By Debbie Gross, LCSW
There were two moments in the past week where some normalcy was beginning to emerge, but I was quickly reminded that our lives are not going to be typical anytime soon, and I would have to acknowledge my emotions and make a plan for how I will reintegrate as my state opens up. The first experience was pickleball. I had been playing about three to four times a week starting in January and loved the friendships and physical activity it brought. When the fitness center closed mid-March, I even purchased a driveway-sized net and set up a court for singles play at home. When my community opened their outdoor courts last week, I was ecstatic! The rule was, if you’re playing doubles, wear a mask. I went with mask, sanitizer and wipes, but soon realized most people were playing without masks. I know I’m a rule follower, but I also know that the best way to prevent spreading the virus is with the mentality of “I protect you, you protect me” and we do this by wearing masks. It heightened my anxiety, and challenged me to think if I should continue playing or advocate for wearing masks. I respect everyone’s individual choice, and I don’t want to be the mask police, so I have decided to wait to play publicly until I feel more comfortable with being around a group of people without masks. Until then, my home court will do. My second encounter came today, when I dropped off some packages at the UPS store. I looked through the window and saw a patron holding her mask in hand. I walked in, stood fifteen or so feet away, and told her the mask would work much better if worn on her face. She put it on and when she left, the store clerk thanked me. So much for not being the mask police!
What does all this mean? We are approaching new territory with states reopening, and it is up to us as individuals to maintain the health of our communities. We need to trust our instincts, find peace in what we do and balance our need for inclusion and normalcy with safety and health. This blog is about how to navigate this while balancing our fears with our hopes.
First, it’s important to recognize that when a state or community reopens, it doesn’t mean the coronavirus no longer is a threat, it means that the numbers are below a threshold that allows for healthcare professionals and hospitals to manage new cases. Therefore, if you don’t have to leave home to work or other essential things, continue to stay home as much as possible. If you go out, limit trips to off-hours, check with establishments about their precautions, and stay vigilant about personal hygiene.
Five Pillars to Successfully Reopen A Community
Dr. Atul Gawande, staff writer for the New Yorker and surgeon at Brigham and Women’s Hospital wrote a great piece on the five pillars to successfully reopening a community: hygiene, distancing, screening, masks and culture.
Hygiene: Did you know that if you clean your hands five times a day, research shows it cuts down on medical visits by 45%! Keep this up! Wash or sanitize your hands every time you go into and out of a group environment or every couple of hours while in that group setting. And make sure you are disinfecting high-touch surfaces at least once a day, more often if that location does not have good ventilation.
Distancing: The six-foot rule for social distancing is extremely important for your health! Pay attention as you reemerge into public when standing in lines, elevators or work stations. Avoid those handshakes or hugs. Our desire for personal connection will have to be tampered down and replaced with “namaste”, a wave, peace sign, hand over heart, or even a ‘live long and prosper’ greeting!
Screening: While we aren’t up to speed with the levels of testing for the virus or antibodies, we can do an informal screening and follow the guidelines each day. If you have a fever over 100⁰, you need to stay home. Talk to your medical professional about how long to remain at home before you can safely go out. Follow the same guidelines if you have body aches, cough, sore throat, cold symptoms, loss of taste or smell, or shortness of breath, or if you have come in contact with someone with COVID. You should get tested if you have the above symptoms. Even with a negative test, remain vigilant and stay home until you are fever free and no other symptoms for 72 hours.
Masks: If we can get 60% of the population to wear well-fitting masks, the epidemic could be stopped! When you wear it correctly, a surgical mask (not N95) should block a high percentage of respiratory droplets. A cloth, homemade double-layered mask will similarly protect you, but are not as breathable, so people tend to touch their faces and wear them loosely. Wearing it properly, you should touch your face less often and help stop the spread! When you remove your mask, do so by the straps to avoid touching the mask itself.
Culture: Knowing what we need to do and practicing it are two different things, as my two stories show. We need to create a culture of practice! If you imagine that everyone you encounter has coronavirus, you will be more cautious and observant of the guidelines. Likewise, if you imagine you have it and don’t want to infect others, you will make safe choices for yourself, and help those around you! One article noted that if a person was in a surgical suite and pulled his mask down to speak, everyone around him would quickly speak up about covering his face to protect the environment. Recognize the culture of today is about keeping ourselves AND our community safe, so do your part!
Anxiety is Real, Understandable and Manageable!
We also need to recognize that feeling discomfort, anxiety and even panic are normal responses right now as things begin to open up. Don’t judge yourself for having these feelings; instead notice and accept your emotions and work to find ways to direct your attention to positivity through mindfulness and calm yourself with healthy, belly breathing. When you are feeling the intensity ramp up, practice gratitude, observe nature, get active, or reach out to someone for support. If you follow the advice of experts and recognize that anxiety is okay, especially during uncertain times, you will see that you can feel anxious and happy!
Activating our prefrontal cortex of our brain is important when we are feeling panicked. Typically, we have a thought that triggers panic. If we act on that, our panic action can lead to impulsive behaviors like stockpiling toilet paper, drinking, or other stress responses. Taking a few seconds to pause and think, we can shift our panic action into a thoughtful action. For example, if you are out in public and encounter a group not wearing masks or walking too closely to you, you might panic, but if you pause and think, “I’m wearing my mask, I am not touching my face, no one coughed or sneezed” you can recognize that brief encounter is highly unlikely to bring you any harm and continue your walk, feeling calmer.
Practical Tips to Reemerge Safely
Now that you are aware of the five pillars for safely opening a community and have some strategies for managing anxiety, here are some tips to help guide you along the path of reopening in as healthy a manner as possible.
1. Keep a mask, hand sanitizer, and wipes in your car
2. Start slowly – begin exposure with safe, similar-minded individuals
a. Babysitter if you need help at home while working
b. Parents/Grandparents if they are continuing to practice safe distancing and aren’t
c. Friends, but with social gatherings below 10 people safely able to distance
d. Nonessential & retail places that are adhering to safe practices
3. Walking, biking, or driving yourself to work is safest
4. If you take public transportation or Uber, roll down windows to circulate
in the fresh air
5. Handle your own bags
6. Elevators – avoid if possible
a. Wear a mask
b. Use tissue or paper towel to press buttons and immediately use
hand sanitizer or wash hands
c. Wait for a less crowded elevator
7. Public bathrooms are hot zones
a. Avoid crowded bathrooms
b. Use paper towels as forced-air hand dryers spread droplets around
c. Use paper towel on door knobs, faucets, and when flushing
d. Wash your hands well!
a. Avoid menus that aren’t throw away and sanitize or wash your hands if you do
handle the menu
b. Download menu on your phone if it’s available
c. Outdoor seating is preferable to inside seating
d. Call ahead to find out safety precautions that are in place and visit
ones that are working on 6’ spacing and following recommended guidelines in place
9. If you have a business and you’re considering reopening, ask yourself:
a. Can I make sure employees and customers are 6’ apart?
b. Can I sanitize my place of business at least once per day, more
often with smaller, less ventilated spaces?
c. Will my liability or malpractice policy cover me for any mishaps/illness claims?
10. Remember: Safety vs. Freedom
a. Your desire to keep others safe means you don’t mind being called out if you’re not
b. I protect you, you protect me mentality
I want to end by recognizing the people in our communities that have tirelessly stepped up and have been working directly with customers or patients while I have been able to sit comfortably at my computer at home while virtually seeing my clients. They have to face these worries every single day! To my daughter Nikki, who works as an occupational therapist at a hospital helping COVID positive patients rehab in order to return to their families, hugs coming soon! To all those doctors, nurses, therapists, store employees, Instacart workers, and first responders, your courage and compassion are so appreciated! I hope we can all step up like you have and do our part to keep our state thriving and safe.
Brewer, Judson A. M.D., A Brain Hack to Break the Coronavirus Anxiety Cycle, NY Times, March 13, 2020, updated April 1, 2020 (https://www.nytimes.com/2020/03/13/well/mind/a-brain-hack-to-break-the-coronavirus-anxiety-cycle.amp.html)
Gawande, Dr. Atul, Amid the Coronavirus Crisis, A Regimen for Reentry, May 13, 2020, The New Yorker (https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry)
Smothers, Hannah & Way, Katie, How to Protect Yourself When Your State Reopens Way Too Early, Vice.com, April 30, 2020. (https://www.vice.com/amp/en_us/article/v745jm/how-to-protect-yourself-when-states-reopen-early-georgia-texas-coronavirus)
Walls, Meghan T., Coronavirus (COVID-19): Calming Anxiety, KidsHealth.org, March 2020 (https://kidshealth.org/en/parents/coronavirus-calm.html)