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Tag: covid-19

  • The Hidden Deaths Of The COVID Pandemic

    A recent analysis predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    BROOMFIELD, Colo. — Sara Wittner had seemingly gotten her life back under control. After a December relapse in her battle with drug addiction, the 32-year-old completed a 30-day detox program and started taking a monthly injection to block her cravings for opioids. She was engaged to be married, working for a local health association and counseling others about drug addiction.

    Then the COVID-19 pandemic hit.

    The virus knocked down all the supports she had carefully built around her: no more in-person Narcotics Anonymous meetings, no talks over coffee with a trusted friend or her addiction recovery sponsor. As the virus stressed hospitals and clinics, her appointment to get the next monthly shot of medication was moved back from 30 days to 45 days.

    As best her family could reconstruct from the messages on her phone, Wittner started using again on April 12, Easter Sunday, more than a week after her originally scheduled appointment, when she should have gotten her next injection. She couldn’t stave off the cravings any longer as she waited for her appointment that coming Friday. She used again that Tuesday and Wednesday.

    “We kind of know her thought process was that ‘I can make it. I’ll go get my shot tomorrow,’” said her father, Leon Wittner. “‘I’ve just got to get through this one more day and then I’ll be OK.’”

    But on Thursday morning, the day before her appointment, her sister Grace Sekera found her curled up in bed at her parents’ home in this Denver suburb, blood pooling on the right side of her body, foam on her lips, still clutching a syringe. Her father suspects she died of a fentanyl overdose.

    However, he said, what really killed her was the coronavirus.

    “Anybody that is struggling with a substance abuse disorder, anybody that has an alcohol issue and anybody with mental health issues, all of a sudden, whatever safety nets they had for the most part are gone,” he said. “And those are people that are living right on the edge of that razor.”

    Sara Wittner’s death is just one example of how complicated it is to track the full impact of the coronavirus pandemic — and even what should be counted. Some people who get COVID-19 die of COVID-19. Some people who have COVID die of something else. And then there are people who die because of disruptions created by the pandemic.

    While public health officials are trying to gather data on how many people test positive for the coronavirus and how many people die from the infection, the pandemic has left an untold number dying in the shadows, not directly because of the virus but still because of it. They are unaccounted for in the official tally, which, as of June 21, has topped 119,000 in the U.S.

    But the lack of immediate clarity on the numbers of people actually dying from COVID-19 has some onlookers, ranging from conspiracy theorists on Twitter all the way to President Donald Trump, claiming the tallies are exaggerated — even before they include deaths like Wittner’s. That has undermined confidence in the accuracy of the death toll and made it harder for public health officials to implement infection prevention measures.

    Yet experts are certain that a lack of widespread testing, variations in how the cause of death is recorded, and the economic and social disruption the virus has caused are hiding the full extent of its death toll.

    How To Count

    In the U.S., COVID-19 is a “notifiable disease” — doctors, coroners, hospitals and nursing homes must report when encountering someone who tests positive for the infection, and when a person who is known to have the virus dies. That provides a nearly real-time surveillance system for health officials to gauge where and to what extent outbreaks are happening. But it’s a system designed for speed over accuracy; it will invariably include deaths not caused by the virus as well as miss deaths that were.

    For example, a person diagnosed with COVID-19 who dies in a car accident could be included in the data. But someone who dies of COVID-19 at home might be missed if they were never tested. Nonetheless, the numbers are close enough to serve as an early-warning system.

    “They’re really meant to be simple,” Colorado state epidemiologist Dr. Rachel Herlihy said. “They apply these black-and-white criteria to often gray situations. But they are a way for us to systematically collect this data in a simple and rapid fashion.”

    For that reason, she said, the numbers don’t always align with death certificate data, which takes much more time to review and classify. And even those can be subjective. Death certificates are usually completed by a doctor who was treating that person at the time of death or by medical examiners or coroners when patients die outside of a health care facility. Centers for Disease Control and Prevention guidelines allow for doctors to attribute a death to a “presumed” or “probable” COVID infection in the absence of a positive test if the patient’s symptoms or circumstances warrant it. Those completing the forms apply their individual medical judgment, though, which can lead to variations from state to state or even county to county in whether a death is attributed to COVID-19.

    Furthermore, it can take weeks, if not months, for the death certificate data to move up the ladder from county to state to federal agencies, with reviews for accuracy at each level, creating a lag in those more official numbers. And they may still miss many COVID-19 deaths of people who were never tested.

    That’s why the two methods of counting deaths can yield different tallies, leading some to conclude that officials are fouling up the numbers. And neither approach would capture the number of people who died because they didn’t seek care — and certainly will miss indirect deaths like Wittner’s where care was disrupted by the pandemic.

    “All those things, unfortunately, are not going to be determined by the death record,” says Oscar Alleyne, chief of programs and services for the National Association of City and County Health Officials.

    Using Historical Data To Understand Today’s Toll

    That’s why researchers track what are known as “excess” deaths. The public health system has been cataloging all deaths on a county-by-county basis for more than a century, providing a good sense of how many deaths can be expected every year. The number of deaths above that baseline in 2020 could tell the extent of the pandemic.

    For example, from March 11 to May 2, New York City recorded 32,107 deaths. Laboratories confirmed 13,831 of those were COVID-19 deaths and doctors categorized another 5,048 of them as probable COVID-19 cases. That’s far more deaths than what historically occurred in the city. From 2014 through 2019, the city averaged just 7,935 deaths during that time of year. Yet when taking into account the historical deaths to assume what might occur normally, plus the COVID cases, that still leaves 5,293 deaths not explained in this year’s death toll. Experts believe that most of those deaths could be either directly or indirectly caused by the pandemic.

    City health officials reported about 200 at-home deaths per day during the height of the pandemic, compared with a daily average 35 between 2013 and 2017. Again, experts believe that excess is presumably caused either directly or indirectly by the pandemic.

    And nationally, a recent analysis of obituaries by the Health Care Cost Institute found that, for April, the number of deaths in the U.S. was running about 12% higher than the average from 2014 through 2019.

    “The excess mortality tells the story,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. “We can see that COVID is having a historic effect on the number of deaths in our community.”

    These multiple approaches, however, have many skeptics crying foul, accusing health officials of cooking the books to make the pandemic seem worse than it is. In Montana, for example, a Flathead County health board member cast doubt over official COVID-19 death tolls, and Fox News pundit Tucker Carlson questioned the death rate during an April broadcast. That has sowed seeds of doubt. Some social media posts claim that a family member or friend died at home of a heart attack but that the cause of death was inaccurately listed as COVID-19, leading some to question the need for lockdowns or other precautions.

    “For every one of those cases that might be as that person said, there must be dozens of cases where the death was caused by coronavirus and the person wouldn’t have died of that heart attack — or wouldn’t have died until years later,” Faust said. “At the moment, those anecdotes are the exceptions, not the rule.”

    At the same time, the excess deaths tally would also capture cases like Wittner’s, where the usual access to health care was disrupted.

    A recent analysis from Well Being Trust, a national public health foundation, predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    “People lose their jobs and they lose their sense of purpose and become despondent, and you sometimes see them lose their lives,” said Benjamin Miller, Well Being’s chief strategy officer, citing a 2017 study that found that for every percentage point increase in unemployment, opioid overdose deaths increased 3.6%.

    Meanwhile, hospitals across the nation have seen a drop-off in non-COVID patients, including those with symptoms of heart attacks or strokes, suggesting many people aren’t seeking care for life-threatening conditions and may be dying at home. Denver cardiologist Dr. Payal Kohli calls that phenomenon “coronaphobia.”

    Kohli expects a new wave of deaths over the next year from all the chronic illnesses that aren’t being treated during the pandemic.

    “You’re not necessarily going to see the direct effect of poor diabetes management now, but when you start having kidney dysfunction and other problems in 12 to 18 months, that’s the direct result of the pandemic,” Kohli said. “As we’re flattening the curve of the pandemic, we’re actually steepening all these other curves.”

    Lessons From Hurricane Maria’s Shifting Death Toll

    That’s what happened when Hurricane Maria pummeled Puerto Rico in 2017, disrupting normal life and undermining the island’s health system. Initially, the death toll from the storm was set at 64 people. But more than a year later, the official toll was updated to 2,975, based on an analysis from George Washington University that factored in the indirect deaths caused by the storm’s disruptions. Even so, a Harvard study calculated the excess deaths caused by the hurricane were likely far higher, topping 4,600.

    The numbers became a political hot potato, as critics blasted the Trump administration over its response to the hurricane. That prompted the Federal Emergency Management Agency to ask the National Academy of Sciences to study how best to calculate the full death toll from a natural disaster. That report is due in July, and those who wrote it are now considering how their recommendations apply to the current pandemic — and how to avoid the same politicization that befell the Hurricane Maria death toll.

    “You have some stakeholders who want to downplay things and make it sound like we’ve had a wonderful response, it all worked beautifully,” said Dr. Matthew Wynia, director of the University of Colorado Center for Bioethics and Humanities and a member of the study committee. “And you’ve got others who say, ‘No, no, no. Look at all the people who were harmed.’”

    Calculations for the ongoing pandemic will be even more complicated than for a point-in-time event like a hurricane or wildfire. The indirect impact of COVID-19 might last for months, if not years, after the virus stops spreading and the economy improves.

    But Wittner’s family knows they already want her death to be counted.

    Throughout her high school years, Sekera dreaded entering the house before her parents came home for fear of finding her sister dead. When the pandemic forced them all indoors together, that fear turned to reality.

    “No little sister should have to go through that. No parent should have to go through that,” she said. “There should be ample resources, especially at a time like this when they’re cut off from the world.”

    View the original article at thefix.com

  • Drinking Surged During The Pandemic. Do You Know The Signs Of Addiction?

    While some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Despite the lack of dine-in customers for nearly 2½ long months during the coronavirus shutdown, Darrell Loo of Waldo Thai stayed busy.

    Loo is the bar manager for the popular restaurant in Kansas City, Missouri, and he credits increased drinking and looser liquor laws during the pandemic for his brisk business. Alcohol also seemed to help his customers deal with all the uncertainty and fear.

    “Drinking definitely was a way of coping with it,” said Loo. “People did drink a lot more when it happened. I, myself, did drink a lot more.”

    Many state laws seemed to be waived overnight as stay-at-home orders were put into place, and drinkers embraced trends such as liquor delivery, virtual happy hours and online wine tasting. Curbside cocktails in 12- and 16-ounce bottles particularly helped Waldo Thai make up for its lost revenue from dine-in customers.

    Retail alcohol sales jumped by 55% nationally during the third week of March, when many stay-at-home orders were put in place, according to Nielsen data, and online sales skyrocketed.

    Many of these trends remained for weeks. Nielsen also notes that the selling of to-go alcohol has helped sustain businesses.

    But the consumption of all this alcohol can be problematic for individuals, even those who haven’t had trouble with drinking in the past.

    Dr. Sarah Johnson, medical director of Landmark Recovery, an addiction treatment program based in Louisville, Kentucky, with locations in the Midwest said that, virtual events aside, the pandemic has nearly put an end to social drinking.

    “It’s not as much going out and incorporating alcohol into a dinner or time spent with family or friends,” Johnson said. “Lots of people are sitting home drinking alone now and, historically, that’s been viewed as more of a high-risk drinking behavior.”

    There are some objective measures of problematic drinking. The Centers for Disease Control and Prevention defines heavy drinking as 15 or more drinks a week for a man or eight or more for a woman.

    But Johnson said that more important clues come from changes in behavior. She explains that, for some people, a bit of extra drinking now and then isn’t a big deal.

    “If they are still meeting all of their life obligations, like they are still getting up and making their Zoom meetings on time, and they’re not feeling so bad from drinking that they can’t do things, and taking care of their children and not having life problems, then it’s not a problem,” Johnson said. “It’s when people start to have problems in other areas of their life, then it would be a signal that they are drinking too much and that it’s a problem.”

    But there are signs to watch out for, she says. They include:

    • Big increases in the amount of alcohol consumed
    • Concern expressed by family or friends
    • Changes in sleep patterns, either more or less sleep than usual
    • Any time that drinking interferes with everyday life

    Johnson noted that for many people, living under stay-at-home orders without the demands of a daily commute or lunch break could be problematic.

    “Routine and structure are important to overall mental health because they reduce stress and elements of unknown or unexpected events in daily life,” Johnson said. “These can trigger individuals in recovery to revert to unhealthy coping skills, such as drinking.”

    Johnson explained that while some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Johnson said that people who are unable to stop problematic drinking on their own should seek help. The federal Substance Abuse and Mental Health Services Administration runs a 24/7 helpline (800-662-HELP) and website, www.findtreatment.gov, offering referrals for addiction treatment.

    Peer support is also available online. Many Alcoholics Anonymous groups have started to offer virtual meetings, as does the secular recovery group LifeRing. And for people who are looking for more informal peer support, apps such as Loosid help connect communities of sober people.

    Darrell Loo at Waldo Thai said that he has been concerned at times about people’s drinking but that he generally has seen customers back off from the heavy drinking they were doing early in the pandemic.

    Loo and others in the Kansas City restaurant business are pushing for the carryout cocktails and other looser laws to stay in place even as restaurants slowly start to reopen.

    “This will go on for a while. It’s going to change people’s habit,” Loo said. “People’s spending habit. People’s dining out habit. So there’s definitely a need to keep doing it.”

    This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.

    View the original article at thefix.com

  • In Hard-Hit Areas, COVID’s Ripple Effects Strain Mental Health Care Systems

    Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened.

    In late March, Marcell’s girlfriend took him to the emergency room at Henry Ford Wyandotte Hospital, about 11 miles south of Detroit.

    “I had [acute] paranoia and depression off the roof,” said Marcell, 46, who asked to be identified only by his first name because he wanted to maintain confidentiality about some aspects of his illness.

    Marcell’s depression was so profound, he said, he didn’t want to move and was considering suicide.

    “Things were getting overwhelming and really rough. I wanted to end it,” he said.

    Marcell, diagnosed with schizoaffective disorder seven years ago, had been this route before but never during a pandemic. The Detroit area was a coronavirus hot spot, slamming hospitals, attracting concerns from federal public health officials and recording more than 1,000 deaths in Wayne County as of May 28. Michigan ranks fourth among states for deaths from COVID-19.

    The crisis enveloping the hospitals had a ripple effect on mental health programs and facilities. The emergency room was trying to get non-COVID patients out as soon as possible because the risk of infection in the hospital was high, said Jaime White, director of clinical development and crisis services for Hegira Health, a nonprofit group offering mental health and substance abuse treatment programs. But the options were limited.

    Still, the number of people waiting for beds at Detroit’s crisis centers swelled. Twenty-three people in crisis had to instead be cared for in a hospital.

    This situation was hardly unique. Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened. Mobile crisis teams, residential programs and call centers, especially in pandemic hot spots, had to reduce or close services. Some programs were plagued by shortages of staff and protective supplies for workers.

    At the same time, people battling mental health disorders became more stressed and anxious.

    “For people with preexisting mental health conditions, their routines and ability to access support is super important. Whenever additional barriers are placed on them, it could be challenging and can contribute to an increase in symptoms,” said White.

    After eight hours in the emergency room, Marcell was transferred to COPE, a community outreach program for psychiatric emergencies for Wayne County Medicaid patients.

    “We try to get patients like him into the lowest care possible with the least restrictive environment,” White said. “The quicker we could get him out, the better.”

    Marcell was stabilized at COPE over the next three days, but his behavioral health care team couldn’t get him a bed in one of two local residential crisis centers operated by Hegira. Social distancing orders had reduced the beds from 20 to 14, so Marcell was discharged home with a series of scheduled services and assigned a service provider to check on him.

    However, Marcell’s symptoms ― suicidal thoughts, depression, anxiety, auditory hallucinations, poor impulse control and judgment ― persisted. He was not able to meet face-to-face with his scheduled psychiatrist due to the pandemic and lack of telehealth access. So, he returned to COPE three days later. This time, the staff was able to find him a bed immediately at a Hegira residential treatment program, Boulevard Crisis Residential in Detroit.

    Residents typically stay for six to eight days. Once they are stabilized, they are referred elsewhere for more treatment, if needed.

    Marcell ended up staying for more than 30 days. “He got caught in the pandemic here along with a few other people,” said Sherron Powers, program manager. “It was a huge problem. There was nowhere for him to go.”

    Marcell couldn’t live with his girlfriend anymore. Homeless shelters were closed and substance abuse programs had no available beds.

    “The big problem here is that all crisis services are connected to each other. If any part of that system is disrupted you can’t divert a patient properly,” said Travis Atkinson, a behavioral consultant with TBD Solutions, which collaborated on a survey of providers with the American Association of Suicidology, the Crisis Residential Association and the National Association of Crisis Organization Directors.

    White said the crisis took a big toll on her operations. She stopped her mobile crisis team on March 14 because, she said, “we wanted to make sure that we were keeping our staff safe and our community safe.”

    Her staff assessed hospital patients, including Marcell, by telephone with the help of a social worker from the emergency room.

    People like Marcell have struggled during the coronavirus crisis and continue to face hurdles because emergency preparedness measures didn’t provide enough training, funds or thought about the acute mental health issues that could develop during a pandemic and its aftermath, said experts.

    “The system isn’t set up to accommodate that kind of demand,” said Dr. Brian Hepburn, a psychiatrist and executive director of the National Association of State Mental Health Program Directors.

    “In Detroit and other hard-hit states, if you didn’t have enough protective equipment you can’t expect people to take a risk. People going to work can’t be thinking ‘I’m going to die,’” said Hepburn.

    For Marcell, “it was bad timing to have a mental health crisis,” said White, the director at Hegira.

    At one time Marcell, an African American man with a huge grin and a carefully trimmed goatee and mustache, had a family and a “pretty good job,” Marcell said. Then “it got rough.” He made some bad decisions and choices. He lost his job and got divorced. Then he began self-medicating with cocaine, marijuana and alcohol.

    By the time he reached the residential center in Detroit on April 1, he was at a low point. “Schizoaffective disorder comes out more when you’re kicked out of the house and it increases depression,” said Powers, the program manager who along with White was authorized by Marcell to talk about his care. Marcell didn’t always take his medications and his use of illicit drugs magnified his hallucinations, she said.

    While in the crisis center voluntarily, Marcell restarted his prescription medications and went to group and individual therapy. “It is a really good program,” he said while at the center in early May. “It’s been one of the best 30 days.”

    Hepburn said the best mental health programs are flexible, which allows them more opportunities to respond to problems such as the pandemic. Not all programs would have been able to authorize such a long stay in residential care.

    Marcell was finally discharged on May 8 to a substance abuse addiction program. “I felt good about having him do better and better. He had improved self-esteem to get the help he needed to get back to his regular life,” Powers said.

    But Marcell left the addiction program after only four days.

    “The [recovery] process is so individualized and, oftentimes, we only see them at one point in their journey. But, recovering from mental health and substance use disorders is possible. It can just be a winding and difficult path for some,” said White.

    Seeking Help

    If you or someone you know is in immediate danger, call 911. Below are other resources for those needing help:

    — National Helpline: 1-800-662-HELP (4357) or https://findtreatment.samhsa.gov.

    — National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

    — Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746.

    View the original article at thefix.com

  • Pandemic Presents New Hurdles, and Hope, for People Struggling with Addiction

    “There’s social distancing — to a limit…I think when someone’s life is in jeopardy, they’re worth saving. You just can’t watch people die.”

    Before Philadelphia shut down to slow the spread of the coronavirus, Ed had a routine: most mornings he would head to a nearby McDonald’s to brush his teeth, wash his face and — when he had the money — buy a cup of coffee. He would bounce between homeless shelters and try to get a shower. But since businesses closed and many shelters stopped taking new admissions, Ed has been mostly shut off from that routine.

    He’s still living on the streets.

    “I’ll be honest, I don’t really sleep too much,” said Ed, who’s 51 and struggling with addiction. “Every four or five days I get a couple hours.”

    KHN agreed not to use his last name because he uses illegal drugs.

    Philadelphia has the highest overdose rate of any big city in America — in 2019, more than three people a day died of drug overdoses there, on average. Before the coronavirus began spreading across the United States, the opioid overdose epidemic was the biggest health crisis on the minds of many city officials and public health experts. The coronavirus pandemic has largely eclipsed the conversation around the opioid crisis. But the crisis still rages on despite business closures, the cancellation of in-person treatment appointments and the strain on many addiction resources in the city.

    When his usual shelter wasn’t an option anymore, Ed tried to get into residential drug treatment. He figured that would be a good way to try to get back on his feet and, if nothing else, get a few good nights of rest. But he had contracted pinkeye, a symptom thought to be associated with the virus that leads to COVID-19, so the evaluation center didn’t want to place him in an inpatient facility until he’d gotten the pinkeye checked out. But he couldn’t see a doctor because he didn’t have a phone for a telehealth appointment.

    “I got myself stuck, and I’m trying to pull everything back together before it totally blows up,” he said.

    Rosalind Pichardo wants to help people in Ed’s situation. Before the pandemic, Pichardo would hit the streets of her neighborhood, Kensington, which has the highest drug overdose rate in Philadelphia. She’d head out with a bag full of snack bars, cookies and Narcan, the opioid overdose reversal drug.

    She’d hand Narcan out to people using drugs, and people selling drugs — anyone who wanted it. Pichardo started her own organization, Operation Save Our City, which initially set out to work with survivors of gun violence in the neighborhood. When she realized that overdoses were killing people too, she began getting more involved with the harm reduction movement and started handing out Narcan through the city’s syringe exchange.

    When Pennsylvania’s stay-at-home order went into effect, Pichardo and others worried that more people might start using drugs alone, and that fewer first responders would be patrolling the streets or nearby and able to revive them if they overdosed.

    So, Pichardo and other harm reduction activists gave out even more Narcan. A representative for Prevention Point Philadelphia, the group that operates a large syringe exchange program in the city, said that during the first month of the city’s stay-at-home order, they handed out almost twice as much Narcan as usual.

    After the lockdowns and social distancing began, Pichardo worried that more people would be using drugs alone, leading to more overdoses. But Philadelphia’s fatal overdose rate during the pandemic remains about the same as it was this time last year. Pichardo said she thinks that’s evidence that flooding the streets with Narcan is working — that people are continuing to use drugs, and maybe even using more drugs, but that users are utilizing Narcan more often and administering it to one another.

    That is the hope. But Pichardo said users don’t always have a buddy to keep watch, and during the pandemic first responders have seemed much more hesitant to intervene. For example, she recently administered Narcan to three people in Kensington who overdosed near a subway station, while two police officers stood by and watched. Before the pandemic, they would often be right there with her, helping.

    To reverse the overdoses, Pichardo crouched over the people who she said had started turning blue as their oxygen levels dropped. She injected the Narcan into their noses, using a disposable plastic applicator. Normally, she would perform rescue breathing, too, but since the pandemic began she has started carrying an Ambu bag, which pumps air into a person’s lungs and avoids mouth-to-mouth resuscitation. Among the three people, she said, it took six doses of Narcan to revive them. The police officers didn’t step in to help but did toss several overdose-reversal doses toward Pichardo as she worked.

    “I don’t expect ’em to give ’em rescue breaths if they don’t want to, but at least administer the lifesaving drug,” Pichardo said.

    In her work as a volunteer, she has reversed almost 400 overdoses, she estimated.

    “There’s social distancing — to a limit,” Pichardo said, “I think when someone’s life is in jeopardy, they’re worth saving. You just can’t watch people die.”

    Even before Philadelphia officially issued its stay-at-home order, city police announced they would stop making low-level arrests, including for narcotics. The idea was to reduce contact overall, help keep the jail population low and reduce the risk of the virus getting passed around inside. But Pichardo and other community activists said the decreased law enforcement emboldened drug dealers in the Kensington neighborhood, where open-air drug sales and use are common.

    “You can tell they have everything down pat, from the lookout to the corner boys to the one actually holding the product — the one holding the product’s got some good PPE gear,” said Pichardo.

    More dealers working openly on the street has led to more fights over territory, she added, which in turn has meant more violence. While overall crime in Philadelphia and other major cities has declined during the pandemic, gun violence has spiked.

    Police resumed arrests at the beginning of May.

    Now when she goes out to offer relief and hand out Narcan, Pichardo packs a few extra things in her bag of supplies: face masks, gloves and gun locks.

    “It’s like the survival kit of the ’hood,” she said.

    For those struggling with addiction who are ready to start recovery, newly relaxed federal restrictions have made it easier to get medications that curb opioid cravings and stem withdrawal. Several efforts are underway among Philadelphia-based public health groups and criminal justice advocacy organizations to give cellphones to people who are homeless or coming out of jail, so they can make a telehealth appointment and get quicker access to a prescription for those medicines.

    During the pandemic, people taking medication-assisted treatment can renew their prescription every month instead of every week, which helps decrease trips to the pharmacy. It is too soon to know if more people are taking advantage of the new rules, and accessing medication-assisted treatment via telehealth, but if that turns out to be the case, many addiction medicine specialists argue the new rules should become permanent, even after the pandemic ends.

    “If we find that these relaxed restrictions are bringing more people to the table, that presents enormous ethical questions about whether or not the DEA should reinstate these restrictive policies that they had going in the first place,” said Dr. Ben Cocchiaro, a physician who treats people with substance-use disorder.

    Cocchiaro said the whole point of addiction treatment is to facilitate help as soon as someone is ready for it. He hopes if access to recovery can be made simpler during a pandemic, it can remain that way afterward.

    This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.

    View the original article at thefix.com

  • Avoiding Family Drama During the Covid-19 Pandemic

    When the pandemic broke out, for the first time since I left home, I felt conflicted between the need to learn my brothers are safe and my need to maintain a drama-free life.

    Several times since the Covid-19 pandemic broke out, I have wondered whether my brothers were safe. Knowing whether John*, my middle brother, was okay was easy. Although we’ve not talked to each other in 12 years, I found out through two of our mutual childhood friends that he was not one of the more than 350,000 people in his state who have contracted the virus.

    Finding out whether Marco* was okay took several weeks. Nobody in our family and none of my childhood friends can deal with him. He has bipolar disorder, and since his diagnosis 39 years ago, he has consistently refused meds. He’s verbally and physically abusive to most people he comes in contact with, especially women, which he came by honestly as the saying goes.

    I never needed a diagnosis to know something was seriously off with Marco. Looking back, he exhibited all the signs: stretches of mania followed by equally long bouts of depression, calculated and well-thought-out verbal and physical assaults, and rage that seemed to come from nowhere.

    When I was 10 (Marco is four years older than I) he planned out his first of two attempts to kill one of the neighbors in our Manhattan apartment building. He tied a thin wire across the top of the staircase. He then rang the doorbell and tried to lure this woman out of her apartment and down those marble stairs, where she would surely have fallen to her death. She saw the wire just in the nick of time and held onto the banister. Marco was hiding out of sight, snickering.

    He told our parents he did it because the neighbor wouldn’t let him play with her daughter. Laughing as he retold the story was creepy as hell.

    A few days later while staring out the window, Marco noticed the same neighbor climbing out of a cab. He had a 10-gallon garbage bag already filled with water, waiting beside the window. As she closed the car door, Marco dropped that 85-pound “water balloon” down 10 flights. It missed our neighbor by a hair and she did as anyone would do: she looked up and saw Marco looking out the window. He not only didn’t duck inside (as most people would have done), he yelled out to her, “Better luck next time!” Although none of us saw this happen, his version of events was identical to hers.

    With me Marco had a trigger hand, like our father. If our father didn’t like something I said or did, I would get knocked across the room. Our father beat all three of us whenever he felt like it, which was probably three to four times a week, as did his father to him growing up. When I was 14, I paid $25.00 from my babysitting money to a neighborhood kid to install a lock on my bedroom door. I couldn’t control the world outside my bedroom, but I could protect myself in my own room.

    And what was John doing as Marco was abusing his sister and trying to kill the neighbor? John has always been good at taking care of John and ignoring everyone else. Give him a substance and the world ceases to exist.

    Forgive and Forget Because Nothing is More Important Than Family

    Those who don’t know my family or think I’m exaggerating when I describe what it was like growing up usually say things to me like, “Nothing is more important than family,” “Whatever happened, just forgive him and move on” or “You’ll regret it when you get older.”

    The last comment has some merit. We are all in our 50s, and I’m acutely aware there are fewer years in front of us than behind. Our parents are now deceased, so they’re non-issues in the forgive and forget department. But for the living, reconciliation isn’t always so easy.

    It involves real work my brothers are too stuck to do. The apple rarely falls far from the tree, although the real mystery isn’t how one brother has bipolar and the other is an alcoholic. The question I’ve had my whole life is, why didn’t I become an alcoholic, have bipolar or both?

    Depression, bipolar disorder and alcoholism run on both sides of my family. My mother struggled with depression and used alcohol to self-medicate. She was a functional alcoholic—so functional that she was the editor for The New Yorker Magazine for years. While she rarely hit me, my mother was the queen of belittling. To give you an idea how biting her tongue could be, when I hit adolescence and my body started changing, she told me, “I don’t know what I did in life to deserve a mother, a best friend, a husband and a daughter who are all fat.”

    My father was a different variety of excrement. He just shit on everyone he knew and claimed to love. When he wasn’t confessing his mortal marital sins to my mother on a near-weekly basis, he was beating the crap out of us. He used whatever was handy: a book, a shoe, a belt, his fist, his legs to kick us, and when he was really frustrated, he’d throw things at us.

    My mother used to say, “Parents give their children unspoken commands their children learn to implicitly obey.” Marco and John learned at a young age to throw weapons instead of using their words. Their weapons of choice included a skateboard, a frying pan, scissors, lamps, glass bottles and a hammer. It amazes me they’re both still alive.

    Shorter and less muscular than Marco, John took up martial arts when he was 11. By the time he was 15, John was a black belt in three styles of Kung Fu. He was still shorter than Marco, but now his weapons became sharper, his hands and arms stronger, and he could inflict serious, life-altering damage. I lost count of how often I had to call the police because I wasn’t about to get in the middle of a fight between two rabid dogs.

    I used to pray for my parents and brothers to get arrested, so I could raise myself.

    Aleutian Islands: Same Name, Not Connected

    After I graduated from high school at 16, I rented a furnished room in the apartment of a different neighbor. By 17, I was in therapy, where I was diagnosed with PTSD and a panic disorder. I would end up spending seven years with Barbara, working through the damage of my childhood. Together, we dismantled me so we could put me back together. I was 24 when Barbara and I decided I was ready to go out into the world without an attendant.

    The first few years after I left home—especially while I was still in therapy—I hardly spoke with my parents or my brothers. I honestly didn’t know what Marco was doing, but I knew from various people he was fine and living with a woman in another state. Periodically, I’d run into John on the street. On those occasions we were cordial, but there was nothing to talk about. It was like seeing someone from my childhood I had nothing in common with now. We’d promise to catch up, knowing full well neither of us would make that call.

    Weeks turned into months and eventually years between check-ins with my brothers. I spoke with my parents every so often because, no matter how much work I’d done on myself, I was also raised with a sense of obligation, and daughters aren’t supposed to just cut off their parents. While they were still alive, I controlled the direction of the conversations to keep them from touching on areas that could trigger me.

    I once told Barbara in therapy that I felt like we were the Aleutian Islands. They were people I knew but had no connection to. I didn’t hate them; I felt nothing for them. My mother used to say, “The opposite of love isn’t hate. It’s indifference.” She was right.

    I met my husband in 1996 and we were married in 2001 while living in Southern California. Although all of my girlfriends who had previously gotten married and who were getting married opted to keep their maiden names, I couldn’t wait to change mine. Despite being every bit as feminist as my friends, for them the decision to keep their maiden name was about maintaining their identity. For me, the act of changing my last name meant adopting a new one.

    As important as leaving my home the first chance I got and staying in therapy for seven years (no matter how uncomfortable things got sometimes), changing my name allowed me to reinvent myself.

    The beauty of having a different last name is that, unless I tell people my maiden name, nobody knows I have any association with those people. It helps that I have an amazing relationship with my husband’s family, who have been my tribe for 23 years.

    Today, my husband and I live in Puerto Rico on an organic farm. We have rich relationships with people both in Puerto Rico and the States. When I think about the stark contrast between my life then and now, I’m reminded of a quote by Maya Angelou: “Family isn’t always blood, it’s the people in your life who want you in theirs: the ones who accept you for who you are, the ones who would do anything to see you smile and who love you no matter what.”

    Separate Lives in the Time of Covid-19

    My husband and I have talked with my brothers a handful of times over the last 24 years we’ve been together. My mother died in 1994 and, after my father’s death in 2002, I was named executor of my parents’ estate. I had to periodically be in touch with both brothers for signatures on this or that document required to sell our parents’ home, which we did in 2008. Between then and now, I had no desire to contact them.

    When the pandemic broke out, for the first time since I left home, I felt conflicted between the need to learn they’re safe and my need to maintain a drama-free life. Once I found John was alive, I felt I was halfway to feeling I wouldn’t need to expose myself.

    It took several weeks, but I was finally able to confirm Marco is also safe from Covid-19. I remembered a nickname he used to refer to himself when we were younger and during times he was manic. I started googling versions of the nickname and eventually came across his Twitter profile.

    He’s on his fourth wife, living somewhere in the Midwest. What I read were 75 tweets in rapid fire succession about everything that angers him that nobody reacted to or commented on. Based on my accelerated heart rate while reading them, I deduced he still isn’t treating his bipolar disorder. I got what I came for: I know he’s alive. Now that I know both my brothers are safe from Covid-19, and that I can continue to confirm it without reaching out to them, I no longer have to wonder and I can continue living my life.

    View the original article at thefix.com

  • Flattening the mental health curve is the next big coronavirus challenge

    Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself.

    The mental health crisis triggered by COVID-19 is escalating rapidly. One example: When compared to a 2018 survey, U.S. adults are now eight times more likely to meet the criteria for serious mental distress. One-third of Americans report clinically significant symptoms of anxiety or clinical depression, according to a late May 2020 release of Census Bureau data.

    While all population groups are affected, this crisis is especially difficult for students, particularly those pushed off college campuses and now facing economic uncertainty; adults with children at home, struggling to juggle work and home-schooling; and front-line health care workers, risking their lives to save others.

    We know the virus has a deadly impact on the human body. But its impact on our mental health may be deadly too. Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself. The latest study from the Well Being Trust, a nonprofit foundation, estimates that COVID-19 may lead to anywhere from 27,644 to 154,037 additional U.S. deaths of despair, as mass unemployment, social isolation, depression and anxiety drive increases in suicides and drug overdoses.

    But there are ways to help flatten the rising mental health curve. Our experience as psychologists investigating the depression epidemic and the nature of positive emotions tells us we can. With a concerted effort, clinical psychology can meet this challenge.

    Reimagining mental health care

    Our field has accumulated long lists of evidence-based approaches to treat and prevent anxiety, depression and suicide. But these existing tools are inadequate for the task at hand. Our shining examples of successful in-person psychotherapies – such as cognitive behavioral therapy for depression, or dialectical behavioral therapy for suicidal patients – were already underserving the population before the pandemic.

    Now, these therapies are largely not available to patients in person, due to physical distancing mandates and continuing anxieties about virus exposure in public places. A further complication: Physical distancing interferes with support networks of friends and family. These networks ordinarily allow people to cope with major shocks. Now they are, if not completely severed, surely diminished.

    What will help patients now? Clinical scientists and mental health practitioners must reimagine our care. This includes action on four interconnected fronts.

    First, the traditional model of how and where a person receives mental health care must change. Clinicians and policymakers must deliver evidence-based care that clients can access remotely. Traditional “in-person” approaches – like individual or group face-to-face sessions with a mental health professional – will never be able to meet the current need.

    Telehealth therapy sessions can fill a small part of the remaining gap. Forms of nontraditional mental health care delivery must fill the rest. These alternatives do not require reinvention of the wheel; in fact, these resources are already readily accessible. Among available options: web-based courses on the science of happiness, open-source web-based tools and podcasts. There are also self-paced, web-based interventions – mindfulness-based cognitive therapy is one – which are accessible for free or at reduced rates.

    Democratizing mental health

    Second, mental health care must be democratized. That means abandoning the notion that the only path to treatment is through a therapist or psychiatrist who dispenses wisdom or medications. Instead, we need other kinds of collaborative and community-based partnerships.

    For example, given the known benefits of social support as a buffer against mental distress, we should enhance peer-delivered or peer-supported interventions – like peer-led mental health support groups, where information is communicated between people of similar social status or with common mental health problems. Peer programs have great flexibility; after orientation and training, peer leaders are capable of helping individual clients or groups, in person, online or via the phone. Initial data shows these approaches can successfully treat severe mental illness and depression. But they are not yet widely used.

    Taking a proactive approach

    Third, clinical scientists must promote mental health at the population level, with initiatives that try to benefit everyone rather than focusing exclusively on those who seek treatment. Some of these promotion strategies already have clear-cut scientific support. In fact, the best-supported population interventions, such as exercise, sleep hygiene and spending time outdoors, lend themselves perfectly to the needs of the moment: stress-relieving, mental illness-blocking and cost-free.

    Finally, we must track mental health on the population level, just as intensely as COVID-19 is tracked and modeled. We must collect much more mental health outcome data than we do now. This data should include evaluations from mental health professionals as well as reports from everyday citizens who share their daily experiences in real time via remote-based survey platforms.

    Monitoring population-level mental health requires a team effort. Data must be collected, then analyzed; findings must be shared across disciplines – psychiatry, psychology, epidemiology, sociology and public health, to name a few. Sustained funding from key institutions, like the NIH, are essential. To those who say this is too tall an order, we ask, “What’s the alternative?” Before flattening the mental health curve, the curve must be visible.

    COVID-19 has revealed the inadequacies of the old mental health order. A vaccine will not solve these problems. Changes to mental health paradigms are needed now. In fact, the revolution is overdue.
     

    [You need to understand the coronavirus pandemic, and we can help.Read The Conversation’s newsletter.]

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Don't Relapse Now

    Time has paused, life has paused, why can’t sobriety pause too?

    Reader, I will make a deal with you. I will talk to you like an adult and say some uncomfortable things. I won’t be your sponsor and I won’t throw the Big Book at your face. But in exchange, you need to promise me you’ll read this to the end. No skips, no tag outs, no skimmy skims. Okay? Okay, great.

    I understand the urge to relapse right now. I’m feeling it too. A lot of us have severely diminished responsibilities – my work has nearly dried up. I hate the Zoom meetings, which feel like impersonal shadow plays where I have to stare at my new fat face. All our other distractions that can’t be done from the couch have been cancelled. My normie friends are mixing up quarantinis before the 5 o’clock news starts. Most importantly, we are all being treated to a daily blast of death, inequity, and press conferences where a poorly tanned moron tells us to shoot up with bleach. It is so much. It is a daily mental weight that is difficult to bear even on the best days.

    If you are saying to yourself, maybe I can’t hold out on this, maybe I am going to break, that is a sane response. It is, in some ways, a rational response. Time has paused, life has paused, why can’t sobriety pause too? The other day I found myself telling a friend that I won’t be jobless, locked down, without the beach (my favorite distraction), and sober. In full Scarlett O’Hara mode, I declared, “Sorry, but I won’t do it!” It felt good to say, the way forbidden things sometimes do. Total, unapologetic narcissism has its pleasures.

    I could probably get away with it, too. I could probably go on a few-days bender and maybe my boyfriend would figure it out (he is sharp!), but no one else would. I could even keep my day count! Why not?!? This is the sort of self-dealing I’ve been doing. I am so good at it. I am the Clarence Darrow of fucking my own shit up.

    But it is wrong. I know it’s wrong. If you are having similar thoughts, you probably know they are wrong too. Even now, with life halted and pain and injustice ascendant, there are reasons both practical and metaphysical that it is crucial for you and me to keep our sober time. Even if every word we ever heard at an AA meeting was false, even if the Big Book itself is a decades-long scam to sell us on religion.

    Practically, you are going to regret it. You know you are! Sorry, but you do. You are going to be annoyed, at the very least, that you need to restart your day count, which yes, you eventually will be forced to do because you won’t be able to lie to your support network for that long. Whatever bender you have in mind is going to come to an end, in what will feel like the blink of an eye, and all you’ll have left is regret and likely, a terrible headache or worse. You also, of course, might take it too far and die.

    If things get really bad, as they very well may, people are going to know what you did and that is going to suck for you. Your family and friends are already extremely stressed out right now (just like you!) – the last thing they need is to hear that you relapsed, in your tiny apartment in some faraway city, and no one can travel to you to make sure you get it together. Your mom is going to cry.

    On that note, if you need hospital care because you overdose or can’t stop, great, you are taxing an already overtaxed healthcare system and exposing yourself to COVID19 at the same time. From a million different standpoints, any decision to relapse right now is selfish, even if it feels like the only person being punished is you.

    Okay, who cares, right? I hear that. When I was first trying to get sober and in a relapse cycle, other people’s problems were some theoretical concern that was a not-close second to my immediate ego gratification. I did not give a shit, and honestly I didn’t care much if I died, either. What worked for me, though, was spite – not giving my enemies the pleasure of seeing me fall.

    Spite could be helpful right now. Picture Donald Trump, in all his 300 pounds of dense mass, standing over you as you take that first drink. “I was always right,” he says without laughing, as he never laughs, “You’re weak. Libs like you, weak, lazy.” Do you want Donald Trump to think he’s better than you? How about the maskless crowds begging states to let them kill themselves, and each other? Should these yahoos and sociopaths be allowed to feel morally superior to you? Or picture a little closer to home. Do you want your douchebag ex to hear that you fucked up again? No you do not.

    The time we’ve all spent cooped up indoors losing our gourds has been an achievement which can be measured in days and lives saved. We’ve been doing this for well over thirty days now. In New York and elsewhere, we’ve flattened the curve. Your sobriety is the same. It’s not some fungible commodity that can be lent out and borrowed back at will – it has a character in itself composed in part of a temporal element. Your sobriety after you relapse is not the same as your sobriety before. When you give it up, you give up effort, sacrifice, things you can never get back. That might not feel important now, but it will feel devastating later.

    Look, I am not Mr. Lockdown. I eat loaves of bread as a snack. I stay up most nights until 5 AM and I sleep till 11. I bleached my hair. I play Nintendo Switch and try to get one or two productive hours into a day. My sheets smell like farts. All of this is fine! You do what it takes to make it to the next day. The people doing pilates every morning, learning a second language, making OnlyFans, whatever – they are fine, too. And it’s even fine to hate them!

    “One day at a time” is a relentless cliché in sobriety circles. But right now, it feels appropriate, as all of the stupid sayings eventually do. The world is a miserable place, maybe always, definitely right now. Don’t add to the misery by giving in to the demons you fought so hard to keep at bay. Be strong, stay home, save lives, stay sober. Good luck.

    View the original article at thefix.com

  • Coronavirus, ‘Plandemic’ and the seven traits of conspiratorial thinking

    Learning these traits can help you spot the red flags of a baseless conspiracy theory and hopefully build up some resistance to being taken in by this kind of thinking.

    The conspiracy theory video “Plandemic” recently went viral. Despite being taken down by YouTube and Facebook, it continues to get uploaded and viewed millions of times. The video is an interview with conspiracy theorist Judy Mikovits, a disgraced former virology researcher who believes the COVID-19 pandemic is based on vast deception, with the purpose of profiting from selling vaccinations.

    The video is rife with misinformation and conspiracy theories. Many high-quality fact-checks and debunkings have been published by reputable outlets such as Science, Politifact and FactCheck.

    As scholars who research how to counter science misinformation and conspiracy theories, we believe there is also value in exposing the rhetorical techniques used in “Plandemic.” As we outline in our Conspiracy Theory Handbook and How to Spot COVID-19 Conspiracy Theories, there are seven distinctive traits of conspiratorial thinking. “Plandemic” offers textbook examples of them all.

    Learning these traits can help you spot the red flags of a baseless conspiracy theory and hopefully build up some resistance to being taken in by this kind of thinking. This is an important skill given the current surge of pandemic-fueled conspiracy theories.


    The seven traits of conspiratorial thinking. (John Cook CC BY-ND)

    1. Contradictory beliefs

    Conspiracy theorists are so committed to disbelieving an official account, it doesn’t matter if their belief system is internally contradictory. The “Plandemic” video advances two false origin stories for the coronavirus. It argues that SARS-CoV-2 came from a lab in Wuhan – but also argues that everybody already has the coronavirus from previous vaccinations, and wearing masks activates it. Believing both causes is mutually inconsistent.

    2. Overriding suspicion

    Conspiracy theorists are overwhelmingly suspicious toward the official account. That means any scientific evidence that doesn’t fit into the conspiracy theory must be faked.

    But if you think the scientific data is faked, that leads down the rabbit hole of believing that any scientific organization publishing or endorsing research consistent with the “official account” must be in on the conspiracy. For COVID-19, this includes the World Health Organization, the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration, Anthony Fauci… basically, any group or person who actually knows anything about science must be part of the conspiracy.

    3. Nefarious intent

    In a conspiracy theory, the conspirators are assumed to have evil motives. In the case of “Plandemic,” there’s no limit to the nefarious intent. The video suggests scientists including Anthony Fauci engineered the COVID-19 pandemic, a plot which involves killing hundreds of thousands of people so far for potentially billions of dollars of profit.

    4. Conviction something’s wrong

    Conspiracy theorists may occasionally abandon specific ideas when they become untenable. But those revisions tend not to change their overall conclusion that “something must be wrong” and that the official account is based on deception.

    When “Plandemic” filmmaker Mikki Willis was asked if he really believed COVID-19 was intentionally started for profit, his response was “I don’t know, to be clear, if it’s an intentional or naturally occurring situation. I have no idea.”

    He has no idea. All he knows for sure is something must be wrong: “It’s too fishy.”

    5. Persecuted victim

    Conspiracy theorists think of themselves as the victims of organized persecution. “Plandemic” further ratchets up the persecuted victimhood by characterizing the entire world population as victims of a vast deception, which is disseminated by the media and even ourselves as unwitting accomplices.

    At the same time, conspiracy theorists see themselves as brave heroes taking on the villainous conspirators.

    6. Immunity to evidence

    It’s so hard to change a conspiracy theorist’s mind because their theories are self-sealing. Even absence of evidence for a theory becomes evidence for the theory: The reason there’s no proof of the conspiracy is because the conspirators did such a good job covering it up.

    7. Reinterpreting randomness

    Conspiracy theorists see patterns everywhere – they’re all about connecting the dots. Random events are reinterpreted as being caused by the conspiracy and woven into a broader, interconnected pattern. Any connections are imbued with sinister meaning.

    For example, the “Plandemic” video suggestively points to the U.S. National Institutes of Health funding that has gone to the Wuhan Institute of Virology in China. This is despite the fact that the lab is just one of many international collaborators on a project that sought to examine the risk of future viruses emerging from wildlife.

    Learning about common traits of conspiratorial thinking can help you recognize and resist conspiracy theories.

    Critical thinking is the antidote

    As we explore in our Conspiracy Theory Handbook, there are a variety of strategies you can use in response to conspiracy theories.

    One approach is to inoculate yourself and your social networks by identifying and calling out the traits of conspiratorial thinking. Another approach is to “cognitively empower” people, by encouraging them to think analytically. The antidote to conspiratorial thinking is critical thinking, which involves healthy skepticism of official accounts while carefully considering available evidence.

    Understanding and revealing the techniques of conspiracy theorists is key to inoculating yourself and others from being misled, especially when we are most vulnerable: in times of crises and uncertainty.

    [Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

    John Cook, Research Assistant Professor, Center for Climate Change Communication, George Mason University; Sander van der Linden, Director, Cambridge Social Decision-Making Lab, University of Cambridge; Stephan Lewandowsky, Chair of Cognitive Psychology, University of Bristol, and Ullrich Ecker, Associate Professor of Cognitive Science, University of Western Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Capitalizing on Smoking Cessation Could Curb Coronavirus Deaths

    The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. 

    Politicians have been hyper-focused on the drug hydroxychloroquine lately, hoping it will be a silver bullet for curbing deaths from coronavirus. Physicians, on the other hand, are less convinced it will be helpful. But we’ve already got a medical intervention that could dramatically alter the course of the pandemic: smoking cessation. Fighting the smoking pandemic could curb coronavirus deaths now and save lives in the years to come. 

    Many people smoke and vape to stay calm. So with rising rates of coronavirus anxiety, it’s no surprise that cigarette and vaping sales are booming. But emerging evidence shows smokers are at a higher risk of serious coronavirus infection. If there were ever a time to quit, it’s now. 

    The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. One study from China estimated that smoking is associated with a 14-fold increased odds of COVID-19 infection progressing to serious illness. This might be because smoking increases the density of the lung’s ACE2 receptors, which the coronavirus exploits to infiltrate the body. On top of this, smoking weakens the immune system’s ability to fight the virus, as well as heart and lung tissue. All of this damage increases one’s risk of severe coronavirus infection and death. 

    While less is known about vaping’s relationship to coronavirus, research suggests that it impairs the ability of immune cells in the lung to fight off infection. This appears to be related to solvents used in vaping products and occurs independent of their nicotine content. Vaping also shares another risk factor for coronavirus with smoking—it involves putting something you touch with your hands into your mouth over and over. Unless you’re washing your hands and cleaning your vape religiously, you’re putting yourself at risk. On top of this, we know that many people—especially those who are younger—like to share their vapes, which really increases the chances of catching the virus. 

    Most smokers want to quit and find that their stress levels drop dramatically when they do. Many vapers want to stop too. Quitting alone can be nearly impossible though. Luckily, support is available. Primary care physicians are still working via telehealth, and they have a wide range of effective treatments for what doctors call “tobacco use disorder.” If you can’t reach your doctor, The U.S. Centers for Disease Control has created a national hotline for support and free counselling: 1-800-QUIT-NOW.

    Psychotherapy is one approach to quitting. However, medications such as bupropion and varenicline are also effective and can be obtained with a phone call to your doctor. Nicotine replacement products like gum, lozenges, patches, and inhalers also greatly increase the odds of success and are available over the counter. Few people are aware that you can purchase these with your health savings and flexible spending accounts. 

    34 million people in the US smoke, and there have already been nearly 700,000 documented domestic cases of coronavirus. Given the number of deaths we could face from people smoking during this pandemic, lawmakers should be doing everything they can to make it easier for people to quit. When patients have better insurance coverage for smoking cessation treatments, they’re much more likely to use them and quit smoking. 

    Federal law requires insurers to cover cessation treatments, but they get around this by restricting access through the use of co-pays and limits on the amounts covered, while also forcing physicians to spend hours on the phone getting them to authorize coverage of medication. With people dying by the tens of thousands, Washington needs to close these loopholes now.

    Amid the widespread panic around coronavirus, it’s important that we stay clear-headed and not overlook easy fixes that could save lives. We know that smoking cessation interventions could prevent deaths, so let’s make sure we’re taking advantage of them.

    View the original article at thefix.com

  • A Lesson from Sobriety: You Are Allowed to Feel Hopeful

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species.

    Imagine waking up one day and everything has changed. Overnight you’ve lost the ability to go to work. All the places you eat, drink, and socialize are closed. You walk down the street and people cross over to avoid your path. You are living the definition of empty. Void. Vast nothingness. You have no idea what tomorrow will bring, but if it’s more of the same, you might not want to have another tomorrow.

    Welcome to the reality of COVID-19. Many of us are currently living under stay at home orders where the situation feels similar to what I’ve described. Overnight, jobs lost or sent to work from home, daycares and schools closed, the few restaurants remaining open offer take out only, and, for some reason, toilet paper has become the national currency. I’ve noticed life during a pandemic has some clear parallels to life when contemplating going from substance abuser to sober.

    Fortunately, most of us can survive this pandemic if we practice some safety guidelines and weather a storm that has an uncertain end date. Again, the same can be said for sobriety. When I first contemplated sobriety, the uncertainty of what the future would look like kept me from moving forward. Eventually, I had to embrace this. I looked at what my life had become versus what I wanted it to be and I knew even uncertainty was better than the present.

    I made the decision to become sober six years ago. For me, sobriety meant losing a routine I’d become comfortably habituated to. A destructive routine that involved daily consumption of alcohol, often until I couldn’t drink any more on any given night. Right now, we are being told our normal routine could lead to a worsening of the pandemic, the potential to spread the disease and expose those most vulnerable to its fatal effects. We’ve been asked to willingly adjust our routines with the absence of an end date.

    In sobriety, I had to define a new normal. This happened both purposely and organically. Part of what I did was attend counseling and AA sessions. That was on purpose. I also started writing more and performing better at work. That was more organic. I didn’t order alcoholic beverages while out with clients and colleagues. That was on purpose. I fell in love with ice cold seltzer water. That was organic.

    We don’t know what our new normal will look like after this first round of COVID-19. There are some behaviors many of us have adopted that will probably persist: wearing masks, avoiding handshakes, increased hand washing. We will adopt other behaviors or adapt in ways we can’t foresee in the coming months. Many of these will bring us joy, or at least decrease potential future situations like our present condition.

    The Present and the Presence of Hope

    Everyone–sober, drunk, or indifferent–is facing some unexpected hardships right now. We’ve been told by experts we are experiencing loss and should feel permission to grieve. This is true. But we have permission to feel hopeful as well. Hope is what led me to embrace and eventually thrive in sobriety. Hope will get us through this pandemic.

    I could have never imagined the wonderful things waiting for me on the other side of sobriety. A marriage (later a divorce, but hey), a child, Saturday mornings, physical health, mental clarity, reduced anxiety, and vomit-free carpets are only some of the things I wouldn’t have accomplished if I were still drinking.

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species. Hope has kept individuals and societies moving forward to better ourselves since the time our external gills disappeared, and our tails fell off. Or we were fashioned from dust. Whatever you choose.

    Hope is what countered the fear and uncertainty I felt initially entering sobriety. Excitement for a future without the shackles of alcohol. We are in the same situation now; there’s no other motivation to go through this if we have no hope the future will bring something better than the present.

    We have some time before this will pass. Spend some of it dwelling on hope. Make a list of things that might be better post-pandemic. Plan your dream vacation (we will travel again). Do something you’ve always wanted to do for yourself. Along with anxiety, fear, or grief, you are allowed to feel hope and excitement in our current situation. Something different is waiting for you. Potentially something better than you can imagine.

    View the original article at thefix.com