If you had told me a year ago that I would be ordered to stay home by the government and only a portion of the population would be able to go to work, while millions more were losing their jobs all due to a potentially lethal virus, I would have said “no way!” That sounds like a movie plot.
As crazy as it might sound, we’re all characters in that movie, and we’re all eager for it to end. Even in good health, we feel drained, exhausted, stressed out, and unable to focus. We’re on an emotional roller coaster, despite practicing physical distancing, wearing masks, and washing everything. Why, when we’re staying home, do we feel so emotionally burnt out?
We’re exhausted because we’re preparing to shift “back to normal,” but we have no idea what that normal will look like. We want answers from our leaders and government, but they too are wondering, “how exactly do we do this?” Uncertainty can lead to stress, and we’re uncertain about what travel will look like, when we can be with our friends again, if schools will reopen, if we’ll wear masks everywhere, if there will be a second wave of the virus, when a vaccine will be ready, and more. We’re in the middle of an emotional response cycle — but knowing which phase we’re in can help us prepare.
Our emotional response to the pandemic comes in three distinct phases (Pre-Peak, Peak, and Post-Peak) and may be region specific. And through it all, our bodies are taking the brunt of it. Therefore, it is important to understand and notice our emotions, monitor our physical well-being and work on ways of promoting strength to overcome the cycle.
Pre-Peak Phase
In the Pre–Peak phase of COVID-19, many are experiencing a feeling of apprehension about the future. We read the news and watch the statistics of viral infections in our country or state, the number of deaths that are mounting, and in some ways, we are bracing for the peak that is going to come. To get through the day, many of us carry on with our jobs and obligations.
However, when we go for a walk and see people in masks, or go into a grocery store where the shelves are empty, our bodies react to the stress of these “new normals,” by releasing cortisol and adrenaline.
Have you been around someone who coughed or sneezed, and felt yourself flinch? Maybe you coughed and had the sudden worry, “could it be COVID?” When the body is in a state of fight or fight, the cortisol builds over time and we become jumpier, looking around us for potential threats.
Given the current environment, the threat is everything — from not being able to go to entertainment or activities, to going to stores where you see everyone wearing masks, to being around those who are potentially sick. Healthcare workers also experience this by “bracing” for the peak that will hit their hospital or clinics by stock piling supplies and screening everyone who comes in for COVID-19.
Peak- Phase
Then comes the Peak-COVID-19 phase. Many of us may know people who contract the virus, and potentially even know someone who dies. Healthcare workers are overextended, caring for as many people as they can. Essential workers face situations every day where they may come into contact with someone who is infected. These workers need to wear protective gear, and when they go home, may need to isolate from their families due to concern they are a vector of the illness. During the Peak– phase, the body is experiencing maximum stress, cortisol is being released freely, and the body is already exhausted from the Pre- phase.
Because many are given little choice, they push through the exhaustion and the anxiety, focusing on work and neglecting to care for themselves.
Post-Peak Phase
Finally, there is the Post-Peak phase of COVID-19 when the infections are decreasing, the rate of people dying is decreasing, and much of what people have been preparing for is starting to pass. The problem is that during Pre–Peak and Peak, we were neglecting to take care of ourselves. The famous book “The Body Keeps the Score,” by Bessel van der Kolk, posits that our bodies remember emotional and mental trauma. When our bodies are depleted and we are emotionally drained, our immune systems are depleted due to the long periods of time we spent with elevated cortisol.
In the movie version of the virus, as soon as quarantine is lifted, we get to return to our lives. But the real-life version is more stressful. How many patrons will restaurants allow to provide guests with adequate distance? Will universities need to rethink cramped dorm structures? Will masks be required at every festival? Will we ever shake hands with a stranger without thinking, “I need to wash my hands”?
For many, the Post–Peak phase is when the depression hits because it’s a marathon, not a sprint.
So How Do We Manage?
This Pre-Peak, Peak, Post-Peak phases of our fight against COVID-19 will be cyclical until we come up with an adequate vaccine or treatment. It is likely there will be a second peak of the virus after physical distancing restrictions are lifted, and we may find ourselves sheltering in place again during the winter as the seasonal flu competes for hospital space.
Between cycles of these phases, there will be also be periods of latency, where it feels like the virus is gone. As cases decline, so too will rule-following. We’ll get more comfortable with crowds, we’ll forget the mask at home, we’re scratch our noses without thinking twice. Times of latency will lead to complacency. But this is the time to take care of yourself. As others forgo the protection of frequent hand-washing and physical distance, more germs will spread, and taking care of yourself will be key.
The best thing to remember is that the body is paying attention. The better you care for yourself, the better prepared you will be when you enter the next phase. You can do that by strengthening your parasympathetic nervous system.
“Toning Up” our Parasympathetic Nervous System
You’re probably familiar with “Fight or Flight” — that’s the reaction our bodies have when the sympathetic nervous system is activated. For many of us, COVID-19 has kept our sympathetic nervous systems activated. We’re irritable, anxious, and our immune systems are feeling the effects of long-term cortisol exposure.
The Parasympathetic nervous system, however, decreases cortisol release, thus strengthening the immune system and lessening the toll that this stress reaction will have on the body. If we can protect our immune systems from this stress, we can decrease our chances of having long–term and potentially permanent stress responses to triggers that remind us of this time.
The good news is, there are many tools at your disposal that can help you “tone up” your parasympathetic nervous system. Yoga, progressive muscle relaxation, mindfulness and meditation, strong and calming social supports, as well as therapy, can all help to strengthen our parasympathetic tone.
So the next time you think about checking the news, think about checking on yourself first. Could you use these three minutes to sit outside and meditate? Or call a friend? Or maybe just to take a few deep belly breaths?
The better you take care of yourself, the better your immune system can take care of you.
By Monika Roots
Chief Medical Officer, Sanvello
Dr. Roots practiced as a child, adolescent, and adult psychiatrist. She was also a Clinical Adjunct Assistant Professor at University of Wisconsin-Madison and was most recently the Vice President of Health Services and Behavioral Health for Teladoc Health. In 2016, Teladoc Health acquired her business, CogCubed, a behavioral health analytics company. Dr. Roots earned her MD from University of Sint Eustatius School of Medicine and completed psychiatry residency and fellowship in child/adolescent psychiatry at the University of Minnesota.