Droplets containing the coronavirus may be in the air, but they're competing for space with panic.

Every day, it seems, the news is worse. In Alabama, as testing for COVID-19 expands, so does the number of confirmed cases. It was just nine days ago that the first case was reported in the state, and as of Saturday evening, there were 131 known cases. Nationally and worldwide, deaths are mounting. On Friday, the governor authorized activation of the Alabama National Guard.

The virus itself or emergency orders designed to slow its spread have already cost many their jobs, and have many more worrying about their financial security. The kids are stuck at home. The stock market is a mess, and with it many retirement plans.

And as the situation gets increasingly grim, uncertainty about the future mounts.

While Alabama’s first confirmed case was March 13, California’s first case was Jan. 25 and that number surpassed 1,000 last week, including 19 deaths as of Friday. Elissa Epel, a professor of psychiatry at the University of California School of Medicine in San Francisco, has been dealing with the widespread fear that just reached Alabama for almost two months.

“There are a lot of unknowns. When we don’t have a lot of information, our minds have a field day, they have a stress party, and they go to the most catastrophic outcomes,” Epel said.

As horrifying as the situation is in California, Epel held out some hope that the hysteria, if not the virus, will ease.

“Maybe Alabama is a few weeks behind us, but the trajectory is this: Initially there are more panic reactions. And then things settle in and people realize the world is not ending, this is not the apocalypse,” she said. “That’s what’s happening here. At the beginning we had horrible grocery lines and now that’s gone down because people have realized the shelves are being replenished the next day.”

The anxiety may not have reached its peak in north Alabama, but it has definitely hit, according to Decatur resident Connie Kane. She’s a licensed professional counselor and clinical director at Crisis Services of North Alabama.

“We certainly are seeing an increase in our call volume. They are of course looking for testing sites. They are worried about finances. We’re also receiving a lot of calls on our help line from people wanting to talk to somebody about their stress and anxiety about the current situation, just wanting someone to listen to them,” Kane said.

Lisa Coleman, executive director of the Mental Health Center of North Central Alabama, said her organization is also encountering more clients with anxiety issues, including sleep issues.

Even as the Alabama Department of Public Health issues orders that endanger many jobs and result in anxiety-producing self-isolation, State Health Officer Scott Harris — formerly an infectious diseases specialist at Decatur Morgan Hospital — is cognizant of the mental health toll from the crisis.

“People have enough anxiety and fear already, and we have health orders that undoubtedly are going to affect the lives of real people and the livelihoods of real people,” Harris said. “We don’t want people to be afraid or anxious or worried. We want you to know that you actually have the power to protect yourself and the power to protect your own family.”

Epel says the panic surrounding the coronavirus is counterproductive.

“Let’s keep the real problems contained to the virus, and not on the human stress response gone awry, which brings out our worst self, our worst behavior. We get more selfish, more egoistic, more xenophobic,” she said. “I do think people should realize they don’t need to panic.”

A unique feature of the COVID-19 pandemic, as compared to most other disasters weathered by Alabamians, is that it isolates. Family units are increasingly confined to home, and with few social outlets for their growing stress.

“We are concerned, since people will be in the house and with family, about domestic violence incidents going up, as well as sexual assaults,” Kane said. “Families will be more isolated. Their support will come by phone, through the internet, but less face-to-face contact. Kids won’t be going to school. There will be more financial worries.”

As Epel has already discovered in California, those dealing with addictions face special challenges as the crisis unfolds.

“Everyone is under stress, and preexisting mental health issues and conflictual family dynamics will only be magnified,” she said. “We expect people with addictions to be really challenged right now and to need extra support.”

And yes, said the veteran of several weeks of coronavirus anxiety, domestic violence is an issue.

“All of the sudden a new challenge is managing the completely novel situation of living with nuclear family members for an extended period with no other physical social contact. It’s unprecedented. We need to rise up and be our healthiest self — our most forgiving, most kind, most compassionate. We need to try to not play out family dynamics that will make this feel intolerable,” Epel said.

Stressors are everywhere: from fear of the disease and of the glares that come from an innocent cough, from isolation, from confinement with family members, from financial insecurity. So what can we do to ease our anxiety?

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‘Catastrophizing’

Kane said the first step is to separate our worries into two categories.

The first category she calls "real-problem worries."

“These are worries about actual problems that need solutions right now. For example, my kids are off school and I need something for them to do; they’re driving me nuts. Or I need someone to take care of them because I have to go to work. Or I don’t have enough food to last. Those are the actual problems that are affecting you right now and you need to deal with,” she said.

This category of worry is benign. We worry about the problem until we come up with a solution, then we move on. The second category, one she’s seeing a lot, is hypothetical worries.

“Hypothetical worries are things that don’t actually exist but might happen in the future. ‘Are we all going to get sick? Is it going to spread like wildfire? Is everybody going to drop dead? Is everybody I know going to catch coronavirus? Am I going to lose my job because of this? Am I going to go to the hospital and they won’t have a ventilator?’ I can catastrophize until I’ve wiped out my entire family, lost my house, my dog’s dead, I’ve lost everything.

“That’s where a lot of us are going. We’re thinking way ahead. It’s leaving us feeling really anxious and apprehensive, because this is a whole new paradigm from what we’re used to. Those are hypothetical worries that we need to put a stop to,” she said.

She acknowledges that’s easier said than done. For those who find themselves unable to stop dwelling on hypothetical problems, she suggests a strategy.

“If you are prone to catastrophizing, then you set out 30 minutes a day and you just catastrophize the heck out of things. ‘What’s the worst thing that’s going to happen to me? Oh gosh that’s awful, that’s awful, that’s awful.’ Then ding, the timer goes off. I’m done for the day thinking that the world is going to end. I’ll pick it up again tomorrow at 8 a.m. and I’ll worry until 8:30 a.m.,” Kane said.

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Coping strategies

Other suggestions from the experts on keeping anxiety to a manageable level:

• Maintain balance and structure. “Treat this as a marathon, not a sprint,” cautioned Epel. “Don’t become depleted. Develop a daily routine where you can stay emotionally well and safe and help others, too. This could go on for weeks or months. It’s not time for business as usual, but it is a time to fight this, not to fall apart.” Eat well, exercise and get enough sleep.

• “Speak to yourself with compassion,” says Kane. “Be understanding of yourself that this is a very upsetting and changing time we are struggling with. It’s OK to be upset. It’s OK to be unglued. But recognize the positive things about yourself.”

• Live in the present. “If you have a pet, look at your pet,” Kane said. “Our cats and dogs just live in the present moment. They’re not worried about the virus. They’re in the moment, and we need to be in the moment.”

• Meditate or pray. “They allow you to focus and clear your mind, and they are very calming,” Kane said.

• Practice progressive muscle relaxation. “This is where you isolate specific muscles, tense them briefly and then relax them, beginning at your head or your toes and working up or down, taking the time to breathe,” Kane said.

• Deep breathing. Kane suggests placing a hand on the belly and inhaling deeply, then exhaling slowly.

• Laugh and cry. “Crying releases stress hormones and it’s a way to relieve stress,” Kane said. “Laughing brings oxygen into the body. It releases muscle tension and it stimulates the production of endorphins. And you know, it just feels damn good.”

• Connect with others. Epel says she prefers the term “physical distancing” to “social distancing,” because maintaining connections — through telephone or digitally — is critical. Echoes Kane: “Talking to someone who is really listening makes us feel understood. It provides us with comfort and relief. It allows us to vent and process our feelings.” If friends and family members are not available to talk, she encourages people to call the Crisis Services help line at 256-716-1000.

• Limit social media. "Take a break from listening to all the social media and the rumor mills about the virus. Hearing about the pandemic repeatedly can be upsetting," said Coleman. Indeed, adds Epel, studies have found that people who watched an excessive amount of media about past disasters, even geographically distant ones, suffered post-traumatic stress disorder symptoms for up to two years.

• Make a to-do list. “Prior to this disaster, how many times did we think, ‘If only I had more time.’ Now many of us have a lot more time. Do a quarantine wish list and hang it on your refrigerator,” Kane said. “Pleasurable things you never had time to do — maybe some crafts that you stuck on your shelf and never finished. … But don’t pressure yourself. Be compassionate. When you’re ready, check some of the things off your list.”

The moderate productivity that can come from making such a list, from maintaining a routine, is an important step toward normalcy.

“Right now we all feel like we’re in a state of shock. We’re feeling like we’re in survival mode,” Kane said. “We need to do something more than bingeing on Netflix, bingeing on news and buying toilet paper.”

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eric@decaturdaily.com or 256-340-2435. Twitter @DD_Fleischauer.

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