Coronavirus (COVID-19) Basics

This post has been updated in light of new guidelines from the CDC. For the most up to date guidelines and information please refer to the CDC website click here.

Many patients had questions this week about the coronavirus (aka COVID-19) outbreak. How dangerous is it? Should I wear a facemask? What if I think I have it? We even had a talk given by our department chair, who predicted that every one of us in the room will contract COVID-19 at some point.

It's very important to note that the facts and stats about COVID-19 are changing rapidly and we just don't know everything about this virus at this time. It is also critical that we make sure that we turn to trusted and reliable sources for more information. There is a lot of false information on line already. One great website is from the Centers for Disease Control and Prevention.

Some highlights:

How is the virus spread? The virus spreads mainly from person to person. It is thought that the main way people can catch the virus is when a person nearby (approx 6 or less feet away) coughs or sneezes. People also might be able to catch COVID-19 by touching a surface or object that has the virus on it, and then touching their own mouth, nose, or even eyes.

What are the symptoms? Symptoms may appear anywhere from 2 days until weeks after exposure. Main symptoms include fever, cough, and shortness of breath. Unlike a cold, a runny nose usually occurs later in the course of the illness.

What can I do to keep from catching it? The best way to prevent illness is to avoid exposure. However, there are general, everyday preventative actions that helps prevent the spread of any respiratory disease including influenza and COVID-19. These actions include:

• Practice social distancing. 
• Avoid touching your eyes, nose and mouth.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue and then throw the tissue in the trash, then disinfect your hands.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. 
• Follow the CDC's recommendation for facemasks: WEAR THEM!!!!!!!!!!!!!!!!! 
• Wash your hands with soap and water for at least 20 seconds after using the restroom, before eating, or after you blow your nose/cough/sneeze. You can also use hand sanitizer with at least 60% alcohol if soap and water isn't available. 

Is there a treatment? Unfortunately, at this time there is no specific treatment recommended. Care is supportive targeting relief of symptoms. 

What if I think I was exposed? If you think you've been exposed, you should contact your healthcare provider immediately. 

For up to the minute information visit the CDC's full Coronavirus Disease 2019 website click here.

Time to vote! Plus quick links to register and learn more about candidates

Line outside an early voter site in Reno on 2/17/20

This week's post focuses on spiritual, mental, and physical health...

The State of Nevada is up next in the presidential primaries. I’m excited—especially as Nevada is a state that caucuses. Unfortunately, I’ll be out of town on the actual day so I voted tonight. It was great to see hordes of people—the wait was over 1.5 hours long with temperatures in the 40s and the atmosphere was festive and jovial. Ranking candidates rather than voting for just one was a positive experience.  Plus being the third primary in this country makes me feel like my vote really can shape the future.

This week I’m devoting this space to encouraging voter registration, being informed about the  choices, and actually getting out there and making our voices heard. I was talking to my millennial daughter this week about voting, and it was great to hear her passion and  interest in this basic right. I remember in my early 20’s voting didn’t seem nearly as important as it does now. I think today’s 20 somethings will be dedicated voters for life.

So first step is to register. Are you registered? If so, terrific. If not, please click here  for information on how to register. And remember, if you’ve moved you must re-register at your new address. I was surprised that a person could actually register on the spot in Nevada.

Second, find information on candidates. One great way to learn about what a candidate believes is to go to their web sites. Here are some of the pages from presidential hopefuls listed in alphabetical order with links to the vision/issues/policies statements if possible to save you time and cut through the endless screens of "donate now" pop ups. Just click on the name below to learn more about that candidate's positions: 

Biden

Bloomberg

Buttigieg

Klobuchar

Sanders

Steyer

Trump

Warren

We can also look to news sources that we trust and see which candidates gained their endorsement. Another option is to look to the organizations whose causes we believe in and see which candidates they are endorsing. For example this week the endorsement by the Nevada Culinary Union was highly anticipated and coveted, but in the end they decided not to endorse a particular candidate.

And lastly, we must take that final step and make the effort to get out and vote. Yes, Reno’s early voting lines are long and the caucus is even longer, but it is the price we pay for being part of shaping our country’s future. If we do not make the effort to vote, we really have no right to complain about whatever course things take. And in the end, regardless of outcome, knowing that we did all that was with in our power to shape our country's future is in fact a matter of spiritual,  physical and  mental health.

What can we do to counter the harsh oppositions that surround us?

The focus this week is on spiritual health. 

In Ephesians 4 Paul writes: 
I therefore, the prisoner in the Lord, beg you to lead a life worthy of the calling to which you have been called, with all humility and gentleness, with patience, bearing with one another in love,  making every effort to maintain the unity of the Spirit in the bond of peace.

It seems that everywhere around us there is discord and division. Reconciliation begins with us, you and me, starting with transforming our own little corners of the world. Towards that end, this week I offer a prayer written by Brother Roger of Taize. May we all be bearers of reconciliation wherever we are placed. 

Lord Christ, at times we are like strangers on this earth, taken aback by all the violence, the harsh oppositions. Like a gentle breeze, you breathe upon us the Spirit of peace. Transfigure the deserts of our doubts, and so prepare us to be bearers of reconciliation wherever you place us, until the day when a hope of peace dawns in our world. Amen. 

Are your thoughts impacting your mood?

This week’s focus is on mental health.

The third year of psychiatry residency usually focuses on outpatient care. The resident learns how to manage medications in different outpatient settings (as opposed to inpatient settings) as well as the basics of therapy.

Right now we are learning cognitive behavioral therapy (CBT), and my supervisor and I are preparing to jointly lead 12 sessions of group CBT helping people experiencing symptoms of depression.

So what is CBT? It’s a form of psychotherapy originally developed in the early 1960s by Aaron Beck. It was first developed to treat depression by changing unhelpful thinking and behaviors. It was later adapted to address a wide range of other mental health conditions.

In a nutshell, the cognitive model is based on the belief that dysfunctional thinking is common to all psychological disturbances. In other words, when a situation or event happens, an automatic thought occurs which then produces an emotion. Symbolically, it looks like this:

Situation/event->automatic thought->reaction (emotional, behavioral, physiological)

For example, if I came into work this morning and the administrator didn’t greet me, my automatic thought might be “oh no, she’s angry with me, what did I do wrong?” which then results in my feelings of  anxiety, fear and/or self-doubt. I might not even be aware of the thought (or the validity of that thought) that occurred between the event and the negative emotions. I just know I suddenly feel uneasy.

CBT helps people to evaluate their thinking which results in an improvement in their overall emotional state and behaviors. Multiple studies have shown CBT to be effective. (See Clark and Beck (2010) on Pub Med for a comprehensive review of the CBT studies.)

If you’re interested in beginning to monitor your own thoughts to see how they might be impacting your mood, you can use the following chart:

Situation or Event	Automatic Thought	Emotional, Behavioral, Physiological Response

As you become more aware of your automatic thoughts, you can then add columns, such as evidence that supports this thought, evidence that doesn’t support this thought, and an alternative thought. You can also start to look at the core beliefs that might be behind an automatic thought. (Going back to the example above, the core belief might be "I can't do anything right" which then leads to the self-blaming automatic thought and the resulting anxiety.)

There is MUCH MUCH more to CBT, but if this way of looking at the relationship between events, thoughts, and emotions appeals to you, you might consider finding a CBT therapist or group. There are also many workbooks available on Amazon and other places that you can work through on your own. A copy of the participant manual that we'll be using in our group CBT class can be viewed by clicking here.

Information from Cognitive Behavior Therapy: Basics and Beyond 2^nd Edition by Judith Beck used as a resource for this post.