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Updated on: March 31, 2020

Tips for Staying Well and Sane in the COVID-19 Era

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Original story posted on: March 30, 2020

Last week, I encouraged you all to comply with the recommendations from the U.S. Centers for Disease Control and Prevention (CDC). This week, I would like to share some thoughts about how we can improve our health and maintain our sanity while working remotely and practicing social distancing.

My first concern is that sitting is the new smoking. Sitting for long periods of time is associated with an increased incidence of obesity, hypertension, hypercholesterolemia, and diabetes. If you used to be hospital-based or even hybrid, you will find that you get far fewer steps when you don’t leave your home.

To counteract this, I suggest you get yourself a wearable activity tracker and set it to give yourself a regular reminder to get up and move. Options would include standing, marching in place, walking around your abode, or doing a quick exercise routine. I have mentioned Body Groove before, which provides fun five-minute dance sessions that get your heart rate up.

Other ideas include utilizing a standing or variable-level desk, and/or sitting personal fitness equipment. I own a desk cycle and a portable elliptical machine. You don’t use them continuously, but intermittently. I can watch my heart rate rise on my smartwatch. If you can’t afford this equipment, do a set of squats or perform biceps curls with canned peaches or green beans. Put a shelf on a few stacks of books for a standing desk.

I know how stressful things are right now, but if you are a smoker, discuss with your healthcare provider how you can limit or quit smoking. There are lots of smoking cessation aids available in our therapeutic arsenal now. It is important for both you and for anyone else cooped up in the house with you to avoid being exposed to second-hand smoke.

Now that the weather is improving, take a walk or run outside daily, or as often as you can. My husband and I try to walk every day after he comes home from work, and on the weekend. This will have the added benefit of injecting some social interaction into your social distancing. If you encounter other people on your walk, just maintain a distance of six feet between you.

Social distancing need not mean total social isolation, in this age of online interconnectedness. More than 20 percent of adults in America report feeling lonely or a lack of companionship under normal circumstances. This feeling of isolation is a significant risk factor for depression and anxiety.

In the work arena, instead of texting or emailing, consider picking up the phone and having a conversation with your coworker. After work, call friends and family. Video chatting has been invaluable to me. I want to see my son’s smile in New York. I want to see that my father in assisted living has shaved and does not appear unkempt. There are platforms where you can see multiple people at the same time (e.g., FaceTime, HouseParty, Zoom, etc.) and have group conversations. Connection is key.

Put a limit on how often you are going to check social media, however. Besides being a huge time suck, it can increase your anxiety. I never have notifications on, but many authorities recommend turning them off at this time.

Vet any articles you read, and ensure they are from legitimate sources. You have to critically read literature, so examine the source, the author/s, the number of subjects, and the methodology, and see if the conclusions are reasonable, based on the data. If the article isn’t sound, don’t disseminate it!

Don’t feel guilty if you laugh at funny memes. It’s also okay to distract yourself for a few minutes looking at pictures of beautiful places or playful kitties. Your constant attention isn’t going to affect whether the world is going to end or the economy is going to crash. Give yourself permission to take a break from these dark times.

What can we do during our imposed time home? I propose we view this as an opportunity. Spend time with your loved ones with whom you are sequestered.

Play games that don’t require communal touching of board pieces. My extended family has played, “Do You Remember?” which features thought-provoking questions to spark memories. Pull out your old Trivial Pursuit cards.

If you play bridge or mah-jongg, there are online versions. I’d wager there are online versions of almost any game, and you can “play with friends” (or with strangers!)

Read. Read books that you have on a shelf at home. Your library has online books. Read something that will expand your knowledge. Read something that is pure entertainment. Try a new genre. Revisit an old one that you loved when you were younger. Reread a book you loved in the past. Start or participate in an online book club.

Is music your thing? Spend time listening to music. Take your old CD collection out for a spin. Use one of the online services like Pandora or Spotify. For a limited time, The Metropolitan Opera is presenting operas online for free (http://www.openculture.com/2020/03/the-met-opera-streaming-free-operas-online-to-get-you-through-covid-19.html).

I think this crisis is unleashing some people’s creativity. Do you have art supplies at home? Maybe try your hand at painting or drawing.

If you are able to concentrate, learn something new. A new language. How to knit or crochet. You may need to learn subjects to help your kids do their schoolwork. Rosetta Stone is offering a free three-month trial for students, and there are myriad free resources like virtual museum tours being offered right now. If you can’t concentrate, know that you are not alone. Many of us, myself included, find it difficult to attend and keep focused.

Try to balance your television watching of news programs with shows that can give you a temporary respite from reality. I bet Netflix, Amazon Prime, and Disney Plus are raking it in! I know my husband and I are loving Downton Abbey, although I am wondering if the next seasons are about to address the Spanish flu pandemic of 1918, which will be disconcerting.

Perhaps it is time to do a really thorough spring cleaning. I don’t think the hutch in my dining room has been dusted since we purchased it 22 years ago. I saw a website that had a 30-day challenge to de-clutter your house (https://loveandmarriageblog.com/declutter-in-30-days/). It said that clutter makes us sad and overweight, and it suggests you get rid of items that are old, broken, never used, duplicates, or (as Marie Kondo says) don’t give you any joy. There is a checklist to help you approach it, biting off one piece of the elephant at a time. Each time I complete a room, I feel like I have accomplished something. There is something powerful about taking back even a little control of my life.

If you have problems with time management, making a schedule for the day and the week may be helpful. Block out times for activities. Shower and dress daily. You don’t need to strictly adhere to the schedule, but it can help impose some normalcy on your life.

You may find it comforting to journal. Keep a diary. Someday, you may have grandchildren asking you what it was like during this time. They might find a firsthand account fascinating, although my college-aged son scoffed at this idea. “Today, I stayed in the house for the ninth day in a row” didn’t seem particularly attention-grabbing to him.

Getting adequate sleep will be essential to your mental health. Have a routine bedtime and rising time. Avoid caffeine too late in the day, and avoid alcohol altogether. If you find it hard to fall asleep, practice meditation. This will help keep panic and anxiety at bay. In general, I find it helpful to do yoga and to breathe deeply: in for four counts, out for eight counts. Repeat for three minutes.

There are many avenues for online yoga and exercise classes. Some are free, or may be included in your membership to a gym or community center that is presently closed. Check online or on their website to see what is available to you.

Exercise is so helpful, especially if you really don’t feel like it. The endorphins you make can improve your mood and outlook. If you have workout equipment in your house, you are lucky. My husband tried to purchase resistance bands and met with great resistance, as they were all sold out! But there are ways to be creative and exercise even if you have no equipment. Just clear a little space on the floor and do some planks and sit-ups, pretend to jump rope; dance; march. Check online for resources.

If you belong to a religious institution, you may be missing your weekly gatherings with other congregants. My temple is streaming services and has posted beautiful song sessions. Yours may as well. A religious leader suggested channeling panic and anxiety by turning it into action. He recommends overcoming that feeling by thinking, “who can I help right now, and how can I help them?” Maybe it is an elderly neighbor or relative. It will make you feel useful.

Where can you get support if you are feeling helpless or hopeless? If you already have a mental healthcare provider, reach out to them. If you do not, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a Disaster Distress Helpline (https://www.samhsa.gov/find-help/disaster-distress-helpline), which provides counseling and support to people experiencing emotional distress due to natural or human-caused disasters, 24/7, 365 days a year. The number is 1-800-985-5990, or text TalkWithUs to 66746. Additionally, the National Suicide Prevention Lifeline is 1-800-273-TALK (8255). They have other resources and suggestions online at https://suicidepreventionlifeline.org/current-events/supporting-your-emotional-well-being-during-the-covid-19-outbreak/.

Value what is important. From all of us at ICD10monitor.com: take care of yourself and your family. I have adopted David Glaser’s sign-off: stay well and stay sane.

Programming Note: Listen to Dr. Erica Remer every Tuesday on Talk Ten Tuesdays, 10-10:30a.m. EST.

Erica E. Remer, MD, FACEP, CCDS

Erica Remer, MD, FACEP, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

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