Thread by @ChecchiaPaul

1/34 I think we need to develop new DSM-5 diagnoses: PPSD or Post Pandemic Stress Disorder. It’s related to PTSD. We all have it. We are seeing it everywhere. However, I think it is worth a bit of analysis and hopefully, some, re-calibrating in the face of Omicron.

2/34 First, by definition, here is a link to the criteria required to diagnose PTSD. (brainline.org/article/dsm-5-…) It’s worth clicking on this and reading through all of it.

3/34 While it seems clear that many of them apply to everyone right now, it is important to note the primary criteria.

4/34 “The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): [at least one must be present] Direct exposure. Witnessing the trauma.

5/34 Learning that a relative or close friend was exposed to a trauma. Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)”

6/34 I raise specifically to highlight the fact that witnessing the trauma through twitter or other forms of media is not one of the true criteria. Additionally, we all can create and re-create the trauma by thinking about it repeatedly.

7/34 At a physiologic level, our stress response doesn’t differentiate between and actual event and the thoughts about such an event. Unlike a soldier or a victim of violence; most of us can control our exposure to the instigating traumatic event.

8/34 We all went through the initial phases of this horrific event. We all locked down. We all witnessed the trauma of news stories about death and chaos in Italy, India, and New York. Many (far too many) experienced the trauma of losing a loved one or friend.

9/34 I just want to try to help people remember that the overwhelming number of people in this world did not. This does not minimize, nor cheapen, nor trivialize the tremendous loss and trauma felt by so many; but it does require each of us to keep our fear in perspective.

10/34 It is our only way to mental well-being. It is our only way to combat fear and break its powerful negative cycle.

11/34 I personally believe that every single ongoing argument, controversy, or twitter troll is ultimately founded in fear. I fear death, so I will be a COVID maximizer. I fear death, so I will deny COVID is serious. I fear for my children, so I will want schools locked down.

12/34 I fear for my children, so I want them in school. I fear what I don’t understand or what I can’t control, so I will live in perpetual anxiety.

13/34 Fear is powerful. Fear binds us. Unfortunately, fear also sells. Whatever you are selling, fear is buying; news stories, clicks, votes, ivermectin, vaccines, masks…anything. Fear can motivate and save; but unremitting fear and stress can debilitate and damage.

14/34 I, as well as so many others, have spent so much time over the past 2 years living with and in fear. This is common amongst healthcare workers, patients and families of those in the hospital, and those that lost someone; but we all must fight the addiction to fear.

15/34 Look at the way fear is manipulated. We are given the opportunity to search for, and find, a constant stream of new things to fear:

16/34 First it was death for all, then death for elderly, then death for unvaxxed, then it was fear of infectivity, then it was fear of not enough hospital beds, then not enough ICU beds, then it was fear of too sensitive of a PCR test, then it was too insensitive of a home test.

17/34 Hot take: this will never end unless we take control and end it for ourselves individually.

“Fear builds its phantoms which are more fearsome than reality itself.”-Jawaharlal Nehru

18/34 Most people on social media are building the phantoms because they have no control over their fears. Most but not all; some are doing it for self-gain. That profit may not necessarily be financial. It may also be psychological; after all misery loves company.

19/34 Either way it spreads faster than any variant.

How do you stop it? I’m not a psychologist, I’m an intensivist. I only know how to cope with fear and anxiety in a field that is filled with stress inducing scenarios that hit far too close to home as a parent.

20/34 Over the years, (this year) I have used some tools.
1. Realize it is not actually happening to you, you are only reading or thinking about it.
2. Control what you can control. (By getting vaccinated)
3. I dive into the evidence and data to combat the unknown.

21/34 So how do we put that into practice?
First, look at yourself in relation to your risk profile. Are you a healthcare worker? Are you actually in a hospital right now and being impacted by not getting a surgery due to staffing?

22/34 Are you trying to get on a plane but the flight is cancelled due to staff? Are you the parent of an at risk child who isn’t eligible for vaccination?

If so, then you have every right to anxious and careful.

23/34 We owe each of these groups of people our compassion and empathy; but we do them no good by giving them our fear.

But if you are just reading about those groups, it is fine to have empathy and compassion, but don’t add into the fear and anxiety.

24/34 Second, control what you can control. If you are vaccinated, you will be fine. You have done what you needed to do to mitigate risk, so reduce your fear.

Finally, look at some data to alleviate stress. We understand so much about this variant.

25/34 It clearly replicates quickly but does not infect the lower respiratory tract very well. (gla.ac.uk/researchinstit…) (researchsquare.com/article/rs-118…) (researchsquare.com/article/rs-121…) [cautionary note: the articles are still under review and they are animal models]

26/34 However, the picture is becoming clear and consistent. You add these findings with the power of our T cell immunity, and you will feel significantly better in a shorter time…if you are vaccinated.

27/34 More data. There seems to be some good signs out of the UK. Not everywhere, yet; but look at London. (data.london.gov.uk/dataset/corona…) There is the very slightest hopeful hint that they are starting to plateau.

28/34 Of course, some of the case drop might be access to testing over the holiday; but that would be fear talking. It might be positive. Plus, look at the flatness of the curves of ventilation and deaths. That is not subject to holiday reporting.

29/34 Again, this is hard time to exist in the world. It is depressing. The hospitals are once again crowded. However, if you are not in healthcare, you can help those of us who are by getting vaccinated AND by not being a carrier of the infection of fear.

30/34 You might think you are being helpful, but stoking fear will not get that anti-vaxxer to roll up their sleeve. Fear will not motivate a politician to finally address the failures of the healthcare system that are being laid bare in staffing shortages and burnout.

31/34 Fear will not keep children at low risk of serious COVID, but high risk of collateral psychological and educational damage, in classrooms.

32/34 Do what you can do by infecting people with perspective, compassion, and empathy. You have more power and influence than you know.

A final quote: “An old man walked up a shore littered with thousands of starfish, beached and dying after a storm.

33/34 A young man was picking them up, flinging them back into the ocean.
“Why do you bother?” the old man scoffed “You’re not saving enough to make a difference”

34/34 The young man picked up another starfish and sent it spinning back to the water.“Made a difference to that one”. he said.”