Charting a Course for Healthier Living
Special COVID-19 Issue
Most people have heard of Murphy’s Law: Whatever can go wrong, will go wrong. If that is not bad enough, consider what my father taught me — Kelly’s Law: Murphy was an optimist.
These two laws may sound a bit cynical but they provide some boundaries to what is going on in our lives, economy, and the world in general. As bad as it may seem, things can always get worse.
With those thoughts in mind, I have been brushing up on some philosophy of old and historical contexts to what we all are experiencing. Life is capricious and random but we also have more control than we often allow ourselves.
Rather than be paralyzed with fear and anxiety about events that are well beyond our control, take this “down time” as an opportunity to reevaluate your life, your daily routine, your relationships, or whatever.
Read about Marcus Aurelius, the Roman emperor who lived through the Antonine Plague in Rome which lasted for 15 years or Seneca the Younger who lived from 4 BC to 65 AD. Both were famous Stoics, a philosophy that espouses basically that we don’t control what has happened or what is happening, but we can control how we respond to those things. It is a bit like the AA mantra asking for “the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
During the Plague of Rome, Marcus wrote extensively on not letting selfishness and greed and panic ruin the character of man even as disease took so many lives. Rather than dwelling on who to blame or the woes of the economy or any number of things, the focus can instead be, “What can I do to make things better.” Currently, that answer is to practice social distancing, to wash hands, and I would add to reach out to those less fortunate in any way possible. It also means staying connected (albeit six feet away) to help maintain a sense that we are all in this together.
The lessons of Winston Churchill are another historical example of how we might live during this crisis. He was a creature of habit, routine, and discipline even in the most stressful of times. He created structure for himself even as the world around him was one of chaos. He would write at the same time of day (he wrote over 10 million words in his lifetime), nap at the same time of day, walk daily, dress up for dinner, avoid seeing his wife before noon (historical fact that I am not advocating for all), and while his accomplishments were many, he also cultivated hobbies including being an accomplished painter and avid gardener.
As for sheltering in place, think of Anne Frank. One common thread amongst Frank, Churchill, Aurelius, and Seneca is that they all were prolific writers, or what we might call today “journaling.”
So let’s move from history to what we might do to take some control back in our own lives.
Create a daily schedule that sets aside time for many different things
Journaling: set time aside to write your thoughts, feelings, observations or whatever. But set daily time for this activity.
Exercise: the gym may be closed but it is a great time to go for a walk. There are also countless apps for home workouts, numerous ones for free on YouTube.
Start an old hobby or a new one
Start reading a book
Study a topic that interests you
Deliberately do nothing (“Sometimes I sits and thinks and sometimes I just sits…”)
The list goes on but the point is to schedule your day so it has a sense of momentum and accomplishment rather than simply reacting to the “news of the day” time and again. Alongside Murphy’s Law and Kelly’s Law we might add Parkinson’s Law, an old adage that says “Work expands so as to fill time available for its completion.” Without a schedule, you won’t accomplish nearly as much and might miss the opportunities that the Covid-19 crisis actually presents.
****** ****** ***** ****** ***** ****** ***** ****** ******
As for my perspective on the crisis, it is distressing to see what is occurring in New York and how the health care system can get completely overwhelmed. I am dismayed that we still don’t have adequate testing and personal protective equipment but hopeful that is changing. I believe that with massive testing we can start to resume some normalcy of life. I am also hopeful that with each week we learn a tremendous amount about the virus, how it is transmitted, who is most at risk, and how to treat those infected.
There are hundreds of studies being conducted that will give much better guidance on how to treat based on evidence rather than conjecture. Of the many news stories regarding treatments, most are about hunches and theories of why certain treatments might be helpful. I have had people ask about nsaids and Ace-Inhibitors or ARBs (certain blood pressure medicines). The current evidence does not give clear guidance other than stating for most they should NOT STOP their medicines. The history of medicine has a graveyard filled with assumptions that turned out false once they were scrutinized by the double-blinded, placebo controlled standard of comparison. The most recent example occurred just this past year with aspirin no longer being recommended for primary prevention against strokes and heart attacks for those over 70 (If you have had a stroke or heart attack, this advice does not apply to you!).
I strongly encourage everyone to practice social distancing, wash your hands frequently, try to maintain a healthy immune system with structure in your life including daily exercise and adequate time to sleep (the single most restorative thing you can do for your health).
If you develop any fever or new onset of cough, shortness of breath, sore throat, muscle aches or other concerning symptoms then don’t hesitate to call my cell or my office.
Things will get better. We can also make ourselves and the world better because of the crisis we are living under (read this Douglas Mallach poem). That may be the single best legacy we provide to those unfortunate victims of Covid-19.
Clark Trask, MD
Uncertainty about NSAID use — Some clinicians have suggested the use of non-steroidal anti-inflammatory drugs (NSAIDs) early in the course of disease may have a negative impact on disease outcome. These concerns are based on anecdotal reports of a few young patients who received NSAIDs early in the course of infection and experienced severe disease. In light of these concerns, some providers are using acetaminophen in place of NSAIDs for reduction of fever. However, there have been no clinical or population-based data that directly address the risk of NSAIDs. The European Medicines Agency (EMA) and the WHO do not recommend that NSAIDs be avoided when clinically indicated.
The product insert has been updated by the FDA regarding NSAIDs and COVID-19 to read the following:
NSAID COVID-19 Safety Alert March 2020
The FDA is aware of news reports stating that the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, could worsen coronavirus disease (COVID-19). The FDA is not aware of scientific evidence connecting the use of NSAIDs with worsening COVID-19 symptoms. However, all prescription NSAID labels warn that "the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections."
More information may be found at https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19.
In addition to concerns about NSAIDs and COVID-19, there is no disagreement regarding the risks of NSAIDs and vascular disease.
ALERT: US Boxed Warning
Serious cardiovascular thrombotic events (excluding NeoProfen): Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction, and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Ibuprofen is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
UseTylenol (acetaminophan) for fever or aches with a maximum dose of 1 gram every 6 hours and no more than 4,000mg in 24 hours.
Source: UPTODATE; CDC; FDA
Click here to view the March 5 Special Issue COVID-19 Newsletter
Click here to read Dr. Trask's letter from the March 22 COVID-19 newsletter
Thanks to everyone who has shared; keep the submissions coming!