Latest / The SHEA Podcast / COVID-19: Taking Care of Yourself, 4/23

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COVID-19: Taking Care of Yourself, 4/23 · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, SHA, promoting the prevention of healthcare-associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:24
  SPEAKER_00: I am Dr.
• 0:25
  SPEAKER_00: Jennifer Hanrahan, infectious disease specialist at the University of Toledo College of Medicine and Life Sciences, and I will serve as your moderator.
• 0:34
  SPEAKER_00: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:44
  SPEAKER_00: Shay is excited to launch the tenth episode of this podcast, COVID-19 Updates, What We Know Now.
• 0:51
  SPEAKER_00: Today's episode will focus on mental health and how we as healthcare professionals can take better care of ourselves during these high-stress times.
• 0:59
  SPEAKER_00: Our speakers are Dr.
• 1:01
  SPEAKER_00: Cindy Prince, Clinical Associate Professor of Epidemiology at the University of Florida, and Dr.
• 1:07
  SPEAKER_00: Alison Holgerson, Clinical Assistant Professor, Department of Clinical and Health Psychology at the University of Florida.
• 1:14
  SPEAKER_00: Thank you for joining us today.
• 1:16
  SPEAKER_00: I will now turn it over to Dr.
• 1:18
  SPEAKER_00: Prince to get us started with a news and guidance update of the week.
• 1:22
  SPEAKER_01: Thank you, Jennifer.
• 1:23
  SPEAKER_01: We are currently at 2.5 million COVID-19 cases worldwide, with over 825,000 cases in the U.S.
• 1:30
  SPEAKER_01: and 45,000 deaths here.
• 1:32
  SPEAKER_01: In the US, 4.1 million people have been tested for COVID-19 to date, which is 1.3% of the population.
• 1:39
  SPEAKER_01: This week, the Centers for Medicare and Medicaid Services released a memo reinforcing the requirement that nursing homes report any communicable diseases, healthcare-associated infections, and potential outbreaks to state and local health departments.
• 1:53
  SPEAKER_01: Reporting to NHSN had previously been optional, but will now be required in order to allow for local and national surveillance by the CDC.
• 2:00
  SPEAKER_01: The Infectious Diseases Society of America released a primer on COVID-19 antibody testing.
• 2:06
  SPEAKER_01: There's been a lot in the news about antibody testing as a public health measure to support return-to-work efforts.
• 2:12
  SPEAKER_01: However, IDSA cautioned that the tests are currently varied and clinically unverified, and that serological testing should not be used to make decisions about the use of personal protective equipment or the use of staffing and healthcare settings until there's more evidence about the effectiveness of serology testing in determining COVID-19 immunity.
• 2:31
  SPEAKER_01: The Center for Health Security at Johns Hopkins University has a list of tests that have been approved for diagnostic use in the U.S., as well as those that have been approved in other countries.
• 2:41
  SPEAKER_01: Among those approved in the US, two are rapid diagnostic tests that detect IgM and IgG to the nucleocapsid protein of SARS-CoV-2.
• 2:50
  SPEAKER_01: One is an ELISA test that tests the presence of IgG to the spike protein receptor binding domain.
• 2:56
  SPEAKER_01: And one is a modified ELISA test that detects total IgG and IgM to the spike protein.
• 3:02
  SPEAKER_01: Two of the U.S.
• 3:03
  SPEAKER_01: approved tests have reported sensitivities and specificities.
• 3:06
  SPEAKER_01: One reported 83% sensitivity when tested against 36 known positive samples, and 100% specificity when tested against 400 known negative samples.
• 3:18
  SPEAKER_01: The other reported 93.8% sensitivity when tested in 128 known positive samples and 95.6% specificity when tested against 250 known negative samples.
• 3:31
  SPEAKER_01: The CDC noted this week in the MMWR that calls to poison control centers in the US for exposures to cleaning agents and disinfectants increased by 20% between January and March, with a sharp increase at the beginning of March.
• 3:46
  SPEAKER_01: 40 to 47% of all calls were exposures in children ages 5 and under.
• 3:51
  SPEAKER_01: Among the increase in calls related to cleaners, 60% were related to bleach exposures.
• 3:57
  SPEAKER_01: While among the increase in calls related to disinfectants, 36.7% were related to hand sanitizers.
• 4:04
  SPEAKER_01: Among routes of exposure, inhalation accounted for an increase of 35% among cleaners and 109% among all disinfectants.
• 4:14
  SPEAKER_01: Also this week, the New England Journal of Medicine published a case series of 393 consecutive COVID-19 patients who were admitted to two New York hospitals between March 3rd and March 27th.
• 4:26
  SPEAKER_01: Of these cases, the median age was 62 years, 60% were male, and one-third had obesity.
• 4:32
  SPEAKER_01: In terms of the most common symptoms, 80% of cases presented with cough, 77% with fever, slightly over half with dyspnea, 24% with myologis, 23% with diarrhea, and almost 20% with nausea and vomiting.
• 4:47
  SPEAKER_01: One-third of cases required invasive mechanical ventilation due to respiratory failure, and of those, only one-third have been extivated to date.
• 4:56
  SPEAKER_01: The authors noted that the percentage of cases receiving mechanical ventilation in this series was more than 10 times as high as recorded for a case series in China.
• 5:05
  SPEAKER_01: Proposed reasons for this include the large percentage of patients with obesity in the US case study, the early intubation strategy adopted by these hospitals, and more severe disease in the US case study patients due to limited testing that was primarily reserved for those with more severe disease.
• 5:23
  SPEAKER_00: Thank you, Dr.
• 5:24
  SPEAKER_00: Prince.
• 5:24
  SPEAKER_00: I now want to move into a discussion with Dr.
• 5:26
  SPEAKER_00: Holgerson.
• 5:28
  unknown: Dr.
• 5:28
  SPEAKER_00: Holgerson, thank you for joining us.
• 5:30
  SPEAKER_02: My pleasure.
• 5:31
  SPEAKER_02: Thank you for having me.
• 5:33
  SPEAKER_00: Healthcare professionals, especially those on the front lines of the crisis, are experiencing many stressors.
• 5:39
  SPEAKER_00: Some of these include anxiety.
• 5:41
  SPEAKER_00: How do you deal with some of the overwhelming anxiety that some people are having now?
• 5:46
  SPEAKER_03: Well, first, I want to validate that this period of unprecedented stress and to be frank, trauma for all of us is likely to increase everyone's anxiety, especially for those on the front line.
• 6:01
  SPEAKER_03: So, first validating that that's normal, you're not alone, and that there are steps you can take to feel better.
• 6:08
  SPEAKER_03: I often use the metaphor of an oxygen mask.
• 6:12
  SPEAKER_03: Most of us have been on an airplane.
• 6:14
  SPEAKER_03: In the emergency briefing, they tell you put your oxygen mask on before you put anyone else's.
• 6:20
  SPEAKER_03: And that can be really challenging, especially when you're in a field where you are caring for others.
• 6:25
  SPEAKER_03: And at the same time, you need to take care of yourself before you can effectively take care of others.
• 6:31
  SPEAKER_03: So when we think about anxiety and stress, the best way is to hopefully get on top of it and engage in behaviors ahead of time that are likely to reduce that overall level and maintain it in a way that feels comfortable.
• 6:45
  SPEAKER_00: How can people make sure that they're aware when they need a break and what kind of break is the most effective, especially given that many people's schedules cannot be changed and remain demanding and high stress?
• 6:56
  SPEAKER_03: Similar to the oxygen mass, we often don't recognize when we need to take a break until it's too late.
• 7:02
  SPEAKER_03: That's usually when our physical anxiety and our mental anxiety has hit its peak.
• 7:08
  SPEAKER_03: And so I encourage everyone to build in breaks kind of more on a schedule as opposed to when you feel like you need them.
• 7:15
  SPEAKER_03: And there are lots of effective tools that are short-term habits that don't take a lot of time and energy that can be used regularly.
• 7:24
  SPEAKER_03: So that it might include relaxation strategies, gratitude journaling, reaching out to others to help stay connected.
• 7:33
  SPEAKER_03: Those should all take 10 minutes a day, and that will allow you to make sure that you're getting a well-needed break most days.
• 7:41
  SPEAKER_00: That sounds good.
• 7:42
  SPEAKER_00: Sometimes healthcare workers engage in activities that might not be so healthy, but you know, now that restaurants and bars are closed, some of that behavior has gone away.
• 7:54
  SPEAKER_00: It's also become more difficult to socialize because of social distancing.
• 8:00
  SPEAKER_00: So, how do you recommend that people stay connected with others during this time?
• 8:05
  SPEAKER_03: Well, we're in a time of technology, we're taking it at the best it can give us.
• 8:11
  SPEAKER_03: So using as much as you can FaceTime, Zoom calls if you can with loved ones, telephone calls, writing letters, anything you can to keep up that social connection, but also setting expectations for yourself so that doesn't become overwhelming.
• 8:27
  SPEAKER_03: You still want to be sure you're setting boundaries and that you still feel comfortable with the amount of social interaction you're getting because it can also be overwhelming.
• 8:36
  SPEAKER_03: So, again, kind of thinking of this as more of a marathon, not a sprint, that spacing those times, setting aside a small amount of time each day to connect with those that you love and care for can be really helpful.
• 8:49
  SPEAKER_00: So, you know, that also brings up the next question, which is that for some of us, our friends and family know that we work in infectious diseases or infection prevention, and they have lots of questions, especially, you know, because of everything that they're seeing on the news all day.
• 9:04
  SPEAKER_00: How can you set boundaries to connect with others that allows you to take a break from COVID?
• 9:09
  SPEAKER_03: It's a fantastic question.
• 9:11
  SPEAKER_03: Assertiveness is really challenging any day of the week.
• 9:15
  SPEAKER_03: It's especially challenging when we're already depleted, both physically, mentally, and emotionally.
• 9:21
  SPEAKER_03: But I encourage you to try it as much as you can.
• 9:24
  SPEAKER_03: So a great way to think about this is to kind of sandwich your statement and ask for what you need.
• 9:29
  SPEAKER_03: Assertiveness and assertive communication is all about having each person's needs met.
• 9:34
  SPEAKER_03: So an example might this might be starting with a statement that validates their concerns and questions, then identifying your needs, and then asking for them to be met with something that will work with each party.
• 9:46
  SPEAKER_03: So an example might be this time is really stressful and confusing for all of us, and I hear your concerns and questions.
• 9:53
  SPEAKER_03: It is also stressful for me, and I would like to take a break from talking about it for now.
• 9:57
  SPEAKER_03: Let's talk about XYZ.
• 10:00
  SPEAKER_03: So that validates that they have questions and that they're reaching out to you, yet you're still asserting your needs to take a break.
• 10:07
  SPEAKER_03: You can offer also to set aside an allotted amount of time or a certain time to answer any questions they might have or be used as a resource if you'd like to, if you feel up to it.
• 10:19
  SPEAKER_03: Then it's a specific amount of time, there's a boundary set around that, and you can say at the end of it, okay, um, our 10 minutes are up, let's talk about something else.
• 10:29
  SPEAKER_00: Yeah, I think a lot of people these days are feeling like they would like to not be thinking about COVID, but it's kind of hard to do that.
• 10:37
  SPEAKER_00: Umrounded.
• 10:39
  SPEAKER_00: So those are some great suggestions.
• 10:41
  SPEAKER_00: How do you recommend that people make the transition from work to home so that they're actually present when they're home and they're not distracted and constantly checking email?
• 10:51
  SPEAKER_03: Yeah.
• 10:52
  SPEAKER_03: First thing that comes to mind is to be gentle with ourselves.
• 10:55
  SPEAKER_03: So that is a tall order to just make that transition very quickly.
• 11:00
  SPEAKER_03: It's hard even more so these days to set that boundaries around your time and around your mental energy.
• 11:06
  SPEAKER_03: Similar to kind of the assertiveness, if you can set aside a block of time when you first get home to put away your cell phone, put away your computer, and really try to just kind of be aware of what's around you.
• 11:18
  SPEAKER_03: A good way to do this is a simple grounding technique where you just kind of use all of your senses.
• 11:24
  SPEAKER_03: What do I see?
• 11:25
  SPEAKER_03: What do I hear?
• 11:26
  SPEAKER_03: That's a brief check-in, usually takes a couple minutes, and then you feel more like you're in your space wherever that might be.
• 11:33
  SPEAKER_03: Recognizing that this might have to be fluid and flexible about when you do this when you get home, but it can be a good practice to just kind of be mindful of literally your environment and what's happening around you to be more present.
• 11:45
  SPEAKER_03: Similar to that, I encourage everyone to set boundaries around when they read the news, what type of news they are reading, when they're working on emails and working, and try to limit as much as possible as you can at home, or set aside a certain block of time when you're at home to do that.
• 12:04
  SPEAKER_03: And again, cut yourself off after that time is done.
• 12:08
  SPEAKER_00: So those are some great suggestions.
• 12:10
  SPEAKER_00: One of the other difficult things that we're seeing is that, you know, some of us who are taking care of patients are seeing people getting very sick and dying, or, you know, having uncertain outcomes, and it can be really difficult to deal with these things.
• 12:26
  SPEAKER_00: How do you help build resiliency for those who are witnessing trauma and grief?
• 12:30
  SPEAKER_03: Yeah.
• 12:31
  SPEAKER_03: Well, you know, witnessing trauma and grief in and of itself can be a secondary trauma where the individual, the healthcare worker, is also experiencing uh traumatic symptoms or heightened anxiety and stress because of it.
• 12:45
  SPEAKER_03: So the first step is to honor that, that that's very real, that you can also be traumatized by witnessing that and to validate that and then engage in any sort of self-care, relaxation, support strategies to go along with that.
• 13:00
  SPEAKER_03: It can also be helpful to seek support from those around you, whether that's coworkers who are living the shared experience, to have that time to process together, but also making sure that you are sharing and speaking, uh, seeking emotional support from people outside of your field as well, to kind of again set that boundary about how much and how often you talk about it.
• 13:22
  SPEAKER_03: If you're noticing that these symptoms are becoming more persistent and you're experiencing, let's say, attention difficulties, sleep difficulties, kind of hypervigilance, avoidance of work or going places, that could be indicative of this secondary trauma or this experience turning into something more serious.
• 13:41
  SPEAKER_03: And that's when it's important to kind of check in with yourself and seek professional help if it feels like it's going in that direction.
• 13:49
  SPEAKER_03: But most importantly, reminding yourself that you have experienced challenges before, that this is a really unique situation of experiencing and being in other people's trauma and grief, and that people are resilient and that you've had ways of coping before that you can draw on and remind yourself of in these difficult times.
• 14:09
  SPEAKER_00: So that's really great.
• 14:11
  SPEAKER_00: And maybe also do you think it's helpful to focus on the fact that it will eventually be over and that at some point things are actually going to be improving?
• 14:20
  SPEAKER_03: Absolutely.
• 14:21
  SPEAKER_03: I think keeping perspective and challenging any negative thoughts that come up is hard in the moment.
• 14:27
  SPEAKER_03: But when you're in a space to be able to do that, you know, oh, this will never end or this just keeps going on.
• 14:33
  SPEAKER_03: Well, you know, we do have information that it will end at some point, are gonna have mitigation measures, that there will be some sense of normalcy returning, that can be inspiring and hopeful and can kind of push you through these difficult times.
• 14:46
  unknown: Dr.
• 14:46
  SPEAKER_00: Holgerson, what are your top mental health recommendations for those who are decision makers for the front line or actually are on the front line of a major crisis?
• 14:55
  SPEAKER_03: So, first reminding yourself that you are only one person and also need to be given grace and understanding in these times and that you're trying to figure it out just as everyone else is.
• 15:07
  SPEAKER_03: You know, seeking support, like I mentioned before, using positive health behaviors, so as much as you can, ensuring positive sleep, healthy diet, physical activity if you can fit it in.
• 15:19
  SPEAKER_03: I know it's a lot to ask, but I try to think of Maslow's hierarchy of needs.
• 15:24
  SPEAKER_03: And I think all of our needs have kind of shifted lower and lower, um, where we're just trying to get by.
• 15:30
  SPEAKER_03: And so taking care of our bodies and then taking care of our minds with relaxation, staying connected to others is really useful.
• 15:38
  SPEAKER_03: Now, for those who are kind of in decision-making roles, this can add an extra layer of pressure that is really unprecedented.
• 15:46
  SPEAKER_03: So being as open and honest as you can with those who you're making decisions with or decisions for, seeking support from colleagues in similar positions to again kind of process that lived experience and feel less alone.
• 16:00
  SPEAKER_00: You mentioned the sleep deprivation or, you know, having difficulty sleeping.
• 16:05
  SPEAKER_00: So, what is the role of sleep deprivation in declining mental health?
• 16:08
  SPEAKER_00: And if people are not sleeping due to stress, what are some of the things that they can do to help get to sleep again?
• 16:14
  SPEAKER_00: Yeah.
• 16:15
  SPEAKER_03: Sleep is such a foundation of our mental and physical health.
• 16:18
  SPEAKER_03: I often think of like a toddler who has not had a nap.
• 16:22
  SPEAKER_03: Um, I'm living that experience right now, and it just, it's rough, right?
• 16:27
  SPEAKER_03: We get, we get cranky, we get upset, everything seems wrong and off.
• 16:31
  SPEAKER_03: And it's the same with adults, but we've just learned how to kind of socially moderate that.
• 16:35
  SPEAKER_03: So we're not throwing a tantrum on the floor.
• 16:38
  SPEAKER_03: But sleep affects us in so many ways.
• 16:40
  SPEAKER_03: And even just a short period of sleep deprivation can start to impact our mental health negatively.
• 16:46
  SPEAKER_03: And so the best thing to kind of avert this from becoming a major issue is one, don't panic.
• 16:53
  SPEAKER_03: Oftentimes when we are not able to sleep, it starts to become really overwhelming.
• 16:58
  SPEAKER_03: Why can't I sleep?
• 16:59
  SPEAKER_03: I need to get to sleep.
• 17:00
  SPEAKER_03: If I don't sleep, I'm gonna do this and that.
• 17:02
  SPEAKER_03: And so your mind can start to race, which obviously makes it more challenging to fall asleep.
• 17:08
  SPEAKER_03: Um, positive sleep hygiene behaviors, using stimulus control, setting aside your phone, TV for a certain amount of time before bed, having a specific routine before bed is really helpful as much as you can, keeping a consistent sleep and wake schedule so that you know you're not kind of all over the place.
• 17:26
  SPEAKER_03: Your body doesn't recognize when it will need sleep or when it's supposed to be sleeping.
• 17:31
  SPEAKER_03: One of the best tips is that if you are not asleep within 15 to 20 minutes, to get out of bed, do something really boring, bring out an old textbook or something that really doesn't interest your mind, and don't get back into bed until you start to feel sleepy.
• 17:46
  SPEAKER_03: Not tired, but that's sleepiness.
• 17:49
  SPEAKER_03: And that is usually helpful to retrain your body that that is for sleep and setting boundaries around that.
• 17:57
  SPEAKER_03: Now, if stimulus control, if sleep hygiene isn't working for you, there are kind of um more intensive interventions.
• 18:04
  SPEAKER_03: Um cognitive behavioral therapy for insomnia goes a little bit further with identifying negative thoughts that are interfering with sleep and even doing some sleep restriction to kind of reset your body's clock, essentially.
• 18:16
  SPEAKER_00: Those are some really helpful recommendations.
• 18:19
  SPEAKER_00: What are some insidious or unseen warning signs of serious emotional stress or anxiety?
• 18:25
  SPEAKER_00: And what should be a clue to people that they should get some professional help?
• 18:29
  SPEAKER_03: Yeah, so there's a wide variety.
• 18:32
  SPEAKER_03: Oftentimes the first sign of this is when other people in our life notice that we're not quite ourselves.
• 18:38
  SPEAKER_03: But if you want to kind of do self-check-ins, you know, depression, anxiety doesn't always come in the sign of sadness or feeling on edge.
• 18:47
  SPEAKER_03: It can come in the form of irritability, increased anger, uh just lower frustration tolerance, even withdrawing.
• 18:54
  SPEAKER_03: So not interested in the same TV shows as you used to be, or reading the same articles as you used to be.
• 19:01
  SPEAKER_03: And then, of course, sleep disturbances, eating disturbances.
• 19:03
  SPEAKER_03: So they're a culmination of a lot of little things.
• 19:07
  SPEAKER_03: And so checking in with yourself regularly, one, doing a body scan of just how am I physically feeling, and two, you know, are my patterns the same?
• 19:16
  SPEAKER_03: Am I behaving the same?
• 19:17
  SPEAKER_03: Am I noticing anything different and how I'm interacting?
• 19:20
  SPEAKER_03: That can usually be a tip.
• 19:21
  SPEAKER_03: Um, and again, asking those around you, like, how do you think I'm doing?
• 19:26
  SPEAKER_03: Have you noticed any changes?
• 19:27
  SPEAKER_03: I'm trying to make sure that, you know, this doesn't get in the way of my functioning.
• 19:32
  SPEAKER_00: Thank you, Dr.
• 19:33
  SPEAKER_00: Holgerson.
• 19:34
  SPEAKER_00: That's some really great information.
• 19:36
  SPEAKER_00: And we certainly have learned from prior epidemics that mental health issues are very important and we really need to be paying attention to this.
• 19:44
  SPEAKER_00: And it sometimes gets pushed to the side a little bit, but I think you've given us some really helpful tools.
• 19:50
  SPEAKER_00: So thank you.
• 19:51
  SPEAKER_02: Thank you for having me.
• 19:52
  SPEAKER_00: Thank you very much to our speakers for sharing your perspectives and experiences and a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 20:03
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 20:10
  SPEAKER_00: You will also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHA COVID-19 town halls.
• 20:19
  SPEAKER_00: Additional resources available on Learning CE pertinent to this pandemic include the SHA CDC Outbreak Response Training Program and the Prevention Course in HAI knowledge and control.
• 20:31
  SPEAKER_00: That concludes this episode of the Rapid Response Podcast.
• 20:34
  SPEAKER_00: Thank you for tuning in.