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 BeWell’s response to COVID-19 for specific information on the BeWell Program, which is ongoing thanks to 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:

• See healthalerts.stanford.edu and Stanford Medicine’s COVID-19 Updates.
• Learn about reporting, and self-reporting, COVID-19 cases.
• This State of California website provides information on staying healthy and includes resources related to COVID-19. 
• If you are a Stanford employee, review and bookmark these important guides: Information for staff and Information for faculty and researchers from healthalerts.stanford.edu.
• View these other campus health and wellness resources.
• See also the #stanford-wellness SLACK channel.

To help your state of mind as you process current events, employees may access free archived Stanford Health Improvement Program (HIP) webinars on such topics as stress, resiliency, mindfulness and many more. HIP is 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:

Home caregivers: Meeting the COVID-19 challenges
Helping Kids and Families Cope with COVID-19
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
How to cope with being home again
COVID-19 resources from Stanford Digital Medic

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, BeWell has also 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:Walks in the Stanford Dish Walks in the Dish area, a popular activity for Stanford community members and neighboring residents, will again be possible starting on Monday, July 6. The Dish website will be updated as conditions change.

Or, if it’s a rainy day, try these “fitness-in-place” exercises at home. See:

• BeWell in Five – exercises you can do in your home, in five minutes or less (please keep a 6-8 feet distance away from your partner or friend, if you plan to excercise with someone else).
• Stanford Recreation & Wellness videos
• Stanford Recreation & Wellness Zoom online fitness classes

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).

Don’t neglect your physical health

This is no time to ignore our physical health, either. People both at average risk as well as at higher risk of getting seriously ill with COVID-19 should do all that they can to stay physically and mentally healthy. COVID-19 is a virus that attacks the immune system, and immune system health can be boosted by:

• Getting enough sleep
• Staying hydrated
• Exercising regularly (see above section on home exercise options)
• Eating nourishing food
• Getting a little sunshine, to boost your level of  Vitamin D (while abiding by 6-ft. social distancing guidelines)

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. The virus can also survive for many days on surfaces, especially metal ones. Data also suggests that, while less common, the virus can be spread through feces/stool/bowel movements. 

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.) 

Going well beyond social distancing: Sheltering in place and the mandated wearing of face coverings/masks

Sheltering in place first become a legal ordinance in Santa Clara and six Bay Area counties on March 16, 2020, and the Order was amended several times but essentially allowed for certain designated activities to continue but otherwise required people to remain and work in their residences and stay away from others as much as possible.

Per the latest updated Order (June 5, 2020): “The primary intent of this Order is to ensure that County residents continue to shelter in their places of residence to slow the spread of COVID-19 and mitigate the impact on delivery of critical healthcare services. This Order allows a limited number of Additional Businesses and Additional Activities to resume while the Health Officer continues to assess the transmissibility and clinical severity of COVID-19 and monitors indicators described in Section 11. [Individuals] may leave their residence only for Essential Activities as defined in Section 15.a, Outdoor Activities as defined in Section 15.m, and Additional Activities as defined in Section 15.o; Essential Governmental Functions as defined in Section 15.d; Essential Travel as defined in Section 15.i; to work for Essential Businesses as defined in Section 15.f, Outdoor Businesses as defined in Section 15.l, and Additional Businesses as defined in Section 15.o; or to perform Minimum Basic Operations for other businesses with facilities that must remain temporarily closed, as provided in Section 15.g.”

Clearly, the “shelter in place” community strategy has been the key to flattening the curve of growth in new COVID-19 cases in California and other parts of 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.

Most Bay Area counties, including Santa Clara, have mandated face coverings — which Governor Newsom has since mandated statewide: “When people need to leave their place of residence for the limited purposes allowed in this Order, they must strictly comply with Social Distancing Requirements as defined in Section 15.k, except as expressly provided in this Order. All people (except for children under the age of six, and people who have trouble breathing or are unable to remove a face covering without assistance) must wear face coverings at all times when at a business facility or using public transportation, and are otherwise strongly urged to wear face coverings as provided in the Health Officer’s April 17, 2020 Critical Guidance on Facial Coverings (the “Face Covering Guidance”).”

Following its initial, fumbled response regarding the benefits of wearing cloth face coverings in public settings, the Centers for Disease Control (CDC) finally issued mask guidelines. However, Megan Mahoney, MD, Stanford Health Care’s chief of staff and a Stanford Medicine professor of primary care and population health, provides a more specific mask recommendation (June 16, 2020 Stanford Medicine Scope interview):

“Cloth masks should have at least two layers of fabric, and tightly woven fabric is best. Surgical masks protect better than cloth masks — they have an electrostatic charge that helps capture more particles — and they provide some protection to the person wearing the mask. Unlike early in the pandemic, they’re now readily available and inexpensive. Face shields are becoming more commonplace and offer some advantages: They can be reused and are easily cleaned with soap and water or common household disinfectants.”

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’re feeling ill
• Where to get tested
• Guidance on working if you are sick or have been exposed to someone ill
  • Can I work? (based on symptoms)
  • Can I work? (based on exposure)

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 June 27, 2020