“These early trends should be concerning enough such that heart transplantation centers need to thoroughly evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors,” said Shivank Madan, MD, MHA, lead author of the study and a cardiologist at the Center for Advanced Cardiac Therapy at Montefiore Medical Center/Albert Einstein College of Medicine in New York.

The COVID-19 pandemic presented challenges for heart transplantation since transplant centers had to continuously modify their recipient and donor management protocols as the pandemic and understanding of the virus evolved. There continues to be a lack of data around long-term outcomes of transplants from COVID-19 infected donors, especially as new virus variants emerge.

Researchers in this study sought to determine utilization trends and outcomes of heart transplants using COVID-19 donors. According to researchers, this data is especially important because the COVID-19 virus can cause cellular dysfunction and myocardial (heart) injury in potential donors that may manifest only very slightly in a pre-transplant. Currently there is no clear consensus regarding evaluation and use of COVID-19 donors for heart transplants.

The study looked at more than 27,000 donors in the United Network for Organ Sharing (UNOS) between May 2020 and June 2022; in total, donors were given more than 60,000 COVID-19 tests prior to organ procurement. Donors were considered COVID-19 donors if they tested positive at any time during terminal hospitalization. Active COVID-19 status was given to those who tested positive within two days of organ procurement and recently resolved COVID-19 status was given to those who tested positive initially but became negative prior to procurement.

Of the donors in UNOS, 1,445 were identified as COVID-19 donors, of which 1,017 were classified as active COVID-19 donors and 428 recently resolved COVID-19 donors. Overall, 309 heart transplants used COVID-19 donors and 239 of those met the study’s guidelines.

Those receiving heart transplants from active COVID-19 donors had increased risk of mortality at six months and one year (7% vs 13.8% at six months and 9.2% vs. 23.2% at one year for non-COVID-19 vs. active COVID, respectively). Those receiving transplants from recently resolved COVID-19 donors had similar six-month and one-year mortality rates as those receiving transplants from non-COVID donors (7% vs. 8.5% at six months and 9.2% vs. 13.6% at one year for non-COVID vs. recently resolved COVID, respectively).

Researchers also found that during the study period there was increasing use of COVID-19 donors but that transplant centers were selective and mostly used donors who were younger and male. Additionally, potential donors were tested for COVID-19 multiple times prior to organ procurement, with those who had at least one positive test receiving subsequent tests more often than those who tested negative the first time.

Limitations of the study include variation in the timing and frequency of COVID-19 testing during terminal hospitalization and lack of information on COVID-19 disease onset and symptom burden, or vaccination status of donor or recipient.

The authors also emphasized that this is still early data, and continued evaluation of COVID-19 donors with larger sample size, longer follow up and newer variants of COVID-19 is needed.

The association also found that the biggest increase in CVD deaths occurred among people of color.

“While the total number of CVD-related deaths increased from 2019 to 2020, what may be even more telling is that our age-adjusted mortality rate increased for the first time in many years and by a fairly substantial 4.6%,” said the volunteer chair of the Statistical Update writing group Connie W. Tsao, M.D., M.P.H., FAHA, an assistant professor of medicine at Harvard Medical School and attending staff cardiologist at Beth Israel Deaconess Medical Center in Boston. Tsao’s remarks were contained in an AHA news release.

 “The age-adjusted mortality rate takes into consideration that the total population may have more older adults from one year to another, in which case you might expect higher rates of death among older people,” she said. So even though our total number of deaths have been slowly increasing over the past decade, we have seen a decline each year in our age-adjusted rates – until 2020. I think that is very indicative of what has been going on within our country – and the world – considering people of all ages being impacted by the COVID-19 pandemic, especially before vaccines were available to slow the spread.”

The news release from the AHA also said that the biggest increases in the overall number of CVD-related deaths were seen among Asian, Black and Hispanic people, populations most impacted in the early days of the pandemic and brought to focus increasing structural and societal disparities.

“We know that COVID-19 took a tremendous toll, and preliminary data from the U.S. Centers for Disease Control and Prevention (CDC) have shown that there was a substantial increase in the loss of lives from all causes since the start of the pandemic. That this likely translated to an increase in overall cardiovascular deaths, while disheartening, is not surprising. In fact, the Association predicted this trend, which is now official,” said the AHA’s volunteer president, Michelle A. Albert, M.D., M.P.H., FAHA, the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology, a professor of medicine at the University of California at San Francisco (UCSF) and Admissions Dean for UCSF Medical School.

 “COVID-19 has both direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clotting and inflammation. We also know that many people who had new or existing heart disease and stroke symptoms were reluctant to seek medical care, particularly in the early days of the pandemic. This resulted in people presenting with more advanced stages of cardiovascular conditions and needing more acute or urgent treatment for what may have been manageable chronic conditions. And, sadly, appears to have cost many their lives.”

According to Albert, who also is the director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center) at UCSF and a renowned leader in health equity and adversity research, the larger increases in the number of coronary heart disease deaths among adults of Asian, Black and Hispanic populations appear to correlate with the people most often infected with COVID-19.

“People from communities of color were among those more highly impacted, especially early on, often due to a disproportionate burden of cardiovascular risk factors such as hypertension and obesity,” Albert said. Additionally, there are socioeconomic considerations, as well as the ongoing impact of structural racism on multiple factors including limiting the ability to access quality health care. “The American Heart Association responded quickly at the beginning of the pandemic to address the impact of COVID-19 and  focus on equitable health for all. The Association launched the first-ever rapid response research grants calling on the research community to quickly turn around transformative science; established a COVID-19 CVD hospital registry through the Get With The Guidelines® quality initiative; and also made an unprecedented pledge to aggressively address social determinants while working to support and improve the equitable health of all communities. We are empowering real change that will save lives.”

Cardiovascular disease, overall, includes coronary heart disease, stroke, heart failure and hypertension/high blood pressure. Coronary heart disease includes clogged arteries or atherosclerosis of the heart, which can cause a heart attack. Known generally as ‘heart disease’, coronary heart disease remains the #1 cause of death in the U.S. Stroke continues to rank fifth among all causes of death behind heart disease, cancer, COVID-19 and unintentional injuries/accidents. COVID-19 appeared in the list of leading causes of death for the first time in 2020, the most recent year for which final statistics are available from the U.S. Centers for Disease Control and Prevention (CDC).

This year’s statistical update includes many references to COVID-19 and its impact on cardiovascular disease. Data points and scientific research findings are inserted throughout most chapters of the document, including those related to the risk factors for heart disease and stroke such as obesity, diabetes and high blood pressure, all of which also put people at increased risk for COVID. Many of the studies noted identify specific gender, race and ethnicity disparities.

However, disparities don’t only occur among age, sex and racial/ethnic groups, according to a special commentary authored by members of the Statistical Update writing committee. While the Statistical Update has been including various social determinants of health data in its report, the commentary noted that data from other underrepresented populations, such as LGBTQ people and people living in rural vs. urban areas of the U.S. are still lacking. The commentary authors call out the lack of scientific research and cumulative data on the impacts of social identity and social determinants.

“We know,” Tsao said in the AHA release, “that to address discrimination and disparities that impact health, we must better recognize and understand the unique experiences of individuals and populations. This year’s writing group made a concerted effort to gather information on specific social factors related to health risk and outcomes, including sexual orientation, gender identity, urbanization and socioeconomic position. “However, the data are lacking because these communities are grossly underrepresented in clinical and epidemiological research. We are hopeful that this gap in literature will be filled in coming years as it will be critical to the American Heart Association’s goal to achieve cardiovascular health equity for all in the U.S. and globally.”

Global data

People should not use the Celltrion DiaTrust COVID-19 Ag Rapid Test that is in green and white packaging. This test has not been authorized, cleared, or approved by the FDA for distribution or use in the United States. The FDA is concerned about the risk of false results when using this unauthorized test.

The FDA said it has not received reports of injuries, adverse health consequences, or death associated with use of this unauthorized Celltrion DiaTrust COVID-19 Ag Rapid Test.

The agency also issued specific cautions for different groups:

Test users and caregivers: Talk to your health care provider if you think you were tested with the Celltrion DiaTrust COVID-19 Ag Rapid Test and you have concerns about your test results.

Health care providers and testing program organizers: If an antigen test was performed less than two weeks ago using the Celltrion DiaTrust COVID-19 Ag Rapid Test, consider retesting your patients using an FDA authorized SARS-CoV-2 diagnostic test if you suspect an inaccurate result. If testing was performed more than two weeks ago and there is no reason to suspect current SARS-CoV-2 infection, it is not necessary to retest.

Report any problems you experience with the Celltrion DiaTrust COVID-19 Ag Rapid Test to the FDA, including suspected false results. The FDA encourages you to report the problem through the MedWatch Voluntary Reporting Form.

Test Descriptions

The unauthorized Celltrion DiaTrust COVID-19 Ag Rapid Test uses a mid-turbinate nasal swab sample to detect proteins, called antigens, from SARS-CoV-2, the virus that causes COVID-19. This unauthorized test has the same name as an FDA authorized version of the test for point of care settings but is not the same test. The unauthorized test has a green and white box with Celltrion Healthcare identified on the outer box label.

The Celltrion DiaTrust COVID-19 Ag Home Test, from Celltrion USA, Inc., was authorized by the FDA on October 21, 2021 for home use. These tests are not affected by this Safety Communication and can continue to be used.

The Celltrion DiaTrust COVID-19 Ag Rapid Test, from Celltrion USA, Inc., was authorized by the FDA on April 16, 2021, for point-of-care use, such as in health clinics. These tests are not the subject of this Safety Communication and can continue to be used.

Please refer to the authorized labeling for the Celltrion DiaTrust COVID-19 Ag Home Test and the Celltrion DiaTrust COVID-19 Ag Rapid Test, both labeled for distribution by Celltrion USA, to confirm that the test you’re using is FDA authorized.

Risks of False Test Results

A false-negative antigen test result means that the test says the person does not have COVID-19 but they actually do have COVID-19. A false-negative result may lead to delayed diagnosis or inappropriate treatment of SARS-CoV-2, which may cause people harm, including serious illness and death. False-negative results can also lead to further spread of the SARS-CoV-2 virus, including when people are housed together in health care, long-term care, and other facilities based on these false test results. When false negative test results are received, actions to limit exposure to an infected person might not be taken, such as isolating people, limiting contact with family and friends, or limiting access to places of employment.

A false-positive antigen test result means that the test says the person has COVID-19 but they are actually do not have COVID-19. A false-positive result may lead to a delay in both the correct diagnosis and appropriate treatment for the actual cause of a person’s illness, which could be another life-threatening disease that is not COVID-19. False-positive results could also lead to further spread of the SARS-CoV-2 virus when presumed positive people are housed together.

The FDA regularly monitors the marketing of unauthorized, unapproved, or uncleared tests, including reports of problems with test performance or results. The FDA is working with Celltrion USA, Inc., to resolve this safety issue.

A recall was issued for all unauthorized Celltrion DiaTrust COVID-19 Ag Rapid Tests that were distributed in the U.S., which includes at least 162,000 unauthorized tests.

Consumers: If you think you had a problem with a SARS-CoV-2 test, the FDA encourages you to report the problem through the MedWatch Voluntary Reporting Form.

Health care personnel employed by facilities that are subject to the FDA’s user facility reporting requirements should follow the reporting procedures established by their facilities.

The FDA will continue to keep the public informed of significant new information.

And while hair loss is one of the lesser known effects of COVID-19, it’s not unexpected.

In fact, temporary hair loss is normal after a fever or illness, and fever is a common symptom of COVID-19. A few months after having a high fever or recovering from an illness, many people see they have noticeably less hair.

While this is usually thought of as hair loss, it’s actually hair shedding, the AAD says. The medical name for this type of hair shedding is telogen effluvium. It happens when more hairs than normal enter the shedding (telogen) phase of the hair growth lifecycle at the same time. A fever or illness can force more hair into the shedding phase.

But, the AAD says, hair shedding is all you should experience. If you have other symptoms such as a rash, itchy scalp, or burning, something other than telogen effluvium is likely causing your hair loss. It’s time to see a dermatologist.

Buy even if you never developed a fever or COVID-19, you may still see hair shedding. Emotional stress can also force more hairs than normal into the shedding phase. And who isn’t feeling more stressed and anxious during the pandemic?

Again, the hair shedding begins about two to three months after the stress starts.

While seeing your hair fall out in clumps can add to your stress, it’s important to try to de-stress. Only when the stress ends will the excessive hair shedding stop.

When the cause of your hair shedding is due to a fever, illness, or stress, hair tends to return to normal on its own. You just need to give it time. As your hair grows back, you’ll notice short hairs that are all the same length by your hairline. Most people see their hair regain its normal fullness within six to nine months.

If you suspect that your hair loss is caused by something more than telogen effluvium from stress or a fever, talk with a hair-loss expert, a dermatologist. Click here for an AAD resource on finding a dermatologist.

According to a news release from the National Institutes of Health, a team led by Drs. Sumedha Gupta of Indiana University and Christopher Whaley of the RAND corporation analyzed how the vaccine rollout affected COVID-19 deaths. The NIH news release said their study is one of the first to assess the impact of state-level vaccination campaigns.

NIH’s National Institute on Aging (NIA) supported the study. The findings appeared in Health Affairs on August 18, 2021.

To determine the speed of vaccination in each state, the NIH said researchers used data from government websites and official statements. The study analyzed the period from December 21, 2020, to May 9, 2021. They compared the amount of time each state took to reach a series of milestones—starting with five vaccine doses per 100 adults, up to 120 doses per 100 adults. They also calculated the number of vaccine doses per 100 adults at the end of each week.

The team used the data to create a statistical model. They then examined the relationship between state vaccination intensity and changes in COVID-19 deaths. The model accounted for the lag between vaccination and effects on death rates.

Based on the model, the institute said, COVID-19 vaccines prevented more than 139,000 deaths during the first five months they were available. About 570,000 COVID-19 deaths had occurred in the U.S. by May 9; the model projected about 709,000 deaths would have occurred without the vaccines. The researchers estimated that the economic value of preventing these deaths was between $625 billion and $1.4 trillion.

The estimated reduction in deaths varied among states. In New York, vaccinations led to an estimated 11.7 fewer COVID-19 deaths per 10,000. Hawaii had the smallest estimated reduction, with 1.1 fewer deaths per 10,000.

The study had limitations that may have affected these estimates. For example, according to the news release, the researchers could not distinguish the role of vaccination from increases in natural immunity or social distancing policies on the numbers of COVID-19 deaths. Despite these limitations, the results highlight the crucial role of vaccinations in saving lives during the pandemic.

“This study brings into focus the dramatic success of the early months of the nation’s coronavirus vaccine rollout,” Whaley said in the news release.

The cases from that research, published today in the American Heart Association’s flagship journal Circulation, are among those reported to the Centers for Disease Control and Prevention’s Vaccine Adverse Event Reporting System (VAERS) documenting the development of myocarditis-like symptoms in some people who received the COVID-19 vaccine.

Myocarditis is a rare but serious condition that causes inflammation of the middle layer of the wall of the heart muscle. It can weaken the heart and affect the heart’s electrical system, which keeps the heart pumping regularly. It is most often the result of an infection and/or inflammation caused by a virus.

The study included seven patients hospitalized for acute myocarditis-like illness following a COVID-19 vaccination, treated at hospitals in Falls Church, Virginia and Dallas. All patients were males under the age of 40; the youngest was 19 years of age and the oldest was 39. Six of the men were white adults, one was a Hispanic adult. Only one patient reported a history of previous COVID-19 infection; six of the seven patients were tested for COVID-19 during hospitalization and were negative.

Six of the men received mRNA COVID-19 vaccines; five of the vaccines were manufactured by Pfizer/BioNTech and one by Moderna. One patient received the adenovirus Johnson & Johnson COVID-19 vaccine.

All patients were hospitalized within three to seven days after receiving a COVID-19 vaccine, with sudden onset chest pain. Myocardial injury was confirmed by either cardiac troponin I or elevated high sensitivity troponin testing. All patients had stable vital signs. None had a pericardial friction rub or rash, a sound that could signal the diagnosis of pericarditis, which is inflammation of the thin membrane surrounding the heart. ECG results varied from a normal heart rhythm to ST-segment elevation, which can indicate a decrease in blood flow to the heart muscle. The three patients who underwent invasive medical imaging showed no signs of coronary blockage. None of the patients reported heart palpitations, and none had signs of heart arrhythmias.

Treatment varied and included beta-blocker and anti-inflammatory medications. Patients left the hospital within two to four days of their admission, and all symptoms were resolved before hospital discharge.

“The clinical course of vaccine-associated myocarditis-like illness appears favorable, with resolution of symptoms in all patients,” the researchers said. “Given the potential morbidity of COVID-19 infection even in younger adults, the risk-benefit decision for vaccination remains highly favorable. Vaccine adverse event reporting remains of high importance.”

The American Heart Association continues to urge all adults and children ages 12 and older in the U.S. to receive a COVID-19 vaccine as soon as they can, as recommended by the CDC. Research continues to indicate that the COVID-19 vaccines are 91% effective at preventing severe COVID-19 infection and spreading the virus to others. In addition, the benefits of vaccination far exceed the very unusual risks.

According to the CDC, fewer than 1,000 cases of myocarditis-like illnesses were reported as of May 31, 2021, and nearly 312 million doses of COVID-19 vaccines have been administered in the U.S. to-date.

And now, research suggests that wearing a face mask may also lessen the severity of COVID-19 if an individual is infected. It’s possible that humidity created within the mask may play a role, as humidity is an essential factor in the process that clears inhaled particles from the lungs.

Drs. Joseph Courtney and Adriaan Bax of the National Institutes of Health’s (NIH)  National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) carried out a study to compare how different face masks affected the humidity of inhaled air. Results were published on February 12, 2021, in the Biophysical Journal.

The scientists tested four common types of masks: an N95 mask, a three-ply disposable surgical mask, a two-ply cotton-polyester mask, and a heavy cotton mask. A volunteer wore each mask for at least 10 minutes before any measurements were taken. The researchers then measured the level of humidity when breathing into a sealed steel box. The volunteer’s face was fitted tightly against the box using high-density foam rubber. Humidity measurements were taken at three different air temperatures, ranging from about 46 to 98 degrees Fahrenheit.

Masks absorb much of the water vapor that is exhaled and then release some of it during inhalation. By measuring the humidity changes in the box under the different conditions, the researchers were able to calculate how each mask affected the humidity of inhaled air.

All four masks increased the humidity of inhaled air substantially, but to different degrees. At all temperatures, the thick cotton mask led to a very large increase in humidity. At room temperature, the surgical mask resulted in the lowest but still sizable humidity increase, while both the N95 mask and the cotton-polyester mask increased humidity to an equal extent. The humidifying effects of all masks greatly increased at lower temperatures.

High levels of humidity may help limit the spread of a virus to the lungs. Humidity supports a defense mechanism that removes mucus from the lungs—along with potentially harmful particles, such as viruses, within the mucus. Low levels of humidity can also hamper the immune system’s ability to fight against viruses. This may help explain why people are more likely to get respiratory infections in cold weather.

“We found that face masks strongly increase the humidity in inhaled air and propose that the resulting hydration of the respiratory tract could be responsible for the documented finding that links lower COVID-19 disease severity to wearing a mask,” says Bax. “High levels of humidity have been shown to mitigate severity of the flu, and it may be applicable to severity of COVID-19 through a similar mechanism.”

Earlier studies from Bax and other colleagues showed that any cloth mask can help block the thousands of saliva droplets that are released when speaking. This study suggests another way that masks may help in the battle against COVID-19.

This long-term immune protection involves several components. Antibodies—proteins that circulate in the blood—recognize foreign substances like viruses and neutralize them. Different types of T cells help recognize and kill pathogens. B cells make new antibodies when the body needs them.

All of these immune-system components have been found in people who recover from SARS-CoV-2, the virus that causes COVID-19. But according to a news release from the National Institutes of Health (NIH), the details of this immune response and how long it lasts after infection have been unclear. Scattered reports of reinfection with SARS-CoV-2 have raised concerns that the immune response to the virus might not be durable.

To better understand immune memory of SARS-CoV-2, researchers led by Drs. Daniela Weiskopf, Alessandro Sette, and Shane Crotty from the La Jolla Institute for Immunology analyzed immune cells and antibodies from almost 200 people who had been exposed to SARS-CoV-2 and recovered.

The NIH news release said time since infection ranged from six days after symptom onset to eight months later. More than 40 participants had been recovered for more than six months before the study began. About 50 people provided blood samples at more than one time after infection.

The research was funded in part by NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and National Cancer Institute (NCI). Results were published on January 6, 2021, in Science.

The researchers found durable immune responses in the majority of people studied. Antibodies against the spike protein of SARS-CoV-2, which the virus uses to get inside cells, were found in 98% of participants one month after symptom onset. As seen in previous studies, the number of antibodies ranged widely between individuals. But, promisingly, their levels remained fairly stable over time, declining only modestly at 6 to 8 months after infection.

Virus-specific B cells increased over time. People had more memory B cells six months after symptom onset than at one month afterwards. Although the number of these cells appeared to reach a plateau after a few months, levels didn’t decline over the period studied.

Levels of T cells for the virus also remained high after infection. Six months after symptom onset, 92% of participants had CD4+ T cells that recognized the virus. These cells help coordinate the immune response. About half the participants had CD8+ T cells, which kill cells that are infected by the virus.

As with antibodies, the numbers of different immune cell types varied substantially between individuals. Neither gender nor differences in disease severity could account for this variability. However, 95% of the people had at least 3 out of 5 immune-system components that could recognize SARS-CoV-2 up to 8 months after infection.

“Several months ago, our studies showed that natural infection induced a strong response, and this study now shows that the responses last,” Weiskopf says.

While many people realize they are facing unparalleled levels of stress and anxiety, others may be so busy trying to keep their lives together that they’re not even aware of how frazzled they are. But no one thrives when they constantly feel afraid, exhausted, and overwhelmed, say Diana Hendel, PharmD, and Mark Goulston, MD.

“COVID-19 has pushed many of us into survival mode,” says Dr. Hendel, coauthor along with Dr. Goulston of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020, ISBN: 978-0-7852-4462-2, $17.99). “We are doing what’s necessary to survive, but the stress of continuing to function while under such extreme pressure to carry on eventually takes a toll.”

“It is important to learn to recognize when your stress is rising and take steps to mitigate it,” adds Dr. Goulston. “Acknowledging what’s going on with your mental health empowers you to do something about it.” The good news is it doesn’t take much time or effort to reduce stress—even the severe stress so many are facing right now. Read on for this tool kit of simple “stress stoppers” you can use any time you feel stress or anxiety taking hold.

Do frequent self “check-ins” to recognize when your stress levels are rising.

When you’re busy and under pressure to perform, it’s easy to go on “autopilot.” Therefore, periodically pause and do a quick self-assessment throughout the day. Consider your emotional state (Do I feel friendly and engaged, or edgy and aggressive?) as well as your physical state (Is my body calm and at ease, or is it holding onto tension?).

“Take 20 or 30 seconds to scan your body and identify areas that may be holding onto tension or stress,” says Dr. Hendel. “For example, you might be carrying tension in your jaw or shoulders. When you notice an area that is tense, gently release the tension. Over time it should become easier to recognize when stress begins to take hold—and to do something about it.”

Ground yourself when you start feeling overwhelmed.

Grounding is a great way to reduce anxiety and arrive in the here and now. Use it any time you feel carried away by anxious thoughts or feelings, or triggered by upsetting memories and flashbacks.

• Find a comfortable place to sit (or stand). If sitting, rest your hands on your legs. Feel the fabric of your clothing. Notice its color and texture.
• Next, bring your awareness to your body. Stretch your neck from side to side. Relax your shoulders. Tense and relax your calves. Stomp your feet.
• Look around and notice the sights, sounds, and scents around you for a few moments.
• Name 15-20 things you can see. For example, the floor, a light, a desk, a sink.
• As you keep looking around, remind yourself that The flashback or emotion I felt is in the past. Right now, in this moment, I’m safe.

Pause and take a few deep breaths.

We tend to hold our breath whenever we are stressed, but this only exacerbates feelings of anxiety and panic. Instead, use “box breathing” to calm yourself and heighten your concentration. Box breathing is the technique of taking slow, deep, full breaths. Here’s a tutorial for when you’re feeling triggered.
Slowly exhale your breath through your mouth. Consciously focus on clearing all the oxygen from your lungs. Inhale slowly and deeply through your nose for four slow counts. Hold your breath for four more slow counts. On the next four counts, exhale again through your mouth until your lungs are empty. Hold your breath again for a final slow count of four beats.

Reach for something that anchors you in the present moment.

Carry a small reminder of what you love about your life and focus on it if you feel triggered and need to center yourself. It might be a photo of your kids or pet, a small rock you picked up on a scenic nature hike, or a special necklace. Think of the gratitude you feel for your life whenever you look at this token.

Keep something that makes you laugh nearby.

Humor is a great way to alleviate stress. Tape a clip of a funny cartoon to your work area or carry a small notebook with jokes that make you laugh every time you read them.

Use calming affirmations to give you strength and peace.

Written positive statements can give you a lift when you feel yourself sinking. If self-talk is not for you, imagine a supportive other saying these to you in your mind’s eye. A few examples:

• I feel energized and ready for anything the day has in store for me.
• I accept myself as I am. I am enough.
• I am safe in this moment.

Let your feelings out (when possible) at work.

At times you may find you need to step away from your work duties for a few minutes and give any intense emotions you might be experiencing some “breathing room.” Try to move to a private area so you can cry or discreetly express your feelings. Sometimes you need to release the stress that’s built up in your body, and finding a private place to let the tears fall or vent for a few minutes can lighten your stress and enable you to get back to work.

Play a mind game.

“If there is no way to speak to someone else and you need comfort in the moment, imagine talking to someone who loves you,” says Dr. Goulston. “Imagine that they are listening and lovingly holding and encouraging you. As you hear them talking and walking you through it, you will feel their love and belief in you. This kind of mental pep talk can be a bridge until you are able to speak your feelings to somebody in person.”

Head outdoors for a few minutes.

If at all possible, try to get outside for a few minutes of fresh air when you are feeling stressed. Take deep breaths, stretch your arms and legs, and take in the gifts of nature around you. And if possible, invite another person (either someone in your household or a coworker if you are at work) to join you for a 10-minute walk so the two of you can blow off steam.

“When you do nothing about ongoing stress, it can increase until it dominates your life,” concludes Dr. Hendel. “None of us can afford to be sidelined when we need all of our energy to face these current challenges. But it is never too late to take charge of your mental health and build up the resilience that will sustain you through the pandemic and beyond.”

# # #

About the Authors:
Mark Goulston, MD, FAPA
Dr. Mark Goulston is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020) and Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side (HarperCollins Leadership, Spring 2021). He is a board-certified psychiatrist, fellow of the American Psychiatric Association, former assistant clinical professor of psychiatry at UCLA NPI, and a former FBI and police hostage negotiation trainer. He is the creator of Theory Y Executive Coaching—which he provides to CEOs, presidents, founders, and entrepreneurs—and is a TEDx and international keynote speaker.

He is the creator and developer of Surgical Empathy, a process to help people recover and heal from PTSD, prevent suicide in teenagers and young adults, and help organizations overcome implicit bias.

Dr. Goulston is the author or principal author of seven prior books, including PTSD for Dummies, Get Out of Your Own Way: Overcoming Self-Defeating Behavior, Just Listen: Discover the Secret to Getting Through to Absolutely Anyone, Real Influence: Persuade Without Pushing and Gain Without Giving In, and Talking to Crazy: How to Deal with the Irrational and Impossible People in Your Life. He hosts the My Wakeup Call podcast, where he speaks with influencers about their purpose in life and the wakeup calls that led them there. He also is the co-creator and moderator of the multi-honored documentary Stay Alive: An Intimate Conversation About Suicide Prevention.

He appears frequently as a human psychology and behavior subject-area expert across all media, including news outlets ABC, NBC, CBS, and BBC News, as well as CNN, Today, Oprah, the New York Times, the Wall Street Journal, Forbes, Fortune, Harvard Business Review, Business Insider, Fast Company, Huffington Post, and Westwood One. He was also featured in the PBS special “Just Listen.”

Diana Hendel, PharmD
Dr. Diana Hendel is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020) and Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side (HarperCollins Leadership, Spring 2021). She is an executive coach and leadership consultant, former hospital CEO, and author of Responsible: A Memoir, a riveting and deeply personal account of leading during and through the aftermath of a deadly workplace trauma.

As the CEO of Long Beach Memorial Medical Center and Miller Children’s and Women’s Hospital, Hendel led one of the largest acute care, trauma, and teaching hospital complexes on the West Coast. She has served in leadership roles in numerous community organizations and professional associations, including chair of the California Children’s Hospital Association, executive committee member of the Hospital Association of Southern California, vice chair of the Southern California Leadership Council, chair of the Greater Long Beach Chamber of Commerce, board member of the California Society of Health-System Pharmacists, and leader-in-residence of the Ukleja Center for Ethical Leadership at California State University Long Beach.

She earned a BS in biological sciences from UC Irvine and a Doctor of Pharmacy degree from UC San Francisco. She has spoken about healthcare and leadership at regional and national conferences and at TEDx SoCal on the topic of “Childhood Obesity: Small Steps, Big Change.”

About the Book: 
Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020, ISBN: 978-0-7852-4462-2, $17.99) is available in bookstores nationwide and from major online booksellers.

To learn more, please visit https://whycopewhenyoucanheal.com/.

Based on the number of vaccinations that have already been administered, as well as findings from a recent study by Columbia University, Judd estimates the nation may reach herd immunity by May. The study by Columbia suggests that, as of the end of January, more than a third of the U.S. population had already been infected with coronavirus.

Scientists believe 72 percent of the population needs to be either exposed or vaccinated for COVID-19 in order to reach this goal.

What happens when we reach herd immunity?

“It means that cases decrease without social intervention, which might be what we are starting to see right now,” Judd said.

Even though the data are hopeful, it does not mean COVID-19 will be eradicated or that we can let our guard down when it comes to following social distancing and masking precautions.

“I think that COVID-19 is going to be endemic in the United States,” Judd said. “It is going to be like the seasonal flu, something we have to tolerate regularly. There will be isolated outbreaks, and they will likely occur in populations with lower immunity. This means that, just like the flu, a strong vaccination campaign will be needed to keep people out of the hospital.”

Another positive trend that shows the reduction of the severity of COVID-19 cases is the decrease in the number of hospitalizations and deaths.

“We are seeing sharp declines in the hospitalization ratio in the last month and a half, likely driven by monoclonal antibody therapy, but possibly also driven by the vaccine,” Judd said. “If people are vaccinated and still become infected, the case may be milder than it would have been if they were not vaccinated, which leads to lower hospitalizations.”

While the production of the vaccine is increasing, there are still millions of people who do not have access to it. To reach herd immunity, Judd says the vaccine needs to be available to every community.

“We need to get consistent vaccine administration to lots of different populations” Judd said. “We cannot leave people behind. We have to make sure the vaccine is getting into all communities to get that base level of immunity to stop the virus from spreading.”