The New Normal

by Jennifer Ashton, M. D.

  How can you tell if you have health anxiety? Here are some questions to ask yourself to help determine if your health concerns may be causing you more harm than good:

  Are concerns about the virus or your general health causing you to feel isolated, depressed, lonely, or anxious?

  Are concerns about the virus or your general health interfering with your ability to work or perform other activities for your day-to-day livelihood?

  Are concerns about the virus or your general health interfering with your relationships or ability to give or receive love?

  Are you taking risks you wouldn’t have before the pandemic to avoid possible exposure to the virus?

  Are you not leaving your home because you’re concerned about the virus (barring stay-at-home orders or the need to self-quarantine)?

  Do you spend an obsessive amount of time sterilizing your body, home, or other surroundings?

  Do you have no signs of infection or illness but constantly worry you have COVID-19 or another medical condition?

  Do you spend an obsessive amount of time googling the virus or other medical conditions?

  Are your concerns about the virus or general health interfering with your ability to sleep or eat?

  Do you find yourself worrying about the virus or your general health multiple times per day?

  Have any of your friends or family told you that your fears or safety precautions are extreme?

  If you answered yes to one or more of these questions, it is possible that you may be suffering from health anxiety. Keep reading to find out ways to help ease this anxiety and how to start thinking like a doctor to navigate our new normal healthfully, happily, and safely.

  When to Seek Help

  If you answered yes to multiple questions in the preceding list, you may be suffering from acute hypochondriasis. Two-thirds of all people diagnosed with hypochondriasis also have a coexisting psychiatric disorder like depression, panic disorder, or obsessive-compulsive disorder (OCD), all of which are serious conditions that may require targeted treatment.8 If you or those around you are concerned about your health anxiety, seek professional help immediately from a psychologist, psychiatrist, or other mental-health professional.

  Six Steps to Help Ease Health Anxiety

  During a major health crisis like a pandemic, it can be easy to feel like you need to stop living a normal life in order to keep living any kind of life in the future. But that’s just not true. You don’t have to live in fear in order to protect yourself against the coronavirus or any other medical condition. Here are six steps you can take now to try to mitigate your health fears. The first five are relatively straightforward; the last step takes some extra intel, which you’ll find detailed in the remainder of this chapter.

  1. Recognize and normalize the issue. You’ve come across this advice in earlier chapters, but there’s a reason I keep repeating it: In our new normal, it’s critical to recognize the hurdles we face in order to get over them and keep moving forward, and the first step to overcoming health anxiety is to admit that it exists in the first place. There’s no shame or embarrassment when you do this, either: Health anxiety is a common occurrence and not a reflection of your intelligence, education, sophistication, mental strength, or emotional resilience.

  Acknowledging that you have health anxiety can also help normalize the problem. When you tell yourself (and others) that you’re suffering, it allows you to accept your fears and start to see them as common and commonplace instead of abnormal and scary.

  2. You don’t have to tell yourself it’s in your head. Your fears are real in the sense that they’re really happening to you. And sometimes, very real fears can create symptoms like difficulty breathing, chest tightness, headaches, fatigue, body aches, and nausea, all of which are also symptoms of COVID-19, among other things. Remember the story here about my colleagues who have called me because they had chest tightness and thought they had COVID-19? That symptom was due to anxiety, not the virus.

  The next time you find yourself zeroing in on perceived symptoms—or taking excessive precautions like over-sanitizing or convincing yourself you will get sick—think instead about what you’re missing by obsessing over your health, including time with family or friends, the opportunity to get ahead at your job, or the chance to practice self-care.

  3. Consider CBT. According to researchers and leading mental-health organizations, cognitive behavioral therapy (CBT) is one of the most effective treatments for health anxiety.9 In fact, one study found that CBT doubled the likelihood of treating health anxiety over standard care.10

  CBT targets negative thought patterns as the root of our emotions and behavior rather than fingering a certain situation as the cause. For example, not everyone has developed health anxiety as a result of the pandemic. CBT can help you manage irrational thoughts and behaviors by guiding you to react to a situation without fear.

  4. Take a vacation from Google Search, social media, and even the news. It’s easy for anyone who spends enough time online looking up medical conditions to develop unhealthy fears about their body or diseases—it’s why many medical school students think they have whatever ailment they’re studying at the time. If you’re suffering with fears about the virus or your general health, take a break from Google and looking up anything related to COVID-19 and/or other medical conditions.

  Similarly, spending less time on social media or watching the news can also help limit anxiety. Remember that some media outlets sensationalize topics—if it bleeds, it leads, as the saying goes—and stories of healthy people getting seriously sick with COVID-19 are the rarity, not the norm.

  5. Remember that common things occur commonly. Many people with health anxiety tend to worry about medical issues for which they have a relatively low risk. For example, many Americans are now more fearful of COVID-19 than heart disease, even though their risk of dying from the virus is extremely low, while their risk of death from heart disease is one in seven. These statistics shouldn’t cause you start to worrying about heart disease, but it’s important to keep your health in perspective as well as in an accurate medical context.

  6. Choose facts over fear. As you know from chapter 2, this has been my maxim throughout the pandemic and ultimately what helped me get over my anxiety. Choosing facts over fear puts you in the driver’s seat of your own emotions. Doctors do it every day in order to deal with harrowing health emergencies and to make medical decisions. If you can learn to think like a doctor, you can stay calm and collected about certain risks while minimizing the harms that health anxiety can have on your physical and mental well-being.

  Don’t Be a Health Hot Dog

  Some people don’t have any health concerns as a result of our new normal. They realize the risks of the virus and take necessary precautions while remaining calm and informed about the threat the pandemic poses.

  Other people, however, have taken it to the opposite end of the extreme and are what I call health hot dogs: They think they’re invulnerable or invincible to the virus and flout safety recommendations or medical guidelines as a result. Many young people have adopted this attitude, assuming they can’t get sick and not wearing masks and/or social distancing as a result—only to come down with COVID-19 and admit that they should have taken safety measures. Older people can be health hot dogs, too, oftentimes because they’re unwilling to accept the increasing vulnerability of their age or believe they’ve outlived enough health hazards over the years and are somehow indestructible now.11

  If you picked up this book, you’re probably not a health hot dog. But if you know someone who is, I would encourage you to tell them what I’ve said on air many times: It only has to happen once. And I know from experience that infectious diseases don’t care how old you are or how many other viruses, pathogens, or similar medical perils you’ve already survived to make you seriously ill now.

  But there’s a much greater problem with being a health hot dog in our new normal—or during any pandemic, for that m
atter. While it’s a free country and it may be okay for you to roll the dice on your own survival, it’s not okay for you to endanger the lives of others. A contagious disease is not like cancer, heart disease, or other chronic illnesses: The choices you make about your own body and health can affect other people’s survival.

  Think Like a Doctor—Now More Than Ever

  Doctors don’t use emotions to make medical decisions. We don’t decide to operate because we’re frightened by a disease or prescribe a drug because we’re afraid of what will happen if we don’t. Instead, we rely on facts and use evidence-based medicine, peer-reviewed published literature, patient data, population research, and known medical probability to make informed decisions about someone else’s health.

  Choosing evidence over emotion like a doctor can allow you to do something I talked about in the introduction: adopt a big-picture perspective of what’s going on. If you look up the statistics for COVID-19, for example, you’ll discover that your odds of getting seriously sick or dying from the disease are very low. For example, in mid-August of 2020, there were more than 5 million confirmed cases of COVID-19 and 170,000 deaths in the United States recorded since the outbreak began.12 There are more than 300 million people living in the United States. Remember, these are facts, not fears or opinions.

  Now let’s put these facts into perspective. According to the National Safety Council, your odds of getting into a fatal car crash in the United States in August of 2020 were 1 in 114.13 Your odds of dying from a fall in the United States during the same time were 1 in 127. These odds were greater than your chances of contracting COVID-19, but you likely never thought twice about getting inside a car or walking up or down stairs. And while your odds of a deadly car crash or fatal fall were higher than your chances of dying from COVID-19 if you became infected, there’s no possibility of a vaccine for vehicular accidents or falls, and the risk of dying from either will last far longer than any pandemic. This is why perspective is so important, which facts can help provide.

  One important note: Calculating your health risk doesn’t necessitate spending a lot of time online doing open-ended Google searches or reading every article you come across. We’ll discuss how to find reliable medical information in more detail in chapter 8, but in short, be selective about where you get your data just like a doctor would, relying primarily on large credible health agencies like the National Safety Council, the CDC, the National Institutes of Health (NIH), and the World Health Organization (WHO).

  Thinking like a doctor also means educating yourself on a disease or health concern. “Fear springs from ignorance,” as Ralph Waldo Emerson said,14 and the best way to fight ignorance—and thereby fear—is with knowledge.

  In the instance of an infectious illness like COVID-19, you don’t need to take a crash course in epidemiology or be able to polish off articles on immunology or infectious diseases in The Lancet with 100 percent comprehension—you just need a basic understanding of how pathogens work. This understanding will help you better navigate any outbreak or pandemic, because while the research on infectious diseases can change daily, basic pathology doesn’t.

  Let’s start with microbiology 101. What we know about the coronavirus is that it’s part of a family of common viruses that affect both animals and humans. Viruses like the coronavirus are one type of microorganism that can cause infectious diseases; bacteria, parasites, and fungi can also infect humans and lead to illness. But these microbes all act differently in the body, and we can’t compare a bacterial infection (like strep throat or a urinary tract infection) to a parasitic infection (like head lice or giardia), to a fungal infection (like athlete’s foot or ringworm), or to a viral infection (like COVID-19 or HIV).

  There are more viruses than stars in the known universe, with trillions in our air at any given time. In fact, an estimated 800 million rain on every square meter of Earth every day, according to research.15 Hundreds of virus families can infect humans, and some can even play a protective role in the body. You actually have about 38 trillion virus cells in your body right now as you’re reading this.16

  And viruses that harm humans aren’t all alike—there are different means of transmission and illness associated with each. Some viruses, like HIV, are spread through sexual contact, while others, like West Nile virus, are spread through insects. Foodborne viruses like hepatitis A are transmitted primarily through food and water contaminated with feces. Respiratory viruses like the coronavirus and influenza are transmitted mainly through the air and infect the respiratory tract.

  Specific to COVID-19, the virus is spread primarily through respiratory droplets, which are microscopic globules made up of saliva, mucus, and other material expelled from the lungs and nose when people breathe, talk, laugh, sing, sneeze, and cough. These droplets can linger in the air or attach to surfaces and survive for several hours after being expelled. The disease can also be spread through aerosolized particles. The difference between transmission through aerosolized particles and respiratory droplets is that the former can travel farther in the air, are smaller in size, and linger for a longer period of time, which is why they’re considered “airborne” or aerosolized. Droplets, on the other hand, are larger, travel a shorter distance from the source, and tend to fall to the ground more quickly, meaning the spread is more likely to occur through closer contact.

  People become infected with the coronavirus when they breathe in respiratory droplets or aerosolized particles that contain the virus. But contact with viral particles doesn’t guarantee infection: People need to be exposed to the infectious dose, or the amount of a virus needed to cause disease, in order for the coronavirus to multiply inside the body and cause COVID-19. While the science changes daily, we don’t know the infectious dose necessary to cause COVID-19.

  What we do know, as of September 2020, is that the primary mode of COVID-19 transmission is through direct or close contact with an infected person, which is defined as less than six feet by the CDC.17 The at-least-six-feet measurement is not written in stone, however, and may evolve to a greater distance as research progresses. However, according to the CDC, “the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.”18

  The coronavirus can also be spread through airborne transmission, which occurs when viral particles linger in the air after being expelled by an infected individual. According to the WHO, airborne transmission of COVID-19 is most likely to occur in indoor places that are crowded or inadequately ventilated, such as bars, nightclubs, and churches, where people may also be talking loudly or singing, thereby expelling more viral particles.

  What’s less likely is contracting the disease through what scientists call fomite transmission, which is a fancy term for viral spread through a contaminated surface. To date, there are no documented cases of COVID-19 infection through touching a contaminated surface and then touching the mouth or nose, although the CDC and WHO both acknowledge the possibility.19 There is also no evidence to show that the coronavirus can be spread through blood, urine, feces, tears, semen, or sweat.

  Why is all this information important if you’re not an epidemiologist? I believe that learning about a disease saps the fear from it and turns what might feel like a frightening mystery into a set of scientific circumstances. Doctors aren’t afraid of diseases, even relatively new ones like COVID-19, because we’ve spent years studying basic pathology. You don’t need to spend years—you just need a few minutes of good solid research. Reread the last several pages and look up anything you don’t know or which interests you.

  I get that some things are scary, but knowledge really is power when it comes to our health. We’re not paralyzed by fears over the flu—another virus, by the way—because we know so much about it and we’ve normalized it. You can normalize COVID-19, too, by learning everything you can about it. I’ve heard this from patients and viewers alike: The more they learn about the disease, the less frightened they are by it.


  Believe in Your Body’s Immune System

  If you’re scared of COVID-19, I suggest you try to turn your fear into faith—for your body’s immune system. As a doctor, I know that the human immune system is nothing short of miraculous. It’s one of the most complex biological systems in the world and is said to be more powerful than any drug invented to date.20 Since you were born, your immune system has been working 24/7 to protect you from millions of microorganisms, fighting off hundreds of harmful microbes every day without your knowledge. Believing in the power of your immune system and that it’s doing everything it can to keep you safe in our new normal can boost mental health while improving your physical well-being: Studies show that being optimistic and hopeful about your medical outcomes may increase immune function.21

  Why More Isn’t Always Better

  When you’re worried about your health, it’s only natural to want to take every precaution possible to try to ease your anxiety. But not all precautions are necessary or even effective in preventing infection or illness, and adopting certain behaviors in the presence of some pathogens can even increase your risk of getting sick.

  In the instance of COVID-19, we know that precautions like wearing a mask, keeping at least six feet from others (farther away is likely even safer), washing your hands frequently, and avoiding crowded spaces are evidence-based, effective, and even imperative ways to reduce your risk of infection. All of these measures have a low risk and very high benefit. But other popular precautions, like wearing gloves, don’t have the science to show they help lower the risk of infection and may even boost your chances of contracting COVID-19.

  Here are some common precautions to avoid, all of which can help you live more safely and with less anxiety in our normal: