COVID-19: Reasons for Optimism

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Are you demoralized by “spikes” and “surges” in COVID-19 “cases”?  Are you afraid to go to the grocery store without a gallon of hand sanitizer and a hazmat suit?  That’s how you’re supposed to feel.  Don’t fall for it.  There are reasons to be encouraged, and they won’t be reported by most people in the media.

Consider the following:

  • Mortality rates continue to fall across the country. The highest number of deaths or maximum mortality in the U.S. occurred on April 10th, 2020.
  • Clinical experience with COVID-19 in hospital and ICU settings over the past five months has improved diagnosis, care, and outcomes dramatically.
  • Hospital length of stay (LOS) for COVID-19 patients is half of what it was in March and April of 2020.
  • Media reports of ICUs being near capacity are misleading. For example, in Texas, on July 6th, COVID-19 patients filled 15% of ICU beds; 85% of ICU beds were filled by non-COVID patients.  Remember, for months, many people who should have been hospitalized with other conditions simply stayed home. Furthermore, most clinicians with significant experience have seen multiple episodes of packed ERs and ICUs at nearly any time of year.  It happens.
  • Protocols using Remdesivir, Dexamethasone, convalescent plasma, and other therapies are improving survival here and in other countries.
  • The current mortality rate for people under the age of 50 is 0.05% or half that of the flu. The mortality rate for people in their 20s is 0.007%.  So far, despite initial concerns, there are no well-documented cases of children transmitting COVID-19 to adults.  Schools in Germany, Norway, Denmark, the Netherlands, and Australia have opened without problems.  The schools in the U.S. can reopen without panic and paranoia.  There is a sensible way to do this.
  • Confirmed cases of COVID-19 are substantially lower than reported cases. An actual case of COVID-19 must be confirmed with additional testing.  False positives seem to outnumber false negatives at present.  A positive “case” or test result does not automatically translate into a sick patient.
  • There is a difference between dying with COVID-19 and dying from COVID-19. Heart disease, COPD, bacterial pneumonias, diabetes, renal failure, strokes, dementia, and cancer have not disappeared.
  • Rapid progress is being made by numerous companies working on vaccines and therapeutics. This would not have been possible without unprecedented public-private partnerships and the easing of burdensome red tape.

It’s easier to scare people than it is to “un-scare” them.  The simplest way to control people is to silence independent thinkers and keep everyone else afraid and uncertain.  Uncertainty promotes fear, and fear is contagious.

The vast majority of people in the med0ia and far too many “officials” and politicians are trying to make this situation sound as bad as possible for as long as possible.  They are teaching people to be afraid of everything including one another.  This is insane.  It borders on sinister.

We are making for more progress than most people realize.  Fear not.  There are plenty of reasons for optimism.

Help for the Helpers on the Frontlines of COVID-19

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Dr. Jennifer L. Abel

Many healthcare workers on the COVID-19 frontlines are overwhelmed and traumatized. In addition to putting your lives on the line, many of you are quarantined from your family and some have insufficient PPE. Many are having to make multiple difficult decisions daily and have see an unprecedented number of people suffer and die; sometimes even colleagues.

You are amazing! You are also human! So, it is crucial that you express your emotions: cry in the restroom, cry on the way home, go outside for 10 minutes to shed tears or blow off steam. Angry at a co-worker, administrator, or politician? Pay attention to your driving, but imagine they are in the passenger seat and express your feelings.

Keeping your body relaxed is very important to help with immune function and to survive emotionally.  “How can I possibly relax? I have no time and am way too stressed to relax” are common thoughts on the front lines of COVID-19. Fortunately, relaxation strategies need not take any time at all and can be done without stopping your work activity. Test it out! Because most of you are standing or walking most of the day, stand or walk now while engaging in your favorite strategy simultaneously. Now pretend. Go through the motions of a common work activity while engaging in your strategy. The exception is you can’t do breathing strategies while talking.

It’s easy to get distracted and forget to use your coping strategies. Try to get into the habit of using strategies every time a machine starts beeping, each time you switch rooms, someone calls your name, or when you change tasks. Put up sticky note reminders when possible. Change the wallpaper on your phone or change the ringtone and text-tones. Each time you experience the reminder, engage in your strategy.

No doubt you’re exhausted. When you experience one of your reminders, ask yourself “do I need all this energy” or “what’s the least amount of energy I can use while doing this procedure? Writing notes? Walking down the hall?” Follow with your favorite word, like soft, loose, or relaxed.

People in helping professions are great at taking care of others, but aren’t nearly as good at taking care of themselves. Now is the time for you to finally ask for what you need, or even want, from others. And take time to self-nurture.

I heard today that people wearing scrubs are being discriminated against out of fear they’re carrying the virus. Some have been mugged or antagonized because they are known to have a job. Please know that the majority of us, not just patients and their families, are very appreciative of your sacrifices.  Know in your heart that having a purpose is a positive predictor of happiness, even though you probably aren’t feeling particularly happy right now. Similarly remember that even when you feel helpless, you are still helping!

Thank you very much for all the help you are providing, especially if you are putting your life at risk and/or isolating from your family to help!


Dr. Jennifer L. Abel is an expert in worry and the author of three books and two card decks including Resistant Anxiety, Worry, & Panic.

Errors in Judgement

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, MD

I’m confused.   It’s too dangerous to go to school.   It could spread COVID-19.   It’s too dangerous to go to work.  It could spread COVID-19.   It’s too dangerous to eat out, get a haircut, go to a concert, a clinic graduation, wedding, or funeral.  It could spread COVID-19.   But riots, vandalism, looting, and arson are somehow First Amendment rights, and they override concerns about spreading COVID-19.  Has everyone gone insane, or is it just I?

The reality is, going to school, work, or other everyday activities was never really problematic.   Riding on filthy, overcrowded subway cars or living in a nursing home has been really problematic.   So far, there is no statistical correlation between the economic shutdown and COVID-19 case rates, hospitalization rates, or mortality rates.   Sadly, there are devastating correlations between riots, anarchy, and the protracted decline of cities.

Some of us are old enough to remember the spring of 1968.   It was horrible.   Shortly after the assassinations of Martin Luther King, Jr. and Robert F. Kennedy, appalling levels of violence broke out at the Democratic National Convention in Chicago.   Cities across the country burned and many neighborhoods never recovered.   Areas of Los Angeles, Detroit, Chicago, Baltimore, Atlanta, and New York City are still scarred today.

Three months of lockdowns from COVID-19 have shown many educated people they can earn a living from the comfort of home.   The violence and destruction of the past two weeks will give many people pause about remaining in big cities.   The exodus has already begun.

Unfortunately, for those left behind, taxes of every type will increase, but the quality of life will decrease even more.   Economic decline leads to declines in education and public health.   And the people who suffer the most are those least able to cope.

The chief duty of any public official is to protect the citizens, not to lock them in their homes.   We have witnessed a series of dreadful errors in judgment on the part of many mayors and governors — over the past few months (in March 2020 and beyond).   It has devolved into gross incompetence and cowardice over the past two weeks of late May and early June 2020.   People in the media love it.   Suddenly, they have a topic to replace COVID-19.

Politics has a massive impact on education and health care.  We cannot pretend otherwise.   In light of that, I’d like to offer a few thoughts:

1.      Ignore 95 percent of the people in the media.  They live for conflict, anger, and fear.

2.      Realize that anyone promoting conflict, anger, or fear is a big part of the problem — in any situation.

3.      Understand that most people are not inherently racist, sexist, xenophobic, or homophobic, but identity politics lives on.  It’s cheap and it’s easy.

4.      Recognize that businesses, large and small, are a good thing for individuals, neighborhoods, and society at large.  Punishing business owners with violence, absurd taxes, or excessive regulations is spiteful and wrong.

5.      Know that people typically get the kind of behavior they tolerate.  If you tolerate violence and chaos, you’ll get more of both.   A famous passage from the Talmud sums it up, “When you’re nice to the cruel, you’re cruel to the nice.”

The year 1968 was awful.  Let’s not make the same mistakes again.

COVID-19: Complications

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

We knew this was coming, or at least we should have known. Several subsets of patients with complex reactions to COVID-19 (the disease from the coronavirus infection) are being recognized.  The very young, the very old, and the very sick may be predisposed to rare and intense immune responses to infection with this coronavirus.  Here is what we know so far:

  • “Cytokine Storm” can be a dire consequence of COVID-19 especially in older patients with several underlying illnesses.  Cytokines are polypeptides or proteins secreted by immune cells coming into contact with bacterial or viral antigens and/or endotoxins.  Cytokines can also be synthesized by adipose cells (one of the reasons overweight patients are at serious risk).  Cytokines include chemokines, interleukins, interferons, and tumor necrosis factors among others.  Simply put, cytokines influence the magnitude of an inflammatory immune response.  Multiple genetic factors seem to play a role.  Clinically, an older, chronically-ill patient with COVID-19 (or other infections, such as influenza) can deteriorate dramatically over 6-12 hours. Vital signs become unstable, O2 saturation drops, respiratory distress intensifies, and inflammatory markers like C-reactive protein rise.  Cardiac function is seriously compromised and liver, kidney, and neurologic function decline rapidly.  Severe clotting disorders may develop.

The outcome is poor, but aggressive efforts to suppress the massive autoimmune inflammatory response may help if initiated at the earliest stages.

  • Toxic Shock Syndrome:  This is an acute, serious, systemic illness triggered by a response to exotoxins produced by staph or strep bacteria. It was first noted in young women in the early 1980s and was linked to tampons, diaphragms, or contraceptive sponges left in the vagina.  It can occur after childbirth, abortion, or surgery.  Symptoms include a high fever, diffuse red rash resembling scalded or burned skin, hypotension and multi-organ system failure leading to shock.  Prompt and aggressive treatment involves removal of foreign bodies, debridement of incisions or wounds, IV fluids, and IV antibiotics (clindamycin and vancomycin).  IV immunoglobulin can be used.

Several patients in the New York area, who tested positive for COVID-19, have presented with symptoms similar to Toxic Shock Syndrome.

  • Kawasaki Disease:  This is a childhood illness with a dramatic presentation and complications related to vasculitis, probably of an autoimmune nature.  Each year in the U.S. there are between 3,000 to 5,000 cases, mostly in children under the age of five years.  Rare cases occur in young infants, teens, or young adults.  Occasional community clusters occur, especially in late winter and spring, without clear evidence of person-to-person transmission.  Diagnosis requires the presence of four out of five clinical findings after fever lasting five or more days.
    • Bilateral conjunctivitis — injection or intense redness without exudate, drainage, or crusting.
    • Mucocutaneous injection of the lips, tongue, and oral mucosa. Lips are red, raw, dry, cracked, and fissured.  The tongue is enlarged, red, and possibly tender.  The classic description is “strawberry tongue.”
    • Skin changes involving the hands and feet.  There is pronounced edema and erythema especially on the palms, soles, and nail beds.  Full-thickness desquamation or sloughing off of skin on the fingers, palms, soles, and toes leaves the underlying denuded skin red, raw, and tender. These changes typically begin around Day 10.
    • Polymorphous rash over the trunk may resemble measles, scarlet fever, hives, or erythema multiform.  The perineal area is often involved.
    • Cervical lymphadenopathy with at least one lymph node in the neck ≥ 1.5 cm in diameter.

The cardiac complications of Kawasaki Disease include coronary artery aneurysms, myocarditis, pericarditis, and valvular disease.  EKG and echocardiogram are indicated at the time of diagnosis and in regular follow-up visits for at least a year.  Treatment involves high-dose aspirin and IV immune globulin.  Approximately 85 children in the New York area who are COVID-19 positive are being evaluated for this condition, now called “Pediatric Multisystem Inflammatory Syndrome.”

Cytokine storm, Toxic Shock Syndrome, and Kawasaki Disease are rare in their original forms or as complications of COVID-19.  The overwhelming majority (over 82 percent) of patients testing positive for COVID-19 remain asymptomatic or mildly ill.  The survival rate in the U.S. (rarely mentioned) is over 99.5%.

Those of us in health care must always be aware of unusual or rare complications of any illness.  But perspective is crucial, a concept lost on many in the realms of media and politics.  After all, the best way to control people is to keep them afraid.

Knowledge, perspective, and prudence:  not fun, but essential.

homestudy

Coronavirus (COVID-19): We’ll Learn To Cope

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Enough.  Enough with the panic, paranoia, and power grabs.  Enough with the hysteria, hoarding, and hyperbole.  Enough with the melodramatic funeral music between commercial breaks on TV.  Fear, malaise, and resignation cannot become a permanent feature of life. This is not the end of the world, and this must not be tolerated as the “new normal.”

One of the most effective antidotes to fear is perspective.  Many of us had loved ones who endured far worse situations during the Spanish Influenza of 1918.  In those days, there were no ventilators or even the ability to deliver nasal oxygen.  There were no ICUs, cardiac monitors, or even TVs.  Antibiotics, antivirals, bronchodilators, anti-inflammatory medications, and corticosteroids did not exist.  There was no such thing as a Respiratory Therapist.  It was bleak.

Ten years later, during the beginning of the Great Depression, socio-economic conditions were equally bleak.  There were no social safety nets.  Social Security, unemployment Insurance, Medicare, Medicaid, welfare, food assistance, personal and small business rescue programs were nonexistent.  Soup kitchens and bread lines were the measures of last resort.

There is another major difference between the present day and 1918, and it revolves around the media.  In 1918, people had newspapers.  Radio was in its infancy.  There were no narcissistic TV “personalities” promoting an agenda 24 hours a day.  Enough is enough.  We don’t need any more people in the media selling panic for profit.  We need facts.  We need reason.  We need sensible, constructive solutions to a serious, infectious disease.  But we cannot sit on our hands for 18 months when a vaccine may or may not save the day.

Anyone telling us we have no choice but to lock down everything is misguided.  We always have choices.  Life constantly presents us with potential risks and benefits.  People can learn how to function with reasonable safety once they have the facts.  We are not helpless, clueless children who must be grounded “for our own good.”

Death is a certainty at some point — for each of us.  It always has been.  What matters is living a life that is good, honorable, and uplifting to others.  We are told no one should determine who lives and who dies.  Yet politicians and bureaucrats proclaim which “workers” (a Marxist term) are essential and which ones are not.  That reflects a stunning level of arrogance.  The only “non-essential” job or business is the one you didn’t pour your heart and soul into.  A handful of officials (where jobs, paychecks, and pensions are secure) is destroying the lives and futures of tens of millions of other people.

We’ve learned how to cope with tuberculosis and terrorism, the Great Dust Bowl and diphtheria, threats of nuclear war, and natural disasters.  We’ll learn how to cope with COVID-19, not through fear, not through paralysis, but through prudent, innovative, courageous action.  Enough with the panic.

Let’s get on with it.

COVID-19: Clinical Observations

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Every new illness brings new knowledge. Global experience with COVID-19 is revealing patterns of clinical illness which will guide our approach to treatment. Here are some of those important observations:

  • The illness in 80% of people causes mild symptoms. Many people remain completely asymptomatic. Moderate and severe illness often has two phases. Days 1‒7 are characterized by fever (above 101° F), headache, significant cough, profound fatigue, myalgias, and malaise. Between days 4‒8 some patients have nausea, vomiting, abdominal pain, and/or diarrhea. Some patients lose their sense of taste and smell. Days 8‒21 are characterized (in 15‒20% of patients) by increasingly severe symptoms, including shortness of breath, dyspnea or difficulty breathing, chest pain or tightness, tachycardia and weakness.
  • The mean interval between onset of symptoms and hospitalization is 9.1‒12.5 days. This delay in the progression to serious illness may give us a window of opportunity for treatment.
  • Clinical findings typically include a low oxygen saturation level (O2 sat) on room air. This is a key finding and levels as low as 75‒90% are being seen (95‒100% is normal).
  • Laboratory results also show patterns similar to what was observed with SARS and MERS:

o   ↓ WBC or leukopenia

o   ↓ Platelet count or thrombocytopenia

o   ↑ Liver enzymes, especially LDH around hospital days 5‒8

o   CXR typically shows streaky opacities in both lungs consistent with an atypical pneumonia.

  • Serious complications of COVID-19 include severe viral pneumonia, ARDS (Adult Respiratory Distress Syndrome) respiratory failure, cardiac injury including arrhythmias and CHF. Poor perfusion can lead to hepato-renal syndrome. Neurologic symptoms, delirium, and coma may occur.
  • There is evidence that intubation and mechanical ventilation may be causing more harm than good in some patients. One component of ventilator function, the PEEP setting (positive end-expiratory pressure) may be delivering pressures that are too high for the alveoli or air sacs in the lungs. It appears that some COVID-19 patients in respiratory distress actually need lower levels of PEEP (15‒20) as opposed to levels around 25. Some patients seem to need higher O2 concentrations delivered by face mask, CPAP or BiPAP, and not intubation and mechanical ventilation.
  • According to the CDC, two thirds of the patients who have died from COVID-19 (as of mid-April) had documented serious underlying conditions (heart disease, diabetes, asthma, renal disease, malignancy, immuno-compromise). Obesity has been a significant factor contributing to mortality. 1.9% of patients who have died had no known underlying condition.

We have only scratched the surface here. The next few weeks will reveal new insights about the illness itself and the best treatment protocols. In the meantime, do what is prudent to protect yourself and others. It may not be obvious to everyone, but tremendous progress is being made.

Blessings to all through Passover and Easter.

 

Novel Coronavirus (COVID-19): Lessons Learned

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology

We are living in historic times.  A century from now, medical personnel, civil authorities, small business owners, corporate leaders, average investors, and everyday citizens will study the lessons learned from this pandemic.  Here are just a few of the ones we’ve learned already:

  • We should all plan and prepare for crisis, disaster, or catastrophe — especially in good, stable times.  Every family and business needs to build an emergency fund of 3-6 months minimum.
  • It’s important to listen to knowledgeable, wise people (not conspiracy theorists and people on social media).  However, even the most brilliant experts can be wrong.  Predictive models are not crystal balls.  There are unrecognized variables in nearly every situation.
  • Panic never solves problems.  If it did, we wouldn’t have any problems left.  The antidote to fear and panic is perspective.  Every day in the U.S., approximately 8,000 people die from multiple causes.  Each year, we lose between 30-40 thousand people from complications of the flu.  We do not shut down the nation.
  • Bureaucracies often do more harm than good.  Their function is largely based on outdated, territorial group-think, and they cannot change or adapt quickly.  Control freaks almost always create more problems than they solve.
  • All decisions have unintended consequences.Some of them can be disastrous. “Either/or” thinking is often a false choice.  Health, both physical and mental, is heavily dependent on financial stability.  The notion that we must choose between public health or a stable economy is a false choice.  They are mutually dependent.
  • Tunnel vision is usually a mistake.  Rigid adherence to long-held principles of epidemiology can crash an economy and engender other, less obvious medical problems like cardiac events, severe depression, anxiety, sexual abuse, physical abuse, emotional abuse, child abuse, drug abuse, alcohol abuse, suicide, violent crime, and eventually societal breakdown.   It takes discipline and wisdom to see the big picture.
  • “Better safe than sorry” is not always the right choice.It’s understandable in a crisis, but it rarely addresses the root of a problem.   We can protect our most vulnerable people with selective isolation and quarantine and still move forward with life.   Sometimes we must take reasonable risks.
  • Saving a buck by reducing housekeeping staff and standards of cleanliness, especially in public places, can be horribly costly in the long run.  Many hospitals, nursing homes, and medical offices are nowhere near as clean as they were 40 years ago.  Better personal and public hygiene will turn out to be a very good thing in the years to come.
  • Living and working in overcrowded, congested areas has been a problem throughout history.   Smallpox, plague, cholera, yellow fever, malaria, and tuberculosis have taken the lives of millions over the centuries.  Flu pandemics, in many cases, have been even worse.   Perhaps this pandemic will teach us all to be more respectful of everyone’s personal space.
  • We have more everyday heroes than we realize.Celebrities are not heroes.   Nurses, doctors, respiratory therapists, pharmacists, social workers, cafeteria workers, cooks, cleaning people, truck drivers, police officers, firefighters, EMTs, grocery-store clerks, bank tellers, delivery people, postal carriers, farmers, utility crews, and millions of everyday people doing their jobs and looking after others are heroes.  They need to be honored.
  • Politicians should not control the number of hospitals, ICU beds, ventilators, or CT scanners.   Hospitals cannot be run as if they were merely ugly hotels, focused almost solely on occupancy rates.  Surge capacity in beds, staffing, and equipment is essential.   Since 1976, we have seen a 16% decline in the number of ICU beds in our country.  Prudence matters.   It always has.   It always will.

This crisis will end.  We will learn more than we can possibly imagine.  For now, be calm, be kind, be patient.  Your actions may be more heroic than you realize.

homestudy

Mindfulness and Social Connections Soothe Anxiety and Boost Immunity

Posted Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars

By Andrea D’Asaro, MBSR

It is normal to be scared and even paralyzed in the midst of so much uncertainty around the Coronavirus (COVID-19). That’s where simple mindfulness practices can help us stay grounded and connected despite recommendations for social distancing and work at home for many Americans. Deep breathing can slow anxiety, depression and keep our nervous system stable. Reaching out to others can boost our sense of connection, increase oxytocin (the love hormone), and maintain our immunity, which can fall when stress rises.

1. Come back to the moment with five mindful breaths

It’s easy to immerse oneself in the constant stream of on-line and often conflicting information. This can also increase our anxiety. With stress, the rational part of our brain can spin out of control into survival mode or fight, flight and freeze.

Whenever you notice yourself ruminating, worrying or feeling overwhelmed, try 5 mindful breaths:

Sit in a comfortable seat with your feet on the ground (lying down or standing are also options) breathe slowly in through the nose and out through the mouth to slow the nervous system, count five breaths with in and out, counting as one. Pause at the end and check your body and mind to see if anything is different. Continue to 10 or 20 breaths, as you wish. You may want to count your five breaths on your fingers, tracing each digit while taking one breath as an additional grounding with the body.

2. Reach out to friends and boost oxytocin

Social distancing is not emotional distancing! We can increase our happiness when we make real-time connections with others and bring ourselves a spurt of oxytocin, “the bonding hormone.” Try calling distant relatives, friends and others who may feel isolated at this time, using an old-school technology–the phone! When we take the step to converse with relatives or friends, we are boosting our own mood with activation of serotonin, according to research from Stanford University School of Medicine. Such social support is associated with a decreased risk of infection and reduced stress hormones, according to research from Carnegie Mellon University.

Many senior living communities are limiting visitors and keeping elders apart from each other to avoid spread of the virus. Older people, who may not use email or social media, are already at greater risk for depression or anxiety. We know that loneliness is deadly too. Real- time phone calls allow us to hear emotion in another voice and exchange concerns and pleasantries; it’s much more engaging than texting, according to research from the University of Wisconsin.

In this time of the elbow bump, we are advised to avoid hugging. No worries, the self-hug can also enhance the oxytocin, also called the “bonding hormone”.

Try the self-hug: Open your arms wide as you take a breath in, then cross them over your chest and you breathe out. Gently grasp your upper arm with the opposite hands and give yourself some kind squeezes. If it’s comfortable for you, close your eyes and bring to mind your personal “circle of caring.” Imagine the faces of those people or pets who care deeply for you (living or decreased) around you, smiling tenderly. Or envision your favorite happy place like a fireplace or a cozy bedroom. Remember to hold your hug for 20 seconds or more for the best benefits.

3. Strengthen self-care with mindfulness

Mindfulness is all about paying attention on purpose. This means observing how you feel, what your body and mind is craving and how you may best care for yourself. Instead of reaching for social media, a new video, or a less nutritious treat, consider the best way to nurture yourself–what you might recommend to a good friend.

During these anxiety-provoking times, remember the tried-and-true stress reduction strategies. Do you best to get adequate sleep, exercise regularly, spend time in nature and employ relaxation techniques on a daily basis.

Meeting a friend for a brisk walk in nature while bringing your attention back to the moment can bring multiple benefits. You might also consider slow mindful walking where you bring attention to each foot as it touches the ground. It’s helpful to say, “heel, ball, toe” as you notice the movement of the foot against the ground. Enjoy your slow walking and remember, there’s wrong way to bring yourself mindfulness.

Prioritizing these behaviors during the coronavirus crisis can go a long way toward bolstering your immune system and increasing your psychological well-being. Caring yourself in these ways may be a new habit to build over time, so start with one practice at a time and add on as you go, with kindness. Giving yourself kindness allows you to extend it to others who are struggling at this time.

Novel Coronavirus (COVID-19): Now What?

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Everybody calm down.  Fear is spreading faster than the coronavirus at this point.  Financial markets are in turmoil over fear of a global economic slowdown caused by the virus.  Worries about lost productivity in China, reduced demand for oil and consumer goods, and disruption of travel, tech, and financial sectors have investors around the world hyperventilating.  The price of gold has reached its highest level in seven years, and the yield on the 10-year treasury is near record lows (1.37%) — both signals of a flight to safety.  Caffeine-toxic media types are nearly histrionic.  As is typically the case, the only two things missing from their breathless banter are knowledge and perspective.

Here are the facts, as of Monday evening, February 24, 2020:

  • The number of global cases of COVID-19 is around 79,000.
  • Virus-related deaths are at 2,600.  The overwhelming majority of deaths is still in China, but China is only reporting in-hospital deaths.
  • The current mortality rate is still around 2–3%.  The mortality rate of SARS was 10% and the mortality rate of seasonal flu is 0.1%.
  • COVID-19 is more readily transmissible than SARS (Severe Acute Respiratory Syndrome), but less deadly.
  • The incubation period is still considered to be 14 days.
  • Viral transmission of COVID-19 appears to occur through large droplets in respiratory secretions.  Both oral and anal swabs have detected virus (viral particles can be found in the GI tract).
  • Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. As a result, transmission occurs mostly from patients with recognized illness and usually not from patients with minimal symptoms.  COVID-19 seems to work the same way.
  • The most serious symptoms involve the lower respiratory tract and lungs, as opposed to upper airways. The resulting disease is now called “novel coronavirus-infected pneumonia” or NCIP (NEJM, Feb. 20, 2020).
  • So far the clinical breakdown of cases is fairly predictable:
    • 80% are mild illness (requiring little or no care).
    • 14% are of moderate severity.
    • 5% are critical (requiring mechanical ventilation).
    • 2–3% are fatal.
  • U.S. cases – 35 (nearly all travel-related).
  • Italy confirms 152 cases around Milan with more than 200 cases throughout the country. South Korea confirms 833 cases after testing over 20,000 people.
  • The most vulnerable patients are older individuals and those with chronic underlying illness. (CAD, CHF, COPD, DM, chronic kidney disease).

So now what?  We wait for more facts.  The headlines will reflect a frustrating level of paranoia for another 2–3 months — at least.  Universal precautions in medical settings, careful personal hygiene, and common sense are always prudent. `

Don’t panic.  Don’t dump your investments.  Don’t overdo the caffeine.  And one more thing:  Everybody, please calm down.

 

Solomon and Churchill

Posted Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Here we are – midway through January 2020.  Have you crystallized your vision of vitality for 2020?  Has anyone noticed you have a new routine or attitude?  Have you already given up?  Don’t be too hard on yourself.  Between coping with severe weather and assorted viruses, many people are doing well to be functional right now.  Fortunately, it’s never too late to focus on the future and take corrective action.  After all, ships and planes rely on constant corrective adjustments of their navigational systems to reach their destinations.  How much more do fallible, fatigued, and sometimes fickle human beings need to take corrective action if we’re to achieve our destiny?

Now there’s a word that gets far too little attention in our culture.  Destiny.  No doubt there are those who would roll their eyes and dismiss the concept as delusional and arcane.  But I really believe each of us has a destiny or at least a potential destiny.  The key is recognizing it and taking steady action to achieve it.  Andrew Roberts, the acclaimed biographer, describes Winston Churchill’s profound sense of personal destiny in his book, Churchill: Walking with Destiny.  An intense spiritual experience at the age of 16 implanted in the young Churchill a deep conviction that he would be called upon to save London and indeed, Great Britain, at some point in his life.

Churchill had some major failures along the way, as all great people do.  And, despite stunning successes, he was the target of relentless, vicious criticism from political opponents, pretentious journalists, and even people in his own party.  Many of Churchill’s speeches were greeted with ridicule and contempt by his detractors.  This should not surprise us.  Nothing fosters criticism more predictably than jealousy.  Those speeches would later be hailed as some of the most inspiring rhetoric in history.  Winston Churchill endured massive criticism at nearly every turn, but his sense of destiny allowed him to persevere.

The concept of destiny infuses the wisdom of the ages. Several thousand years ago, Solomon wrote a sentence in Proverbs that should be noted by individuals and nations alike.  He wrote, “Where there is no vision, the people perish.” Solomon was onto one of the great secrets of the universe.  Can there be much doubt that communism has largely collapsed because it tried to suppress the vision of its people?  Would inner city darkness and despair exist if people pursued a vision of future success?  Would many of us wallow in depression for long if a vision of great destiny propelled us forward?

If you were less than thrilled with the accomplishments and personal progress you made last year, make a change.  Change whatever isn’t working in your life.  Of course, that means changing the way you think.  It means daring to dream and develop a vision for the future.  Don’t dwell on your circumstances, change them.

The vision to see, the faith to believe, and the will to work can bring your destiny within reach.  Solomon and Churchill were onto something.  The question is, are we?