Scenes from a Pandemic, Volume 7 – Cognitive and emotional care during COVID-19

In a typical emergency – and yes, there is such a thing, and yes, the COVID-19 pandemic qualifies – there is a hot zone, a warm zone, and a cold zone. We will talk about those terms in more detail, and how you can use them to help yourself, later in this post. You are, in one sense, involved in the disaster response, so you may benefit from the same kinds of emotional self-care strategies that emergency responders use.

I have already written that COVID-19 has involved everyone in health care, in the sense that we are all involved in monitoring our own physical condition, watching for the well-known symptoms of the illness. We are all also actively sanitizing our environments to protect ourselves and others. I’m not a medical care provider and I need to stay within the boundaries of my profession, so I will leave the physical health side to the experts. I want to talk about the emotional risk instead.

Everyone is exposed emotionally to the disaster. We are all living in the COVID-19 response, so let’s talk about how to protect yourself cognitively and emotionally, which in turn will also help to protect you physically.



Routines and habits

You have almost certainly stopped following your normal ways of going about your normal days, at least for the moment. I’m going to use the terms routine and habit as though they mean the same thing. They might not be, I don’t know, but I will not get technical here.

You may have heard that it takes it takes 21 days to form a new habit. It might, but that’s not always true. That rule comes from a book written by Dr. Maxwell Maltz in 1960. It’s a good book and in the references section of this post, but the book, and the rules that Maltz inferred and published, may not apply now. Instead, we will draw on a good and current book, called Making Habits, Breaking Habits and written in 2013 by Dr. Jeremy Dean.

According to Dean, the purpose of a habit is to conserve mental energy. We create habits so that we don’t have to spend our resources (time, effort) on making decisions. For example, your route to work is a habit. You may have had the experience of driving to work and realizing when you arrived that you don’t remember any of the details. That can be scary, but you were conscious and alert the whole time, and if a kid had jumped out in front of your car, or if somebody had nearly hit you, you would have taken the necessary action, and you surely would have remembered it when you arrived. Along the same lines, you may have driven part of your route to work on the way to a different destination and found yourself at work, even though it wasn’t your intended destination. Habit kicks in.

COVID-19 has come and now your daily habits no longer work. You don’t need a morning routine for getting your kids ready to go to school because school is closed. If you aren’t going to work then the routines that helped you to prepare for work are no longer useful.

However, we still need routines and habits. Not only do they conserve resources, they also give us a sense of predictability, which becomes a sense of safety, both of which are very important in a time which is unpredictable and unsafe. Here are a few suggestions:

• Keep a regular bedtime and a regular wake-up time, to the point of setting an alarm. Be generous with yourself, to make sure that you are getting enough sleep, which you need for both cognitive and physical health, but keep a predictable daily routine.
• It’s OK to dress for work, even if you don’t go in to work or you aren’t on a web cam for work right now. If putting on business attire makes you feel confident and effective, if the clothing makes you comfortable, wear it.
• Kids have a particular need for routines. Set a regular time for study and a regular time for play, as close as you can to what they have in school.
• As you build new routines, think about how they will fit with your eventual return to a typical week. It may be hard to predict how that will look, but make your best estimate. Set yourself up for an easier return to your usual life.
• Think about your old routines and ask if they still serve you. Sometimes we get into bad habits, and the environment cues us to the behavior. Maybe you were buying coffee every morning, and that became a habit of buying a doughnut with your coffee every morning, and now you realize that you don’t want to spend the money or add the calories so you decide to visit a different coffee shop when you go back to work. Maybe you have found that you prefer the coffee that you are making at home, so you get yourself a nice new travel mug and skip the coffee shop entirely.

You may have added exercise to your day, which will discuss below, and found that you have time for it, especially when it no longer involves going to the gym. Try to build a schedule that will fit into your day when work and school resume.



Action binds anxiety

That phrase is a staple for emergency responders, which everyone is right now, to one degree or another. Action builds confidence, the sense that you can influence what happens to you, so it influences your mood, and that in turn helps to keep your body healthy.

We’re not talking about random, spastic activity. We’re not talking about being busy for its own sake. You don’t have to alphabetize the books on the shelves in your living room, unless that is something that is important to you. What makes for healthy activity, the kind that will ease your mind? Here are a few suggestions.

• It’s important to you. It makes no difference if anyone else would do it. If you think that the task is worth doing then it is.
• Look for an activity that yields a tangible product and is discrete (has a clear start and end). These qualities will give you a sense of accomplishment that will make you feel better.
• Cleaning is certainly a good option, not only sanitizing but general cleaning. I have dusted more in the last week than I have in the last year, and yes, that’s a bad scene and no, I’m not going to confess any more than that, but when my environment is not only sanitary but orderly then I feel better. I clean when I’m not busy doing something else.
• If you have a “honey do” list then, really, you should make it a “honey done” list right now. You are going to feel productive, so it will be good for you, and your spouse will appreciate the effort, which will also be good for you.
• Learning is always good. If there’s a book that has been collecting dust because you haven’t had the chance to read it then grab it and go. Keeping your mind sharp and occupied is a good use of this time.
• Exercise is also good. Anything helps but aerobic activity is good for both your body and your mind. Anything that moves blood to your body also moves blood to your brain, and the prefrontal cortex, which is home to executive functioning (planning, organization, impulse control, delayed gratification, etc.) particularly benefits from exercise. Exercise also increases the size of the hippocampus, one of the brain’s memory centers, in older adults (Raichlen & Alexander, 2019). We will talk more about memory below, in the section about common reactions to stress.
• Thoughts influence actions, but actions also influence thoughts. As you think, so are you (Proverbs 23:7). When you act like you will get through COVID-19 then you will think that you get through COVID-19 and you will feel like you will get through COVID-19. The prophecy will fulfill itself.

However, work can become too much, or too difficult. When it does, that is called task saturation or helmet fire.



Task saturation or helmet fire

Some of the skills and qualities that we see in effective disaster responders are:

• Flexibility
• Patience
• Tolerance for uncertainty
• Working independently when needed and as part of a team when needed
• Attention to detail (Crimando, 2017)

The condition that is the opposite of these skills and qualities is called task saturation. In the military, it is often called helmet fire. Stress can make you sharp and every person has an individual optimal level of stress, which can be different based on the situation. When stress exceeds the optimal level then it becomes hard to do what has to be done. We will talk about common stress reactions in the next section. For now, let’s look at the signs that a person is experiencing helmet fire:

By CapCase, used with permission

• Shutting down entirely
• Seeming to be busy but not with productive work
• Sticking to initial decisions or impressions, even when new information changes the situation
• Focusing on one thing/idea/goal to the exclusion of everything else (Crimando, 2017)
• The perception, internal or expressed, that you have to do too much with too little time or too few resources (Crimando, 2018)

These are signs that this person is becoming overwhelmed by the situation. Demands to “calm down” or “snap out of it” will not make it better and might increase stress levels, making the problem worse. There may also be a tendency to want to “cowboy up” and persist. With a thought to the common stress reactions listed below, though, we need to move that person to a safer place, away from the stress (last section, below) and allow an opportunity to recover. Those around the person with helmet fire may have to make a tough decision but it is important to realize that this person has been injured, is not to blame, and may act in ways that make a difficult situation worse (Crimando, 2017).

How do you get to a safer place during a pandemic, though? We will talk about that in the section below, about hot and warm and cold zones, looking for way to feel safer, even if just for a bit. If we don’t have the option to move to a safer place, away from the demands, then the next-best way to cool helmet fire may be to change jobs, putting the saturated person into any other role for awhile. If you live alone and find yourself saturated then you may want to do something else and come back to what you were doing in a bit, especially after getting some rest and maybe something to eat and drink.



Hot zones, warm zones, and cold zones

This is where COVID-19 becomes especially difficult, in that it is different from other every other disaster. In a typical disaster, let’s imagine a hurricane, there will be a hot zone, a warm zone, and a cold zone. In the hot zone, the environment is dangerous, and rescue activities are typically happening. In the warm zone, there is still some danger, but much less than in the hot zone, and you will find rescuers coming from and preparing for work in the hot zone. In the cold zone, there is no danger. This could be an area which was never significantly affected by the disaster – minor or no damage, in the case of our example of a hurricane – or a place which has been searched and secured and is starting recovery and rebuilding activities.

That’s the model for most disasters, and it’s easy to see how it fits most events. The problem with COVID-19 is with finding a place that is safe both physically and emotionally. I suggest that you are in the hot zone whenever you are outside of your home or with someone whom you aren’t certain is free from the virus, and you are in the warm zone all of the rest of the time. However, we can use this model to create a cold zone where you can get some time to recover.

Many medical staff and first responders are removing their clothing in the garage or another entry area before coming into their homes. Shoes and uniforms stay there until sanitized, if time allows, or put back on for the next shift. If there are any infected droplets on those garments, they remain away from the rest of the home and family.

You can do something similar, not only with clothing but with anything else coming from the outside. Pick a space near the entrance to your home and leave mail, bags, and anything else there. These are objects that you clean your hands after touching and that you don’t leave on other surfaces. The exact line between a hot zone and a warm zone may be tough to draw, but the most important element here, by far, is creating a cold zone.

A cold zone is where you are safe and feel safe, and it can be a time as well as a place. You need the latest information from good sources, like the CDC and the Department of Health, and policies and rules keep changing as we improve our understanding of the virus and what we need to do to protect ourselves. You need these updates.

However, you do not need the constant rapid-fire flow of information that modern devices not only offer, but throw at you. You can pick a time and place to check for news, and coming back to the first section of this blog, you may want to create a limited time and place to do that, a daily routine. Check for new information, decide what it means for you, then go about your business. Whatever time and place you check for updates will become associated with COVID-19 for you, so doing it in an out-of-the-way spot is better than sitting in your favorite chair, which may not be your favorite chair if it reminds you of COVID-19.

Do you remember when people talked about stuff other than COVID-19? It seems like forever ago, doesn’t it? What about creating a NO-COVID rule with your friends and family, perhaps a deal that you will catch up with each other about the virus for 10 minutes and then not mention it again for the rest of the conversation? If you did that then those conversations would become cold zones.

It makes sense that COVID-19 dominates our thoughts. It has changed every aspect of our daily lives and it is life-threatening. Humans are still here precisely because we focus on things that threaten our lives. There’s nothing wrong with being highly aware of something dangerous, but the COVID-19 pandemic is pervasive, it saturates our worlds and our thoughts, and it is exhausting. You know the fight-or-flight response (freeze is also one of the survival reactions but it doesn’t rhyme with the other two). The complement to fight-or-flight is rest-and-recovery, which can only happen when we don’t perceive danger. We need that time to recover, to protect our minds and emotions and bodies from the chronic state of readiness for danger. We need to create cold zones, in whatever forms those take – times, places, interactions – whatever works for you.



Common stress reactions

You had stress in your life, and ways of coping with it, long before COVID-19 came along. If those strategies are still working for you, keep using them, but nobody has ever encountered a stressor like COVID-19. Even the analogies to the Spanish Flu, over 100 years ago, don’t hold because that disease wasn’t exactly the same, and the world was very much different.

Right now, you might be experiencing some stress reactions that are completely normal for the circumstances. They might include:

• Sleep disruptions (nightmares, more sleep than usual, less sleep than usual)
• Changes in appetite (food, sex, anything else – more than usual, less than usual)
• Feeling very alert, with trouble relaxing (the fancy word for this is hypervigilance)
• Feeling grouchy or irritable
• Feeling sad (in men, this tends to take the form of being grouchy or irritable)
• Trouble remembering things, especially new information and especially new auditory information) so you may want to write things down, or text rather than call
• Trouble with impulse control and planning and making decisions
• If you have a history of addiction, those cravings can come back and you may want to reach out to your sponsor or find a phone or online support meeting.
• General confusion, which can look like dementia in older people

If you use caffeine or nicotine then you may find yourself using more. There’s no moral judgement on this or on alcohol use, just a practical suggestion to limit these substances if you can because they interfere with sleep, which is one of the most important things that you can get to protect your thoughts, feelings, and body right now.

All of these reactions noted above are common and they make sense at a time like this. In a typical disaster, I would tell you to expect these to diminish with time and not to be too worried about them, but to seek professional support if any of these come to interfere with your life. That second part still holds but the pandemic isn’t going to end any time soon, and it’s unlikely that you will find anyone who knows what to expect for most people living through this time. It’s uncharted territory.

One of the best, simplest ways of calming your thoughts and feelings is by calming your body with your breathing. The technique goes by a lot of names – tactical breathing, four square breathing, probably some others. You inhale for about 4 seconds, hold for about 4 seconds, exhale for about 4 seconds, and wait for about 4 seconds before you inhale again. You can get a free app for your phone, called Tactical Breather, if you are not sure about your sense of time while doing it, and a very nice, soothing voice will talk you through it. You can control your breathing consciously, and when you slow your breathing, you will also slow your heart rate and lower your blood pressure and calm all of your other symptoms. It works for first responders and the military and we teach it to survivors of smaller disasters. It works.

I will add that if you find yourself thinking about suicide, especially if you have a plan (time, place, method) then please call someone for help. Call your doctor. Call 911 if you don’t think that you can be safe. The world of emergency response and emergency medicine still exists, in all of its forms, even now, and someone will help you.



Putting it all together

The world has never seen an event like the COVID-19 pandemic. Experts in all fields are figuring things out day to day. Doctors are learning how to defeat the virus and how to prevent infection. Emergency responders are creating new procedures and establishing new facilities. Everyone is learning a new way to live with the danger of COVID-19. As a country and as a species, we are going to survive this, and there will be a day when we realize that we haven’t heard “social distancing” or “COVID-19” or jokes about toilet paper for a very long time. There will be a day when you no longer have to worry about Coronavirus.

That day will not be soon. Pandemics typically take about 12 to 18 months to run their course (Crimando, 2020). There will be a lot of challenges, a lot of difficult days, considerable loss and pain before the pandemic ends.

However, there are also, with no exaggeration, tens of millions of acts of courage and determination in this country every day. God bless the first responders who keep putting on the uniform and handling every call as it comes in. God bless all of the medical staff, who are also putting their lives in danger but still showing up for work, improvising equipment and procedures as they go. I am grateful for the staff in grocery stores and restaurants and Wawa and pharmacies, people who keep the rest of us going, who make the world outside something similar to how it was way back in February 2020. Those are the people I see, from a safe distance, when I venture outside.

There are people you don’t see, the researchers who are working on vaccines and treatments for COVID-19. There are businesses who are supporting their workers and manufacturers who have increased production or even changed what they produce to meet our needs. Finally, there are the disaster response staff, both paid and volunteer, working on the next steps or just doing what has to be done right now.

We are going to get through this and come out better on the other side. You are going to get through this and come out more certain of your own strength and courage and determination. COVID-19 won’t end soon, but it will end. Take care of your thoughts and feelings and body and do what has to be done.

I’m going to give Mr. (Fred) Rogers, a good Pennsylvanian and ordained Presbyterian clergy, the last word on this post:

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.




Sources

Crimando, S. (2018). Operational stress control and Psychological First Aid: Approaches to psychological force protection.

Crimando, S. (2020). Are you ready for the next pandemic? Behavioral Science Applications LLC.

Dean, J. (2013). Making habits, breaking habits: Why we do things, why we don’t, and how to make any change stick. Boston: Da Capo Lifelong Books.

Maltz, M. (1960). Psycho-Cybernetics. New York: Penguin.

Raichlen, D. A. & Alexander, G. E. (2019). Why your brain needs exercise. Scientific American, 322 (1), 26-31.