Throw It Back with MTV
April 30, 2020
It has taken me a few days to come down from this high of living my own version of "Made" thanks to MTV (remember that show?). When I was invited to represent the Health Heroes for CLUBMTV's first virtual dance party, I had no idea how many amazing people I would get to meet...or that I would get to dance like no one was watching on a live broadcast (hence these silly faces). Despite social distancing, we were still able to socially connect right from our living room. Hosted by DJ D-Nice and Keke Plamer, we got to throw it back on MTV and VH1 with celebrities like Usher, John Legend, Rita Ora, Tiffany Haddish, and more. I even recognized some of my favorite TikTokers in our Zoom chats. And for those of you that missed the show, do you recognize who is in the clip below?
That's right, your favorite doctor was featured on national TV! Of course, the best part was that the event was all for charity. We partied it up to encourage others to stay at home while raising money for the VH1 Save The Music Foundation. This non-profit organization was started by MTV executive John Sykes after he was "principal for a day" in a Brooklyn school whose music program was at risk. Their goal is to help schools, communities, and students reach their full potential through the power of making music. Right now, that means helping students impacted by COVID19 gain access to music education remotely. To donate text DANCE to 91999.
Watch the recap below (thank you @itsthemcfarlands for the music inspiration):
PS: I have been giving out autographs on every prescription I write, my patients just don't know it yet ;)
Protect Yourself From COVID19
April 8, 2020
In medical school we learn early on that healthcare is constantly changing, recommendations are updated based on new evidence, and treatments are replaced by more efficacious, less harmful counterparts. It takes a lot of time, research and energy to develop protocols, algorithms and the best scoring systems to determine if and when an intervention's benefit outweighs the risk.
The general public is seeing first hand and in real-time the process of applying evidence-based medicine to understanding and managing SARS-CoV-2, the virus that causes COVID19. This includes developing standard of care practices like preventative measures, assessment tools, treatment regimens, and decision-making guidelines. As a result, the entire situation is and remains fluid with updates from CDC, WHO, federal, state, and local governments announced almost hourly. My inbox is inundated with information from hospitals, medical societies, and educational associations that can become overwhelming and difficult to keep up with on a daily basis. I have waited to put this post together until there was more consistency for the public regarding how to protect yourself from COVID19 in order to not overwhelm you as well. I spent a significant amount of time researching all available data and hope this streamlines several of the current recommendations. Understand that this is not complete and I encourage all of you to visit the CDC and WHO for further information.
RECOMMENDATIONS
1. WEAR A MASK IN PUBLIC
The community has been advised now to wear a cloth mask in public and given the severity of the situation, I agree with this measure. According to a Public Library of Science article published in 2008 on Professional and Home-Made Masks, "any type of general mask use is likely to decrease viral exposure and infection risk on a population level," (van der Sande et al., 2008). The SARS-CoV-2 virus is transmitted through respiratory droplets such as when individuals cough or sneeze.
Cloth masks can help stop the spread of large virus-laden droplets being exhaled, to provide a barrier that prevents the virus from being inhaled, and to prevent people from touching their face - this only works if you are conscious about not touching your face to adjust the mask (Freilich, 2020). These can be washed appropriately and reused but keep in mind when removing the masks to handle by the earloops only and do not touch the material of the mask itself. Additionally, wearing a mask does not give you sufficient protection such that you can disregard social distancing. While a cloth mask is considered a last resort, it is better than nothing when it comes to preventing droplet transmission (Davies et al, 2003).
The following graphics depict the effectiveness of different material in filtering out particles:
Recent literature states the pathogen can be what is called aerosolized. This means the respiratory droplets can survive in the air for up to 3 hours after a procedure that converts droplets into a spray such as with a nebulizer treatment. These procedures are most commonly performed in hospitals. With a shortage of personal protective equipment for healthcare providers comes an even higher risk of exposure in an already high-risk environment, especially for those on the front lines. This is why medical-grade protection like N95 masks, P100 respirators, and surgical masks must be reserved for medical professionals. Additionally, you must be fitted to wear the N95 as different facial structures require different sizes to guarantee a tight seal. If we are not protected, we will not be around to treat our patients and protect you. The only other consideration of when to wear a medical-grade mask is if you yourself are infected or you are caring for someone who is positive.
Some tips for those in the medical field: Follow your hospital's protocol but in general, when wearing your N95, place a surgical mask over it to protect it. You can don an additional cloth mask over all of these to add further protection. There were some recommendations to use HEPA filters but I was recently informed this filter carries the health hazard of inhaling fiberglass and causing lung damage. I advise against this addition to PPE.
My colleague, Dr. Marc Katz, put together a great tutorial about wearing masks including a short clip on how to make your own:
In summary:
The following is a simple CDC guide for how to make your own mask at home (they recommend adding a coffee filter for additional protection). Other options can be found HERE.
2. STAY SIX FEET APART
While I and several of my colleagues use the term social distance, what we really mean is PHYSICAL distance. This space prevents the spread of the virus as it can travel between people in close proximity. Six feet apart is better than six feet under.
That being said, the best way to protect yourself and your loved ones is to stay home. Social distancing is not a punishment, it is a privilege. Many of us doctors and other medical personnel are putting our lives at risk to fight on the front lines of this pandemic battlefield. Your efforts are helping us flatten the curve to ensure our hospitals are not overwhelmed and our resources are not depleted.
3. WASH YOUR HANDS
The viral droplets can easily be transferred from your hands to your eyes, mouth, or nose. This is why hand hygiene is crucial to protecting your health. Wash your hands for at least 20 seconds (hint, sing Happy Birthday to yourself twice). You can also use an alcohol-based hand sanitizer.
If you choose to wear gloves, understand that germs can survive on gloves and this does not replace handwashing nor does it prevent the ease of transmissibility from you to objects.
4. AVOID TOUCHING YOUR FACE
See #4 before touching your face. Again, the virus infects people through eyes, nose, and mouth. One guideline I have been following is wearing glasses instead of contacts to prevent touching my eyes.
5. CLEAN SURFACES
6. AVOID THE BEACH
7. DO NOT LIE
When a healthcare provider asks about your medical, social, or travel history and any associated symptoms or exposure risk, please be honest. We want to help you and protect you but as much as we are trying to be open and transparent with you, we ask you to do the same.
8. CONTINUE WITH SELF-CARE
Stay hydrated, stay active, stay engaged with your friends, family, and community. Mental and physical well-being are important to maintaining overall health.
9. ADDRESS CODE STATUS
This is a tough and extremely sensitive discussion but important to consider early so as not to have to face difficult decisions later on without knowing the wishes of your loved ones or yourself. Should the time come to make life-sustaining decisions, you must understand what this means. Our default plan of action is to treat patients as if they are FULL CODE, where every medical intervention is to be done for them.
We often use the terms DNR (Do Not Resuscitate), DNI (Do Not Intubate) and CMO (Comfort Measures Only) for patients who wish to have a limited code status. Patients who are in critical condition because of COVID19 require intubation, which is when a tube is placed down their throat and hooked up to a machine called a ventilator to help them breathe. If a patient does not want this done, their wish is to be DNI.
If their heart were to stop beating, the course of action is to perform cardiopulmonary resuscitation (CPR). The patient will receive chest compressions, which can cause ribs to break, shocks to the heart and other medications. If a patient does not want this done, their wish is to be DNR. There are risks to these interventions, which is why establishing code status is necessary to ensure we are following each individual patient's plan for their goals of care.
There are additional components to this discussion including non-invasive interventions for breathing and nutrition methods. My colleague, Dr. Marc Katz, put together a detailed blog post for further information that can be found HERE.
10. BE VIGILANT
While it has been a few weeks since these lockdown and shelter-in-place orders were instated, you cannot lose sight of the end goal. As much as we want to be with our family and friends to celebrate the holidays, we have to put each other's health and our own health first. We must be resilient and persevere as we wait for brighter days ahead.
References:CDC. (n.d.). Retrieved April 8, 2020, from www.cdc.gov
COVID-19: What We Know so Far About the 2019 Novel Coronavirus. (n.d.). Retrieved April 8,
2020, from https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-
coronavirus
Davies, A., Thompson, K.-A., Giri, K., Kafatos, G., Walker, J., & Bennett, A. (2013, August).
Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?
Retrieved April 8, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/24229526
Doremalen, N. van, Vaduganathan, M., & Fineberg, H. V. (2020, March 17). Aerosol and Surface
Stability of SARS-CoV-2 as Compared with SARS-CoV-1: NEJM. Retrieved April 8, 2020, from
https://www.nejm.org/doi/full/10.1056/NEJMc2004973
Freilich, S. (2020, April 1). Health Warning - HEPA Filter. Retrieved April 8, 2020, from
https://www.youtube.com/watch?v=qiYbXsIcI7E
Robbins, G. (2020, March 31). UC San Diego Virus Expert Pleads With Surfers to Stay Out of the
Ocean to Avoid Coronavirus. Retrieved April 8, 2020,
from https://www.sandiegouniontribune.com/news/science/story/2020-03-31/uc-san-diego-
atmospheric-chemist-pleads-with-surfers-and-beach-walkers-to-stay-home
van der Sande, M., Teunis, P., & Sabel, R. (2008, July 9). Professional and home-made face masks
reduce exposure to respiratory infections among the general population. Retrieved April 8, 2020,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/
WHO. (n.d.). Retrieved April 8, 2020, from www.who.int
Cover illustration by @sarapaglia
Quarantine & Chill
March 24, 2020
With so much information about COVID19 disseminating across media outlets, I realized there is a MAJOR gap in one of the most important aspects of our current situation: your mental health. I partnered with Philadelphia psychiatrist, Dr. Joe Resignato (@joeyresmed), for an Instagram Live Quarantine & Chill where we provided an overview on how to process what is happening while maintaining a good headspace. Read below for a summarized transcript of our recommendations and a few FREE wellness resources at the end.
DISCLAIMER: This is not to be taken as medical advice as we do not have a patient-physician relationship with viewers. This is educational and informative. If you have medical questions or concerns, we recommend talking to your primary care physician.
Dr. Alyssa Cole, DO is a Physical Medicine and Rehabilitation doctor (also known as a physiatrist) in Philadelphia, PA. Physiatrists specialize in the medical management of patients as they undergo physical, occupational, and speech therapy, helping improve their quality of life and reach their functional goals. Many of our patients have spinal cord injuries, traumatic brain injuries, strokes, or other musculoskeletal and neurologic conditions.
Dr. Joe Resignato, MD is a psychiatrist in Philadelphia, PA, specializing in the medical diagnosis, treatment, and prevention of mental disorders. Dr. Resignato is an expert in management of mental health and wellness, from PTSD to anxiety and depression.
“Death is in sight, Nowhere to hide, It’s All Over” - Headlines from several news articles about the COVID19 global pandemic that has swept not only the nation but the globe. These are statements that instill fear, anxiety, and panic in readers. How do we handle this type of fear media?
- 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.
What are the effects of quarantine? Who is most at risk?
- 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
What can people do to be productive in the community?
- 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.
Can you differentiate between fear and anxiety and where this situation exists?
- 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.
What might be the manifestations of increased anxiety?
- A recent NYTimes article discussed the differences between worry, stress, and anxiety
- Worry is in your head and can cause you to go into a cycle in your head of worrying about something over and over again or even finding yourself in an endless narrative of worrying about one thing after another.
- Stress is in your body, which can cause increased tension and muscle tightness, especially in your back and neck. A great way to manage this (outside of a massage) is with a foam roller to help relax your muscles.
- Anxiety is a combination of worry and stress in your head and your body
How can people cope with these?
- 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.
- Deploy: Follow all directives and instructions from public health officials and government.
- 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.
- 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.
- 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.
- 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.
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)
Coronavirus Update
March 14, 2020
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.
Regarding National/Regional updates as of 3/14/20:
- 2486 cases in US; 50 deaths in WA, CA, FL, NJ, SD, NY, CO, KS, GA
- 45 cases in PA
- At least 30 cases in Delaware Valley
- 3 cases in Bucks County
- 6 cases in Delaware County
- 18 cases in Montgomery County
- 3 cases in Philadelphia County
As a physician, I am not scared of this virus. I am scared of the media sensationalizing it and the mass hysteria that has ensued causing public panic and anxiety. This type of response, from hoarding basic household goods to stealing medical supplies, is dangerous. It is taxing on our healthcare system and leading to a shortage of resources. It is mentally straining to individuals and families. I feel for those who are now in need of child care, food, shelter, even something as simple as toilet paper, and encourage all of you to spread KINDNESS not viruses.
I hope my posts bring several of you some form of understanding and reassurance that despite school and business closings, event cancellations, flight groundings, economic disruptions, countries on lock down, we, the physicians and healthcare community, will be open and ready on the front lines fighting for you. However, we cannot do it alone. We need your help. Here's how:
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?).
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| 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.
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