o Private residence
o Hospital
o Public institution
o Others (cruise ships, etc)
The most important strategy for the population to undertake is to frequently wash their hands and use portable hand sanitizer and avoid contact with their face and mouth after interacting with a possibly contaminated environment. To reduce the risk of transmission in the community, individuals should be advised to wash hands diligently, practice respiratory hygiene (i.e., cover their cough), and avoid crowds and close contact with ill individuals, if possible. There are posters and brochures prepared by many organizations on all issues related to protection from COVID-19 and are widely used all over the world (Figure 1).The WHO and other similar health organizations have published visual tools such as videos and posters to demonstrate the correct application of hand hygiene throughout the entire society (Figure 2).These posters, distributed throughout different parts of society in order to draw maximum attention to the importance of hand hygiene, created awareness among all of them. With the increase in the number of people carrying hand sanitizer with them for the application of instant hand hygiene and the spread of mask usage among people in countries such as China, Korea, and Japan, the pandemic was brought under control much more quickly. In those countries where such measures were not made mandatory, the exponential rise in the number of cases continues.
Poster regarding important prevention measures for COVID-19, prepared by Turkish Ministry of Health.
Poster regarding hand washing, prepared by Turkish Ministry of Health.
Social distancing is advised, particularly in locations that have community transmission. Many countries have installed quarantine and social/physical distancing as measures to prevent the further spread of the virus.
These measures can include:
· The full or partial closure of educational institutions and workplaces,
· Limiting the number of visitors and limiting the contact between the residents of confined settings, such as long-term care facilities and prisons,
· Cancellation, prohibition and restriction of mass gatherings and smaller meetings,
· Mandatory quarantine of buildings or residential areas,
· Internal or external border closures, and
· Stay-at-home restrictions for entire regions or countries.
Personal protective equipment
For people without respiratory symptoms, the WHO does not recommend wearing a medical mask in the community, since it does not decrease the importance of other general measures to prevent infection. The single use of a mask does not obstruct the disease; the improper use of the mask actually increases the risk of COVID-19 infection. In the WHO’s “Advice on the use of masks in the context of COVID-19” interim guidance, the prioritized use of medical masks by health personnel was emphasized [4].
To reduce COVID-19 transmission from potentially asymptomatic or presymptomatic people, the ECDC recommends the use of face masks [5]. The use of face masks in the community may primarily serve as a means of source control. This measure can be particularly relevant in epidemic situations when the number of asymptomatic but infectious persons in the community can be assumed to be high. Wearing a face mask could be considered, especially when visiting busy, closed spaces, such as grocery stores, shopping centres, etc.; when using public transport; and for certain workplaces and professions that involve physical proximity to many other people (such as members of the police force, cashiers – if not behind a glass partition, etc.) and when teleworking is not possible.
In the United States, the CDC updated its recommendations in early April to advise individuals to wear a cloth face covering (i.e., homemade masks or bandanas) when in public settings where social distancing is difficult to achieve, especially in areas with substantial community transmission [6]. Individuals should be counseled to avoid touching the eyes, nose, and mouth when removing the covering, practice hand hygiene after handling it, and launder it routinely.
The rationale for the face covering is primarily to contain secretions of and prevent transmission from individuals who have asymptomatic or presymptomatic infection. The CDC also reiterates that the face covering recommendation does not include medical masks, which should be reserved for health care workers.
Individuals who are caring for patients with suspected or documented COVID-19 at home should also wear a face cover when in the same room as that patient (if the patient cannot wear a face cover).
Social distancing
Social distancing is designed to reduce interactions between people in a broader community, in which individuals may be infectious but have not yet been identified hence not yet isolated [7]. As diseases transmitted by respiratory droplets require a certain proximity of people, social distancing of persons will reduce transmission. Social distancing is particularly useful in settings where community transmission is believed to have occurred, but where the linkages between cases is unclear, and where restrictions placed only on persons known to have been exposed is considered insufficient to prevent further transmission. Examples for social distancing include closure of schools or office buildings and suspension of public markets, and cancellation of gatherings. In public markets where it is difficult to maintain social distance, limitation of the entered person and encouraging online shopping can reduce the amount of contact.
Workplaces are also one of the high-risk areas for COVID-19 transmission. Therefore, home office working must be encouraged if possible. In workplaces where home office working is not possible, adherence to recommendations of WHO remains quite important [8].
Studies have been conducted that support the infectiousness of SARS-CoV-2 in the presymptomatic stage; social distancing is thus of critical importance in establishing control over the pandemic[2].
Quarantine is one of the oldest and most effective tools of controlling communicable disease outbreaks. This public health practice was used widely in fourteenth century Italy, when ships arriving at the Venice port from plague-infected ports had to anchor and wait for 40 days (in Italian: quaranta for 40) before disembarking their surviving passengers. The quarantine of persons is the restriction of activities of or the separation of persons who are not ill but who may been exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases. Quarantine is different from isolation, which is the separation of ill or infected persons from others to prevent the spread of infection or contamination.
Looking at the available studies in the literature, quarantine is the most effective method in reducing both the number of infected and dead [9,10]. It has been much more effective in countries which initiated strict quarantine rules right from the beginning. In an article quickly published by the Cochrane Library evaluating 29 studies, results indicate that quarantine can reduce the number of infected at rates from 81% to 44%, and in the number of dead from 61% to 31% [11].
In a mathematical model done on the spread of COVID-19 in Italy, it was shown that without strict quarantine rules the pandemic could not be controlled and that the number of secondary cases increased in proportion to the size of households. According to the simulation, if the household is comprised of 2 people and full quarantine has been put in place, expected secondary cases are 3 within the 14-day period; with a household of 6, this number increases to 16 [12].
Despite more than 2 months passing after the discovery of the first case in the US, the calls to stay at home put out in 33 states and by many local governments were insufficient. On the other hand, while it was greatly criticized, the quarantine and severe rules applied by China’s central government to people from Wuhan meant that they were able to effectively control the number of cases in states outside of Hubei and that death rates were reduced.
In the influenza pandemic in 1918, the importance of quarantine measures was demonstrated very clearly [13]. The most striking example of this comes from the US–the first case in the city of Philadelphia, Pennsylvania, was observed on September 17, but social restrictions to prevent spread such as reducing crowds in public spaces were instituted on October 3, when there were 40 deaths per every 100,000 people. Unfortunately, the measures instituted after this point were insufficient and by the middle of October, this number reached 250/100,000 people. In contrast, the first case in St. Louis, Missouri, was observed on October 5, social restrictions were instituted on October 7, and both the number of cases and the rate of mortality was kept at low numbers.
The WHO recommends that contacts of patients with laboratory-confirmed COVID-19 be quarantined for 14 days from the last time they were exposed to the patient [14]. For the purpose of implementing quarantine, a contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:
· Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 min,
· Providing direct care for patients with COVID-19 disease without using proper personal protective equipment,
· Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time,
· Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any kind of conveyance.
Active monitoring of people who are quarantined is one of the important points for controlling the epidemic in the society. There are several mandatory mobile phone applications that control the compliance of people to quarantine in countries such as China, Japan and Korea. In Turkey, with the support of mobile phone operators, all persons who are quarantined are alerted instantly when they move away from their location. Certainly, deterrent fines will also increase compliance with quarantine.
Cleaning and disinfection
High-touch areas such as bedside tables and door handles should be disinfected daily with regular household disinfectant containing a diluted bleach solution (that is, 1-part bleach to 99 parts water). For surfaces that cannot be cleaned with bleach, 70% ethanol can be used. Toilets and bathrooms should be cleaned and disinfected with a diluted bleach solution (one part bleach to 9 parts water to make a 0.5% sodium hypochlorite solution). Disposable gloves should be used when cleaning or handling surfaces, clothing, or linen soiled with body fluids. All used disposable contaminated items should be placed in a lined container before disposing of them with other household waste. Clothes, bed linens, and bath and hand towels should cleaned using regular laundry soap and water or machine washed at 60–90°C with common laundry detergent. Disposable gloves should be used when cleaning or handling surfaces, clothing, or linen soiled with body fluids. All used disposable contaminated items should be placed in a lined container before disposing of them with other household waste.
Increasing testing capacity
Another important point in preventing the spread of the disease throughout society is to increase the number of tests and thus pinpoint more cases, isolate them, and trace those who have been in contact. For this reason, increasing laboratories’ test capacity and developing new testing strategies are of utmost importance. Different methods such as rapid-testing kits, serologic methods and self-collected specimen tests are being used throughout the world to determine cases which in turn help adherence to isolation rules.
In South Korea, which acted quickly to administer free-of-charge and extensive public testing for COVID-19, “drive through testing” was initiated for the first time [15]. The ease of its application, reduction in the number of people who applied to health centres, and the capacity to investigate more people in lesser time appears as a successful strategy. Similar applications based on this model are being instituted in Germany and other countries after South Korea.
Prevention and control measures in Turkey
Several different containment measures were implemented by the Turkish government. These included social distancing, travel restrictions on visitors arriving from high-risk counties, quarantine for nationals returning from high-risk locations, and closure of schools and certain types of workplaces. The government declared on March 12th that all schools including universities were to be closed starting from March 16th.
Turkey put into place several measures to limit movement of people. Citizens 65 years old or older, patients with immune system deficiency, chronic lung disease, asthma, COPD, chronic cardiovascular disease, chronic renal disease, hypertension, chronic liver disease as well as users of drugs that disrupt the immune system were restricted from leaving their homes and using public transportation.
Major containment actions taken are summarized in Figure 3. All ministries published general instructions on COVID-19 prevention and control measures in their organizations [16]. As of April 13, approximately 40,000 tests have been reached per day with a total of 73 authorized laboratories, and the number of performed daily tests is gradually increasing.
Timeline for prevention and control measures in Turkey.
In COVID-19, which has no approved treatment, it is very important to prevent the spread in the society. The main points in preventing the spread in society are hand hygiene, social distancing and quarantine. With increased testing capacity, detecting more positive patients in the community will also enable the reduction of secondary cases with stricter quarantine rules.
Rahmet GÜNER and Firdevs AKTAŞ are the members of the COVID-19 Advisory Committee of the Ministry of Health of Turkey. Rahmet GÜNER and İmran HASANOĞLU are working in the main pandemic hospital, Ankara City Hospital, a 3800-bed hospital with 700 ICU beds.
Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .
Reviewed By:
Lisa Lockerd Maragakis, M.D., M.P.H.
Now that the new coronavirus and COVID-19, the illness it causes, are spreading among communities in the United States and other countries, phrases such as “physical distancing,” “self-quarantine” and “flattening the curve” are showing up in the media.
What do they mean, and how might they apply to you, your family and your community?
Lisa Maragakis, M.D., M.P.H. , senior director of infection prevention at Johns Hopkins, helps clarify these concepts so you can understand better why they’re being recommended.
The practice of social distancing means staying home and away from others as much as possible to help prevent spread of COVID-19. The practice of social distancing encourages the use of things such as online video and phone communication instead of in-person contact.
As communities reopen and people are more often in public, the term “physical distancing” (instead of social distancing) is being used to reinforce the need to stay at least 6 feet from others, as well as wearing face masks. Historically, social distancing was also used interchangeably to indicate physical distancing which is defined below. However, social distancing is a strategy distinct from the physical distancing behavior.
Infectious disease expert Lisa Maragakis explains how physical distancing can help prevent the spread of the coronavirus and offers tips to practice it correctly.
Physical distancing is the practice of staying at least 6 feet away from others to avoid catching a disease such as COVID-19.
As noted above, “social distancing” is a term that was used earlier in the pandemic as many people stayed home to help prevent spread of the virus. Now as communities are reopening and people are in public more often, physical distancing is used to stress the importance of maintaining physical space when in public areas.
Wear a face mask or covering when you are not in your home and whenever you are around people who are not members of your household. Maintain at least 6 feet of distance between yourself and others. Avoid crowded places, particularly indoors, and events that are likely to draw crowds.
Other examples of social and physical distancing to avoid larger crowds or crowded spaces are:
People who have been exposed to the new coronavirus and who are at risk for coming down with COVID-19 might practice self-quarantine . Health experts recommend that self-quarantine lasts 14 days. Two weeks provides enough time for them to know whether or not they will become ill and be contagious to other people.
You might be asked to practice self-quarantine if you have recently returned from traveling to a part of the country or the world where COVID-19 is spreading rapidly, or if you have knowingly been exposed to an infected person.
Self-quarantine involves:
Once your quarantine period has ended, if you do not have symptoms, follow your doctor’s instructions on how to return to your normal routine.
For people who are confirmed to have COVID-19, isolation is appropriate. Isolation is a health care term that means keeping people who are infected with a contagious illness away from those who are not infected. Isolation can take place at home or at a hospital or care facility. Special personal protective equipment will be used to care for these patients in health care settings.
Flattening the curve refers to using protective practices to slow the rate of COVID-19 infection so hospitals have room, supplies and doctors for all of the patients who need care.
A large number of people becoming very sick over the course of a few days could overwhelm a hospital or care facility. Too many people becoming severely ill with COVID-19 at roughly the same time could result in a shortage of hospital beds, equipment or doctors.
On a graph, a sudden surge in patients over a short time could be represented as a tall, narrow curve.
On the other hand, if that same large number of patients arrived at the hospital at a slower rate, for example, over the course of several weeks, the line of the graph would look like a longer, flatter curve.
In this situation, fewer patients would arrive at the hospital each day. There would be a better chance of the hospital being able to keep up with adequate supplies, beds and health care providers to care for them.
We are ready to safely care for you in our community practices, clinics, surgery centers and hospitals. Learn about our additional steps to keep you safe and how you should prepare for your appointment.
It’s important to know what to do if you feel sick. The coronavirus pandemic is making everyone aware of handwashing and protecting others from coughs and sneezes. Along with those essential steps, practices such as social and physical distancing, and self-quarantine and isolation when appropriate can slow the rate of infection in a city, town or community.
The pandemic can seem overwhelming, but in truth, every person can help slow down the spread of COVID-19. By doing your part, you can make a big difference to your health, and that of others around you.
What you need to know from Johns Hopkins Medicine.
What Activities Are Safe During the Coronavirus Pandemic?
Don't Avoid Your Doctor During the Coronavirus Pandemic
Coronavirus Diagnosis: What Should I Expect?
A narrative essay on the effects of the enhanced community-quarantine.
NARRATIVE ESSAY ON ENHANCED COMMUNITY-QUARANTINE – In this article, we are going to share perspectives on the enhanced community quarantine in the Philippines.
As the Philippines faced the coronavirus pandemic, several countermeasures were imposed to curve its spread. As such, President Duterte imposed an enhanced community quarantine on Luzon.
However, the spread of the virus brought to light some of the worst traits of the Filipino people. Instead of helping out, people began panic buying. Worse, they tried to profit off of their fellow countrymen by hoarding important supplies such as alcohol and face masks.
Furthermore, the inconsistencies and incompetence of some politicians and public servants were highlighted. Clearly, some were not prepared to handle the spread of the virus.
This caused a debate online regarding what to do amid the pandemic and the quarantine in the Philippines. Many argued that criticizing the government would do no help, however, many would disagree.
Because of the outcries of netizens online, thousands of people have been helped by the government and got aid. Moreover, several politicians have listened to the masses and provided the desperate needs of the people.
But hope still remains. The Filipino people is resilient and brave. In light of this global health crisis, and the community quarantine, the hope is that we would all learn from this.
The majority of the people would want “things to get back to normal”. However, the normal that we had before was a culture of being apologetic on behalf of politicians and normalizing hate.
After this quarantine, when the dust has settled and the world begins to rebuild from their losses, let us look back on the pandemic as a reminder that we should move forward for the better.
Like this article? READ ALSO: Huseng Sisiw – Who Is This Famous Filipino Writer?
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Student Health and Wellness Center
Life in isolation and social distancing can be hard. Here are stories from JCU students with their thoughts, feelings, and experiences during this time.
We are grieving the college experience we thought we were in store for. While others may be going through more tangible losses of family members and employment opportunities, our grief is just as valid. No matter how much you have lost in this process, you have still experienced loss. Grief is said to come in six stages: Shock & Denial, Anger, Depression & Detachment, Dialogue & Bargaining, Acceptance, and the Return to a Meaningful Life. Let me take you through my grief process for my last semester of college, and hopefully you can find some familiarities and a sense of hope in your own ability to process this loss.
The second I heard that in person classes were cancelled until April 13th I immediately packed a bag and left campus. I did not process, I did not say goodbye, I did not think anything through. I just left because I did not know what else to do. How could my senior year just have been minimized by such a margin? How could my formal and Greek Week and my internship all just be obliterated? My dad promised me Chinese food and a warm bed to sleep in at home an hour and a half away, so I just left and tried to clear the confusion from my mind. I told him that there was no way they wouldn't let us come back for the last few weeks. They had to let us finish classes in person, to have finals week, to have our weekend in Put-In-Bay… to have commencement. So, I took baths, enjoyed the free food, reveled in having my own bathroom again, and tried to think of this as a little “vacation” from reality. I was in denial up until the moment we got the email completely cancelling our final semester as college students.
Throughout the day I would remember the situation and get angry all over again. I would just walk around the house permanently frustrated. If my parents tried to talk about the situation I would be pissed off, if they tried to talk about something else I would be pissed off, and if my dogs barked at the wrong moment in my ever spiraling thought process I would be pissed off. I described it to my mom as “wearing a vest of anger,” I felt it constantly weighing down on my chest, inhibiting everything I wanted to do to cope. I was more aggressive and quick to anger that I had ever felt. I perceived every form of communication as a threat. I assumed that the world intended to just keep hurting me and that no relief would come. This stage ended when I finally sat down with my mom and explained how much pain I was in.
As someone prone to depressive episodes, this stage almost felt comfortable. I would stay in bed all day and avoid responding to texts. It was a daily struggle to convince myself to shower and do basic self care tasks. I didn’t feel like eating healthy or working out. I wanted to be alone. I was honest with my boyfriend about how low I felt. I wanted to be as far from my old life as possible, in order to ignore the feeling of loss I had. If I didn’t think about my friends and my opportunities, I couldn’t miss them… right? I broke out of this stage when a friend finally got a hold of me, and we had a genuine conversation for the first time in a little while. She reminded me of just how much life I have yet to live.
I would say that I’m currently in this stage. These stages take time, and no one is expected to be out of them in any “perfect” timeline. I feel more at peace with my new normal, and ready to start adapting to my new life. I am thinking ahead to the fall, and making adapted plans in case this continues. I am keeping my options open, while also trying to keep my future plans intact as much as humanly possible. Part of my dialogue of healing is writing this article and getting my feelings out. I’m trying.
How long will it take to get to this coveted stage? Who’s to say. Could be days, weeks, months… and I’m okay with that. I understand that this situation is still very uncomfortable for me, but I also understand that some day it won’t be. I’m trying to do a better job of being emotionally transparent with those close to me in order to help this process along as smoothly as possible. Open and honest communication is the keystone of healthy grief. Eventually, through the employment of healthy and progressive coping mechanisms, we grieve and we heal.
Ideally, this will be when the quarantine is over… but we really have no idea when that will be. To take pressure off of myself to heal, I am trying to create a culture of meaningful life in my current situation, so that I do not feel the need to hold myself back until a formal “resolution” is found. Sure, I can hypothesize that a graduation ceremony or return to tactile schooling will fill this need… but I don’t want to set myself up for failure by setting these restrictions on myself. Grieving is a process that must be felt in it’s own time, and one that you must totally give yourself up to.
A lot of these stages aren’t pretty, and I’m not afraid to admit that. I’m not all too proud of my behavior and how the grieving process has affected me. But - *spoiler alert* - I’m human… and so are you. We all process grief and loss in our own time and in our own methods, with these stages as a potential common theme. It is normal, natural, and VALID for these next few months to be a little tender for us. We lost our last semester. We have every right to feel this grief, and heal from it on our own schedule.
Sending love to the Class of 2020 and to anyone who has felt a great loss from this horrific situation. Stay healthy and never forget to address your personal wellness as another factor of health. We are all in this together.
- Anabelle Nietupski ‘20
JCU Counseling Center continues to provide virtual services to support all JCU students.
Other Resources including 24/7 crisis support services, info on how to cope with emotional reactions to everything related to the pandemic all the resulting changes to daily life, and suggestions on how to maintain some routine and normalcy in our lives.
We encourage everyone to connect with each other virtually in general, and even more specifically to connect in order to process these feelings of grief and loss. Students can do that on their own, within their student groups, and soon the Counseling Center will offer the JCU community opportunities to request Zoom presentations or facilitated group discussions on various topics. Topics may include 1) Counseling Center services, 2) coping with anxiety/worry, 3) coping with grief/loss, and 4) coping with day-to-day stressors like increasing productivity and maintaining social connection. Look for more information through Inside JCU and their website.
I know a lot of people are on edge because of the current COVID-19 crisis going on globally and the alarming rates at which the cases are increasing, but one way that we have been advised to “flatten the curve” is SOCIAL DISTANCING. This is aimed to result in a controlled reduction of the cases by limiting our level of social interaction. However, this has proved to be a challenge, especially for young people who live by the phrases “Live your best life” and “You Only Live Once (YOLO)” who still move about and act oblivious to the warnings of health organizations and the government. But I hope that by the time people are done reading this, we will better understand the need to practice social distancing.
As young people, the tendency to be rebellious is almost inevitable. Some feel it more than others but it is still a feeling that is very present in us because we want to make the most of our youth, even if it means breaking a few rules to do so. However, when the rules are made to protect us from ourselves, we need to ask ourselves whether the rebellion is worth it. Social distancing is a strongly recommended method of effectively handling COVID-19 by reducing exposure to each other and the environment. This is because the virus is transferred through droplets (sweat, saliva, etc) and can be easily spread by people who cough, sneeze, or by touching a surface that has been contaminated. And since no one really knows where people have been, it is better to be safe than sorry by staying and protecting yourself and the people you care about. But some young people see this as “grown-ups trying to stop them from having fun”.
There are other methods of avoiding the virus such as, keeping your hands sanitized, washing your hands for at least 20 seconds, coughing into your elbow, not touching your face, etc., but these other methods can only go so far, especially for those who have already been infected. Which is why we need to take those extra measures to ensure that we are not at risk of catching the virus.
Personally, I have been practicing social distancing as best I can, even though it’s not the most fun thing in the world. But finding ways to make things interesting is usually the fun part. As annoying as it might be sometimes, I know who I am helping by practicing social distancing. I am helping my family, my friends, and the people in the community that I live in, in some way also helping the world by reducing the statistics. At the end of the day, the sooner this goes away, the sooner we can return to our normal lives and appreciate the world a lot more.
I was devastated when I was told that I would have to pack up all of my things, leave the dorm room that I called “home” and abandon all of my friends for the rest of the school year, I was absolutely devastated. I was scared, and did not want to spend the rest of my school year at home and without my friends. This time is extremely exhausting, demanding, and even inconvenient. This time can be made even more difficult for students who are dealing with mental illness, as well as unfortunate home situations. I personally struggle with generalized anxiety disorder and major depressive disorder. I can also personally say that being without my friends has been intensely fatiguing, especially since I love being in the physical company of others. I know many other people do as well, but there is so much technology nowadays. Although it cannot in any way replace the experience of being in the physical presence of others, it is still helpful to utilize programs such as Skype, Zoom, a simple phone call, FaceTime, Google Duo, and Netflix Party during this difficult time.
I know we, as the younger generation, sometimes feel that this time of social distancing is not meant for us. That it is unimportant, that we are stronger than the coronavirus, and some might say that we are “immune.” Although for a majority of the younger population the risk of the coronavirus is not as great as the risk for the elderly population, those that suffer from prior health conditions and those that have a weakened immune system, a prior condition that compromises their immune system, the risk is still prominent. Lately, more and more young people are becoming hospitalized from the Coronavirus, and even ending up with permanent lung damage from it. Also, even if we do not catch the virus ourselves, we are still able to be carriers for the virus and have the possibility of catching either a mild or severe form of the virus. Being a carrier is especially dangerous because that means the person is asymptomatic and does not know that they have the virus. The virus could then unknowingly be passed onto others, and possibly to someone who could experience a very severe case with a less chance of recovery.
I personally am staying home and practicing social distancing for my grandma. She is in the at-risk category because she is older and has pre-existing health conditions. I’ve always had a very close relationship with her and I love her with all my heart. Since I have been raised by a single-mother, my grandma has helped to raise my brother and I for our entire lives and has continued to do so. She has done so much out of the goodness of her heart to make sure that we would have a good life. This small, tiny, little favor of staying inside my home and practicing social distancing is something that I owe to my grandma. I’m doing this selfless act for her because not only is it a simple and easy task, but it is also something to show her how much I care about her. For all that my grandma has done for me, staying inside and limiting my exposure for her is a small price to pay.
As college students, I recognize that sometimes we have this concept that the world is revolving around us. We have a full course load and are just trying to live our lives. I, too, am guilty of being selfish. But, I just ask that during this time you attempt to take a step out of the box and practice being selfless in order to protect those around you. I’m sure most of us have someone or multiple people that we love that we do not want infected with this virus. Practicing social distancing and staying at home is the greatest example during this time to show your selflessness while also protecting those you love the most. I understand this is a very heavy topic, but the amount of people that are not remaining in their homes and not practicing social distancing is what is causing the continual increase in cases of the Coronavirus. As I finish writing this, I just ask you to reflect on this: is going out (for any reasons besides for food, medication, or other life-sustaining reasons) really worth the risk of potentially infecting those you care about?
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Here are 8 new habits people want to keep post-lockdown.
by Sigal Samuel
Cities are reopening. Lockdowns are lifting. And some people are starting to feel they can glimpse a return, however slow and partial, to “normal.”
But the pandemic has changed us. Although being on lockdown has been pretty grueling on balance, the surprise is that many of us have realized there are some things about quarantine life that are worth preserving. We’re questioning the very fundamentals of the “normal” we’d all come to unthinkingly accept — and realizing we don’t want to go back, not to that.
For some, going back isn’t even an option. Those who are grieving the loss of loved ones, for example, have suffered a tragic and irrevocable loss. Millions who’ve lost their jobs don’t have any work to go back to, and many essential workers have been working through the pandemic without much choice. Older and immunocompromised people are still advised to stay home.
At the same time, living in quarantine for months has offered some — mostly the privileged among us — a rare opportunity to reflect on our lives and, potentially, to reset them.
Workers whose jobs defined their lives are now asking what all that productivity was for , and whether we really want to measure our self-worth by the yardstick of hypercompetitive capitalism. Many are finding that the things that made them look “successful” actually also made them feel miserable , or precarious , or physically unwell .
Quarantine has allowed them to experiment with new habits and new lifestyles. And they want to keep some of these things going, even in a post-lockdown world.
I asked Vox readers to tell me which specific changes they want to maintain as they emerge from quarantine and stumble their way to a new normal. More than 100 people responded across the globe, from the United States to the United Arab Emirates and from Portugal to Pakistan. Some broad trends leaped out in the responses. Below are the eight most common.
This was by far the most popular response. Many told me they want to spend less money shopping for new material goods like gadgets and clothes. A long period of being shut in and not spending as much has led to the realization that so much of our consumer behavior is about instant gratification, not lasting happiness.
Several people also noted that they plan to eat out less often at restaurants. Eating in during the lockdown has enabled them to save money, and some have discovered a taste for home-cooked meals.
A few said they’ll look to “mend and make do” more often. In situations where that’s not possible and they’ll have to buy something new, respondents told me they want to be more mindful of where they spend their money.
“I think I will be more inclined to direct my consumption toward small local businesses,” said Nora Zeid, a 23-year-old illustrator and designer in the United Arab Emirates. “It breaks my heart how much they have suffered lately and how, unlike big corporations, they are less likely to survive.”
Being stuck in our houses has made many of us realize that we’ve spent years rushing through life, pressuring ourselves to get the “right” jobs and attend the “right” events, even if all that status-chasing was making us miserable.
“Quarantine has forced me to slow down in ways I haven’t since I was a kid. From high school and college, through my 20s and a master’s program, I have been on the go constantly for half my life. I always said I was one who liked to be busy, but the last two months of forced slowdown has really called on me to think about what I want my life to look like moving forward,” said one Vox reader in the US who preferred to remain anonymous. “I’m trying to figure out what it would look like to intentionally build in space in my life to breathe, reflect, and focus on the most important aspects of life — the people around you who make it all worth it.”
Some younger respondents told me they want to put less career pressure on themselves because they now realize work is not what matters most in life. A couple of older adults told me they’d been considering retiring before Covid-19 came around; the pandemic pushed them to finally do it. And even for some who were already retired, the slower pace of life created by the lockdown has come as a relief.
Post-pandemic, the goal will be to “not fill every waking moment with a commitment of some kind,” said Patricia Murray, who lives in Savannah, Georgia. “Even retired persons, like myself, need leisure time. I seem to work as much as a volunteer as I did in paid jobs; slowing down is the biggest change I’ve made and it feels good.”
Again, it’s worth noting that the ability to slow down entails a great deal of privilege. Millions who’ve been pushed out of the workforce wish they could be working more, not less. And some older and immunocompromised people have had to go back to work, even if they don’t feel safe doing so yet, because they need the income and the employer-provided health insurance.
When the chips are down, you see who really shows up for you. Several people told me they’ve come to appreciate the family members and friends who’ve been there for them during this tough time, and that long after the coronavirus dies down, it’s this group that they want to re-up their investment in.
“Quarantine has reinforced the necessity of telling people how you feel about them,” said Andrew Goldberg, a recent graduate from Syracuse University. “With social distancing and stay-at-home orders in place, it is easier than ever to feel isolated from the world. But as the days stretch into weeks, I’ve decided that the only way I’ll be able to keep my spirits up is by making sure the people I care about know exactly how I feel about them.”
Others emphasized that the bizarre, unprecedented nature of this global pandemic has allowed them to reach out to people they haven’t spoken to in ages. Suddenly they’ve found themselves on Zoom with estranged family members or old college roommates halfway around the world.
“I’ve talked with my older nephews more in the last few weeks than I’ve talked with them in years,” said Nancy Skinner Ringier, a retired speech-language pathologist, adding that they now share recipes and jokes.
This was perhaps the most encouraging set of responses: People told me that the global health crisis has shown them how interconnected we all are, and that they want to keep doing more for others after the pandemic ends. They’re donating more to charitable causes, trying harder to reduce their carbon footprint, and engaging in more political activism.
“I’d like to keep my home a headquarters for the three different county mutual aid coalitions I’m affiliated with,” said Erin Brown of Tazewell County, Illinois. “I currently have donations stored here that delivery volunteers and folks in need come to collect. My landline, which is part of my internet package, was never used before but is now a mutual aid contact number. I’m in a good location, near all three of those counties, and I suspect mutual aid will be vital for some time to come.”
The protests against police brutality have also galvanized millions to fight for racial justice.
“For the longest time, I did not keep up with current news. It’s not hard to see why — our world is a shitshow, and my mental health is bad enough as is,” said Adrian DeRoy, a 27-year-old reader in the US. “But the black community rising up yet again to face their challenges made me look, and seeing the world slowly but surely start to fall in step with the protests here, the voices crying out as one ... it gives me some small semblance of hope. Hope that maybe we will get through all this, and come out better than we were before.”
This was another very common response. Many people who weren’t previously into fitness have been getting into running, yoga, and other activities as a way to cope with lockdown. And they’ve been astounded at how much daily exercise can improve life.
“Desperate for any excuse to leave the house, I’ve finally been able to keep up a daily exercise routine. It’s incredible how much difference even a short jog every morning makes!” Katie Reynolds, a Vox reader in the US, told me. “My sleep is better, my brain feels clearer, my mood is improved, and it feels easier to keep up other good habits. Definitely will be keeping this habit, at least until there’s ice on the ground again.”
Yes, the sourdough obsession is real. Several people wrote to me in glowing terms about their starters.
“I believe I’ll be keeping my sourdough starter. It’s like another family pet at this point,” said Matthew Schreiber, who lives in New Orleans.
In addition to baking bread, people also mentioned that they plan to keep fermenting things like sauerkraut and generally cooking more of their own meals so they can eat less processed food.
Specifically, people want to cook more vegetarian meals and lean away from meat-eating. The impulse seems to be coming not only from the fact that there are meat shortages in some US grocery stores, but also from the knowledge that a live-animal market in China may have given rise to the coronavirus and that the giant factory farms that supply 99 percent of America’s meat are a pandemic risk, too .
Many also told me they’re enjoying growing herbs like mint and cilantro on their patios, or growing vegetables like celery and scallions in little glasses on their windowsills.
It’s not really surprising that the coronavirus crisis has prompted this reaction. It’s reminiscent of World War I and II, when Americans grew their own fruits and vegetables in “victory gardens.” The back-to-nature impulse offers psychological comfort at a time of great uncertainty, as well as a practical safeguard against supply-chain problems: If the stores run out of food, at least we’ll have our vegetables!
Getting outdoors has been, for many of us, a crucial way to maintain our sanity during lockdown. In particular, parents have wanted to give their cooped-up kids a chance to run around and release some energy (which, frankly, is probably as crucial for the parents’ mental health as for the children’s).
“I have developed a morning routine that involves ‘quiet listening’ on the porch with the kids. It’s a great way to start out calm with my wild little ones,” said Sharon Lapin, a painter in Atlanta.
Others are simply enjoying the chance to reconnect to the natural world. Its rhythms and resilience can help to calm our anxious minds.
“I want to stay in this less distracted zone and enjoy the time I have with my husband by taking advantage of the natural world (hiking, kayaking) and taking trips in our camper,” said Camille Costa Nerney of upstate New York.
Lockdowns across the globe led to millions of people suddenly working from home — and guess what? It turns out we can do many jobs just as well in the comfort of our own homes (and sweatpants) as in our offices.
Of course, for many people, this is not an option. It’s a privilege to be able to work from home. That said, the myth that remote work isn’t as practical as a 9-to-5 office job has been proven to be just that: a myth. Some are finding that working from home actually offers unique benefits.
“I’m a counseling psychologist, and I have been doing client work remotely. I think I will keep doing it remotely! It’s quite convenient,” said Raphael Doval-Santos. “My practice also gets to be more global, and my new clients are not just within my city anymore.”
Several respondents said they love no longer having to commute to work. It means no pollution, more sleep, and less stress.
“I actually like this now; it’s better this way,” said Hermee Sorneo, a 36-year-old customer service team leader for a data management company in the Philippines. “There’s so much benefit in working from home, and I think the world should do this voluntarily, with or without pandemic, at least once every 10 years for at least three months.”
The “with or without pandemic” point brings up a key question. Lots of us say we want to maintain our new habits in a post-pandemic world, but will we, really?
As anyone who’s ever tried a New Year’s resolution knows, maintaining new habits is hard. But psychologists who specialize in behavior change say there are things you can do now to make it more likely that you’ll succeed down the line. For instance, you can prime your environment, whether by setting up an automatically recurring monthly donation or putting running shoes by your bed to nudge you to go for that morning run. It’s also good to reward yourself each time you engage in the target behavior — but make it an intrinsic reward, not an extrinsic one. So instead of reaching for a smoothie after every run, pause to savor the extra energy and strength you feel.
Finally, it’s important to note that if you don’t emerge from this pandemic with any great new habits, that is absolutely all right. Sometimes surviving is an accomplishment in itself.
“With my quarantine, good habits came of it. But I want others to know it’s okay if good, bad, or nothing came out of this quarantine,” said Farishta Saifi, a 23-year-old home health aide. “The world is a scary place right now, and just you living another day is excellent enough.”
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This is AI generated summarization, which may have errors. For context, always refer to the full article.
Alecs Ongcal
MANILA, Philippines (UPDATED) – On midnight of Tuesday, March 17, the Philippine government will put in place stringent social distancing measures in Luzon in a bid to contain the spread of the novel coronavirus.
The lockdown , described by government officials as an “enhanced community quarantine,” will set in motion efforts to limit the movement of people going in and out of the island region, home to at least 57 million. These measures were recommended by the Inter-Agency Task Force (IATF) on coronavirus.
In the run up to the lockdown, the government had implemented a “general community quarantine” on Metro Manila, where the officials attempted to restrict the movement of those coming into and out of megacity to those working and traveling to provide essential goods only.
But gaps in early implementation have illustrated the near impossibility of observing social distancing measures crucial to preventing the spread of the coronavirus.
Aside from this, classes in all levels and government work in the executive branch were suspended until April 14 , additional travel restrictions were put in place; and land, air, and sea travel to and from Luzon will also be prohibited as a general rule.
Just how effective will the government’s community quarantine be?
Rappler interviewed Dr Edsel Salvana, a specialist in infectious disease and tropical medicine, and the lead member of the technical advisory group for the IATF on what quarantine measures include and why they matter.
Here’s what you need to know:
Latest count: As of Monday, March 16, the Philippines listed 142 confirmed coronavirus cases, including 12 deaths. Three have recovered, including the first Filipino infected in the country.
A memorandum signed by Executive Secretary Salvador Medialdea, by order of President Rodrigo Duterte, on Friday, March 13, and shared with media on Saturday, defines this as taking place on two levels:
The first level is called a “general community quarantine.” This means that the movement of people is largely limited to “accessing basic necessities and work” while uniformed personnel and quarantine officers are present at border checkpoints.
The second is an “enhanced community quarantine,” more akin to a total lockdown with hard borders.
In this scenario, strict home quarantine for all households will be implemented, transportation will be suspended, provision for food and “essential health services” will be regulated, and there will be a heightened presence of uniformed personnel to enforce quarantine measures.
What’s in place now is a an “enhanced general community quarantine.”
Salvana said a community quarantine with extreme social distancing measures were implemented as preemptive measure to help manage the increase in cases in the country.
This is largely to help the Philippines’ health system cope with treating patients as a sudden surge or increase can overwhelm hospitals and health workers.
“We have relatively few cases at this time but we feel that it is important to have extreme social distancing already because our healthcare system would be unable to cope with the case numbers in Wuhan, which even they had a hard time managing,” Salvana said.
In coming up with the current general community quarantine, government officials scrambled to clearly define what this might look like on the ground and how to implement on all 12 million residents of the capital region.
At this early stage of the epidemic, Salvana said, a total lockdown “may cause widespread panic and unrest and cause a drastic disruption of daily life” when it is essential for people to remain level-headed.
China and Italy are among the countries which have in place sweeping measures to isolate cities where cases were concentrated. In the case of Wuhan, China – ground zero of the disease – lockdowns were favored as cases were rapidly increasing into the thousands.
For a general community quarantine then, what is being done is “a preemptive intervention which will hopefully be enough at this stage and at these case numbers,” Salvana said.
On Monday, Duterte changed that, citing a need to take more stringent measures.
“I have come to the conclusion that stricter measures are necessary. For this reason, pursuant to my powers as President under the Constitution and RA 11332 (Law on Reporting of Communicable Diseases), I am placing the entire mainland of Luzon under quarantine until April 12, 2020.”
After going off tangent, Duterte later clarified this would be an “enhanced community quarantine.”
Government officials have urged the public to go out of their homes only for essential tasks like going to work and getting basic necessities. This is to decrease the risk of spreading the diseases especially to those who are at higher risk of infections.
Salvana said for the quarantine measures to work, the public needs to remember to do the following:
In calling for self-quarantines and social distancing measures, epidemiologists have touted the strategy of trying to control the speed of an outbreak occurrence. This is largely to help spread out the number of infections over time so as to cushion the impact on hospitals and medical workers dealing with the disease first-hand.
A now viral image on the internet dubbed as “flattening the curve” illustrates this in a simple graphic below:
Salvana explained that these measures, if followed will “flatten” the epidemic curve, meaning the “number of cases per day slows down to a level where our healthcare system can manage.”
Too many cases, he warned, will translate to more hospitals being overwhelmed and increasing the possibility of more deaths.
“So this community quarantine, while inconvenient, is preferable to more harsh measures if it doesn’t work. Lives are at stake, especially those of the elderly and sick,” Salvana said.
In trying to mitigate the spread of an outbreak, Salvana points out that timing is key.
Waiting for more cases to prop up can bring about worse effects for the Philippines.
“Italy, Wuhan, South Korea all thought that they intervened at the right time and were swamped with cases and had to resort to drastic measures. This response is preemptive, and builds on the knowledge that by the time you think you have enough cases to respond, it is already too late,” he said.
For Salvana, it’s important to know that the novel coronavirus disease is “unlike any other disease we have faced.”
“The public needs to cooperate and understand the rationale for doing this. Countries with much better healthcare systems responded in what they thought was an appropriate fashion and it blew up in their face,” he said.
“The public needs to understand that if even these places had difficulty coping, then it would be a true disaster if we delayed these measures for much longer,” he added.
Transparency and honesty are key, Salvana said. It’s important people are always kept up to date with the current situation and developments.
“I think government needs to be transparent and honest with what is going on. (The) DOH has been working hard, but there is a lot of polarization due to politics,” he said.
He added, “We need to set aside political games at this time and unite to fight a common foe. The most vulnerable to this disease are the sick and the elderly. Their lives are in our hands. We need to get our act together now.” – Rappler.com
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European Journal of Clinical Nutrition volume 74 , pages 852–855 ( 2020 ) Cite this article
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COVID-19 is causing a global pandemic with a high number of deaths and infected people. To contain the diffusion of COVID-19 virus, Governments have enforced restrictions on outdoor activities or even collective quarantine on the population. One important consequence of quarantine is a change in lifestyle: reduced physical activity and unhealthy diet. 2019 guidelines for primary prevention of cardiovascular disease indicate that “Adults should engage in at least 150 minute per week of accumulated moderate-intensity or 75 minute per week of vigorous-intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity) to reduce ASCVD risk.” During quarantine, strategies to further increase home-based physical activity and to follow a healthy diet should be implemented. Quarantine carries some long-term effects on cardiovascular disease, mainly related to unhealthy lifestyle and anxiety. Following quarantine a global action supporting healthy diet and physical activity is mandatory to encourage people to return to good lifestyle.
Introduction.
Quarantine and isolation are two measures that can prevent, or at least minimize, the impact of infectious disease outbreaks. In public health practice, “quarantine” refers to the separation of persons (or communities) who have been exposed to an infectious disease. “Isolation,” in contrast, applies to the separation of persons who are known to be infected [ 1 ]. There are several examples of Government imposed quarantine or travel bans, i.e., at least 18 US states quarantined people returning from West Africa during the 2014 Ebola outbreak [ 1 ]. Now, COVID-19 infection is causing a global pandemic with a high number of deaths. By March 29, Italy reported 10,023 deaths (Italian Health Ministry, https://www.salute.gov.it/portale/nuovocoronavirus/ ) [ 2 ]. To contain the diffusion of the COVID-19 virus, the Italian Government as well as others have enforced on the population. The previous experience of the SARS outbreak showed the efficacy of timely quarantine and isolation measures [ 3 , 4 ]. Quarantine is often an unpleasant experience: loss of freedom, uncertainty over disease status, and boredom can create dramatic effects. The potential benefits of mandatory mass quarantine need to be weighed carefully against the possible long-term negative effects on cardiovascular risk burden [ 4 , 5 ].
The main consequence of quarantine is a change in lifestyle and nutritional habits (Table 1 ). Nutritional habits will change due to reduced availability of goods, limited access to food caused by restricted store opening hours, and to a switch to unhealthy food. A recent review on the psychological impact of quarantine [ 6 ] reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Having inadequate basic supplies (e.g., food, water) during quarantine was a source of frustration [ 7 ] and continued to be associated with anxiety and anger for 4–6 months following release [ 7 , 8 ]. Due to anxiety of future food shortage, it is plausible that people will purchase packaged and long-life food rather than fresh food. This leads to weight gain and to a reduced intake of antioxidants. Oxidative stress and mild chronic vascular inflammation are part of the pathophysiology of hypertension and atherosclerosis [ 9 ]. Diets rich in antioxidant food (i.e., Mediterranean diet and Dash diet) are vascular protective. Several studies found that the Mediterranean diet is associated with a reduction in incidence, prevalence, and mortality from coronary artery disease, cardiovascular disease, diabetes, and in all-causes mortality including cancer [ 10 , 11 ]. A systematic review on 7186 subjects (5168 subjects assigned to a Mediterranean diet), reported a significant reduction in central obesity with a Mediterranean-type diet [ 12 ]. Mediterranean diet is naturally low in sodium due to its low degree of processing, unlike processed foods (a term that covers all foods that have undergone manufacturing methods, including convenience foods and products like bread, cheese, and meat products) and is also rich in fruit and vegetables [ 13 ]. Diets rich in fruits and vegetables have several positive effects: known health benefits of high flavonol intake, potential increase in nitric oxide species, concomitant weight loss, reduction of blood pressure, and reduction of inflammatory markers [ 14 , 15 ]. These beneficial effects are similar in men and women despite the fact that adherence to diet and healthy lifestyle is influenced by gender [ 11 , 16 ].
Quarantine induces anxiety and stress. Torres and Nowson analyzed the relationship between stress and eating behavior and identified that people cope with stress by eating and drinking in an attempt to feel better (“stress-related eating”). These stress-driven eaters and drinkers were more likely to eat unhealthy foods such as snacks, hamburgers, soda cola, and chocolate regularly and to drink wine and spirits more frequently. In addition, the lack of emotional support from friends and relatives was predictive of stress-driven eating and drinking behaviors [ 17 , 18 ]. During quarantine, stress-driven eaters would easily switch from a healthy diet to unhealthy ones. This would affect cardiovascular risk mainly in high-risk patients.
Together with the unhealthy diet, the reduction of physical activity will contribute to weight gain during quarantine. Regular physical activity is mandatory to maintain health status, and is associated with reduction in cardiovascular risk [ 11 , 19 ]. The OMS suggests performing physical activity, such as walking, cycling, sports, dance, and yoga, in a manner that will prevent noncommunicable disease [ 20 ]. During quarantine the Italian Government prohibited the great majority of outdoor and social activities (e.g., going to the gym) resulting in a reduction of physical activity. Despite the guidelines to workout at home, only few subjects comply.
The reduction of physical activity will increase oxidative stress. Oxidative stress leads to apoptotic cell death of endothelial cells, reduces nitric oxide levels, increases activity of matrix metalloproteases and amplifies vascular inflammation, provoking vasoconstriction, LDL oxidation, and accumulation of foam cells [ 19 , 21 ]. Oxidative stress is mutually linked to inflammation, often associated with an increased risk of endothelial dysfunction [ 21 ]. In addition, obesity is associated with elevated circulating levels of IL-6 and TNFα, which are subsequently decreased with weight loss. In obese subjects, adipose tissue becomes dysfunctional, promoting a pro-inflammatory, hyperlipidemic, and insulin resistant environment that contributes to cardiovascular disease [ 22 ].
It is well recognized that chronic physical activity attenuates oxidative stress in healthy subjects via the improvement of antioxidant enzyme capacities and inflammation via the enhancement of anti-inflammatory molecules [ 23 ]. The reduction of physical activity worsens cardiovascular risk by increasing cardiovascular risk factors burden.
The role of negative psychological factors—including depression, anxiety, and hostility—in the development and progression of cardiovascular disease is well established [ 24 , 25 ].
By contrast, several studies have linked positive psychological characteristics with lower levels of traditional cardiovascular risk factors and decreased incidence of CV disease [ 26 ]. Prospective investigations of patients with existing CVD have shown that greater positive well-being is associated with reduced risk of secondary cardiovascular events and mortality [ 26 , 27 ].
Positive well-being is thought to influence cardiovascular disease by (a) promoting adaptive physiological functioning, (b) motivating better health behaviors, and (c) buffering against the detrimental effects of stress on health [ 26 , 28 , 29 ]. These three pathways are interrelated and not mutually exclusive.
Positive well-being may act as a modifiable protective factor that could reduce the burden of CVD through its potential influences on lifestyle behaviors [ 24 , 26 , 27 , 28 ]. People with higher positive well-being tend to have better health behaviors, including nonsmoking, greater physical activity, better dietary patterns, and lower incidence of sleep disturbances. It remains unclear whether positive well-being leads to better subsequent health behaviors or vice versa, however a strong relationship has been demonstrated. Positive well-being is thought to have multiple salutary effects during stress, such as reducing inflammatory and cardiovascular responses to acute stressors. Positive well-being also acts on cardiovascular function and cardiac autonomic control, reducing heart rate and blood pressure [ 24 , 26 ].
It is difficult to see the acute effects of quarantine on atherosclerosis. Nonhealthy lifestyle through increase of inflammatory status could trigger activation of preexisting plaques. We cannot exclude that changes in lifestyle persist after quarantine. In this case the risk of an economic crisis will maintain stress and anxiety in subjects, principally in those belonging to low socio-economic categories, leading to an increase in cardiovascular risk.
Following the Spagnola pandemic throughout 1918, a peak of cardiovascular events was reported. Such events manifest from 7 to 10 days after the emergence of influenza symptoms. In 1918, immediately after the end of the Spagnola epidemic, deaths caused by cardiovascular events had outmatched deaths from other causes, including superimposed pneumonia [ 30 , 31 ].
We think cardiologists need to be prepared to face the likely increase in obesity immediately after the end of the pandemic.
During quarantine we must promote physical activity at home. Little information is available on effects of home-based physical activity on chronic disease [ 32 , 33 , 34 ]. Despite physical activity being defined mandatory for cardiovascular prevention, guidelines do not contain home-based physical activity indications [ 35 ]. The “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease” recommended that “Adults should engage in at least 150 minute per week of accumulated moderate-intensity or 75 minute per week of vigorous-intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity) to reduce ASCVD risk” (Class I LOE B-NR) or “for adults unable to meet the minimum physical activity recommendations, engaging in some moderate- or vigorous-intensity physical activity, even if less than this recommended amount, can be beneficial to reduce ASCVD risk” (Class IIa LOE B-NR) [ 35 ].
The WHO has just released guidance to “Stay physically active during self-quarantine” in order to improve healthy behaviour during quarantin [ 36 ]. Today there are thousands of workout videos available on the Internet. The goal is to assist people perform these workouts independently on their own. A common observation is that even people who visit gym regularly find it difficult to perform all steps (body pose alignments) in a workout accurately. By continuously doing an exercise incorrectly may eventually cause severe long-term injuries [ 37 ].
After quarantine we need to reevaluate the cardiovascular risk in patients together with metabolic parameters including glycemic status. Patients also need to be evaluated by psychologist to early identify the persistence of anxiety and stress (Table 2 ). A global action supporting healthy diet and physical activity is mandatory to encourage people to return to good lifestyle. This action has to be stronger at a low socio-economic level where individuals will suffer to a higher degree from the restrictions.
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Mattioli, A.V., Ballerini Puviani, M., Nasi, M. et al. COVID-19 pandemic: the effects of quarantine on cardiovascular risk. Eur J Clin Nutr 74 , 852–855 (2020). https://doi.org/10.1038/s41430-020-0646-z
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The Philippine government has imposed a strict community quarantine order amid the coronavirus disease (COVID-19) outbreak. Residents, however, have concerns, as the guidelines require that everyone should as much as possible stay at home.
The guideline of 'enhanced community quarantine' includes the suspension of all mass transportation, closure of schools and universities, checkpoints at borders, and the cancellation of domestic air, sea, and land travel. International flights have also been halted.
Under the new measure, the government will also implement strict quarantine and the regulation of the provision of food and essential health services.
“The idea is to keep everybody in home quarantine. The mindset should be, in case of doubt, stay at home,” Cabinet Secretary Karlo Nograles said. “For outbound international passengers traveling from Luzon, he said they would be allowed to leave the country within 72 hours from the start of the enhanced quarantine. Those who want to leave will leave within that period. We assume that after 72 hours, it is your decision to stay here,” he added.
Millions of people in the Philippines were left confined after the implementation of the new community quarantine order, causing chaos in the country’s capital, Manila. The National Capital Region (NCR) first reported the cases of confirmed COVID-19. As of writing, the country has 187 confirmed cases and 12 deaths, with the highest fatality rate globally of 8 percent.
In the capital, there are long queues of workers wanting to cross the border to attend work. Some companies have already suspended work, including non-essential businesses that are ordered to close. Companies that offer basic necessities and services remain open, including takeaway restaurants, water stations, supermarkets, banks, and pharmacies.
On Mar. 17, the President, Rodrigo Roa Duterte placed the entire Luzon region into lockdown to combat the coronavirus disease, which has now taken more than 7,900 lives worldwide, with a total of 197,496 confirmed cases. In the entire Luzon region, public transport is suspended, with residents who still need to work crowding the borders in the hopes of hitching a ride to and from work.
Several companies have promised to maintain the salaries of affected employees, while others continue their operations. Health care workers, government workers, police officers, military, and other front liners are still required to work, facing the threat of infection and serving the country.
Still, there is confusion and frustration concerning the orders which aim to hinder the spread of the coronavirus, estimated to infect as many as 70,000 Filipinos. The Philippines does not have adequate resources to face a pandemic, with the healthcare system groaning for more supplies of PPEs for its health workers.
Many Filipinos are worried about how to make both ends meet. The World Bank has projected that the poverty incidence in the country is at 24.5 percent for 2016, and 21.9 percent for 2018, based on the lower-middle-income poverty line of $3.20 per day.
Workers are confused and frustrated about how to earn income for their families amid the quarantine orders. However, the government has assured that there are food and basic supplies in the ‘Barangays’ (smallest administrative division) of each local government, especially for those in dire need during the quarantine period.
The Department of Labor and Employment (DOLE) announced a financial assistance program for employees affected by the new measures, with a USD $25 million (P$1.3 billion) COVID Adjustment Measures Program (CAMP). Each employee in private establishments will receive cash assistance of nearly USD$100. About 250,000 workers will benefit from the program.
Private companies have also assisted their employees, while others still gave out salaries and assistance to their constituents.
The local government of Baguio City, located north of the NCR, has imposed strict implementations of the enhanced community quarantine. Mayor Benjamin Magalong has released measures in an attempt to maintain the city’s COVID-free status.
As of Mar. 17, the city has been placed on a 24-hour curfew, beginning at 5 a.m. of Mar. 18. Authorities will regularly and strictly check the purpose of people who go out in the streets. They will ensure that residents will stay at home, while barangay local authorities oversee the implementation of the measures among their constituents.
For critical personnel, such as health workers and government officials, the curfew remains between 9 p.m. and 5 a.m. Public transport has been suspended, while non-residents were given a 48-hour window to leave the city. Further, non-residents going into the city will not be allowed entry.
Only one person is permitted by the government to go out of the household and buy essentials. Private vehicles and motorcycles can be used, provided that only one person per vehicle. Special permits may also be issued to vehicles to ferry employees, including health care workers, critical personnel, and employees of private establishments.
In the city of more than 300,000 people, eight cab units have been assigned for emergency medical care services. These units are “on-call” to address the need for transportation in cases of emergencies. Public utility jeepneys were also assigned to transport people to buy their essentials in supermarkets and markets in the city.
The government has assured that the movement of essential goods and services will remain unhampered, to ensure that all residents are safe and secure amid the quarantine order.
In all supermarkets, pharmacies, and other essential businesses, social distancing is strictly imposed.
Posted in: Disease/Infection News
Tags: cAMP , Coronavirus , Coronavirus Disease COVID-19 , covid-19 , Food , Health Care , Healthcare , Labor , Pandemic , Poverty
Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.
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