During this time of national crisis, we must manage two things simultaneously: 1) Protect ourselves from the Coronavirus, and 2) Protect ourselves from anxiety. If your anxiety, fear, and worry has been overwhelming, put these ten strategies into practice.

Media Distancing: To stop the spread of COVID-19, we’ve had to practice social distancing. But to stop the spread of anxiety, we must distance ourselves from the media. All anxiety stems from uncertainty and an active imagination which produces catastrophic thoughts. The media, which is 24/7 Coronavirus and virtually all negative, is the driver of those thoughts. My patients who are the most anxious about the Coronavirus are those who are consuming the most news from social media, online, and traditional outlets. The more anxious you feel, the more you should distance from the media. And if you are extremely fearful, stop altogether. Do no Google or research. Stop checking the latest news about the virus. Any vital information you need to know, you will find out.

Do Not Engage with Worry. Take Action: Whether you are worried about contracting the virus, your struggling business, or being unemployed, the more your mind focuses on worst-case scenarios, the more anxious you feel. You can’t stop thoughts from entering your mind, but you can choose to stop dwelling and you can choose to take action to solve problems. There is a huge difference between worrying and problem solving. When your mind tries to bait you into worry, don’t take the bait. If you do, like a fish in a lake, you will be caught. Anxiety will try to bait you with many “what if” questions. Don’t answer them. Respond, “Not taking the bait,” turn your attention away, and focus elsewhere. Spinning your wheels with questions that don’t have answers will take you down the rabbit hole of fear. Instead, find creative measures to get you through this storm until you can get back on your feet. None of these measures will be comfortable. Like an umbrella and a raincoat, we use them to get through the storm, not to stop it. Much of anxiety stems from a lack of confidence in our ability to handle challenges. Push yourself to take one uncomfortable step at a time. The goal is to stay afloat until the storm passes, and now with a vaccine, the forecast looks brighter

Focus on Present Odds: All deaths are tragic and the coronavirus can be deadly but maintaining proper perspective can reduce your anxiety. No doubt the symptoms of COVID-19 can be horrible but the vast majority of people infected with COVID-19 have mild to moderate symptoms or no symptoms at all. The Infection Fatality Rate (IFR) is the total number of deaths divided by the total number of people that carry the infection, regardless of them having clinical symptoms or not. The IFR is the chance of death once you have the virus. This number is difficult to calculate accurately because of the high number of asymptomatic individuals. As of November 2020, the estimated Infection Fatality Rate of Covid-19 for various age groups is as follows: 

For purpose of comparison only, the World Health Organization has stated that influenza has an overall Infection Fatality Rate of 0.1% or lower. With increased testing over the last several months as well as people spending more time inside because of the cold weather, the number of cases has risen, yet, the chance of you or a loved-one dying is still remote. But death is possible and COVID-19 is a serious illness, and that is why anxious people take the bait and dwell. Possibility becomes probability.

Remind yourself of the present odds, which are very good. If you take care of yourself properly, even if you are in a higher risk category, your risk of death is still low. And if you’re under the age of 59 your risk is incredibly low. There are roughly 74 million children in the United States.  Between February 1 and August 1, approximately 13,000 children died from all causes, 105 died of the flu and 45 died of coronavirus and almost all of them had a pre-existing medical condition. I am not minimizing the seriousness of COVID-19 but children, teens, and people in their 20s and 30s, should not worry about dying from coronavirus. 

Do Not React to Physical Symptoms: If you cough, it does not mean you have the COVID-19. The same is true for others who cough.  Allergies, bronchitis, post-nasal drip, and the cold are more common and a more likely explanation. Accept uncertainty as you do in other areas of life and assume what is most likely. Do not scan your body looking for symptoms. This behavior reinforces your worries and will increase anxiety.

Focus on Being Productive and New Ways of Enjoying Life: Although we have no control over the national crisis, we must focus on where we do have control – our response to the crisis. This is an opportunity to try something new and do things we haven’t had time for. Organize a messy room, paint a fence, clean the garage, edit the photos on your phone, clean a rusty bike and take it for a ride, and play a board game ­— remember those? You can also learn a new skill or start a new hobby from videos on You Tube or various apps and websites. My son, who hasn’t played piano in six years, downloaded a free piano course and is practicing once a day. Creating and accomplishing puts your attention on what is satisfying. Consider starting something new: genealogy, gardening, photography, knitting, drawing, cooking, woodworking, video editing, ballroom dancing, or chess, just to name a few. You can start and learn all of these online. Put your attention on creating and accomplishing, not on the virus.

Engage in Stress Reduction Activities: Focusing on what you are grateful for, exercising your body, and relaxing your mind will help give you the peace you desire. Guided meditation, yoga, exercise, and a gratitude journal are all practices that lower stress. Select one or two, learn about them so you do them correctly, and practice each day. If you and your loved ones are not severely sick or experiencing dire financial hardship, be grateful. Once this crisis has passed, perhaps we will all appreciate what we take for granted: a healthy society, freedom to gather, dinner with friends, a night at the movies, and a simple haircut.

Do Not Go Beyond CDC Guidelines: Compulsive hand washing until your hands are dry and red, taking off all of your clothes before entering the house, and isolating indoors are anxiety’s guidelines, not the CDCs. People who spray everything in sight with bleach and other harsh cleaners should know that disinfectants can irritate the lungs and is not necessary based on what science knows about transmission of the virus. Emanuel Goldman, PhD, a professor of microbiology, biochemistry, and molecular genetics at the New Jersey Medical School of Rutgers University wrote in The Lancet Infectious Diseases, "In my opinion, the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on a surface and someone else touches that surface soon within 1-2 hours." Dean Blumberg, MD, chief of pediatric infectious diseases at UC Davis Children's Hospital talked about the likelihood of catching Covid-19 from inanimate surfaces: "You'd need a unique sequence of events. First, someone would need to get a large enough amount of the virus on a surface to cause infection. Then, the virus would need to survive long enough for you to touch that surface and get some on your hands. Then, without washing your hands, you'd have to touch your eyes, nose, or mouth.” Our skin is a protective barrier. As long as you wash your hands and don’t touch your face, there is no reason to clean packages brought to your home. Anxious behaviors maintain worry. To reduce worry, slowly reduce unnecessary behaviors that are not recommended.

Preserve Some Sense of Normalcy: During World War II, second-tier baseball players filled in for the professionals who were entering the army. Baseball, during a time of war, was important for the morale of the country. To the extent you can, maintaining a structure to your day with some semblance of normalcy will help reduce anxiety. Much has been learned about the virus since last spring and doctors are treating it more effectively now. Unless you are in a high-risk category you do not need to lock yourself in your home. According to the New England Journal of Medicine, “Public health authorities define a significant exposure to COVID-19 as face-to-face contact within 6 feet with a patient with symptomatic COVID-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching COVID-19 from a passing interaction in a public space is therefore minimal.” They Journal article and subsequent articles stress the importance of wearing a mask but maintain that the risk of contracting COVID-19 comes from “sustained contact within six feet” not from “a passing interaction.” Therefore, wearing a mask when driving a car, exercising outside, or walking in a quiet neighborhood alone is not necessary. You might believe wearing masks outside is socially responsible and in some cities, it is required by law, but if you happen to cross paths with an unmasked person, there is no reason to worry. 

Be Kind to Yourself and Others and Have Faith: It’s normal to feel anxious and worried during a national crisis. Don’t be hard on yourself. Reaching out to relatives and friends who are isolated or in need will boost their spirits and yours. If you are in good financial standing, be grateful and continue to pay others for the services they cannot provide. Venmo or mail checks to your housekeeper, hairdresser, or others who are unable to work. If you are unemployed or your business is suffering, this is tragic and may lead to depression or other mental health issues. Your new job is to manage through the crisis as best as you can until it passes. Have faith that it will, despite not having all the answers. Having faith or imagining the worst is a choice. Which one will you choose?

Seek Out Professional Help: You don’t need to do this alone. If you are experiencing an escalation of anxiety, talk to a professional who can help you through this difficult time. Almost all therapists are using telehealth, so you are not limited to professionals in your area. Medication for anxiety, depression, and insomnia might also be needed and can be prescribed by a psychiatrist or your primary care physician. You can find a therapist and psychiatrist at the Anxiety and Depression Association of America (ADAA.org).

This list is a recipe to reduce anxiety. Review it again and put it into practice. Otherwise, it’s like reading a cooking recipe in bed – in the end you have nothing to show for it. 

This blog was originally written in March, 2020 and updated by the author on December 30, 2020

We invite you to read Ken's latest ADAA COVID-19 blog post: Flatten the Fear with Facts: What is an Appropriate Level of COVID-19 Worry and the Steps You Can Take to Reduce Anxiety