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| How to Manage Panic Attacks | How to Manage Panic Attacks |
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| Anna Daniels, a 27-year-old living in Chagrin Falls, Ohio, was scheduled to start a new job as a nanny on March 30. But that has been put on hold indefinitely because of the coronavirus pandemic. She has been unemployed since the end of February. Ms. Daniels’s fiancé works for the local government and is considered an essential employee, so her days have been spent alone. It has taken a severe emotional toll. | Anna Daniels, a 27-year-old living in Chagrin Falls, Ohio, was scheduled to start a new job as a nanny on March 30. But that has been put on hold indefinitely because of the coronavirus pandemic. She has been unemployed since the end of February. Ms. Daniels’s fiancé works for the local government and is considered an essential employee, so her days have been spent alone. It has taken a severe emotional toll. |
| “I can’t go to the gym or socialize with my family. I can’t provide for myself. It’s like my world is crashing,” she said. | “I can’t go to the gym or socialize with my family. I can’t provide for myself. It’s like my world is crashing,” she said. |
| On March 26, Ms. Daniels was in bed watching the news, when suddenly her vision started to get blurry. Her chest tightened, and she couldn’t breathe. “I thought I had the coronavirus and could die from this,” she said. “It was one of the worst experiences I have ever had in my life.” After 20 minutes, her symptoms subsided and she realized she had suffered her first panic attack. | On March 26, Ms. Daniels was in bed watching the news, when suddenly her vision started to get blurry. Her chest tightened, and she couldn’t breathe. “I thought I had the coronavirus and could die from this,” she said. “It was one of the worst experiences I have ever had in my life.” After 20 minutes, her symptoms subsided and she realized she had suffered her first panic attack. |
| The coronavirus pandemic is affecting the entire globe, and it’s no wonder that, as a result, many people may be experiencing panic attacks for the first time. A panic attack comes on suddenly, bringing with it short-lived disabling anxiety, fear or discomfort. | The coronavirus pandemic is affecting the entire globe, and it’s no wonder that, as a result, many people may be experiencing panic attacks for the first time. A panic attack comes on suddenly, bringing with it short-lived disabling anxiety, fear or discomfort. |
| It’s an activation of the body’s physiological “fight or flight” response, which is triggered by a perceived threat, said Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic. “So all the things your body would want to do if you’re near a tiger become activated at the wrong time,” he said. | It’s an activation of the body’s physiological “fight or flight” response, which is triggered by a perceived threat, said Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic. “So all the things your body would want to do if you’re near a tiger become activated at the wrong time,” he said. |
| Your heart starts racing and pumping blood so your muscles have the fuel to run and fight and get yourself out of danger, said Lynn Bufka, senior director of the American Psychological Association. Yet most of the time when people are having a panic attack, they’re not responding to something that requires running or fighting. “Sometimes it can be invisible triggers,” she said. Panic attacks can be terrifying. “It’s the feeling you have when you’re about to cross the street and there’s a bus right there,” she said. | Your heart starts racing and pumping blood so your muscles have the fuel to run and fight and get yourself out of danger, said Lynn Bufka, senior director of the American Psychological Association. Yet most of the time when people are having a panic attack, they’re not responding to something that requires running or fighting. “Sometimes it can be invisible triggers,” she said. Panic attacks can be terrifying. “It’s the feeling you have when you’re about to cross the street and there’s a bus right there,” she said. |
| Panic attacks are fairly common even under far less dire circumstances. A study in Arch Gen Psychiatry indicated that one in four Americans will have at least one panic attack at some point in their lives. But coronavirus seems to be causing many people to suffer panic attacks within a short time. “There’s an increased level of stress due to all this uncertainty,” Dr. Bufka said. | Panic attacks are fairly common even under far less dire circumstances. A study in Arch Gen Psychiatry indicated that one in four Americans will have at least one panic attack at some point in their lives. But coronavirus seems to be causing many people to suffer panic attacks within a short time. “There’s an increased level of stress due to all this uncertainty,” Dr. Bufka said. |
| Dr. Neha Vyas, a family medicine doctor with Cleveland Clinic, said she had spent a majority of her time over the past few weeks trying to manage anxiety related to the pandemic in patients. Making matters worse, some of the symptoms of a panic attack — tightening of the chest and breathing difficulties — are often confused for symptoms of the coronavirus. | Dr. Neha Vyas, a family medicine doctor with Cleveland Clinic, said she had spent a majority of her time over the past few weeks trying to manage anxiety related to the pandemic in patients. Making matters worse, some of the symptoms of a panic attack — tightening of the chest and breathing difficulties — are often confused for symptoms of the coronavirus. |
| Dr. Vyas says there are telltale differences between panic attacks and coronavirus symptoms. Panic attacks come on suddenly and typically last only 15 to 20 minutes, while coronavirus symptoms emerge over a few days. With coronavirus, shortness of breath is usually accompanied by other symptoms, like a fever and a cough, neither of which is present with a panic attack. | Dr. Vyas says there are telltale differences between panic attacks and coronavirus symptoms. Panic attacks come on suddenly and typically last only 15 to 20 minutes, while coronavirus symptoms emerge over a few days. With coronavirus, shortness of breath is usually accompanied by other symptoms, like a fever and a cough, neither of which is present with a panic attack. |
| “There’s no one particular symptom that’s diagnostic of the coronavirus. It’s a group of symptoms,” Dr. Vyas said. | “There’s no one particular symptom that’s diagnostic of the coronavirus. It’s a group of symptoms,” Dr. Vyas said. |
| As a result, calling your health care provider to get advice — instead of heading for a visit in person, which risks exposure — is important. | As a result, calling your health care provider to get advice — instead of heading for a visit in person, which risks exposure — is important. |
| Dr. Vyas points out that panic attack symptoms can be similar to those of a heart attack. So if a patient has certain conditions — a cardiac history, high blood pressure, excessive sweating or pain down their arm, neck and back — that can be cause for greater concern. She would encourage patients with cardiac risk factors who are experiencing these symptoms to seek immediate medical attention. | Dr. Vyas points out that panic attack symptoms can be similar to those of a heart attack. So if a patient has certain conditions — a cardiac history, high blood pressure, excessive sweating or pain down their arm, neck and back — that can be cause for greater concern. She would encourage patients with cardiac risk factors who are experiencing these symptoms to seek immediate medical attention. |
| Lauren S. Hallion, an assistant professor in the psychology department at the University of Pittsburgh, is a leader of a newly formed group of over 100 researchers and clinicians called “PsychVsCovid,” which is pulling together resources on handling the virus. The group created several outreach initiatives, including one to develop a set of guidelines and resources for patients and clinicians to help distinguish between panic attacks and Covid-19, the disease caused by the coronavirus. | Lauren S. Hallion, an assistant professor in the psychology department at the University of Pittsburgh, is a leader of a newly formed group of over 100 researchers and clinicians called “PsychVsCovid,” which is pulling together resources on handling the virus. The group created several outreach initiatives, including one to develop a set of guidelines and resources for patients and clinicians to help distinguish between panic attacks and Covid-19, the disease caused by the coronavirus. |
| “For healthy people, a panic attack isn’t dangerous,” she said. But being able to identify a panic attack is helpful because even just realizing that you’re having one can help it dissipate, she said. | “For healthy people, a panic attack isn’t dangerous,” she said. But being able to identify a panic attack is helpful because even just realizing that you’re having one can help it dissipate, she said. |
| Dr. Bufka urges those experiencing a panic attack to practice full, consistent breathing to combat hyperventilation. Dr. Nestadt said it helps to reassure yourself that you’re safe and that the uncomfortable feelings will pass. He suggests using relaxing distractions, like listening to music. A technique called “5, 4, 3, 2, 1” is another distraction method: You stop to notice five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. | Dr. Bufka urges those experiencing a panic attack to practice full, consistent breathing to combat hyperventilation. Dr. Nestadt said it helps to reassure yourself that you’re safe and that the uncomfortable feelings will pass. He suggests using relaxing distractions, like listening to music. A technique called “5, 4, 3, 2, 1” is another distraction method: You stop to notice five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. |
| Dr. Vyas also recommends exercising, which can relieve anxiety. | Dr. Vyas also recommends exercising, which can relieve anxiety. |
| Ms. Daniels said she was trying to stave off future panic attacks by taking six-mile walks to breathe fresh air and be around nature. She has also returned to art, a hobby she pursued in high school. “I’m focusing on minor activities to try and plan out my day, so I don’t freak out, and have something to do.” | Ms. Daniels said she was trying to stave off future panic attacks by taking six-mile walks to breathe fresh air and be around nature. She has also returned to art, a hobby she pursued in high school. “I’m focusing on minor activities to try and plan out my day, so I don’t freak out, and have something to do.” |
| Updated June 5, 2020 | |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| It’s hard to watch a loved one in distress. Still, Dr. Nestadt said, it’s important not to intervene automatically. First, ask if the person experiencing the attack wants space or support. Above all, don’t tell the person to “just calm down,” Dr. Bufka said. Acknowledge their fear, let them know you’re there to support them and help them to problem solve. Ms. Daniels said her fiancé was able to calm her down by holding her face, encouraging her to breathe and assuring her that everything would be fine and to take it one day at a time. | It’s hard to watch a loved one in distress. Still, Dr. Nestadt said, it’s important not to intervene automatically. First, ask if the person experiencing the attack wants space or support. Above all, don’t tell the person to “just calm down,” Dr. Bufka said. Acknowledge their fear, let them know you’re there to support them and help them to problem solve. Ms. Daniels said her fiancé was able to calm her down by holding her face, encouraging her to breathe and assuring her that everything would be fine and to take it one day at a time. |
| If panic attacks are interfering with your daily functioning, it’s worth considering seeking treatment from a professional. | If panic attacks are interfering with your daily functioning, it’s worth considering seeking treatment from a professional. |
| When looking for professional mental help for the first time, go online or call and ask your primary care provider for recommendations. Dr. Nestadt suggests checking out your insurer’s website for a list of providers. Keep in mind that not all those providers will take new patients, or some may no longer be accepting insurance. But it’s the best way to find a provider in your insurance network. | When looking for professional mental help for the first time, go online or call and ask your primary care provider for recommendations. Dr. Nestadt suggests checking out your insurer’s website for a list of providers. Keep in mind that not all those providers will take new patients, or some may no longer be accepting insurance. But it’s the best way to find a provider in your insurance network. |
| Another source is the Anxiety and Depression Association of America’s Find a Therapist site, where you can enter your address to find verified providers near you. | Another source is the Anxiety and Depression Association of America’s Find a Therapist site, where you can enter your address to find verified providers near you. |
| During a time of stay-at-home orders, many providers are agreeing to see patients virtually. Medicare can now pay for care provided through telehealth that occurs under a much broader range of conditions. Again, it’s important to check with both your insurance provider and mental health professional to determine what is covered. | During a time of stay-at-home orders, many providers are agreeing to see patients virtually. Medicare can now pay for care provided through telehealth that occurs under a much broader range of conditions. Again, it’s important to check with both your insurance provider and mental health professional to determine what is covered. |
| “The rate of panic attacks is a symptom of general anxiety,” Dr. Nestadt said. “They peak during times of stress.” He’s hopeful that once we make inroads in getting the virus under control, we will feel less anxiety, he said. “And we might see fewer panic attacks as well.” | “The rate of panic attacks is a symptom of general anxiety,” Dr. Nestadt said. “They peak during times of stress.” He’s hopeful that once we make inroads in getting the virus under control, we will feel less anxiety, he said. “And we might see fewer panic attacks as well.” |