Emerging From Quarantine: Keeping Your Health Priorities Straight In A Post-COVID World

COVID-19 lockdowns are easing across the U.S., and there is a lot to process as these restrictions begin to end and transition.

What is the new safe? Can we return to the gym? Can we schedule regular medical appointments again? What should we include on our post-quarantine list of health practices? And if you forged some new habits or rediscovered old hobbies while staying at home, should you consider making those part of your new normal routine?

As the world begins to recover from some of the unfortunate consequences of the pandemic such as shuttered businesses, lost jobs, and social-distancing, there have been some positive changes, too.

More than before, people are spending more time outdoors in the sunshine. Almost everyone I know has picked up a new exercise habit. People are spending more time with their families, bringing people together and making interpersonal bonds stronger.

So perhaps the first thing to do is decide which of the new habits will you keep, and maybe you'll decide to keep them all.

The next step is to put together a list of your health priorities. To do this, you'll need to understand your own risk for contracting COVID based on your age and particular issues. Then make sure that you know your local data - know the COVID rates in your area, and understand any new trends such as an increase in new cases. Pay attention to what experts are counseling people to do in your area with respect to your own care.

Here's a helpful list with some annotations:

1. If you've missed medical appointments, testing, or treatments, it's time to reschedule any missed procedures or screenings, especially high-priority ones. Most likely your health care providers have already or will soon begin to see patients in their offices.

As an article in the American Heart Association News mentions:

In a recent report, 16 North American cardiovascular societies issued guidance for health professionals on safely reintroducing diagnostic tests and invasive cardiovascular procedures, with an eye to regions with lower rates of infection.

The pandemic has taken a toll on cardiovascular care, said cardiologist Dr. Robert Harrington, chair of the department of medicine at Stanford University in California. He co-authored the report as president of the American Heart Association.

"We've seen a large drop-off in patients seeking acute care for suspected heart attacks and strokes. There's been a decrease in more elective procedures such as exercise testing, cardiac catheterization and other procedures. Anecdotally, we also hear of people having worsening symptoms at home, with a reluctance to seek care for issues such as heart failure management."

The new report goes on to highlight the need for cardiologists to prioritize procedures or screenings with the most benefit for the most people in an attempt to "balance the risk of further care postponement against the risk of further spreading COVID-19."

Other medical provider organizations such as the American Cancer Society are also in favor of resuming cancer screenings and exams in the hopes people will be able to work with their health providers to take into account their own personal situations.

2. Get back in touch with your primary care provider to let them know how you've been and if there have been any changes in your health. Update your doctor on any ongoing conditions, and most especially, if you've had COVID-19.

Interestingly enough, your primary care provider may be a great source of local COVID data and be able to balance your personal health vulnerability against local COVID-19 infection trends to determine whether and when to pursue in-person visits for routine care such as vaccinations and dental checkups.

3. Get back to regular exercise & try to lose any bad habits you may have picked up.

Hopefully, you haven't gone back to smoking, but some have. Maybe it's some extra wine, but no matter what the habit, now is a good time to take an inventory and start formulating your exit strategies. For many, however, the worst habit developed during this long period of quarantine was once again staying on the couch instead of moving our bodies. That may be the easiest exit strategy to plan: time to get up off the couch and get back to it.

4. Set some goals and follow-through check-ins.

The new normal, post-COVID reality is still very much the same as the old normal, pre-COVID world. Your health priorities are still to eat healthfully, exercise, manage your stress, and pay attention to your mental health. The things that worked before to achieve those goals still work. Exercise, meditation, yoga, etc. all work to promote both physical & mental well being.

5. Don't forget to maintain personal protective precautions.

It's still important to assess the risks of every return. Whether it's the gym or a physician's visit, you must use the same amount of pragmatism and caution. Don't forget that in all situations, you must continue to observe the proper social distancing and masking when near others as well as always remembering to maintain good hand hygiene.

Dr. Mark L. Meyer received his M.D. from the Yale University School of Medicine and his J.D. from Yale Law School. He has a private cardiology practice in Manhattan.

It's OK To Worry About Your Local Movie Theaters

It’s a beautiful, sunny morning, and spring is in the air. There should be a bounce to your step as you prepare to decamp from your home, meet your friends for coffee, head into the office, and begin another wonderful day. But then it comes to you: there is still a quarantine. You turn on the news, see the rise in the death toll, and you think about the people you know who are sick, the ones you’ve known who have died, and you feel a twinge of something. Is it survivor’s guilt, or a pressing need to help in some way, or fear that maybe you have the virus and are minutes away from your first symptom, or is it a hope that you may have been one of the asymptomatic carriers who now has that most sought-after thing that money can’t buy (the ANTIBODIES)? Or is it a mishmash of all of these feelings?

Well, as this describes some aspect of everyone’s collective experience, you clearly are not alone. A sexagenarian told me this morning that he had never been under such enormous stress in his ENTIRE life. Which is saying something given over six decades of world events as a point of comparison.

So if it is fear which is principally driving the feelings of anxiety, what are we afraid of? Parsing and unpacking the mishmash can be helpful. Fear of death is a potent distracter, to say the least. Most of us (though far from all) are able to compartmentalize this fear, and by following the CDC-recommended measures, we are also taking affirmative steps to minimize this outcome, and so far these measures seem to be working to “flatten the curve”. Actions which produce results make us feel better.

I think a more prevalent though not always identified fear is the concern that things will NEVER return to normal. Considering that a person who has the flu for three days wonders if she will ever again feel whole, the COVID pandemic, with no clear end in sight, amplifies these feelings logarithmically. And as if social isolation weren’t enough, when we do venture out, there is the feeling that people on the street see us as the enemies, as the very agents of their own doom. This has a funny way of making us feel dirty, like lepers to be avoided. Normally, as New Yorkers, we are very protective of our personal space. But now, when faced with compulsory isolation, we find ourselves longing for those annoying and probing questions from people standing in line at the market, at Starbucks, and on the subway.

We even long for traffic, and if that’s not a paradigm shift, I don’t know what is. I was driving with my son yesterday, and said I couldn’t wait until I have to drive around a few times to find a parking space, instead of being faced with spot upon empty spot. Be careful what you wish for, I told myself. Of course, we are not longing for traffic or a lack of parking spaces, but rather a return to normalcy.

But if the WHEN is a driver of anxiety, so is the fear of the WHAT. The worry that there will be a new norm, and this sort of newness is unsettling. Will the movie theaters ever open again? Will my favorite restaurant still be in business? Will stores be in business, now that online-everything has settled in even more firmly than BC (before COVID)? And then comes the guilt—who are we to be thinking of movies and shops and groceries and bakeries when people are DYING? And yet to recognize that many, many people are feeling this way (remember, I talk to people all day, and in the confines of the legally-protected safe space of a doctor’s visit, I hear a LOT) helps us identify as normal the things which are driving our fears and our anxieties (and our palpitations). And in so doing, enables us to face these realities head-on, and to begin to deal with them. Or more to the point, there is nothing WRONG with you for feeling these things, even while you are concerned about the macro-environment which is destroying so many precious lives.

We are living through historic times. Infamous, to be sure, but historic nonetheless. So chronicle how you are feeling. Take notes, photos and videos. For when the worst is over, there will be the post-worst. The post-traumatic stress reactions, the smoldering anxieties, the new reality. And having notes and photos will help the healing.

Will any of us ever again have fewer than 36 rolls of toilet paper in the pantry? Whose home will be without masks, gloves, and Purell? Will we ever shake hands again without fear of death? Never mind the nervous laughter. Many of us will be feeling this way. Those of us who expect it, recognize it, legitimate it—will be the best-prepared to deal with it.

Now look out the window, even open it, take a breath, look at the trees and the sky. There is ample beauty still in this world. Enough to get us through what is to come.

Dr. Mark L. Meyer received his M.D. from the Yale University School of Medicine and his J.D. from Yale Law School. He has a private cardiology practice in Manhattan.

Running A Marathon Could Prove To Be A Vascular Fountain Of Youth

There is new research out that suggests that first-time marathon runners could help reduce their vascular age — the age of one’s arteries — by up to four years. (https://www.sciencedirect.com/science/article/pii/S073510971938369X?via%3Dihub) The study's purpose was to determine whether the rigorous training for a first-time marathon can reverse stiffening of the aorta due to age. The results of the study were straightforward and impressive. Even at relatively low exercise intensity, training for and completing a marathon both reduce blood pressure and aortic stiffness to approximately a 4-year reduction in vascular age. There was even increased vascular rejuvenation seen in older, slower individuals.

For the study, researchers followed 138 untrained and healthy first-time marathon runners over a six month period ahead of the 2016 and 2017 London marathons, including the two weeks post-marathon. According to the report, study participants had no significant past medical or cardiac history, and were not running for more than two hours per week at baseline. The average of the participants was 37-years old, but ages ranged from 21 to 69, and 51% of them were female.

All the participants were directed to follow the 17-week "Beginner’s Training Plan" provided by the London marathon’s web page, which consisted of approximately three runs per week that increase in difficulty each week. Researchers did allow participants use other training programs. The average running time for female marathoners was 5h40min, and for males it was 4h50min.

As with everything in our bodies, blood vessels stiffen with age. One of these blood vessels is the aorta, which is the highway that carries oxygenated blood to our muscles and organs. Decreasing elasticity in the aorta has been associated with heart disease, kidney disease, and dementia, among other problems.

Tests of the marathon runners in the study showed that their aortas had increased flexibility during the training process, so much so that they looked about four years younger after the training period. Additionally, the systolic (top number) and diastolic (bottom number) blood-pressure measurements dropped an average of four and three points, respectively, for each runner. Encouragingly, older runners saw the greatest health improvements. "We were gratified to see that it's possible to improve things in older people that you think would have established irreversible changes," said study co-author Dr. Charlotte Manisty, a cardiologist at the University College London.

For those of us who don't fancy ourselves runners, it is still possible that the benefits extend to other cardiovascular exercises like cycling. Dr. Manisty pointed out that workout regimens tend to be more successful if someone is training with a goal in mind.

It's certain that for many, marathon training still sounds daunting, but finishing times for the study participants were about a half-an-hour slower than for typical marathon runners. Nevertheless, all participants showed significant vascular improvement. "This is running for health benefits for normal, real-world people running real-world marathons."