• Viewers must understand that there are still several unknowns and questions even for us healthcare professionals. This is why it is important to focus on your sources including the CDC and WHO as well as other credible healthcare professionals. There is a lot of misinformation - anywhere from “blowing a hairdryer up your nose to kill the virus” to simply “this won’t affect me.”
• There are vaccines under Phase 1 trials and anecdotal treatments but these have yet to be definitively proven. Rapid COVID19 testing was also recently approved by the FDA to detect SARS-CoV-2 within 45 minutes.
• Stay informed but stay positive and understand why you’re doing what you’re doing. Social distancing means stay at home and this is to prevent the spread of the virus, especially to vulnerable populations. This additionally helps prevent the hospitals from becoming overcrowded and limiting resources. Recognize that for the majority of patients, they have mild symptoms and recover. Additionally, new data is coming to light that almost half of these patients have GI symptoms (maybe that’s why people bought all the toilet paper?) from anorexia to diarrhea.
• Limit your exposure to news both in quality and quantity - (see below)
• If you are going to worry, be productive with it - find out what you can do to help.

• Post-traumatic stress syndrome, depression, and anxiety are all potential psychological effects
• Individuals who have experienced trauma in the past, healthcare professionals and parents of one to two children
• For more information, check out Dr. Resignato's summary of a case study review about this topic HERE

• Outside of your duties at home and working, find ways to help others, especially healthcare workers - this includes continuing to social distance (remain six feet apart).
• Advocate for personal protective equipment (PPE) by messaging suppliers and public health officials, donate masks or other medical supplies (Philly Mask Brigade is a mask collection agency for the greater Philadelphia area). Major fashion designers like Christian Siriano and Dev Charney of American Apparel have traded in gowns for masks, repurposing their manufacturing warehouses and factories to protect us. Even medical TV shows are donating their resources to help us in this fight.
• Reach out to those you know on the front lines with messages of love and support as this is going to be a long road ahead for many of us.

• Understand where anxiety originates.
• Fear is the physiologic fight or flight sympathetic activation in response to a dangerous stimulus perceived as a threat (for example a Saber-Tooth tiger). If you did not have a fear response, your ability to survive would be at risk.
• Anxiety occurs when there is no specific threat or stimulus to provoke the sympathetic response (there is no Saber-Tooth tiger). If anxiety is uncontrolled, this can be damaging to our mental and physical health.
• We have to be able to manage what we are experiencing because there’s not much we can do to curb the threat.

• MAKE YOUR BED - This is the first thing you should do in the morning in order to set a precedent for future tasks to be accomplished the rest of the day
• STRUCTURE - Create a to-do list and set a schedule for structure. Designate time for specific things and prioritize your activities. For example, outline a time frame of when you are going to watch the news instead of watching it throughout the day. If you are going to worry, set a time for this aside. Otherwise you are going to make yourself more stressed. You have to minimize the time you spend on things you cannot solve.
• EAT - Make sure you are eating at least three well-balanced meals a day. Your body needs adequate nutrition to stay healthy.
• HYDRATE - One of the most common presenting signs of patients with COVID19 is dehydration. Ensure you are actively drinking water throughout the day.
• STAY ACTIVE - While you must continue to social distance and maintain six feet apart, you can still get outside and enjoy the fresh air and stay active. The exercise challenges on social media are a great way to connect with people and maintain your physical well-being.
• LAUGH - They say laughter is the best medicine and they are not wrong. You have to enjoy the humor of the situation to lighten the mood and manage your stress.

You can save the world by staying home, watching TV, and wearing PJs 24/7.

• LIST - List three things you are grateful for and understand that we are not just going through this, we are growing through this TOGETHER. 3 things you’re grateful for
• MEDITATE - Headspace is offering free subscriptions to healthcare professionals. There are several great resources to meditate as well (see below). As someone who does not like to sit still, I was not keen on trying this but with practice have improved and feel like I am able to think more clearly.
• CONNECT - with family, friends, and yourself! From virtual happy hours to spa days, take this time to focus on yourself, your passions, and your relationships.
• MINIMIZE ALCOHOL - We do NOT recommend drinking alcohol to ease your anxiety or help you sleep. If anything, this can exacerbate your symptoms as it is harmful for mood and sleep. Alcohol is a depressant and in response, your mind will become overactive. When the alcohol wears off, you will be even more "revved up" than before, which is often why you end up waking up earlier and do not have a good night's sleep. Also keep in mind alcohol is a liver toxin and recent data has shown that SARS-CoV-2 causes elevated liver enzymes and possible viral hepatitis (meaning it can also damage the liver).
• JOURNAL - Pick a song and in the time the song plays, write down your thoughts - whatever comes to mind. I got this idea from my friend Beth.
• STOCK UP - If you are going to "hoard" something, we recommend stocking up on YOUR prescriptions that YOU need. Insurance companies are offering a three-month supply so as to limit the number of trips you have to make to the pharmacy.
• GET A THERMOMETER - If you or a family member start to feel sick, you want to make sure you have a thermometer to monitor your temperature for fevers.
• SEEK HELP - If you find you are struggling to the point that no other interventions are helping, do not be afraid to seek professional help - many places have transitioned to telehealth or phone appointments. This is unprecedented and you need all the support you can get.

Any advice for helping people sleep at night?

• Your bed should ONLY be used for sleep and sex
• Set a bedtime and have a bedtime tradition
• Try blue-light glasses to filter out the light that can otherwise cause your body to stay awake longer
• Avoid activities like exercising, watching TV, or eating late at night
• Put your phone away
• Think of three good things that happened that day to uplift your mood
• Meditate beforehand
• If you still cannot sleep, you may want to talk to your primary care doctor about alternatives

I am currently feeling stressed about this situation but Dr. Resignato, you mentioned you're feeling sad. Can you elaborate?

• Many of us are mourning what our children, our friends, our family, and ourselves are missing in life. This is why it is so important to stay connected and to seek help from experts if you feel like you are having difficulty coping with the situation.
• On the bright side, at least there’s no FOMO

What recommendations do you have for families now tasked with working and teaching their kids?

• Find ways to entertain and teach your kids through arts and crafts, science experiments, cooking, and more. Pinterest has some great ideas for these types of activities.
• You can practice meditating with them, practice quiet time, do yoga or other exercises together. A lot of people have found making videos like on TikTok to be a fun outlet and bonding experience.
• Get outside - I have seen neighborhoods get creative and host things like Zumba classes while social distancing.
• Understand that there are some who don’t live with anyone - hug your partner or kids a little bit longer for those people.

What can healthcare workers take away from this?

• Please know that you are not alone.
• Several healthcare workers are worried they are under-protected and that they could put their loved ones at risk. There are many who are or will be redeployed to areas of medicine they have not practiced in years. As a result, we must OVER prepare so that we are not under-equipped. Consider the worst situations and pivot your thinking to how we can turn them into the best version of the worst possibility.
• I personally am struggling with the fact that as much as I am helping patients, I cannot help my neighbors for fear of exposing them given we are in such a high risk of exposure.
• The emptiness of 6 feet has never been so LOUD and the idea that I do not know when I will be hugged again is difficult to process. It has helped to talk with other physicians who are experiencing similar feelings.
• Dr. Resignato brought up a great point to be aware of the potential for survivor’s guilt as our ER and ICU colleagues fall.

For those just tuning in, can you summarize what we have talked about (the 5 Ds) and how this relates to the community?

Dr. Resignato cites a conversation he had with Dr. Salman Akhtar, MD, a world renowned psychoanalyst, who suggests using the "5 D's" to mitigate the psychological effects of a pandemic: Deploy, Distill, Depathologize, Distinguish, Direct.

1. Deploy: Follow all directives and instructions from public health officials and government.
2. Distill: Distill the quantity and quality of what you are watching or reading when it comes to news - ensure the sources are CREDIBLE. Designate time for this activity rather than taking in the news all day and worrying, which can make you more stressed out.
3. Depathologize: You do not have to diagnose yourself with something because this is normal stress. It is okay to feel sad, worried, anxious, or hurt. These are normal reactions and does not mean something is wrong with you or you are developing a complex. It is natural.
4. Distinguish: Distinguish between physical and social distancing. The term is poor because we should not socially isolate ourselves. You want physical distancing between people (six feet apart) but you can still keep in touch and connect with them, especially virtually.
5. Direct: Direct your attention elsewhere. It is okay to play and have fun, to dance, or to sing. Dr. Resignato brought up a great point that if you sing, you become two people - you are the person singing and the person listening.

Do not be in denial about this as COVID19 is a real threat. It is not the time to have a party or ignore what is happening. We implore you to take this situation seriously.

HUGE shout out and thank you Jenny Meassick (@jennymeassick) for posting a great video that complements this discussion...and for letting me steal Joe for two hours to host this IG Live!

Free Wellness Resources:

• Headspace - great meditation app
• Blogilates - You know how much I love my Cassey Ho workouts. These are FREE on Youtube and she often puts together a monthly calendar with your daily workouts.
• DoYogaWithMe.com - free online yoga and meditation videos (you can choose what level you want and how long you want to work out for)

I still cannot believe I was in Florida last week at an international medical conference and fast-forward to today when the thought of traveling seems out of the question. It's amazing how fast things can change now that COVID19 has officially been declared a pandemic. In order to continue my INVEST series, I am combining the final installment on investing in your environment with a COVID19 update since these go hand in hand (pun intended).

Looking at the positive side: All the lockdowns, air travel restrictions, decreased demand in oil and gas, factory/business closures, and event cancellations set in place around the world have helped reduce greenhouse gas emissions and combat climate change.

Ways to protect yourself and your environment

• Practice social distancing
• To further reduce the spread of coronavirus, avoid large crowds, public places, and non-urgent or non-emergent travel (especially cruises).
• Avoid shaking hands or touching other people as best you can.
• Many airlines are offering credits or refunds to travelers.

• Continue good hygiene
• 20 seconds of soap and water or a hand sanitizer go a long way.
• Don't touch your face as the virus is transmitted through respiratory droplets.

• Boost your immune system
• Stay hydrated.
• Get plenty of sleep.
• Take a multivitamin and vitamin C.
• Practice stress relieving techniques like exercise or meditation.
• Fresh flowers have been proven to help reduce anxiety as well.
• PLEASE stop mass buying all the cleaning products
• If the rest of the community does not have access to these, they cannot care for themselves with proper hygiene and sanitization, putting you even more at risk.
• This will inevitably perpetuate the spread of the virus leaving you little protection despite hoarding multiple bottles of Purell and toilet paper (seriously, what is with the TP stockpiling? Is it acceptable to now give a roll of toilet paper in place of a bottle of wine?).

PC: The Bachelor on ABC

• Respect healthcare workers
• Have patience and only go to the emergency room if you are severely ill. If you have cold-like symptoms stay home. The healthcare system capacity can only be stretched so thin. Efforts and resources must be diverted to the critically ill patients. This is why we have a triage system.
• If you are infected, you could be contagious for 20-37 days.
• If you are unsure, call your primary care doctor.
• At this time there is no cure for the virus. 80% of patients recover and we are working on an antiviral drug as well as a vaccine.
• PLEASE stop stealing our masks
• We need these to care for patients who are actually sick.
• COVID-19 is not the only disease out there and if we do not have personal protective equipment available, we cannot provide appropriate or effective treatment.
• Already efforts have been put in place to decrease the number of individuals using these resources, with medical schools removing their students from clinical sites to hospitals only allowing doctors and essential nursing care into rooms.
• STAY INFORMED
• Review WHO and CDC guidelines and updates
• Understand that by PREVENTING this disease we are saving lives. The less individuals infected means this is not an overreaction. Know that the flattening of the curve is an indication that your efforts for mitigation and containment are indeed helping save lives
• ABOVE ALL, BE KIND
• I have heard stories of fights breaking out over the last laundry detergent, price gouging (this should be illegal), and elderly couples afraid to go grocery shopping. All I can think is please remember we are all in this together.
• Spread kindness, not disease

Finally, as much as I would like to shout out to all my colleagues in healthcare from the physicians to the nurses, physician assistants, nurse practitioners, pharmacists, techs, and more, I would ESPECIALLY like to share my gratitude and appreciation for the sanitation and janitorial teams that are the real MVPs  Thank you for helping work so hard to keep our environment clean and safe.

What is Coronavirus or COVID-19?

How is COVID-19 spread?

• It spreads via respiratory droplets (think coughs/sneezes)
• It spreads via person to person contact (within 6 feet)
• It can remain for about a week on surfaces (known as fomites)
• Symptoms include fever, cough, and shortness of breath
• Those who are immunocompromised, the elderly, and the young are the most at risk and susceptible to falling severely ill

What is the best prevention?

• WASH YOUR HANDS (soap and water or alcohol-based rub for at least 20 seconds. I always keep a travel size bottle attached to my bag and have an automatic soap dispenser in my home - linked these for you in my liketoknow.it)
• Avoid touching your eyes, nose, and mouth with unwashed hands
• Cover your cough or sneeze with a tissue and discard
• Stay home when you are sick
• Clean/wipe down all surfaces with disinfectant

Should you wear a mask?

• Unless you are sick, NO
• Save those for healthcare workers, caregivers, and people who are ACTUALLY SICK
• The best thing you can do is WASH YOUR HANDS
• Often the general public ends up touching their face MORE when they wear a mask to adjust it thus you are more likely to get sick because of this if you wear one

How else can you protect yourself from getting sick?

• While coronavirus does not yet have a vaccine the flu does: GET YOUR FLU SHOT
• Stay informed by visiting the CDC and WHO websites.
• SHARE THIS POST TO SPREAD THE FACTS

What about social stigma?

• Fear and anxiety exacerbate unnecessary and undue prejudice, especially right now against those of Chinese and Asian-American descent
• This virus does not discriminate and NEITHER SHOULD YOU - everyone is at risk for COVID-19 no matter their nationality (that being said, at this time there is little immediate risk of exposure in the United States)
• Fight the stigma and use your energy instead to fight the disease