Boost Self-Care by Knowing Your Numbers

**By Teera Crawford, MD**

When you think about self-care, you might think of yoga, meditation and journaling – not measuring your blood pressure.

However, tracking your critical health numbers – blood pressure, cholesterol, hemoglobin A1C and waist circumference – goes a long way in ensuring both a healthy body and healthy life. Staying on top of these will help you take charge of your health, especially as we continue to navigate the pandemic.

Of course, this is easier said than done, and learning how to identify and keep your numbers in check requires a bit of work up front. However, it is advantageous to keep up to date with this practice in the long run. Read on to understand what these numbers mean, why they’re important and how to incorporate monitoring them into your self-care routine.

Blood PressureBlood pressure

Measuring your blood pressure consists of familiarizing yourself with two numbers: systolic and diastolic. Systolic tells you how much pressure your blood is exerting on the blood vessels with each heartbeat, and diastolic tells you how much pressure your blood is exerting when your heart is relaxing. For reference, an elevated blood pressure is one that is greater than 120/80. Measuring blood pressure can be done from the comfort of your home and is as easy as purchasing and using a quality blood pressure cuff. Pro tip: when you buy a new blood pressure cuff, it’s a good idea to have it checked against the blood pressure cuff used at your doctor’s office to ensure its accuracy.

Total cholesterol

Cholesterol is a fat-like substance that your liver makes and is found throughout all of the cells in your body. Maintaining a certain level of cholesterol is important to keep your body functioning, but an elevated total cholesterol (a measure of the total amount of cholesterol in your blood) is more harmful than helpful. For reference, an elevated total cholesterol is one that clocks in at greater than 200. Obtaining this number requires blood tests done in a laboratory and should be checked at your doctor’s office every five years or so.

If your cholesterol errs on the higher side, or you have a family history of high cholesterol, you’ll want to get this checked a bit more frequently. Work with your doctor to set up the appropriate plan for you to keep this in check.

 Hemoglobin A1C

The hemoglobin A1C test measures the amount of blood sugar (glucose) attached to hemoglobin, or protein in your red blood cells. Hemoglobin A1C is a type of blood test typically used to screen for diabetes and can tell you your average blood sugar level over the three months prior. For reference, a measurement greater than 5.7% indicates a prediabetic range and means you’re at a higher risk for developing diabetes, while a measurement greater than 6.5% means you have diabetes. Check in with your doctor to help develop the right plan for you to stay on top of your hemoglobin A1C.

Waist circumference

Waist circumference is exactly what it sounds like – the measurement of your waist, which can fortunately be conducted at home with a flexible tape measure. Starting at the top of your hip bone, wrap the tape measurer around your body until it reaches the starting point. For reference, your waist circumference should typically be less than 40 inches for men and less than 35 inches for women. Pro tip: try to relax your body when measuring your waist to produce the most accurate reading.

Elevations in any of these numbers can lead to cardiac, vascular and other organ abnormalities over time, and Overweight Woman Measuring Waist in Gymmonitoring and staying on top of them is vital to healthy living. According to the CDC, heart disease is the leading cause of death in the U.S. and elevated numbers increase your risk of developing heart disease.

Frequent exercise is a surefire way to keep everything under control but unfortunately during the pandemic, going to the gym is not an option for all. Alternatives to the gym include online exercise videos that can be done at home or getting outside for a walk or run around your neighborhood.

In addition to exercise, it’s important to communicate about these measures openly, honestly and frequently with your doctor to set yourself up on the right path to healthier living. Pairing these efforts with your other self-care methods of choice will keep you living your best life.

Teera.CrawfordTeera Crawford, MD, is board-certified by the American Board of Internal Medicine and specializes in women’s health, preventive care, diabetes and weight management. Dr. Crawford practices at Virginia Mason Lynnwood Medical Center


Managing Screen Time in a Virtual Learning Era

**By Traci McDermott, MD**

Many students this year are attending school virtually. This means around eight hours of their day will be spent in front of a screen — far more than the recommended 60-minute daily screen-time limit. This can pose a lot of challenges for parents, who are dealing with having to manage their child’s schooling while balancing working from home. Parents may feel guilty about not being able to limit the amount of time their child is spending on screens.

While you may not be able to control the amount of screen time your children must spend in class, there are many things you can do to help offset your child’s screen consumption outside of school.

Set limits

Take advantage of automatic shut-off settings in order to limit screen time. It’s also more important than ever to ensure you are sitting down and talking with kids about safe internet content and safe use of social media.

Whenever possible, try to limit additional screen time outside of virtual learning to quality social connections with family members or friends. Live chats over Facetime, Skype or Caribu are better than quick texts, SnapChat or other social media platforms that don’t involve real-time conversations. Zoom meetings or practices that help keep kids engaged in their community and with other kids should be prioritized over free screen time use.

Take breaks

No matter if you are a child or a parent, in school or at work, everyone should build a habit of spending 10 minutes away from a screen each hour. You could do this by using a simple kitchen timer or by turning on automatic shut-off settings on your device.

family dance partyMake breaks from school work at home physical – not a game or video on the screen. Turn on music and have a make-shift dance party, or let kids create their own dance routine. Use painters’ tape to create hopscotch on the floor, or encourage them to learn a new active skill, like juggling.

Get physical

Parents should try to prioritize exercise or active play with their kids for 60 minutes most days. This will take away time spent in front of a screen.

If your child has an already established physical routine due to team sports or practices during normal times, do your best to keep a similar schedule. Your child might be used to a 30-60 minute practice two or three times a week at, say, football practice. Encourage them to continue that same schedule by keeping their bodies moving in some way on their own. With no games to attend on the weekends, the whole family could instead go for a walk or run, or have your own scrimmage in the yard (or closest open green space).

You can even consider virtual physical classes, like online workouts. Yes, this is inviting another screen into your child’s day, but in moderation, these encourage kids to move and exercise, which is beneficial to the body as a whole. Also, many dance classes have been shifted to virtual, which help kids keep social connections and stay active. This can be a good indoor option once the weather cools down.

Unplug at night

 Consider setting a limit for your child to ditch the phones, video games and YouTube videos no less than an hour before bed each night. Some parents even opt for “family charging stations,” where all electronics live at night to help kids (and parents, too!) unplug when it’s time for sleep.

Of course, these tips are not one-size-fits-all. While many families are able to easily set limits for their children, there are just as many where setting limits will pose a significant challenge.

If you’re worried that your child is still spending too much time in front of a screen even after following these steps, make sure to look for the following warning signs. Seek medical help if your child:

  • Develops problems sleeping
  • Develops regular/daily headaches
  • Has significant weight change (either gaining or losing)
  • Has emotional withdrawal

Good luck! Remember, making sure your child’s sleep and exercise needs are met will significantly reduce the overall time spent on screens, while boosting their readiness for virtual learning.

Traci.McDermott MDTraci McDermott, MD, specializes in Pediatrics at Virginia Mason University Village in Seattle. Dr. McDermott is an American Board of Pediatrics-certified practitioner.

Helping Your Child Wear a Mask During COVID-19

**By Rebecca Partridge, MD**

If you are a parent of a young child during the pandemic, you know firsthand how hard it can be to explain what is going on and why your child must wear a face covering when in public places or around people outside of your household. I’m sure many of you have felt like giving up on having your little ones mask up.

As a parent myself, I recognize that teaching children the importance of wearing a mask has its challenges. Still, I’m here to tell you that even if your child is struggling with this new directive, you can do it! It’s just going to take time and persistence. Current CDC guidelines state that anyone able to wear a mask, excluding children under 2 years of age, should do so in order to keep each other safe. Advice for younger children includes prioritizing mask wearing for times when it is difficult to maintain a distance of 6 feet from others, such as in carpools or when standing in line. 

mom-maskAs a mother and a physician who sees many parents struggling when it comes to teaching their young children why and how to wear their masks, I’ve come up with a few kid-friendly tips.

Get them excited about it

I’ve found that kids respond well to masks featuring their favorite cartoon characters or other designs that excite them. By providing your child with different choices in terms of the color, shapes, styles and features on the mask, you can turn something that is foreign and uncomfortable into something exciting and actually fun. Many children love to look like Spider-Man or Minnie Mouse; if their mask gives them an opportunity to “become” their favorite characters, your child is more likely to wear it. Parents should also express their own enthusiasm for masking up when around their kids to serve as an example that hopefully gets followed.

Gradually increase mask time

I’m hearing from many parents that their child is willing to try on the mask, but that they can only keep it on for a few seconds before they get bored and take it off. Parents should work with their child on wearing a mask for short periods of time to start and then graduate to longer periods of mask wearing. Try doing a countdown with your kids, distract them by playing their favorite video or giving them their favorite toy. Provide praise and positive attention when they keep the mask on. Do this until your child is able to keep the mask on for the time needed to run an errand in public or other activities you’d like to enjoy with your family.

Read stories with your child that include mask-wearing characters

For children who are having a really hard time tolerating wearing a mask, consider reading books to them about the topic. Book characters might go into the steps of putting on a mask or its importance to protect one’s health and those around them. Hearing and seeing these behaviors in a child-friendly format might resonate with your child, helping them better understand why mask-wearing is so important.

Don’t give up!

It will take time to get your child used to wearing a mask. Continue to employ these steps and your efforts will pay off. If your child is still having trouble after trying some of the advice above, you might consider a face shield. Although a mask is the best way to keep your child and others safe, a face shield is a good option for parents of kids who might be more sensitive to touch or having things touching their faces. In these cases, a shield can be a good introduction in teaching your child to wear a mask later on. 

Meanwhile, don’t forget to give yourself credit for everything you’re doing to support your family during such a challenging time. Good luck and be well!   

Rebecca Partridge

Rebecca Partridge, MD, is a Pediatrics specialist at Virginia Mason Issaquah Medical Center. Dr. Partridge is board-certified by the American Board of Pediatrics. Her medical interests includes general pediatrics, Down syndrome and emergency pediatrics.

Prioritizing Your Health During COVID-19

**By Donna L. Smith, MD**

Reports indicate nearly one-third of U.S. adults have avoided seeking medical care because they are worried about contracting COVID-19, and experts are concerned about deaths from non-COVID-19 illnesses that could be due to people not seeking treatment. This trend is alarming.

As a physician, I will always encourage people to be active participants in caring for their health. While staying healthy is understandably a top priority for all of us right now, it is also a time when many people might be tempted to minimize and deprioritize symptoms of serious illness. Although hand hygiene, social distancing and masking are key actions to avoid infectious diseases such as COVID-19, it is also important to seek prompt evaluation and treatment for any other health concerns. This includes care for yourself and for those you love.

Don’t ignore symptoms

A single symptom could be just that, or it could be an indication of a more systemic health condition. Though not always the case for every concern, it is often better to identify the cause of symptoms sooner rather than wait until they progress.Staying current with your health care is important, even during a pandemic.

Pay attention to changes in your body; you know your body best. An acute increase in symptoms, a new symptom that persists, or something that persists and then increases could all be causes for concern. Don’t hesitate to reach out to your health care provider when concerns arise.

Get it checked out now, for better future outcomes

Delayed care can result in a need for more involved treatment later. Diseases such as cancer are a prime example of this.  It is important to have routine, recommended screenings for diseases such as cancer, especially if you are at increased risk.  With regular screenings, diseases can be detected earlier and result in better health outcomes.

If you have chronic disease, regular check-ins are essential

For those living with and managing chronic disease, a change in daily life patterns, including eating habits, exercise routines and social activities, can leave you stressed and vulnerable to developing new or increased symptoms. Make sure to keep up your regular check-ins with your health care team to ensure you are taking the best actions to optimize your health.

Health care facilities have COVID-19 prevention top of mind. Here at Virginia Mason, we rigorously screen patients for symptoms, and have a separate entrance for those with respiratory illness. We provide masks to all patients and visitors upon arrival. We’ve arranged our waiting areas to provide at least six feet of distance between patients. And of course, we always have intensive cleaning processes in place including disinfecting all surfaces and handles in exam rooms after each patient visit.

There are virtual options for care available as well. Call or send portal messages to talk with care team members and determine if virtual care or in-person is optimal for you. And, if you prefer in-person visits, be certain to tell the team member of this preference, and they will advise accordingly.

We encourage you to continue seeking medical care even in the time of COVID-19 to protect your health and the health of your family, whether it’s virtually or in-person. When you do seek care, Virginia Mason providers are ready and able to help.

Dr. SmithDonna Smith, M.D., MBA, is Executive Medical Director and Associate Chief Medical Officer of Virginia Mason Medical Center. Previously serving in multiple medical leadership roles at Virginia Mason, she is responsible for oversight of the health care system’s hospital and clinics. Dr. Smith is board-certified by the American Board of Pediatrics and also specializes in primary care. She practices at Virginia Mason University Village.

Why You Should Vaccinate Your Child, Even During a Pandemic

**By David J. Schneider, MD, FAAP**

The Centers for Disease Control (CDC) recently reported a plunge in vaccination rates for children, with numbers suggesting childhood vaccination rates essentially halting from March to April 2020 during the height of coronavirus concerns.

While many families continue to stay home to prevent the spread of COVID-19 until there is a proven, safe and effective vaccine, parents shouldn’t delay seeking health care for their children, particularly routine immunizations.

Current unvaccinated children for vaccine-preventable diseases do not have a higher risk of contracting COVID-19, but they do have a higher risk of contracting other preventable diseases, like meningitis, whooping cough and measles that can potentially lead to worse outcomes. Measles is still spreading globally, with two outbreaks in Washington state last year. Measles is more infectious than the novel coronavirus and young children, pregnant women and immunocompromised children are at an increased risk for complications and have a higher fatality rate.

As a pediatrician who supports children’s overall health, my advice to parents is to not delay health care for your child if you are worried about COVID-19. Aside from vaccine-preventable diseases, delays in care for your child can slow the detection of congenital or developmental issues, diagnosis of new problems or treatments for chronic illnesses.

At Virginia Mason, we are doing new things to help put parents’ worries at ease. We are separating well and sick children into different clinics at physically distant locations so that parents and kids who come in for routine care will have decreased likelihood of being exposed to kids who are unwell. We are doing extra sanitizing of each exam room between patients, using personal protective equipment (PPE) for all visits with full PPE for sick visits, masking all patients at the entrance, and making it possible to maintain a six-foot physical distance from other people within the clinic.

This outbreak has reminded us how important vaccines are, as they help prevent the quick spread of infectious diseases and the horrible consequences that come with an outbreak.   –David Schneider, MD

Patients who are scheduled in the “sick clinic” are asked to wait in their car and they are called when we are ready for them to come in. They are led directly to a clean exam room to avoid possible exposures in waiting rooms and hallways. For visits that do not require in-person care, we offer video visits and have seen a significant increase in this service.

Everyone carries some level of risk for contracting COVID-19. Fortunately for children, most cases of COVID-19 appear to be mild, but there are some children who develop more severe symptoms and complications. It’s important to continue good hand washing, physical distancing and maintaining hygiene practices to help avoid infection.

This outbreak has reminded us how important vaccines are, as they help prevent the quick spread of infectious diseases and the horrible consequences that come with an outbreak. When a COVID-19 vaccine is available, it will be important for everyone to stay up to date with the vaccination to achieve herd immunity and avoid a devastating outbreak like we are having now.

Dr David Schneider_2019David Schneider, MD, FAAP is board-certified in general pediatrics. He practices at Virginia Mason Bellevue Medical Center. Dr. Schneider specializes in pediatric and adolescent medicine, with special interests ranging from well child visits and sports-related injuries to LGBTQ health and mental health concerns around ADHD, depression and anxiety.

Tips for Summer Travel During COVID-19

**By Chia Wang, MD**

Summer is underway and many of us are feeling restless and ready to get out and enjoy the warm weather. Some of us are itching to see family and friends whom we may not have seen for a while. But is it safe to travel this summer amidst the ongoing COVID-19 pandemic? There is no question that in terms of catching the virus, isolating at home is the safest thing to do. However, each person must weigh their individual risks, and for those who are very elderly, or who have underlying risk conditions, staying at home until there is a vaccine or until rates of transmission are very low is still the best advice.

To travel or not this summer also depends on where you are traveling to. Personally, I would be hesitant to travel from a place where viral transmission rates are low to one where transmission rates are high. Conversely, if traveling from somewhere where transmission rates are high, you would want to consider carefully whether you would be putting others at risk by traveling, and take steps to mitigate any risk, such as bringing your own food and water and monitoring for symptoms. I would also caution against traveling to a place where being able to practice physical distancing would be difficult, such as to a dense urban area or visiting someone with a very small apartment.

People must take into account their own risk profiles, as well as their own comfort level with risk.  –Dr. Chia Wang

Here are some things to keep in mind if you choose to travel this summer:

Couple tandem bikeConsider your mode of transportation

Travel by car is generally preferred to plane travel, because you have more control over your surroundings, and you are not breathing the same air as many strangers for hours on end. That is not to say that plane travel is unsafe in terms of COVID-19, but car travel is generally safer. However, if you need to travel cross-country, and traveling by car would involve multiple hotel stays and eating at many restaurants, particularly if traveling through virus-hot spots, then plane travel may actually be safer than car travel.

Choose lodging that minimizes contact with others

The virus does not seem to be transmitted as easily outdoors as indoors, so choosing hotels or lodges with doors that open to the outside, instead of into a hallway, are also choices that may make you safer. Avoid lodging that requires you to use an elevator. The less contact you have with other people, whether other travelers, or staff at hotels and restaurants, the safer. Staying in private homes through services like Airbnb, staying in cabins, tents or RVs are all ways that you enjoy less risky travel.

Wearing a mask while indoors, or when around people while outdoors, is one safety measure that is recommended. Washing hands frequently, and avoiding touching the face, are also important.

Bring the appropriate supplies

Masks and hand sanitizer are the most important things to bring when leaving the home for most reasons. For road trips, bringing things that will allow you to minimize contact with others is helpful, such as extra food and drinks, and day trip supplies including sunblock, bandages and pain relievers such as Tylenol.

Think outside the box – or just think outside

Camping, hiking, biking, and outdoor adventuring seem like activities that will allow families to adhere best to physical distancing guidelines. Sitting outdoors at a scenic location reading a book or just nature-gazing can also be a nice change of pace for those who are tired of being cooped up. For those who prefer the comforts of home rather than sleeping on the ground and using a Porta-potty while camping, “glamping” may be a great option—with beds and flush toilets and hot showers, but still in tents that are well-distanced from each other and lots of fresh air. Overall, for travel this summer, trips that emphasize time outdoors are the safest. People must take into account their own risk profiles, as well as their own comfort level with risk. Until transmission rates have dropped much further than they have so far—basically until there is a vaccine—the safest option for most people is still to stay home.

Dr.WangChia Wang, MD, is an infectious disease specialist at Virginia Mason Medical Center in Seattle. She is board-certified by the American Board of Internal Medicine. Dr. Wang also specializes in HIV/AIDS care and travel health.

A Tale of Two Pandemics: The 1918 Flu and COVID-19

**By Chris Baliga, MD, and David Wilma**

“We’re in unprecedented times.” During the COVID-19 pandemic, we hear variations of this statement on repeat. While current times are heartbreaking and incredibly trying, there is, in fact, a precedent.

As an infectious disease specialist here at Virginia Mason, I was curious about historical similarities and differences between the 1918 influenza pandemic and the current COVID-19 pandemic.

I checked in with David Wilma, author and historian, to help answer some questions many people have related to what we are experiencing now compared to what happened more than a century ago.

Chris Baliga, MD (CB): What did the early days of the 1918 influenza pandemic look like?

David Wilma (DW): First, let’s discuss the 1918 pandemic’s commonly used name, the “Spanish flu.” It’s entirely a misnomer. The name “Spanish flu” mainly spread far and wide because Spanish public health officials were the first to report an influenza epidemic in 1918. But the virus did not originate in Spain.

Due to wartime censorship during World War I, reports of severe influenza-like illnesses from several years earlier in army camps in France were suppressed. Because Spain had been the first to publicly declare an epidemic of influenza, the world latched onto that association.

CB: So, if not Spain, where did the influenza of 1918 originate?

DW: There are a few theories. One posits the virus transferred to humans from birds in China. Thousands of Chinese people were recruited by the British Army as laborers, sailed across the Pacific Ocean and were transported by trains across Canada, where the first known infections were recorded. Then, these recruits and additional passengers boarded ships and returned back across the Atlantic Ocean, subsequently infecting armies in France.

Another theory places the first outbreak in Kansas in February 1918. But, it’s possible that outbreak was the result of the virus returning with travelers from France. An unfortunate reality is that the likely origin and means of transmission have never been established and will never be known.

CB: What did the influenza pandemic of 1918 look like in Seattle and our region?

DW: The first influenza infections in Seattle occurred aboard a trainload of Navy recruits arriving from Philadelphia in early October 1918. Statewide containment measures were not rolled out until Nov. 3, 1918. Still, there was no state authority over local governments, and bans on public gatherings were spotty and irregular.

Hospital 1920

Virginia Mason Hospital in 1920

In Seattle, public gatherings resumed on Nov. 11, 1918, to celebrate Armistice Day, only to prove that the city was not ready to return to “normal.” Infections increased again, resulting in a total of 1,441 deaths in Seattle and more than 5,000 deaths across Washington state, of which more than half of victims were between 20 and 39 years of age.

At the time, Seattle had a population of three hundred thousand, making it the largest city in the state. Inadequate hospital beds in the city forced a dormitory at the University of Washington to be pressed into service for the sick and dying.

The shortage of good hospital care in Seattle prompted the Virginia Mason founders to consider a new hospital built around a team of specialists. As a result, Virginia Mason Hospital opened in 1920 in direct response to the 1918 flu pandemic.

CB: What are we seeing with COVID-19 that is similar to the influenza pandemic in 1918?

 DW: First, both the 1918 flu and COVID-19 are caused by a virus. Both highly contagious, the viruses also share similar transmission between humans by contact with infected air particles. Transmission is exacerbated by travel. Though ships and trains back then were physically slower than airplanes travelling internationally today, they were still just as effective in moving passengers around and contributing to disease spread. During both pandemics, seaport and airport cities were home to the earliest infections, largely due to the volume of travelers through the area. For many people in 1918, the notion that influenza came from “somewhere else” outside their own country in combination with wartime tensions contributed to harmful xenophobic, racist ideas and scapegoating of foreign populations. We’ve unfortunately seen similar reactions to the coronavirus.

And as influenza and COVID-19 arrived in and spread throughout cities, they’ve affected Native, Hispanic and African-American populations more than other populations.

In both pandemics, the virus alone is not the sole cause of fatalities. Rather, it’s the escalation of symptom severity that can become a problem. Influenza and the coronavirus can rapidly contribute to severe, often fatal complications like pneumonia.

As we analyze various government responses and containment efforts directed at COVID-19, it’s important to remember what we saw during the 1918 influenza pandemic. Intentional, thorough and well-implemented containment measures are likely to be most effective in virus control. In fact, during the 1918 pandemic and COVID-19 today, countries and cities that imposed contact restriction measures early and kept those measures in place experience fewer fatalities overall. Acting early is an important lesson for all of us to learn, as well as ensuring a thorough response and not returning to normal operations too quickly.

CB: How is our current response to COVID-19 different from how we experienced and handled the influenza pandemic in 1918?

DW: Perhaps the most significant determinant of the 1918 influenza response was the limited medical understanding and technology at the time.

Our lack of understanding of viruses and their behavior meant we were never able to respond to the 1918 influenza pandemic properly. The particular strain of influenza was not even identified as a virus until 1930, and no vaccine was ever developed to combat the disease. The pandemic only really calmed down after infection rates declined in waves in the late winter of 1918. Wartime censorship limited our understanding of the ongoing pandemic and early outbreaks on the battlefields. Potential drug treatments like Tamiflu simply did not exist at the time.

Recordkeeping practices in 1918 also posed a challenge, and reports of influenza were likely overlooked. We know that the 1918 flu infected populations across the board – hitting the youngest, the oldest, men and women. But contact tracing and tracking the disease’s spread in real time was minimal. Wartime record suppression, lack of reporting requirements and health authorities’ conflation of data among deaths from influenza and pneumonia all contributed to inaccurate data.

Around 100 years later, we have a much greater understanding of viruses, their behavior, effective treatments and the capabilities of health care workers and medical systems overall. We’ve been here before, and we’ll get through this now, by all working together.

Baliga, ChrisChristopher Baliga, M.D. is board-certified by the American Academy of Internal Medicine in infectious diseases and internal medicine. He practices at Virginia Mason Seattle Medical Center. Dr. Baliga specializes in infectious diseases, HIV/AIDS care and travel health issues.

David WilmaDavid Wilma is a writer and author of history books and historical fiction. He is based in the Pacific Northwest.


When COVID-19 Comes Home: How to Protect Healthy Family Members

**By Gabrielle Worzella, DO**

Let’s say someone in your household shows symptoms of COVID-19 or tests positive for the virus. It’s a reality that many of us have now experienced personally or know of a family who has.

If your loved one is confirmed positive with COVID-19, what you can do to ensure the virus doesn’t spread to other family members may follow what you do when someone in your household has the flu. It may even seem like common sense. However, because this virus is so contagious, it’s important to take extra precautions to give your family the best chance of avoiding other members getting sick, while supporting the recovery of those infected.

Here are some steps you can take to minimize the spread of COVID-19 in your home:

Maintain separation from the infected family member entirely, or as much as possible.
This can be hard as the infected family member will likely need help from family to monitor their temperature, help with meals and other needs. However, it is best to at least confine the ill individual to one room in the house while they recover. If possible, this should include access to their own bathroom as well. Since that’s not always feasible, all high-touch bathroom surfaces like the toilet, doorknob, light switch and sink should be disinfected after every use.

Designate one caregiver.
Preferably only one person should have direct contact with the infected family member. Discuss this as a family and determine who will be best suited to meet these demands. When caring for the individual, the designated caregiver should protect themselves by following recommended guidelines by the CDC like wearing gloves and a mask. Wearing gloves is also recommended when washing the ill individual’s dishes or handling anything they have touched.

Virus concept. Protection and isolationWash your hands!
Sound familiar? Everyone in the household should be washing their hands frequently to avoid the spread of disease, especially after going to the bathroom, handling commonly used objects like the television remote and after sneezing or coughing.

Maintain cleanliness of the household.
Members of the household should disinfect and clean high-touch surfaces such as kitchen counters, doorknobs and light switches frequently to avoid the spread of the virus, which experts have said could live on hard surfaces for hours, even days depending the type of surface material.

Take extra precautions for immune-compromised individuals.
If there is an immune-compromised person living in the home, consider isolating that individual as much as possible from all common areas in the home and from the infected family member at all times. If both family members are sharing the same space, both should wear masks.

Be there for your ill family member, safely.
It can be difficult mentally and emotionally for your family member to be in isolation, while they’re feeling sick and may be frightened by their diagnosis. It’s important to check in on them regularly and using virtual means is a great way to do that safely. You can use video chat to communicate when in separate rooms; send encouraging text messages; and ask friends and family members to reach out.

If you have new symptoms that sound like they might be COVID-19, such as fever, body aches, cough, loss of taste and smell, consult your health care provider as soon as possible. He or she may recommend a virtual visit or in-person evaluation, depending on your symptoms. Your provider can also give you additional advice on caring for yourself while at home to reduce potential spread of the virus.

Dr. WorzellaGabrielle Worzella, DO specializes in women’s health, preventive medicine, osteopathic manipulative treatment and integrative medicine. She is board-certified by the American Board of Family Medicine. She practices at Virginia Mason’s Edmonds Family Medicine clinic.






Practicing Mindfulness in a Time of Uncertainty and COVID-19

**By Astrid Pujari, MD**

The coronavirus, or COVID-19, is challenging all of us to find inner strength during a time of much uncertainty in our world. Each of us is affected by this health crisis, and we are all learning to navigate our “new normal.” While we cannot control our external environment, we can control our reaction to it and our thoughts, which is why staying mindful is so important right now.

As a trained physician in integrative holistic medicine, I want to share with you how to practice mindfulness, what it is and how it can help strengthen and steady our minds.

What it means to be mindful

Being mindful is about learning to respond rather than react. In any event we go through in life, whether positive or negative, we will experience an internal reaction first. Then, there’s a brief moment where we decide what happens next – what we say or what we do.

Most of the time, if we are not present with our thoughts, we will react based off of past experiences, fears, programming and fight-or-flight responses. These reactions might not be as helpful as we intend. Instead, we need to pause and focus on the words, the triggers, the events we are experiencing and ask ourselves in that moment how we really feel. Whether it’s thinking about COVID-19 or getting stuck in traffic, being mindful lets us choose how we want to be – and often a more sound and understanding response.

Reacting vs. responding

Let’s first understand the difference between reacting and responding.

As our senses take in any event – imagined or real – information travels through our limbic system. Connected to different parts of the brain, the limbic system is instinctually wired to respond immediately. When we react, this is what is being exercised. Think of it like being on autopilot.

Thinking vs. reacting supports better problem solving in stressful times.Yet, as humans, we have a slower track in our minds, which processes a lot more information and context as events occur. Because it does this, it activates a different area of the brain, the frontal cortex. This area allows for long-term thinking and long-term planning. When we respond, we are exercising this more thoughtful function.

So, when we confront experiences in our day-to-day lives, we have two options. We can react to it based on instincts and past experiences, connected to our limbic system’s desire for immediate reaction. Or, we can respond after thinking it through.

Mindfulness boosts resiliency in times of crisis

With COVID-19, most of us are reacting rapidly driven by fear and the unknown. Yet, these fight-or-flight responses shut down our ability to be resilient in times of uncertainty and stress.

Mindfulness can help boost our creative thinking and problem-solving by exercising a response, not a reaction. In turn, we may be able to envision more constructive solutions and think more positively, or at least calm our minds, even during difficult and trying times as we face COVID-19.

How to practice mindfulness during the COVID-19 outbreak

Breathe deeply
When we’re in a fearful state of mind, our breathing shallows. We must breathe to relax. Deep breathing offers an opportunity for us to deal with the emotional and mental stress. To start, I like to follow the Dali Lama’s guidance: place your hand on your heart and breathe in naturally. As you do this, cherish yourself and feel that cherishing of self. When you breathe out, cherish others – in your life, in this world. [Watch Dr. Pujari demonstrate several easy breathing techniques here.]

Focus on your body during simple activities
We consider many routine activities in our lives to be thoughtless, like hand washing or brushing our teeth. These routines are wired into our brains and muscle memory. However, by focusing on these simple activities – the feeling, sound, smell, look, taste – we open ourselves up to new feelings and perspectives. Next time you wash your hands, take note of how the water feels on your hands; what the soap smells like; the sound of the water coming out of the faucet; and even how your hands feel once you’re done. Before you know it, you’ll be mindful in many other areas of your life.

Listening to music is a mindfulness practice that can lower stress.Listen to soothing music
Music is a powerful way to relax our minds and generate positive, calm emotions. Certain pitches, tones and rhythmic structures can center us in the present. Listen to songs that fit your mood. Playing music in the background while you work or do other daily activities such as showering or getting ready can subtly soothe you and get you in the right mindset to achieve your daily goals. When feeling tense, I often listen to “Weightless” by Marconi Union. Designed to reduce anxiety, research has found this song helped reduce anxiety in 65% of listeners.

Take a break from watching the news and your social feeds
Many of us probably feel exhausted or overstimulated by the constant, unsettling COVID-19 news, yet we still want to be informed. Consider limiting the amount of time spent on your phone and online and make “instead of” time, where you do something for YOU.

Astrid PujariAstrid Pujari, M.D. is board-certified in internal, integrative and integrative holistic medicine. She practices at Virginia Mason’s Center for Integrative Medicine. Dr. Pujari specializes in holistic support for cancer, women’s health and functional medicine, holistic treatment options for gastrointestinal issues and mind-body tools.

Finding Calm in a Crisis: Changing What We Tell Ourselves

**By Bethany Davis, LSWAIC**

“I’m feeling too much all at once.”

Is this what you think when people ask “how are you” during the COVID-19 crisis? If so, you’re not alone: the impact the pandemic is having on our lives, families and communities makes higher stress a natural response. We want to know when this will end, how to stay protected, what will happen to our loved ones and so much more.

What I see as I work with people is that it’s not the course of the crisis that’s having the most effect, but more what they’re telling themselves about what’s going on. Our self-talk can undermine our sense of how safe we are, as we sort through not only a morass of information, but changes in our work, daily routines and relationships.

Here are four key areas in which redirecting our self-talk – and taking some simple actions – can help us feel more grounded in in a storm of emotions.

Minding the monologue

Does any of this self-talk sound familiar?

  • I am unproductive, I should be doing more.
  • I’m feeling alone.
  • This reminds me of feeling depressed, maybe that’s coming back.
  • This is how it’s going to be forever.

It’s important to know it’s possible to adjust our framework. Think of it like changing a lens on a microscope; seeing things in different focus can break the cycle of thought patterns that tend to feed anxiety and obsessive thinking. Here are examples of how to reframe your self-talk:

  • Staying home during this crisis is not a reflection on my self-worth or work ethic.
  • I can still maintain good relationships and reach out to those I love.
  • It’s normal to feel down when distancing, but it is not permanent.
  • This situation is temporary.

Be aware of “should” during self-talk, as in “I should be handling this better,” or “I should be more grateful.” Should and shouldn’t feed negative self-judgment.

Examining Isolation

dog-comfortTime to change that lens again! What are you telling yourself about being physically alone? Shame, blame or depression are some of the feelings that may come up when we are isolating from others. Switching your mindset can start with considering the difference between being “alone” versus being “lonely.”

Remember that we are temporarily distancing ourselves for health precautions. We are not cut off from relationships, friendships or love. We all count on these connections to check in and feel OK, and we can make still make those connections while distancing. In the meantime, try being curious about what feelings come up about being alone. Don’t see them as good or bad, but as evidence that everyone’s well-being depends on human connection.

Creating Feelings of Control

A good single phrase for self-talk when you feel out of control: “I’m going to be OK.” We’ve all heard the stories of panic buying, which may be an attempt to feel more in control. In moments of being overwhelmed by a perceived need, it can help to physically pause to regain a sense of calm. Try opening your hands while sitting in a posture of acceptance, close your eyes and take deep breaths.

Remember activities that you can control: I can go outside or take a walk. I can FaceTime or call family members or friends. I can listen to music. I can pick up an old project or start a new one. I can write down my thoughts or write a loved one a letter. I can sit in the sun.

Engaging Joy  

So much is happening in our world now, and if we’re being honest, it’s taking a lot of our energy and mental space. Consider giving your brain a break from scrolling through the endless crisis news and social media threads.

Here’s a question: When was the last time you felt happy? What were you doing? For me it was FaceTiming with my niece and nephew, sitting in the sun, calling my grandmother and looking up dog memes online (try it!) If you can remember something you enjoyed last week, try to think of how you felt in the moment. Whatever it was, try to do more of that, more often.

Another pathway to joy is through empathy and compassion for others. Once you’ve recognized the importance of self-talk and showing compassion for yourself, holding it for others becomes possible. Opening our minds to what people outside our circle are facing helps switch off our negative thought patterns and ease resentment about our own situation. We can think of (or maybe we know) people who work in health care, or who’ve lost their job, or even have symptoms and are stressed and self-isolating. Recognizing that we all face different challenges can open our capacity to feel joy again.

If You Need More Help

There will be times when all of us feel more stress than we have the tools to handle ourselves. If you have resources or access to a therapist via an online format, this would be a great time to connect to help you build on a more positive framework. The King County 24-hour crisis line offers immediate help and translation services for over 155 languages: (866) 427-4747.

Feeling anxious – or a variety of other emotions – during this crisis is completely normal. What can help is noticing patterns of thinking that get in the way of experiencing pockets of happiness and calm that can keep us moving forward in difficult times. We may all experience pain, heartache and loss, but soon we will all know the joy that still lies ahead.

Here’s some joy you can pocket to get you started, from the poem “Invictus,” written by William Ernest Henley in 1873, while recovering in an infirmary:

“It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate,
I am the captain of my soul.”

Bethany.DavisBethany Davis, LSWAIC, is an Oncology Social Worker who enjoys writing about mental health.