Dr. Asim Shah, professor and executive vice chair of psychiatry at Baylor College of Medicine, stopped by ABC13 on March 13 to discuss all-things coronavirus, especially when it comes to subduing anxieties and preventing panic.
You can see Dr. Shah's entire interview with ABC13 in the video here.
Dr. Asim Shah is here to answer all of your COVID-19 questions
How do we calm ourselves and our families down? How do we get a handle on that tendency to feel anxious and panic?
"It's a very important question because they say the panic is bigger than the disease. So, panic can cause more issues than the disease itself. How can we do that? There are numerous ways to do that. First is, we need to look at the facts. What are the facts? Is it really a deadly disease? Yes, it is a deadly disease. But all diseases have a death, mortality ratio. Most of the diseases are deadly. Is it more deadly than the others? That's one. Number two is, if we are calm, we can handle it better, or being panicky is not going to help us. So how do we stay calm? Simple thing, what we can do is a lot of time, when we repeatedly listen to media coverage of the same thing again and again, three cases, five cases, eight cases, tests, this causes more anxiety and panic. Everybody's threshold is different. Maybe your threshold is more than mine. So if mine is low, I need to know and I need to watch the news, but maybe a little bit less, maybe once a day, twice a day, but not every minute. Those simple things can help reduce your anxiety and panic easily."
How do you counsel your kids and not make them panicky?
"We say the three groups of people which are more susceptible to any kind of stress are people who have mental illness or substance use, children and first responders, which are healthcare workers, doctors, nurses, all of them, especially focusing on kids or children. What happens is, kids usually see what their parents are doing. So if the parents are calm, they're going to be calm. If the parents are stressed, they will be stressed. If the parents make it a big issue, they will make it a big issue. If the parents are holding everything and getting everything, which definitely you need to have some stuff, especially the medicines and all, they will see that. So we are a role model for our kids. If we are better around them and try to become better, they will become better."
Should you tell your kids?
"Absolutely, yeah, absolutely. Because, they're hearing bits and pieces of it around them. It depends on age. So, if the child is less than five, you discuss in a very different way. If the child is over five, you discuss it differently. And if they're teenagers, they can be engaged. So it's a different thing, but definitely, you discuss with them based on their age, sit down, tell them facts, without emotions, and without frustrations. That is the best way to do it."
What would you say to a child under the age of five?
"You basically say that, you know, you go to the doctor, you have injections, people get sick, and there is some sickness that can be spread. We can prevent it, and here's how. Actually, the best is to teach them how to wash their hands. If you just say 20 seconds, they may not be able to comprehend. Make it a habit with them, make it a fun activity with them. Not, 'Oh, let's just do that you sanitizer all the time.' They will make it a habit, and they will be happier and make it a fun exercise. So, you can try to teach them in a fun way. "
What would you say to kids over the age of five?
"You tell them a little more than what you've already told the five year old, which is that this disease can result in some mortality. If you don't take care of yourself, if you don't wash hands, if you touch your face in the eyes a lot, you can be infected, which can result in a hospitalization, which can result in complications, and you can give it to other people. So you're, again, increasing it from what you did. When you go over that age, you can talk about the whole mortality, and what percentage of mortality you're seeing. But over the age of 12, kids these days will be getting all this information from anywhere. Everybody has a smartphone, right?
We haven't seen children getting sick at nearly the rate as their grandparents or other, older people. How do you tell your child they might not be able to be around their grandparents as much?
"Luckily, as you said, kids are not as affected with this disease. Actually, some studies show they are even prevented, but elderly people are not. How do you tell them now? We need to observe those elderly people and see if they have symptoms. If they do, we have to quarantine and we have to easily tell them the fact which is that, 'Please don't come near me because otherwise, you can get my sniffles.' That should be something we should be doing even otherwise, for the flu, for example. Right now, between October and March, about 20 to 50,000 people died because of flu, just in this six months, five month period. So, we should be doing that anyway, because flu also affects a lot of elderly people. That should be standard."
Are we looking at signs of panic when we see more and more people out there, you know gathering up food and toilet paper?
"Exactly. That's what happened. So for example, two or three days ago, there was not a whole lot of panic, people buying stuff. You see it now in the media, long lines in Costco, long lines in this store, that store, you get panicky, you're like, 'Do I have all this money to go?' So this is a ripple effect, right? This is a vicious cycle, you see one person, you want to go, and the lines have an increased burden. So we need to be careful in showing that, and if we do show that, we need to kind of show a solution to only get your necessary things. Of course, the first thing is medicine, then your necessary food items. And then hopefully, because this is not one of those things where you won't be able to get supplies. It's not a hurricane. You need to stock up a little bit, but you don't need to panic and stock up for six months. "
If it does get to the point where you have to isolate in your home, how do you keep a positive mindset and again, not panic, not feel the walls are closing in on you?
"There are numerous things you can do first, if you are isolating these days, it will be self-quarantine. It will be more than likely your home. Right? You're familiar with the environment, it's your home. Think about the people who are on a cruise, not knowing when they will come back and when they do come back, will they be able to even go home right away? So always think about the worst scenario and then your scenario looks better. Also these days, social media, internet and TV, everything is there. Even if you're at home, you can watch TV, you can listen to music, you can watch shows. You can go on your phone, you can do a lot of activities. So it's not as boring as it would have been 20 or 30 years ago. You can do a lot. So maybe it's your mini vacation, although I hope nobody has to be quarantined."
Some people have been expressing their frustrations towards the media and their reporting of coronavirus. Is there a fine line to walk?
"First of all, media's responsibility is to deliver information. That's what media is all about. And as early as possible, again, breaking news as early as possible. It's easy to blame media. But what is our responsibility? If I feel I'm a sensitive person and watching these things again and again and again, does it disturb me more than maybe somebody else? Why am I watching? I can watch once a day. If somebody gets even bothered by once a day, why do they even have to turn on the TV? Why can't they go on an app without emotion? Remember reading is without emotion. Read the facts. You need to know the facts, we have a responsibility to. It's media's responsibility not to sensationalize things, and most media doesn't. But we also have a responsibility, and if we feel certain media is doing that for us, maybe don't watch it. Nobody's forcing you to watch it."
What's the best way to relieve anxieties associated with the stock market dropping?
"Factual figures are the best. So, for example, I have a 401k, I'm sure you do too. It's plummeting, right? But I'm not going to look at it right now, because I know where it is. I don't even know how bad it is, but it's going to be bad, right? But look at the history of the country. We usually rebound. We have always rebounded, things have gotten better, maybe in six months, maybe two months, maybe in a year, sometimes even four years. So, always look positive. Always be an optimist. Because yes, this is the best country in the world. We are a great patient, we will rebound we will get out of this. We hope soon. We don't know how long it will take, but we are going to get out of this. So be positive, look at it positively and look at the factual stuff, which is that these things have happened before, but every time, they came out of it. Nobody knows the time period, but we will come out of it."
What can be said to people who fear they will lose their jobs or make less money with less opportunity to work?
"So that's a difficult question, but it depends on the person. So for example, people who have permanent jobs usually will continue their job. It's the more the seasonal workers...who might not be able to do their jobs. You know, unfortunately, they have to look at some alternate sources right now, and there are plenty of alternate sources. So for example, delivery is a big thing, right? I'm sure. Delivery companies are looking for more people to help. Actual stores are looking for more people to even stock and as managers, because everybody's going there. So you can find things which are more in need today than not. It's easier said than done. But there is hope, because certain things are flourishing today. So try to find something which is going on right now. "
How can you make yourself more positive and optimistic?
"I think that's a little bit of personality. Some people may have, unfortunately, a pessimistic personality. I'm not talking about just this crisis, I'm talking about even otherwise, they will look at the negative side. Studies have shown that people who are on the pessimistic side or negative side usually are on the depressed side. So when you try to treat their depression, they become a little bit more positive. Because if you, in life, think like a glass is half empty, if you look at the empty side, you will always be negative. You can try to find a little bit of positive in everything. Sometimes it's not a whole lot, but it's better to have maybe one positive as opposed to 20 negatives. "
ABC13 spoke with Dr. Edward Rensimer with the International Medicine Center on Thursday, March 12 for answers to your top questions regarding coronavirus symptoms, risks and more.
You can watch the full video below.
Get your coronavirus questions answered by experts
Can you get the virus when you exchange money?
"The virus can live on inorganic surfaces, desktops, money, credit cards, pens, door knobs for hours, possibly even days. That's why you need to be washing your hands frequently."
How do I know if I have the coronavirus?
"The main way you can tell allergic inflammation and nasal passages from either flu which is a virus or coronavirus would be you're gonna have fever. So if you have fever, you're feeling body aches, you're feeling systemically ill, that's not an allergy that's probably a viral illness, in which case, it would be prudent to probably check with your doctor about coming in."
Can you just go to your doctor and request a coronavirus test?
"I don't know if insurance is going to pay for coronavirus testing for people who have no symptoms just because they're worried. The CDC's stipulations right now are (to go to the doctor if) you have a fever, or that you have had contact with a recent proven case, say someone in your family and you're living with them."
What do you see this situation looking like. a month from now, two months from now all the way to three months from now?
"There'll be a point where so much of the population has been infected and then generated immunity, that they're not open to infection anymore. So the targets for the virus will be less and less so the incidence of disease will fall off. And with better warmer weather people aren't congregating indoors in much enclosed air spaces, that will see the incidence of cases taper off in Houston say April. That's that's the hope."
What is the recovery rate from the virus? Is it killing most of the people it infects?
"No. Overall recovery rates are about 80% people having basically ambulatory elements. They're at home, they're not in a hospital. They're not gravely ill. They're uncomfortable. They're like a routine case of flu. About 15% of the people are ending up in a hospital. Almost all of those are elderly people."
Have any animal shown signs of being sick from this?
"I'm not aware of any animals that have been sick, but some animals like dogs in China have been cultured and found positive."
If a person may have been infected with COVID-19, what are some of the first symptoms that they will start to see?
"It's usually going to be upper respiratory symptoms like a sore scratchy throat and a low grade fever. And then when it progresses more down into lower respiratory tract where it becomes a pneumonic illness pneumonia, then shortness of breath, and sometimes chest pain, and cough would be a prominent symptom."
Are there any special things in place for those in the sickle cell community? We've been talking a lot about people with compromised immune systems or serious illnesses. Would they be certainly at high risk?
"I wouldn't see them as a high risk group."
What can people do to protect themselves that are already infected with HIV, the AIDS virus?
"Their immune systems are not impaired. They're fully reestablished. And if they're taking their medication, I wouldn't see them as a special group for this problem."
If (people) suspect there's something wrong with them, rather than show up in the waiting room, don't you want them to call ahead and warn you?
"Let whoever you're going to visit know you're concerned about this. Is there anything I need to do? Give them a chance to meet you in the hallway with a mask."
Is this a lot like the flu?
"It's a viral respiratory illness. Flu may have maybe a little bit more incidence of diarrhea. With COVID-19, It's about 3%. So it's a very minor part of the cases, but otherwise, it'll be very similar to flu."
My baby woke up with fever and a pinkeye. I feel like it's viral but I'm so afraid to take him to the doctor to get tested. I don't want him catching the virus.
"The coronavirus is not a risk to her so much at her age. But if she's got something else, it's treatable. So you want to call your doctor. You need to express to the staff I'd like to bring the baby in. How can you work with me on my cell phone so that I bring the baby in and we get right into a private room?"
People are asking about pregnancy and where the risk stands in that case.
"It's not been around long enough to know if enough babies have been born with a problem that would have been due to coronavirus but not to the pregnancy. Pregnancy is not a immune deficiency state. You should not have to worry about (coronavirus). Just get through the pregnancy and stay healthy."
Should we be worried about eating out at fast food or nice restaurants or what about shopping carts and grocery stores?
"I don't see this yet as a foodborne illness."
Is there anything you sort of want to say to the public out there starting with whether they should be taking this seriously?
"The best thing to do is keep on top of it. See information, develop, make rational decisions. Make personal decisions about your family, in your own life. If you've got elderly people in the family, pay real attention. They're the ones that are really a big risk."
ABC13 spoke with Dr. Michael Chang who answered your most pressing COVID-19 questions on March 10.
You can watch the full video below.
Answering your coronavirus questions
Coronavirus is not new, what makes COVID-19 different?
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The history of coronavirus actually dates back to the 1960's when people realized it's actually a virus that came from animals and somehow crossed the species barrier onto humans. But it never really caused any issues other than the common cold up until 2003 with the SARS virus. That was an example of coronavirus that kind of went awry and actually became a great pathogen on humans. This last coronavirus, the novel coronavirus, COVID-19, came out of China just back in December of 2019. If we think about it, it's so, so new. China has been the epicenter of coronavirus and a lot of what we know today actually came out of China.
Can the virus travel through water?
No. The water, I'm presuming the water the question involves is tap water. Tap water has been chlorinated and cleaned by the city. And as a result, very few pathogens will be able to travel through the water. That being said, you always have to be careful because you do not want to take contaminated water from other sources and put it on your face.
How worried should I be with this virus affecting my kids?
This virus is a very interesting and unique virus in the sense that children are not particularly affected. There are almost no fatalities under the age of 15 which is very, very unusual. Because, you know, back in the day, viruses like the flu had a high mortality rate among children. The novel coronavirus, COVID-19's biggest patient population that you have to be really, really careful about is the elderly and those with immunosuppressants such as diabetes, immunosuppressive states such as cancer, lung disease and heart disease. So, those are the patients that we really have to protect. Now, that doesn't mean that the children are spared from this. They might get some type of infection, but they're just not critically ill. So, I'm not recommending that they just go free and just run around and do whatever, because I think they can also become the transmitters of disease. So in other words, if they are playing with Grandpa, grandparents that have underlying medical problems, you really got to make sure that they're also protecting the elderly.
I'm a cancer survivor. I still take medication for cancer. I'm 61 years old. Am I more susceptible to this virus because I work handling money. Is this even dangerous?
So there's two parts to that, first is, yes, a person who is undergoing, still undergoing treatment for cancer, i.e. with immunosuppressants, yes, they are a risk factor for this disease because you're suppressing your immune system, which is necessary to fight off this virus to begin with. And again, I want to emphasize again, age, and other comorbidities such as diabetes, lung disease, heart disease, they're the ones that you really will have to be very, very careful. One of the messages I want to make sure everybody gets is take care of the elderly. Whether they're in your homes and nursing home, even hospitals, because the sick, those are the ones that are going to be at the highest, highest risk.
I've heard symptoms for some can be mild. How can you distinguish virus symptoms from typical sinus allergy issues to something like COVID-19?
This is what makes this disease so hard to deal with because the symptoms oftentimes are indistinguishable from the common cold, or even none at all. Just by looking at the statistics from other countries, about 80% of the infected patients either show minimal symptoms or mild symptoms. Even a cough, runny nose, it may be cold virus. But COVID-19 cannot be diagnosed based on symptoms alone.
I think that's what scares a lot of people. Right now, we have flu season going on and allergy season here in Texas as well.
So again, this is another point I really want to hammer home, which is the flu is still rampant. And one of the best ways to help take care of yourselves and others is to do the same precautions that you normally would do with the flu, i.e., get a flu shot, and do all the things that you would do for the flu. Don't go to work when you're sick, and wash your hands. I would avoid things like close contact with others, shaking your hands. Try not to cough into your hands, for example. I think it's worth mentioning too that by not having the flu, by taking those specific precautions against the flu, if you get some respiratory ailment, it will make it more likely for you to think that, "Well, maybe this is not the flu to start off with."
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Can I go to my doctor and request coronavirus testing if I have symptoms, follow up question to that what is required for me to get a test?
So the CDC has put out interim guidance over this particular issue. Right now, it requires not just symptoms, but also epidemiologic, previous predisposition. Meaning that you could be considered high risk if you recently visited China, Iran, Japan, South Korea or Italy. So, if you travel to any of those places, then that puts you automatically at a higher risk. And then if you also present symptoms, then you definitely are what we call "person under investigation" and you should be tested. There are currently not enough test kits to test everybody with symptoms. And as such, we have to be very selective on who we test because we just can't test everybody at this point. At the end of the day, at this time, you're more likely to have the flu, the common cold or allergies.
Is coronavirus airborne?
So, the short answer to that is yes, it can be airborne. It is transmitted primarily through respiratory droplets. So every time you cough, sneeze, and if that gets airborne, then if somebody is in close proximity and it gets to their mouth, nose or eyes, then yes, it can affect them. However, another critical point I think it should be made is that the same airborne droplet can also land on your keyboard surface, your desk, your arm, your hand, your elbow, and if you touch it, and then touch your face, you potentially could get infected. That's why hygiene is paramount here. You have to make sure that you break the habit of touching your face and your eyes, at least resist, especially, at least, before you wash your hands or use some type of hand sanitizer. If you're sick, please do not go out to public places. If you're sick, you also need to protect other folks. Meaning that's where, believe it or not, a face mask would be very helpful. Because, again, you're not trying to protect yourself at that point, you're trying to protect other people. Every time you cough and sneeze, at least, the droplets are in the mask and not on somebody else.
Is it really as bad as everyone is making it out to be?
That's a nuanced question. So the good news is, it doesn't seem to affect clinically, meaning that it doesn't seem to affect the children, which is the great. The flip side is, it is the elderly, the folks with a lot of medical issues that are getting sick from this. And so once again, the point I would like to make sure everybody understands is that it is the elderly, the patients with medical issues that we really need to protect.
So this person is saying they've been to Costco, and they have seen people just buying toilet paper left and right, and that's making them scared. What is the deal with that?
Well, I think this has a lot to do with the underlying concern that people have about this. I think a lot of it is very, very legitimate. We just need to make sure people really understand as much as possible what this virus is all about. Once people understand, then maybe they can make the best judgment on what they need. This is not a situation where I think we're going to need a lot of water, for example, because water is not going to cure this. I think there are some precautions that need to be made. I think an anti-septic certainly will be very helpful. But stocking over the next three months, I'm not sure if it's necessarily the best course of action.
Can I get or carry COVID-19 from flying, and should I cancel my trip?
That is a great question, and it's a nuanced question. So this has to do with risk. Again, if you're 85 years old, with COPD and diabetes, I would try very hard to avoid any situations where you increase your risk. But on the other hand, if you are essential personnel and you're 25 years old, and you have to go someplace, please go. But obviously, take the usual hygienic precautions. This is not necessarily a prohibition on traveling, but it's about knowing what your risks are and taking effort to mitigate those risks. That certainly includes wiping down surfaces, like your airplane seat, that kind of stuff.
Map of COVID-19 cases across the US, updated as confirmed by CDC
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Important tips for protecting yourself from coronavirus
- Stay home if sick and contact your medical provider before visiting their office.
- Wash hands often with soap and warm water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. If you use a tissue, throw it in the trash.
- Avoid shaking hands.
- Routinely clean and disinfect frequently touched objects and surfaces.
- Avoid close contact with people who are sick.
- Stay up to date on CDC travel health notices: https://wwwnc.cdc.gov/travel/notices
The CDC does not recommend that people who are well wear a facemask. You should only wear a mask if a healthcare professional recommends it.