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IC@N Project ECHO

Integrated Care at NEOMED (IC@N)

On Physical Distancing

By David E Sharp, PhD. Assistant Professor, Department of Nutrition School of Health Science, Kent State University

05/08/2020

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"A thousand fibers connect us with our fellow men; and along these fibers, as sympathetic threads, our actions run as causes and are returned to us as effects.” This statement, written in the nineteenth-century by the preacher Henry Melville, was intended to promote a righteous life but couldn’t be more relevant when looking at how our fibers have been modified over the past few months of living through a global pandemic. As a communal species, the sympathetic threads of social connection can be found in every element of our daily interactions with others. These manifest as hugs, food sharing, holding hands, opening the door for strangers, happy hours, birthdays, graduations, concerts, cheering for the same teams, or offering someone your seat. Our proximity and physical interactions with friends and strangers gives us an almost collective consciousness and offers us both security and resiliency. There is a warmth in connecting with a person or people and any disruption to this is deeply disruptive to a species that thrives in a social setting.

Poster by amplifier.com. Titled "There's no quarantine on kindness" the poster depicts a sunrays and a rainbow. It is in response to the COVID-19 pandemic

This is what makes the practice of distancing in the time of SARS-CoV-2 so difficult. The very social threads that have brought us comfort and joy are now vectors for viral transmission for those most important to us. To keep our family, our friends, and our community safe, we must limit physical contact to the best of our individual capacities while still embracing the social contacts that anchor us and keep us healthy. We can externally justify these restrictions as a small expense for promoting a greater good, but our brain’s job is to construct a “reality” out of whatever sensory data it receives. In these isolating times, the brain may interpret a near complete elimination of physical touch as being alienated from the community. In a rapid review of the psychological impacts of quarantine, commonly reported feelings of those who were isolated were fear, nervousness, sadness, and guilt [i].  Resilience to these negative emotions 

are imperative for health care professionals because the stress from these feelings can lead to depression, substance abuse, and burn-out. This can not only deplete our workforce, it can also impair attention, decision making, emotional control, judgment, willpower, and self-monitoring of those who are working. Unlike a broken arm or laceration, the distressed mind cannot be easily seen without mindful and deliberate efforts to keep in touch with those that we can no longer touch. At individual and community levels, we can find opportunities to cultivate relationships and insulate each other from stress and loneliness.

Start with something small. Every storm begins with a raindrop and every journey starts with a single footstep. Teaching yourself to cook or bake can offer you the chance to turn your isolation into education. Some people make their beds every morning because it is a short activity that provides you with an instant sense of completion. Others create to-do lists of attainable goals so that they can stay focused and have a tangible weekly reminder of everything that they accomplished. And for still more, simply getting out of bed that can be an event worth celebrating. Confinement can feel like you have lost control. By being proactive and keeping yourself moving forward, you can regain your autonomy and you might just end up learning a new skill in the process.     

Be active. As Dory from Finding Nemo sagely opined- Just keep swimming. An idle mind can become bored and destructive. We all have a room, attic, or basement that could use organizing or painting. Many of us have access to a sidewalk, park, bike path, or hiking trail that can offer a change of view and appropriate physical distancing. Grab a mask and invite a friend or use the time to call or video chat with a different friend every time. With the weather warming up, place some chairs six feet away and host a happy hour in your front yard. Kicking a soccer ball or group zoom yoga also offers the opportunities to interact with others at an appropriate distance.   

Maintain a routine. We are creatures of habit. It’s why we have favorite songs, favorite sleeping positions, and favorite foods! While our normal daily activities may no longer be possible, that doesn’t mean that we cannot internalize new ones. In my introduction to nutrition class at Kent State, I challenge my students to spend the semester changing one part of their routine for ten weeks to showcase how our conscious repeated actions eventually become automatic. At the end of the semester, and with very little effort, the students admit surprise at how easy it was to remove or improve a habit when you incorporate it into a routine. Our behaviors are like a river that has slowly cut a path through the ground. If a tree or landslide blocks our normal route, the answer isn’t to stop flowing. You cut around the damaged section and create a new path.

Do not be an island. We are all, at our core, inexorably linked to the lives and welfare of those around us. Form social ties that are both satisfying and meaningful not just to you but also to those you interact with. Ask your friends about their day and then listen attentively. Do not let someone answer with a single word when you inquire how they are doing. Press them for more details and make sure they are truly okay. And finally, when someone asks you how you are doing, answer truthfully and in detail.  As Melville said, a thousand fibers connect us together. The choice is our on how we want SARS-CoV-2 to impact those threads. With care and attention, we can come together as a community and weave them into a beautiful tapestry.

Poster from amplifier.com. Contains the text "Physical distancing is social solidarity," it displays an artistic rendering of candles and stars. Created in response to the COVID-19 pandemic

  • Have your children write pen-pal letters, email, or video chat with friends and relatives

  • Prepare meals for essential employees and health professionals that may be working more than full time

  • Donate blood

  • Donate to a food bank

  • Recreate famous pictures or paintings at home

  • Go for a walk

  • Check in on your neighbors, volunteer to mow lawns or walk dogs

  • Send something to a service-based local shop to let them you know are thinking of them

  • Explore genres of music and artists from other cultures

  • Call and text your friends

  • Take care of yourself, self-care is not selfish

  • Be a leader

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[i] Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet (london, england). 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8

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Contact our team with your thoughts at integratedcareECHO@neomed.edu

Image Sources: Skye Sturm for amplifier.org, and Shyama Kuver for amplifier.org

 

Additional Reading

Project ECHO COVID-19 Video Recordings