and optimism in the midst of despair.

Optimism may seem an incongruent or jarring concept to think about right now. But In fact, the ability to maintain a sense of hope and optimism is crucial for strong mental health. At its core, optimism is about having hope and confidence in the future, even in the middle of bleakness. It doesn’t mean ignoring reality or sticking your head in the sand. And it doesn’t mean you won’t continue to feel those negative emotions. Fear, anxiety, and despair are normal, appropriate and useful responses to this pandemic. They spur us to take appropriate safety precautions like social distancing. But creating emotional balance is key. Finding ways to feel hopeful and optimistic brings balance and can make the uncertainty bearable.

Much advice has been written to help people cope day-to-day during the pandemic: eat right, get regular exercise, maintain social contacts, reach out, maintain routine, limit news watching. In the same way, it is possible to take steps to cultivate optimism and hope.

Practice Gratitude. Being grateful seems hard right now. But the research is clear that taking time to focus on the blessings, really noticing them, expressing them, can lift our mood. Being grateful for front line workers is an obvious place to start. Plus, when you are in the act of being grateful, it is the opposite of anxiety. Anxiety involves worrying about the future. When you take time to recall the 3 or 4 or 5 things you are grateful for, it keeps you grounded in the present.

Do Acts of Kindness. Self-care is critical right now and we have to take care of ourselves. But research also shows that reaching out to others in need to lend support contributes to our own wellbeing. Call a neighbor, check on an old friend, donate to a charity that is feeding the unemployed, bake brownies for nurses at your local hospital. Then, feel the good of doing good. Acts of kindness sow the seeds of a greater purpose and meaning, which is key to feeling hopeful and optimistic.

Consider the Positive Outcomes. During uncertain times, many of us tend to focus on all the possible negative outcomes. Take the time to remind yourself, make a list, of all the many positive or probable outcomes. The negatives won’t seem so certain.

Know your resilience. Resilience is built out of adversity, how we respond to it. You have surely experienced some suffering, whether personal, (death, illness, family strife) or societal (9/11, natural disasters, the 2008 recession). But you survived those, and you are likely stronger because of it. Remind yourself that you did it, identify the strengths you drew on then, and draw on them now.

Even as the sun finally shines, and many states and senior living communities start loosening restrictions, hope may naturally emerge, but uncertainty will persist. Making room emotionally for optimism can help make the uncertainty bearable.

Our thanks to Robin Mansfield, LCSW-C, of Aging Network Services in Bethesda, MD for this excellent advice. Aging Network Services has been providing geriatric care management and psychotherapy since 1982. Our clients are people who feel a strong sense of responsibility to parents who can no longer function independently. They are determined to keep their parents safe and as high-functioning as possible, and they also want to retain the joys and routines of their own lives. They rely on us to help them succeed at the difficult, emotion-laden balancing act they face.

VIRUS WARS! and COVID-19

Molly Gee was sitting in the coffee shop on a warm winter day.  Others were gathering late in the afternoon. She didn’t even hear the cough, so unknown to her, she had inhaled a virus that causes the corona virus infection. Her mouth and nose and even her eyes were the portals for the virus. Viruses are much smaller than bacteria: they can’t even be seen by a regular microscope.  Like all viruses, they can’t be killed by antibiotics. Amazingly, they are not even really alive.  We call them half alive. A virus is composed of either DNA or RNA inside a protein coat. Some are further enclosed by an envelope of fat and protein. They are parasites and they have to get to a living cell to continue to exist and reproduce.

As Molly quietly sat enjoying the day, she was unaware that a war had started within her body. The virus might have been trapped by mucus and expelled by the body, but in her case, it made it past the this first line of defense, and now the virus was ready to invade. The spikes seen around the 2019-nCoV’s cell are the keys to the castle and a protein, ACE2, on human cells, is the lock. The virus’ spike protein attached to her cells, piercing through, and then the virus injected its DNA or RNA (in COVID-19 it is RNA) into the cell.  Now inside, it could make a slave of that cell, using the cell’s own machinery to reproduce its genetic material. When each infected cell was filled, the new COVID RNA was released into her body to invade other cells. Some viruses burst the cell and sometimes genetic material is released, leaving the cell alive to become a virus factory. It is not clear which type COVID-19 is but either way, the number of infected cells grew exponentially.

In COVID-19 millions of body cells are infected. Molly’s immune system launched a defense. The innate system detected that something was an invader and phagocytes were sent in to devour foreign cells and release interferon that warns surrounding cells of trouble. Interferon may not work this way in COVID 19. When the phagocytes could not destroy the invading force, it notified the lymph nodes that called in killer T-Cells and B cells. If these cells had ever fought this particular virus before they would have retained the memory. The body knows how to fight off viruses with antibodies previously formed: this is how vaccines work. The problem with this corona virus is that it is novel, and Molly’s cells did have any weapons already prepared to fight it.

In the corona virus infection, Molly’s immune cells poured into the lungs. The corona virus then invaded some of the immune cells causing confusion that sent them into a fighting frenzy. As the immune cells continued to flood into the lungs, they killed as many healthy cells as virus cells: friendly fire.  The immune cells sent in way too many cells, killing healthy lung tissue. Molly’s immune system slowly regained control, killed the infected cells, intersected the virus trying to impact other cells and cleaned up the battlefield. In some people, the damage to the lungs makes them very susceptible to pneumonia and the immune system can get overwhelmed leading to the need for life support ventilators, and even death. Molly recovered.

It is much more dangerous than the flu and much is not yet known. Two things we can do to fight the war is to not get sick and to keep others from getting sick. It is a very complicated problem with a couple of simple solutions. The very best thing that we can do is to wash our hands. Remember the fatty envelope around the virus? Soap is a powerful tool that dissolves this fatty layer and makes the virus unable to infect us. It is also slippery and keeps the virus from clinging to our hands.

The other method is to socially distance. This reduces how many people are infected and gives the scientists time to develop medications and a vaccine. It is not fun but the solution is up to us. Molly plans to go back to the coffee shop, sometime.

 

Thanks to THE MEDICAL TEAM for providing this excellent post. THE MEDICAL TEAM Home Health and Hospice is fighting with a dedicated team to care for people who have tested positive for COVID-19 and a team that cares for people’s health who do not have the virus. Private duty aides help people care for themselves maintaining nutrition, hydration, hygiene and company. The Hospice team gives comfort and support to people in the final part of the journey. THE MEDICAL TEAM recognizes the everyday heroes in our senior communities who are working to protect and care for their residents. THE MEDICAL TEAM