We are all learning to adjust to a new reality of daily life from the COVID-19 pandemic. Elbow bumps and 20 second hand-washing, out-of-stock hand sanitizers and empty Costco shelves. School and business closures, mandated remote work, and event cancellations create an eerily surreal scene on the streets. March Madness is now March Sadness. No more live sports, no more concerts, no more outings. And more unsettling, no more sense of safety or security with what was previously normal. Social Distancing and Flattening the Curve, terms previously unheard of, have instantly integrated into our national vernacular as much as the coronavirus has invaded our collective psyche. Now it is more critical than ever in our shared lifetime that we work together while simultaneously isolating from each other.
I live in a hot zone area in Santa Clara County in Silicon Valley where confirmed infected cases increase by the day, with climbing death rates soon expected to follow. For my wife and 5-year-old son, our first major disruption was cancelling our long awaited Spring Break vacation to London, prior to the announcement of the travel ban. My spouse, who is immunocompromised, broke the news to our son that we could no longer travel due to her health condition. Rather than getting upset and making a fuss, our son comforted her instead, responding, “That’s OK mommy. I’ll protect you.”
Four years ago, my wife and I found out she had dermatomyositis (DM), a rare and incurable autoimmune disorder marked by chronic inflammation of the skin and muscles. We also discovered her lungs were secondarily diseased, which significantly worsened her prognosis. She had a 1 in 4 chance of dying within a year. Her immune system had misidentified components or her own body as foreign, activating an inflammatory cascade that downstream damaged her lungs in the crossfire. The unchecked inflammation destroyed the precious tiny spaces in her lungs, which were vital for the exchange of oxygen and carbon dioxide between the air and her blood. Moreover, as the by-products from the friendly fire deposited, gathered, and obstructed the delicate air spaces in her lungs, they further intensified the feed-forward inflammatory cycle, ultimately initiating the process of fibrosis, permanent scarring of the lungs. Without proper lung function, her body would not obtain the necessary amount of oxygen to maintain vital bodily functions. All in all, my wife’s fate rested on whether her lungs were capable of reversing course or else succumb to the extensive inflammation and injury that had been insidiously materializing for months without our knowledge.
When we’re overwhelmed with stress, our mind and body goes into fight, flight, or freeze mode without our conscious awareness.
I was a new father at the time of my spouse’s diagnosis. I was terrified as hell yet I didn’t recognize the fear I was experiencing. When we’re overwhelmed with stress, our mind and body goes into fight, flight, or freeze mode without our conscious awareness. It’s a reflexive survival mechanism. Autopilot habits and reactive coping behaviors kick into gear, causing us to obsess, ruminate, and catastrophize. More deceivingly, we tend to engage in relentless and inflexible problem-solving activity. While we perceive ourselves as taking productive and decisive action, the reality is usually that we are avoiding what’s actually happening right in front of us.
My mind didn’t have the capacity to deal with what my wife was going through. It couldn’t process the plausibility of her premature death, nor that our infant son may never get to know his mother. My mind retreated into denial and rationalization. I failed to be present and supportive to her. As she underwent the rounds of chemotherapy and its uncertain effects, with the hope treatment would slow down her immune system’s unrelenting activity that was a runaway speeding locomotive, I exhausted myself researching incessantly online in attempt to gather all the information about DM. Armed with a background in medicine, I was determined to uncover the underlying cause of her DM and fault her doctors for failing to diagnose her symptoms sooner. Maybe if they had listened to her growing complaints of increasing physical pain and fatigue, skin irritation, and hair loss with a keener degree of clinical suspicion, we could have identified and treated her DM months earlier. Perhaps the extent of her lung damage would not have progressed to the near-critical stage of fibrosis and irreversible loss of respiratory function. We definitely would not have been thinking about premature death.
Luckily, my wife responded positively to the chemo. The condition of her lungs improved, albeit with residual fibrosis. Her lungs will never function the same and will always be at higher risk for respiratory infection.
The coronavirus, a pathogen specifically targeting our lungs, will eventually infect the majority of us. It is only a matter of time. Most will experience only mild or flu-like symptoms. The higher risk population, however, comprised of the immunocompromised and adults over 60 are likely to develop moderate pneumonia. If the pneumonia worsens in severity, the condition may rapidly progress into acute respiratory distress, further increasing the risk of secondary infections and sepsis, making death an almost certainty.
At the time of my wife’s DM diagnosis, I could only perceive our circumstances, particularly facing the realistic risk of her premature death, as a complete nightmare — nothing happening was good. l am very grateful she survived and especially appreciative that our son got to know his mom. With hindsight on my side now, I truly feel fortunate for the experience we faced, particularly given our current situation with the unthinkable COVID-19 pandemic. Having the experience of being blind-sided by the possibility of my spouse dying of inflammatory lung disease taught me a few invaluable lessons, which are greatly magnified in light of the coronavirus outbreak.
Once we recognize fear, we can begin to understand and appreciate how fear impacts us.
First, I gained the opportunity to become intimately familiar with the chronic daily stress of living in real fear of losing a loved one to premature death. I learned firsthand when we are afraid, we are not consciously aware until we pause and acknowledge that there is indeed fear. As a therapist, it is imperative for me to emphasize admitting fear is not a sign of weakness; it is a sign of security with ourselves. We may try to convince ourselves we are not afraid or the fear is irrational, however, doing so will inevitably misguide us to denial. The consequence is the costly loss of precious time we will never regain. If however, we are able to acknowledge and identify our fear, we will be capable of effectively navigating through it. Once we recognize fear, we can begin to understand and appreciate how fear impacts us. Fear causes anxiety, worry, and panic, which are all associated with a degree of maladaptive avoidance. To successfully navigate fear, we must summon courage, which is to act responsibly and proceed forward in spite of fear.
Engaging in mindful awareness rescues us from being mentally and emotionally trapped in the vicious cycle of stress…
Secondly, I learned to prioritize and incorporate wellness habits into our daily life to combat the negative effects of inflammation and chronic stress. In addition to proper sleep and nutrition, aerobic exercise and mindfulness meditation are fundamental in overcoming acute and chronic stress. Exercising allows us to increase our capacity to tolerate and endure sustained periods of physical and mental discomfort; it strengthens our tolerance and resilience to stress. Mindfulness meditation helps us regulate our mind’s natural fixation on past and future events, helping us remain aware of our present experiences. Under chronic distress, we may re-experience the trauma of past events or the agitation of potential future events as if we were actually living the imagined event in real time. Our perception becomes our reality. Engaging in mindful awareness rescues us from being mentally and emotionally trapped in the vicious cycle of stress, allowing us to cultivate a sense of calmness in the chaos.
NAC, a widely available, over-the-counter supplement, has powerful antioxidant and anti-inflammatory effects that particularly protect the lungs from inflammatory damage.
Lastly, and perhaps most specific and relevant to the disease process of COVID-19, I learned about the profound benefits of N-acetylcysteine (NAC). NAC, a widely available, over-the-counter supplement, has powerful antioxidant and anti-inflammatory effects that particularly protect the lungs from inflammatory damage. My wife has been taking this supplement for the past few years. Her lung function has not deteriorated, and even improved, defying the natural progression of her lung disease. As I have recently learned, the virulence of the novel coronavirus may have less to do directly with the virus itself and more to do with the overreactive inflammatory response triggered in our lungs. The inflammatory response of our immune system, yet again, is causing the damage, rather than the viral infection itself. Moreover, the antioxidant and anti-inflammatory mechanisms of NAC have been shown in recent studies to be effective in reducing the virulence of RNA viruses such as the coronavirus. NAC inhibits viral replication and reduces virus-induced pulmonary inflammation in RNA viruses, decreasing severity of pulmonary illness. As current treatment is only supportive once symptoms occur, ie. oxygen therapy and IV fluids, I strongly recommend taking prophylactic measures to minimize the potential extent of pulmonary inflammation. NAC may give our lungs a fighting chance. (Please purchase a bottle of the NAC supplement and start taking 600mg twice daily. If you are in the high risk group, I would recommend up to 1,200mg twice daily)
My family and I are fortunate to have existing and available resources to best prepare ourselves in navigating the disruptions, uncertainties, and chronic stress caused by this pandemic. We are extremely grateful. We recognize canceling a vacation trip is immensely trivial compared to what many others are dealing with across the world. Regardless of our circumstances, I believe we are all in this together. Like my son who wholeheartedly believes he can protect my wife, I too believe we as a society and global community can protect each other. Together, let’s summon our courage, isolate from each other, and be socially responsible as we each do our part to flatten the curve.
M.F. McCarty and J.J. DiNicolantonio, (2020) Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus. Progress in Cardiovascular Diseases.
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Geller J et al. (2010) N-acetyl-L-cysteine (NAC) inhibits virus replication and expression of pro-inflammatory molecules in A549 cells infected with highly pathogenic H5N1 influenza A virus.Biochem Pharmacol. Feb 1;79(3):413–20.