This Is What Long COVID Feels Like Fatigue Dizziness Brain Fog and Muscle Spasms

When the novel coronavirus began to spread across the world in February 2020, Freya Sawbridge was caught in a bind. The 27-year-old was living in Scotland, but when businesses and borders began to close she packed up and flew home to Auckland, New Zealand. On arrival, she felt feverish and couldn’t smell or taste food.

In those early months of COVID-19, every new symptom made global headlines. Freya got tested and the result came back positive. Panic began to set in.  “I was in the first wave,” she says.

“There weren’t many people that had had it by that stage, so I knew no-one could tell me anything about it, no-one could offer me any real guidance because it was a new disease.

“No-one can tell you anything about it or when it might end. You’re just existing in the unknown.”

Freya found herself on a vicious merry-go-round of symptoms — fever, sore throat, dizziness, muscle spasms, numbness, chest pains and fatigue. The symptoms kept coming around and around and around.

After 12 days, she stabilised, but four days later the pains returned with a vengeance. It would be a sign of things to come. Freya would relapse five more times over the next six months.

“Each relapse, the depth of it would last about 10 days and then I would take about four or five days emerging from it, have about two or three symptom-free days before another relapse would kick off,” Freya says. “The symptoms would come and then dissipate…

“I’d have a fever for an hour, a sore throat for four hours, then dizziness for two hours, then I was OK for an hour.

“…it was just a cycle like that.”

By April 2020, “long COVID” was being mentioned in Facebook support groups. It’s not an official medical term; it was coined out of necessity by the public. It’s sometimes also referred to as long-haul COVID, chronic COVID and post-acute sequelae of COVID-19 (PASC).

Exactly what constitutes long COVID remains extremely broad. Earlier this month, the World Health Organization released its clinical case definition of what it calls ‘post COVID-19 condition’, which affects people at least two months after a COVID-19 infection with symptoms that “cannot be explained by an alternative diagnosis”.

For Freya, symptoms like chest pain and a sore throat were manageable, but the dizziness and “brain pain” she experienced were debilitating. “It’s as if there was like a mini person in my brain and he was scraping my whole brain with a rake, it was just pain,” Freya says.

“And then it would feel like it would flip on itself continuously and so it makes it really hard to sleep because you’re lying there and it feels like your brain is doing somersaults and then it’s also spinning.”

The memory loss was especially unnerving. “Heaps of people say, ‘Oh, I get that and I’m young,’ but it just feels different… you’d be mid-sentence and then completely forget what you’re talking about.”

Doctors couldn’t give Freya any clarity about what was happening to her because the reality was no-one knew enough about COVID-19.

The hardest was month four, when Freya ended up in hospital from her long COVID symptoms. In a journal entry dated August 24, 2020, she wrote: “Must stay hopeful. Must believe I will get better.” After so many relapses, she had fallen into a depression filled with grief, for her healthy body and her old life.

To this day, we still know very little about long COVID, including just how many people it affects.

Various studies over the past 18 months estimate long COVID can affect anywhere from 2.3 per cent to 76 per cent of COVID-19 cases. It’s important to remember these studies vary in method, with some tracking only hospitalised cases and some relying on self-reported surveys.

A comprehensive study by the University of NSW places the figure at around 5 per cent. Researchers tracked 94 per cent of all COVID-19 cases in NSW from January to May 2020. Of the 3,000 people surveyed, 4.8 per cent still had symptoms after three months.

The uncertainty doesn’t end there. We also have no idea why long COVID hits certain people, but not others. It’s been likened to a kind of “Russian roulette”.

Studies have consistently found long COVID to be more prevalent in women, older people and those with underlying conditions, but there’s evidence to indicate children are capable of developing long COVID too.

Being young and fit is no guarantee you’re safe either, and nor is having a minor initial COVID case. The longer-term symptoms can strike even those who had few initial symptoms.

Those with long COVID report a constellation of symptoms including fatigue, dizziness, shortness of breath, brain fog, memory loss, loss of taste and smell, numbness, muscle spasms and irritable bowels.

One of Australia’s leading researchers in the area, Professor Gail Matthews, says long COVID is likely a spectrum of different pathologies.

Dr Matthews is the Head of Infectious Diseases at St Vincent’s Hospital and Head of the Therapeutic Vaccine and Research Program at the Kirby Institute at UNSW. She says the issue of long COVID will be huge on a global scale and it’s crucial to understand it better.

One theory is that COVID-19 can trigger the immune system to behave in an abnormal way, releasing cytokines that can make you feel unwell with fatigue and other symptoms.

Another is that there could be some elements of the virus — called antigen persistence — somewhere in the body that continues to trigger an ongoing activation in the immune system.

There’s also early evidence that vaccination might help reduce or even prevent long-term symptoms. Freya stopped relapsing around month seven, although her senses of taste and smell still haven’t fully recovered. She says rest was a big part of her recovery.

“Other people, if they don’t have parental support, or they have to work because they’ve got no savings, or they can’t rely on their parents, or they have young kids — I have no idea how they got through it, because it would have been impossible in my eyes,” Freya says.

Judy Li is in an impossible situation. An all-encompassing fatigue has taken hold of her mind and body, stripping away her ability to work, parent or plan for the future.

The 37-year-old got COVID-19 in March 2020 while an inpatient at a Melbourne hospital. She had been struggling after giving birth to her second child and was getting the help she needed.

Despite her anxieties, Judy’s case was very mild and it wasn’t until three months later when her three-year-old brought a bug home from day care that she realised something was wrong.

As day-care bugs so often do, it ripped through the young family. “It felt like I hit a brick wall, I was a lot worse than everyone else,” Judy says.

“It wasn’t the usual symptoms… I was just really lethargic, really fatigued and I remember at about the three-week mark of having those symptoms, that kind of fatigue, I thought, ‘this isn’t right, this is a bit odd.’”

Her fatigue is not like being tired, it’s a different kind of exhaustion, a severe lack of energy that doesn’t replenish after sleep.

“This is like something you feel in your limbs; you feel like they’re really heavy, they’ve got this kind of, I wouldn’t say ouch-kind of pain, but it’s sort of an achiness to your limbs,” she says.

The fatigue comes and goes, but Judy has noticed it can flare up when she gets sick or when she expends herself physically or mentally.

One of the worst episodes came after an eight-hour trip to Canberra for Christmas to visit her in-laws. “I woke up and I was completely paralysed,” Judy says. Distressed, in tears, she could only call out to her partner for help.

“I just did not have the strength to move my limbs and I kept trying and trying and trying and eventually he helped me up. “I sort of dragged my arm up, I could barely hold a glass of water and he’d help me to drink out of it. If I had to go to the toilet, he had to basically carry me.”

This fatigue has derailed Judy’s life because when it sets in, she never knows how long it’s going to last or whether it will go away.  It makes work and parenting impossible. Judy’s two young children don’t understand what’s wrong with mum or why she can’t get out of bed.

“When the kids are crying at home, I can’t go and soothe them,” she says.

“This is not a lack of motivation, it’s like I want to get up and I want to go to my children.

“I want to get up, I’ve got work I need to do. I want to get up and even go get something to eat, I’m hungry, but I can’t actually tell my body to move in that way.”

Fatigue or post-exertional malaise is one of the most common symptoms of long COVID, but it’s also a very common symptom in myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), a biological disease affecting an estimated 250,000 Australians.

There are striking similarities between long COVID and ME/CFS. Both can cause symptoms such as fatigue, dizziness, memory loss or ‘brain fog’, and irritable bowel, and both are likely to encompass a range of different pathologies.

ME/CFS is usually triggered by a viral infection — ebola, dengue fever, glandular fever, epstein barr, ross river virus, SARS and even the more common influenza have all left trails of chronically ill people in their wake.

Experts have even questioned whether long COVID could be ME/CFS by another name, although the jury is still out on that theory. ME/CFS has been around for decades but we still don’t know much about it.

Australian advocacy groups desperately want to see more research and support to help people with this chronic illness navigate medical, financial and accommodation services. They also say doctors need better education to diagnose and treat the condition early on.

Bronwyn Caldwell knows what it’s like to live with a condition that no-one understands or knows how to treat. She’s lived with ME/CFS for 20 years, ever since a suspected case of glandular fever in her 20s.

The 46-year-old from South Australia is adamant the early advice from her doctor to rest was the reason her condition didn’t immediately worsen. She was able to work part-time as a brewer up until 2013 but a relapse has left her mostly bed-bound.

Bronwyn considers herself lucky — her illness was validated by doctors and family, she doesn’t have cognitive difficulties and isn’t in pain. But her voice begins to break when mentioning that most people with ME/CFS face stigma that they’re being lazy or faking their illness.

“I can’t imagine what it’s really like to have everyone in your life say you’re just being lazy, because the reality is all of us beat ourselves up to that all the time,” she says.

A 2018 study published in the Journal of Health Psychology looking at links between people with chronic illness and suicidal ideation found stigma, misunderstanding and unwarranted advice exacerbates patients’ feelings of overall hopelessness.

Long COVID is creating a cohort of people vulnerable to the same thing, and Judy herself has sometimes wondered whether her family would be better off without her (which, of course, it wouldn’t).

“I honestly go through periods where I wish COVID had killed me instead of just left me with this, this big burden,” she says. With no sick leave left, Judy has had to take unpaid time off work.

It’s a big blow for the high-earning, career-driven project manager who took pride in handling stressful situations and juggling multiple tasks. These days, her mind doesn’t work like it used to.

“It’s just little things like struggling to find the word that I just knew… I would know… sorry… like being able to construct sentences,” she says with an ironic laugh.

“I can try to read something but it just seems like I have to read it over and over and over again. “I frequently walk into a room and can’t remember why, when I would put something down, seriously, two minutes later I have no idea where it is. “I just feel like I’m losing my mind.”

In the COVID-ravaged UK, daily cases peaked at more than 68,000 and daily deaths at more than 1,300. It’s a situation few in Australia — where we have enjoyed long periods of little-to-no community transmission — can fully appreciate.

Adam Attia was living in London through most of 2020 and says it was almost rare if you hadn’t had COVID-19. “I’ve known of people that had given it to their parents and it killed their parents,” the 30-year-old Australian says. “People that we knew on our street had passed away.”

So one day around August, when Adam couldn’t taste the wasabi on his sushi, he immediately knew what was wrong. “I just started to go through the kitchen for things like garlic — I had a whole garlic, I couldn’t taste anything. I ate a lemon like an apple and couldn’t taste a thing.

“I ate ginger like a cannibal, like I ate it with all of the bumps and things on it and couldn’t taste a thing.”

But Adam’s infection was mild and he spent his 10-day isolation staying active. Life went on as normal until three months later, after a trip to Croatia. On the flight back to London, somewhere above Germany, Adam felt an excruciating pain in his stomach. He felt like he was going to vomit, he couldn’t breathe and his head began to spin.

The flight crew didn’t know what to do, contemplating an emergency landing in Berlin while Adam desperately sucked air from a vent they’d given to help him breathe.

The flight managed to land in London and Adam was escorted off the plane. At the hospital, doctors ran tests for internal bleeding and signs of reflux or gastritis but they all turned up empty.

In the weeks and months after that flight, as little as two hours of work would leave Adam shattered and disorientated.

His symptoms are like dominoes. Exhaustion leads to stomach pain, which leads to nausea, faintness and breathlessness.

Adam has learned to manage his symptoms and as soon as he feels the exhaustion creeping in he takes an anti-nausea pill, uses the asthma puffer he now has to carry with him and finds somewhere to lie down.

He ended up moving back to Australia to sort out his health issues, but it wasn’t until a doctor at St George Hospital in Sydney mentioned Adam’s symptoms could be an effect of COVID-19 that he twigged.

“Is it from COVID? Look, I could be shooting in the dark, I don’t actually know,” Adam says. “But what I do know is I didn’t have these [symptoms] before COVID, so I guess it’s more of an educated guess.”

Much about long COVID remains exactly that. More research is needed to really know what’s going on.

The US and UK have allocated billions of dollars into research and set up long COVID clinics to help patients find the right treatment. The Australian government has provided $15 million for research grants into the long-term health effects of COVID-19 and the nation’s vaccination efforts through the Medical Research Future Fund.

As Australia moves beyond lockdowns towards a future where most Australians are vaccinated, borders are open and COVID-19 is actively spreading through communities, this research will be crucial in our understanding of the long-term health issues and the impact on individuals, families, workplaces and the economy.

For now, Dr Matthews says the biggest take-home is that we don’t know who is or isn’t susceptible to long COVID.

“One of the biggest messages is that it’s very hard to know who this will strike.”

Health officials in Victoria have already highlighted the plight of long COVID patients as part of their drive to encourage more people to get vaccinated, as experts say it probably can prevent long COVID.

Dr Matthews says it’s important Australia recognises long COVID as a real issue and makes sure there is appropriate support to help people.

“Even if it’s just an understanding that this condition exists, and recognition that it exists, as opposed to expecting these people to return to full health,” she says.

But until we know more, those like Freya, Judy and Adam won’t have the closure of knowing exactly what’s happened to them.

“It’s hard to wrap your head around,” Judy says, “to say this is potentially a life sentence”. “There’s no defining this is as bad as it gets, you know?  “This is just the big mystery question mark.”

By:  Emily Sakzewski, Georgina Piper, and Colin Gourlay

Source: This is what long COVID feels like — fatigue, dizziness, brain fog and muscle spasms – ABC News

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Why Women Are More Burned Out Than Men

Statistics show that stress and burnout are affecting more women than men en masse. Why – and what happens next?

When Jia, a Manhattan-based consultant, read Sheryl Sandberg’s bestselling book Lean In in 2014, she resolved to follow the advice espoused by the chief operating officer of Facebook.

“I’d just graduated from an Ivy League business school, was super pumped up and loved the idea of leaning in,” says Jia, whose last name is being withheld to protect her professional reputation. “Learning to self-promote felt so empowering, and I was 100% ready to prove that I was the woman who could have it all: be a high-powered career woman and a great mother.”

But today, the 38-year-old strikes a different tone. For years, she says, she feels like she’s been overlooked for promotions and pay rises at work on account of her gender, particularly after becoming a mother in 2018. Since then, she’s picked up the brunt of childcare responsibilities because her husband, who is a banker, has tended to travel more frequently for work. That, she adds, has given her a misguided reputation among her colleagues and managers – the majority of whom are male – for not being professionally driven.

Then when Covid-19 hit, it was as if all the factors already holding her back were supercharged. When her daughter’s day care closed in March 2020, Jia became the default caregiver while trying to stay afloat at work. “I was extremely unmotivated because I felt like I was spending all hours of the day trying not to fall off an accelerating treadmill,” she explains. “But at the same time, I felt like I was being trusted less and less to be able to do a good job. I could feel my career slipping through my fingers and there was absolutely nothing I could do about it.”

In early 2021, Jia’s therapist told her she was suffering from burnout. Jia says she’d never struggled with her mental health before. “But now I’m just trying to get through each week while staying sane,” she says.

Jia’s story is symptomatic of a deeply ingrained imbalance in society that the pandemic has both highlighted and exacerbated. For multiple reasons, women, particularly mothers, are still more likely than men to manage a more complex set of responsibilities on a daily basis – an often-unpredictable combination of unpaid domestic chores and paid professional work.

I could feel my career slipping through my fingers and there was absolutely nothing I could do about it – Jia

Though the mental strain of mastering this balancing act has been apparent for decades, Covid-19 has cast a particularly harsh light on the problem. Statistics show that stress and burnout are affecting more women than men, and particularly more working mothers than working fathers. This could have multiple impacts for the post-pandemic world of work, making it important that both companies and wider society find ways to reduce this imbalance.

Unequal demands

Recent data looking specifically at burnout in women is concerning. According to a survey by LinkedIn of almost 5,000 Americans, 74% of women said they were very or somewhat stressed for work-related reasons, compared with just 61% of employed male respondents.

A separate analysis from workplace-culture consultancy a Great Place to Work and health-care start-up Maven found that mothers in paid employment are 23% more likely to experience burnout than fathers in paid employment. An estimated 2.35 million working mothers in the US have suffered from burnout since the start of the pandemic, specifically “due to unequal demands of home and work”, the analysis showed.

Women tend to be dealing with a more complex set of work and personal responsibilities, leading to stress (Credit: Getty)

Experts generally agree that there’s no single reason women burn out, but they widely acknowledge that the way societal structures and gender norms intersect plays a significant role. Workplace inequalities, for example, are inextricably linked to traditional gender roles.

In the US, women still earn an average of about 82 cents for each dollar earned by a man, and the gap across many countries in Europe is similar. Jia’s firm does not publish its gender pay-gap data, but she suspects that it’s significant. Moreover, she thinks many of her male peers earn more than her, something that causes her a huge amount of stress.

“The idea that I might be underselling myself is extremely frustrating, but I also don’t want to make myself unpopular by asking for more money when I’m already pushing the boundaries by asking my company to make accommodations for me having to care for my daughter,” she says. “It’s a constant internal battle.”

Research links lower incomes to higher stress levels and worse mental health in general. But several studies have also shown more specifically that incidences of burnout among women are greater because of differences in job conditions and the impact of gender on progression.

In 2018, researchers from University of Montreal published a study tracking 2,026 workers over the course of four years. The academics concluded that women were more vulnerable to burnout than men because women were less likely to be promoted than men, and therefore more likely to be in positions with less authority which can lead to increased stress and frustration. The researchers also found that women were more likely to head single-parent families, experience child-related strains, invest time in domestic tasks and have lower self-esteem – all things that can exacerbate burnout.

Nancy Beauregard, a professor at University of Montreal and one of the authors of that study, said that reflecting on her work back in 2018, it’s clear that Covid-19 has amplified the existing inequalities and imbalances that her team demonstrated through their research. “In terms of [the] sustainable development of the human capital of the workforce,” she says, “we’re not heading in a good direction.”

A pandemic catalyst

Brian Kropp, chief of human resources research at Gartner, a global research and advisory firm headquartered in Connecticut, US, agrees that while many of the factors fueling women’s burnout were in play before the pandemic, Covid-19 notably exacerbated some as it forced us to dramatically overhaul our living and working routines.

When the pandemic hit, many women found that their domestic responsibilities surged – making juggling work even harder (Credit: Getty)

Structures supporting parents’ and carers’ lives closed down, and in most cases, this excess burden fell on women. One study, conducted by academics from Harvard University, Harvard Business School and London Business School, evaluated survey responses from 30,000 individuals around the world and found that women – especially mothers – had spent significantly more time on childcare and chores during Covid-19 than they did pre-pandemic, and that this was directly linked to lower wellbeing. Many women had already set themselves up as the default caregiver within their households, and the pandemic obliterated the support systems that had previously allowed them to balance paid employment and domestic work.

That’s exactly what Sarah experienced in March 2020, when schools across New York first closed. “Initially the message was that schools would stay closed until the end of April, so that was my target: ‘Get to that point and you’ll be fine’,” recalls the Brooklyn-based 40-year-old. Now, more than 18 months into the pandemic, her two sons, aged 6 and 9, are only just reacquainting themselves with in-person learning, and Sarah’s life has changed dramatically.

In April 2020, for the first time ever, she started suffering from anxiety. The pressures of home-schooling her children while working as marketing executive for a large technology company overwhelmed her. She couldn’t sleep, worried constantly and felt depressed. Worst of all, she felt like whatever she did was inadequate because she didn’t have enough time to do anything well.

Six months into the pandemic, it was clear something had to change. Sarah’s husband, a lawyer, was earning much more than her, and had done so since they got married in 2008. So, in August 2020 the couple jointly decided that Sarah would leave her job to become a stay-at-home mother. “Before this, I never really knew what being burned out meant,” she says. “Now I know beyond a shadow of a doubt.”

Sarah’s experience is emblematic of a much broader trend. In September last year, just as the pandemic was gaining pace, more than 860,000 women dropped out of the US workforce, compared with just over 200,000 men. One estimate put the number of mothers who had quit the US workforce between February and September last year at 900,000, and the number of fathers at 300,000.

As women lost crucial social lifelines during lockdown which may have been emotional and physical outlets for stress, it’s clear that the abrupt avalanche of extra domestic responsibilities pushed many who were already busily juggling home and work life further than they could go.

‘What’s the cost?’

One of the greatest concerns workplace experts harbour is that poor mental health among women in the workplace could discourage future generations from setting ambitious professional goals, particularly if they want to start a family. That could exacerbate the gender inequalities that already exist in terms of pay and seniority in the labour market.

Data indicate that this is indeed a legitimate concern; statistics collected by CNBC and polling company SurveyMonkey earlier this year showed that the number of women describing themselves as “very ambitious” in terms of their careers declined significantly during the pandemic. Data from the US Census Bureau shows that over the first 12 weeks of the pandemic, the percentage of mothers between the ages of 25 and 44 not working due to Covid-19-related childcare issues grew by 4.8 percentage points, compared to no increase for men in the same age group.

In terms of [the] sustainable development of the human capital of the workforce, we’re not heading in a good direction – Nancy Beauregard

Equally, there are concerns about how new ways of working such as hybrid could impact on workplace gender equality. Research shows that women are more likely than men to work from home in a post-pandemic world, but there’s evidence that people who work from home are less likely to get promoted than those who have more face-time with managers. “Women are saying, I’m working just as hard and doing just as much, but because I’m working from home, I’m less likely to get promoted,” says Kropp. “That’s extremely demotivating.”

Dean Nicholson, head of adult therapy at London-based behavioural health clinic The Soke, suggests that perceptions of fairness – or otherwise – could impact on women’s workplace participation. “When the balance of justice is skewed against us in the workplace, then it’s invariably going to lead to negative feelings, not just towards the organisation, but in the way that we feel about ourselves and the value of our contribution, as well as where we’re positioned on a hierarchy of worth.”

To prevent an exodus of female talent, says Kropp, organisations must appreciate that old workplaces practices are no longer fit for purpose. Managers need to fundamentally rethink how companies must be structured in order to promote fairness and equality of opportunity, he says. That means pay equality and equal opportunities for promotion, as well as creating a culture of transparency where everyone – mothers, fathers and employees who are not parents – feels valued and can reach their professional potential while also accommodating what’s going on at home.

Steve Hatfield, global future of work leader for Deloitte, notes that mothers, especially those in senior leadership roles, are extremely important role models. “The ripple effect of what they’re seen to be experiencing right now has the potential to be truly profound on newer employees, and so it’s up to organisations to prove that they can accommodate and cater to the needs of all employees,” he says.

As such, Hephzi Pemberton, founder of the Equality Group, a London-based consultancy that focuses on inclusion and diversity in the finance and technology industry, emphasises the need for managers to be trained formally and to understand that the initiative to create a workplace that’s fit for purpose must come from the employer rather than the employee. “That’s absolutely critical to avoid the risk of burnout,” she says.

But Jia, who says she’s now on the brink of quitting her job, insists that notable changes need to happen in the home as well as the workplace. “What’s become abundantly clear to me through the pandemic is that we all have a role to play in understanding the imbalances that are created when stereotypical gender roles are blindly adhered to,” she says. “Yes, of course it sometimes makes sense for a woman to be the default caregiver or to take a step back from paid work, but we need to appreciate at what cost. This is 2021. Sometimes I wonder if we’re in the 1950s.”

By Josie Cox

Source: Why women are more burned out than men – BBC Worklife

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Cancer Without Chemotherapy A Totally Different World

Dr. Seema Doshi was shocked and terrified when she found a lump in her breast that was eventually confirmed to be cancerous. “That rocked my world,” said Dr. Doshi, a dermatologist in private practice in the Boston suburb of Franklin who was 46 at the time of her diagnosis. “I thought, ‘That’s it. I will have to do chemotherapy.’”

She was wrong.

Dr. Doshi was the beneficiary of a quiet revolution in breast cancer treatment, a slow chipping away at the number of people for whom chemotherapy is recommended. Chemotherapy for decades was considered “the rule, the dogma,” for treating breast cancer and other cancers, said Dr. Gabriel Hortobagyi, a breast cancer specialist at MD Anderson Cancer Center in Houston. But data from a variety of sources offers some confirmation of what many oncologists say anecdotally — the method is on the wane for many cancer patients.

Genetic tests can now reveal whether chemotherapy would be beneficial. For many there are better options with an ever-expanding array of drugs, including estrogen blockers and drugs that destroy cancers by attacking specific proteins on the surface of tumors. And there is a growing willingness among oncologists to scale back unhelpful treatments.

The result spares thousands each year from the dreaded chemotherapy treatment, with its accompanying hair loss, nausea, fatigue, and potential to cause permanent damage to the heart and to nerves in the hands and feet.

The diminution of chemotherapy treatment is happening for some other cancers, too, including lung cancer, the most common cause of cancer deaths among men and women in the United States, killing about 132,000 Americans each year. Breast cancer is the second leading cause of cancer deaths among women, killing 43,000.

Still, the opportunity to avoid chemotherapy is not evenly distributed, and is often dependent on where the person is treated and by whom.

But for some patients who are lucky enough to visit certain cancer treatment centers, the course of therapy has changed. Now, even when chemotherapy is indicated, doctors often give fewer drugs for less time.

“It’s a totally different world,” said Dr. Lisa Carey, a breast cancer specialist at the University of North Carolina.

Dr. Robert Vonderheide, a lung cancer specialist who heads the University of Pennsylvania’s Abramson Cancer Center, remembers his early days on the job, about 20 years ago.

“The big discussion was, Do you give patients two different types of chemotherapy or three?” he said. There was even a clinical trial to see whether four types of chemotherapy would be better.

“Now we are walking in to see even patients with advanced lung cancer and telling them, ‘No chemo,’” Dr. Vonderheide said.

The breast cancer treatment guidelines issued by the National Cancer Institute 30 years ago were harsh: chemotherapy for about 95 percent of patients with breast cancer.

The change began 15 years ago, when the first targeted drug for breast cancer, Herceptin, was approved as an initial treatment for about 30 percent of patients who have a particular protein on their tumor surface. It was given with chemotherapy and reduced the chance of a recurrence by half and the risk of dying from breast cancer by a third, “almost regardless of how much and what type of chemotherapy was used,” Dr. Hortobagyi said.

In a few studies, Herceptin and another targeted drug were even given without chemotherapy, and provided substantial benefit, he added.

That, Dr. Hortobagyi said, “started to break the dogma” that chemotherapy was essential. But changing cancer therapies was not easy. “It is very scary,” to give fewer drugs, Dr. Hortobagyi said.

“It is so much easier to pile on treatment on top of treatment,” he continued, “with the promise that ‘if we add this it might improve your outcome.’”

But as years went by, more and more oncologists came around, encouraged by new research and new drugs.

The change in chemotherapy use is reflected in a variety of data collected over the years. A study of nearly 3,000 women treated from 2013 to 2015 found that in those years, chemotherapy use in early-stage breast cancer declined to 14 percent, from 26 percent. For those with evidence of cancer in their lymph nodes, chemotherapy was used in 64 percent of patients, down from 81 percent.

More recent data, compiled by Dr. Jeanne Mandelblatt, a professor of medicine and oncology at Georgetown, and her colleagues, but not yet published, included 572 women who were 60 or older and enrolled in a federal study at 13 medical centers. Overall, 35 percent of older women received chemotherapy in 2012. That number fell to 19 percent by the end of 2019.

Cheaper and faster genetic sequencing has played an important role in this change. The technology made it easier for doctors to test tumors to see if they would respond to targeted drugs. Genetic tests that looked at arrays of proteins on cancer cells accurately predicted who would benefit from chemotherapy and who would not.

There are now at least 14 new targeted breast cancer drugs on the market — three were approved just last year — with dozens more in clinical trials and hundreds in initial development.

Some patients have reaped benefits beyond avoiding chemotherapy. The median survival for women with metastatic breast cancer who are eligible for Herceptin went from 20 months in the early 1990s, to about 57 months now, with further improvements expected as new drugs become available. For women with tumors that are fed by estrogen, the median survival increased from about 24 months in the 1970s to almost 64 months today.

Now some are in remission 10 or even 15 years after their initial treatment, Dr. Hortobagyi said.

“At breast cancer meetings, a light bulb went off. ‘Hey, maybe we are curing these patients,’” Dr. Hortobagyi said.

Dr. Doshi’s oncologist, Dr. Eric Winer of the Dana-Farber Cancer Institute, gave her good news: A genetic test of her tumor indicated she would not get any significant benefit from chemotherapy. Hormonal therapy to deprive her cancer of the estrogen that fed it would suffice.

But as much as Dr. Doshi dreaded chemotherapy, she worried about forgoing it. What if her cancer recurred? Would chemotherapy, awful as it is, improve her outcome?

She got a second opinion.

The doctor she consulted advised a “very aggressive” treatment, Dr. Doshi said — a full lymph node dissection followed by chemotherapy.

She had multiple conversations with Dr. Winer, who ended up discussing her case with four other specialists, all of whom recommended against chemotherapy.

Finally, Dr. Doshi said, “my husband said I should just pick a horse and run with it.” She trusted Dr. Winer.

Her struggles mirror what oncologists themselves go through. It can take courage to back off from chemotherapy.

One of the most difficult situations, Dr. Winer said, is when a patient has far more advanced disease than Dr. Doshi did — hers had spread to three lymph nodes but no further — and is not a candidate for one of the targeted treatments. If such a patient has already had several types of chemotherapy, more is unlikely to help. That means there is no treatment.

It falls to Dr. Winer to tell the patient the devastating news.

Dr. Susan Domchek, a breast cancer specialist at the University of Pennsylvania, can relate to those struggles.

“It is the nature of being an oncologist to be perpetually worried that you are either overtreating or undertreating a patient,” she said.

“Some cases keep me up at night,” she said, “specifically the cases where the risks and benefits of chemotherapy are close, yet the stakes still feel so high.”

When Dr. Roy Herbst of Yale started in oncology about 25 years ago, nearly every lung cancer patient with advanced disease got chemotherapy.

With chemotherapy, he said, “patients would be sure to have one thing: side effects.” Yet despite treatment, most tumors continued to grow and spread. Less than half his patients would be alive a year later. The five-year survival rate was just 5 to 10 percent.

Those dismal statistics barely budged until 2010, when targeted therapies began to emerge. There are now nine such drugs for lung cancer patients, three of which were approved since May of this year. About a quarter of lung cancer patients can be treated with these drugs alone, and more than half who began treatment with a targeted drug five years ago are still alive. The five-year survival rate for patients with advanced lung cancer is now approaching 30 percent.

But the drugs eventually stop working for most, said Dr. Bruce Johnson, a lung cancer specialist at Dana-Farber. At that point many start on chemotherapy, the only option left.

Another type of lung cancer treatment was developed about five years ago — immunotherapy, which uses drugs to help the immune system attack cancer. Two-thirds of patients from an unpublished study at Dana-Farber were not eligible for targeted therapies but half of them were eligible for immunotherapy alone, and others get it along with chemotherapy.

Immunotherapy is given for two years. With it, life expectancy has almost doubled, said Dr. Charu Aggarwal, a lung cancer specialist at the University of Pennsylvania.

Now, said Dr. David Jackman of Dana-Farber, chemotherapy as the sole initial treatment for lung cancer, is shrinking, at least at that cancer treatment center, which is at the forefront of research. When he examined data from his medical center he found that, since 2019, only about 12 percent of patients at Dana-Farber got chemotherapy alone, Dr. Jackman said. Another 21 percent had a targeted therapy as their initial treatment, and among the remaining patients, 85 percent received immunotherapy alone or with chemotherapy.

In contrast, in 2015, only 39 out of 239 patients received a targeted therapy as their initial treatment. The rest got chemotherapy.

Dr. Aggarwal said she was starting to witness something surprising — some who had received immunotherapy are still alive, doing well, and have no sign of cancer five years or more after their initial treatment.

She said: “I started out saying to patients, ‘I will treat you with palliative intent. This is not curative.’”

Now some of those same patients are sitting in her clinic wondering if their disease is gone for good.

Chong H. Hammond’s symptoms were ambiguous — a loss of appetite and her weight had dropped to 92 pounds.

“I did not want to look at myself in the mirror,” she said.

It took from October 2020 until this March before doctors figured it out. She had metastatic lung cancer.

Then Dr. Timothy Burns, a lung cancer specialist at the University of Pittsburgh, discovered that Mrs. Hammond, who is 71 and lives in Gibsonia, Pa., had a tumor with two unusual mutations.

Although a drug for patients with Mrs. Hammond’s mutations has not been tested, Dr. Burns is an investigator in a clinical trial involving patients like her.

He offered her the drug osimertinib, which is given as a pill. This allowed her to avoid chemotherapy.

Ten days later she began feeling better and started eating again. She had energy to take walks. She was no longer out of breath.

Dr. Burns said her lung tumors are mostly gone and tumors elsewhere have shrunk.

If Mrs. Hammond had gotten chemotherapy, her life expectancy would be a year or a little more, Dr. Burns said. Now, with the drug, it is 38.6 months.

Dr. Burns is amazed by how lung cancer treatment has changed.

“It’s been remarkable,” he said. “We still quote the one-year survival but now we are talking about survival for two, three, four or even five years. I even have patients on the first targeted drugs that are on them for six or even seven years.”

Mark Catlin, who is being treated at Dana-Farber, is one of those patients.

On March 8, 2014, Mr. Catlin, who has never smoked, noticed a baseball-size lump under his arm. “The doctors told me to hope for anything but lung,” he said.

But lung it was. It had already spread under his arm and elsewhere.

Oncologists in Appleton, Wis., where he lives, wanted to start chemotherapy.

“I was not a fan,” Mr. Catlin said. His son, who lives in the Boston area, suggested he go to Dana-Farber.

There, he was told he could take a targeted therapy but that it would most likely stop working after a couple of years. He is 70 now, and still taking the therapy seven years later — two pills a day, with no side effects.

He rides a bike 15 to 25 miles every day or runs four to five miles. His drug, crizotinib, made by Pfizer, has a list price of $20,000 a month. Mr. Catlin’s co-payment is $1,000 a month. But, he says, “it’s keeping me alive.” “It’s almost surreal,” Mr. Catlin said.

Gina Kolata

By:

Source: Cancer Without Chemotherapy: ‘A Totally Different World’ – The New York Times

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13 Ways to Invest in Yourself

When you hear the word “investing,” you probably think about stocks, bonds, maybe commodities. It’s far less likely that your reflex will be inward – but indeed, you can, and should, invest in yourself, too.

Investing is an enormous industry solely dedicated to the idea of using capital to create more capital. We highly suggest you do it. But in many instances, investing time and energy – which, just like money, are in finite supply – in yourself can lead to a meaningful payoff, too. And sometimes that payoff includes the accumulation of wealth.

It’s just a matter of application, and making a plan.

To that end, here’s a rundown of 13 different ways to invest in your career, your mind and your happiness that have nothing to do with buying low and selling high. Becoming a more marketable worker, earning a chance to be your own boss and simply broadening your horizons can yield rewards, too.

Find a Mentor

Spending time with a mentor is one of the best investments you can make. Mentors are plentiful. It doesn’t cost much to talk with them – just the price of a cup of coffee, or maybe an Uber trip if your mentor works elsewhere. And they can provide you with a wealth of benefits: They can improve your current job skills, help you network within your field and potentially become an employer in the future.

What workplace mentorship looks like will vary from one employer to the next. But in almost all cases, it could and should involve a senior employee acting as a guide for a newer worker with less company-specific experience. In some cases where management is willing to provide time off and funding, leadership “camps” and team-building experiences can also make employees more effective.

But what if your employer doesn’t facilitate such programs? Be the organizer of a formal, company-wide effort that pairs newer workers with veterans. It’s not a difficult sell. Your boss will benefit from a staff that at the very least better knows one another, and they’ll probably appreciate the subsequent synergies too. Meanwhile, you’ll make new intra-office contacts.

You can find mentors outside of your workplace, too. A simple way to start is by simply reaching out to leaders and other knowledgeable members of your field for “informational interviews” – nothing more than a cup of coffee or lunch to talk about the profession.

Depending on the topic, you might be able to find more plentiful outside resources. For instance, small-business entrepreneurs have a host of options at their fingers, such as Score.org, which pairs individuals up with local SCORE (Service Corps of Retired Executives) chapters to pair them with one of more than 10,000 volunteer business experts.

More Education for a Career Change

Many young college graduates might be happy working in the field they just finished studying, but some individuals further into their careers might be mulling a change – perhaps a pivot toward one of these top jobs of the future.

In many cases, however, these individuals don’t feel they can because they lack a degree related to their new dream job. Or if they do “change things up,” they make a move within the industry rather than taking on a whole new category – even when that new job could prove more lucrative.

Knight Kiplinger points out the benefit of such an investment in his “Keys to Financial Security”: “A $30,000 pay hike can be viewed as an annual return on a capital investment, like earning a continuous yield of 6% on $500,000 of savings. You know how hard it is to save up $500,000. Maybe that $30,000 boost in salary is easier to achieve.”

There’s good news for the hesitant, however. More than 80% of people who changed careers after they turned 45 years old found success in their new field, according to the American Institute for Economic Research.

For some occupations, such as teachers and nurses – two of the most popular second careers for older rookies – might require a brand-new degree. But the advent of the internet has changed the way we learn. Traditional college classrooms are still an option, though career-changers with families who might need to work at the same time they’re going back to school have plenty of internet options. Roughly one-third of college-level studies are now done online, and many employers see this classwork as credible.

Professional Certifications

In some cases, a college degree might not be the right kind of continuing education for you. Some employers are more interested in specialized skills and credentials. Company hierarchies in the modern workplace are optimized by a diversity of detailed, focused knowledge that sometimes comes in the form of a professional-level certificate.

And at the least, there aren’t many industries that don’t encourage the attainment of specialized credentials.

Take the finance industry as an example. Most career-minded jobs in the sector require a minimum of a college degree. But some of the most successful financial planners are Certified Financial Planners, with a CFP designation. Chartered Financial Analysts (CFAs) also enjoy a high-level of credibility within the investment management arena. There’s even a professional designation for investment professionals that specialize in analyzing stock charts: Chartered Market Technicians.

The technology arena arguably offers the most, and most diverse, options for readily attainable certifications. Certificates aimed at demonstrating expertise in Cisco networking, Microsoft systems and coding languages such as Java and C++ can all be earned in just a few months.

In most cases, these certificates can be secured while you work a full-time job. Some employers will even pay the costs associated with them.

Join Toastmasters

Even when Toastmasters International was in its infancy nearly a century ago, the organization invoked the occasional eye roll. Some outsiders snickered as the seemingly silly gathering of like-minded people that just wanted to practice public speaking in front of other members wishing to do the same.

However, the clubs – all 16,800 of them that meet regularly in 143 different countries – are no joke. Aside from a judgment-free, supportive environment where individuals can get comfortable confronting the one thing they fear more than death itself, Toastmasters is a chance to network with other aspiring business-minded individuals in the area.

And the organization certainly has its share of high-profile success stories. MSNBC’s Chris Matthews, comedian and actor Tim Allen, the late iconic Star Trek actor Leonard Nimoy, and the late James Brady, former presidential press secretary, are all former Toastmasters members, along with a whole slew of other recognizable names that leveraged their Toastmasters experiences into successful careers.

Toastmasters charges $45 in semi-annual dues as well as a $20 new member fee. Meeting frequency varies by club but typically are held weekly or every other week, for one to two hours per meeting.

Move

It doesn’t sound like a way to invest in yourself. It sounds more like a chore, or even just a flat-out expense. But you might find that simply moving from one place to another can open all sorts of doors … and not just career-oriented ones. New locales bring new people into your life, new kinds of entertainment, lower expenses and new scenery that can make your life better in a myriad of ways.

The latest relocating-minded trend is an exodus from the nation’s biggest cities and the establishment of new roots in less urban areas. Bustling New York City lost 76,790 residents in 2019, and 143,000 in the year before that, mirroring a bigger trend evident across the entire northeaster portion of the country. Lousy weather is cited as one reason for the growing disinterest in the region, though the bigger concern is the sheer cost of living in places such as New York City and Washington, D.C.

Conversely, there are still good reasons to head toward the pricier parts of the country, particularly for people looking for jobs in the financial and tech arenas. Most Wall Street-type jobs require you to actually live somewhere near Wall Street, and Silicon Valley in northern California is the nation’s technological development hub. If you want to work there, you typically have to be there.

If you’re broadly looking for a place to start, consider these states with the fastest rates of job growth. And if you’re looking to figure out how much to budget, Moving.com says the average cost of a long-distance move (1,000 miles) is $4,890, based on a two- to three-bedroom move of about 7,500 pounds.

Start a Side Gig

The idea of a “job” has changed dramatically in just the past few years. Gone are the days when individuals clocked in at 9 a.m., worked for an employer that was trusted to remain in business, and then clocked out at 5 p.m.

The new normal is … well, there is no new normal, given the statistics.

Roughly one-third of U.S. workers claim they utilize “alternative work” arrangements as their primary source of income. That is, they don’t necessarily run their own businesses per se, but rather are contracted, self-employed people that rely on middlemen to connect with a stream of customers. Think driving for Uber, completing projects through Amazon Mechanical Turk, or picking up regular work at a website like Freelancer.com. In some cases, these workers might see more income by being self-employed. But certainly, some see less.

It doesn’t have to be an either/or matter for the entrepreneurial-minded, though. Side gigs can be managed without “giving up your day job” by doing work outside of regular work hours.

The effort is arguably worth it. A recent survey performed by The Hustle found that the average side-gig operator spent an average of 11 hours per week as their own boss, and earned $12,609 per year – an average of about $22 per hour. Real estate, management and money-related side gigs appeared to be the most lucrative, according to the survey.

The payoff can be more than in immediate income. You can use a side gig to hone new skills or test new ideas that can be used to fuel a career shift.

Set Up a (Real) Home Office

Whether you’re self-employed or just one of the lucky corporate employees who are allowed to work from home, there’s much to be said about a space that functions and feels more like an office and less like a bedroom or basement. Indeed, you might be more productive working at home, for yourself or for an employer.

Despite all the noise often made about the pros and cons of working from home, it’s not as widely available an option as you’d think. Only 7% of employers facilitate work-from-home options, according to Fundera, even though the option saves companies an estimated $44 billion per year. Fewer than 4% of employees (including freelance workers) are allowed to work from home for at least half the workweek, says Small Business Trends.

In other words, if you do have an employer that allows you to work from home, be sure to perform just as you would if in an office setting. Companies remain broadly suspicious of the practice.

The one area where it pays to spend more than you might like to on a home office is on a new computer. It is, for better or worse, the centerpiece of the modern work world. Not only are computers used to create and store documents, they’re also becoming the key means of communication with clients and customers. They’re even replacing phones with apps such as Skype. An unreliable or underpowered PC can quickly turn into a nuisance.

Get Healthy

The benefits of living a healthier lifestyle are clear: A longer life, feeling better and being able to physically do more are all good things.

However, there’s a financial upside to eating better and getting more exercise too. More than one, in fact. Chief among them is the sheer cost of being unhealthy, and as such, needing to see a doctor more often.

As part of efforts to make health insurance, and therefore health care, more affordable for everyone, deductibles have soared in recent years. In 2008, according to the Kaiser Family Foundation, the average deductible for a single-person health plan was $735. It has since soared to $1,655. Premium prices are up, too, at $7,188 annually as of 2019, and the maximum out-of-pocket expense in 2019 for an ACA-compliant plan was $7,900 for individuals, and $15,800 for family plans.

Although health insurance is effectively a must-have, using it can prove expensive.

The other financial upside to healthier living: Feeling better, or not being distracted by fatigue, lets your mind stay sharp during sales calls, when meeting new people and when simply being sized up (literally and figuratively) by someone interested in your work. Every interaction or connection is in some way an effort to sell something. Being at your best makes it likelier you’ll perform well.

Get Organized

Most individuals who live disorganized lives, personally and professionally, would argue they don’t have time to organize. In reality, it takes more time, energy and money to not be organized.

Did you know the average American spends 2.5 days per year trying to track down lost items? That’s the case, according to a study by Pixie, a smart-location solution for missing objects. Did you also know that the National Association of Productivity and Organizing Professionals (yes, it’s a thing) reports that between 15% and 20% of the average household’s budget is wasted by buying items to replace ones that simply can’t be found? Here’s the kicker: NAPO also estimates that 40% of housework currently being done in the U.S. wouldn’t be necessary if we were willing to de-clutter.

It’s not just time and money. Your mental well-being is at stake, too. People who have successfully mastered the art of self-organization find they’re less stressed, sleep better and ultimately end up being more productive. In the workplace, a more organized desk, office, briefcase or vehicle makes a good impression on prospective clients, co-workers, even your boss.

Keep Your Brain Sharp

By many measures, it’s a cruel trick. Never before have people been expected to stay as focused as they are now, yet never before has it been so difficult to prevent your mind from being overwhelmed by a constant barrage of digital data.

Your smartphone has much to do with that. We check our phones for no particular reason about once every 12 minutes; some of us, more frequently.

But the challenge extends beyond just phones. On average, says productivity expert Chris Bailey, we’re distracted by something every 40 seconds. Bailey also says all the regular distractions we experience ultimately extend the time needed to complete a task by 50%. Plus, it can take several minutes just to resume the work being done before the distraction took place.

So, how do you keep your mind sharp in this kind of environment?

For one, try to put down the phone a little more often. Then, start following some of the other steps on this list.

Staying in shape isn’t just a good way to cut down on medical costs – it also helps brain health as you age. Art Kramer, professor of neuroscience and psychology at Northeastern University, tells Kiplinger that people who do more aerobic exercise tend to be better at solving problems, have better memory and show lower rates of dementia.

You want to “network,” too – but not just professionally. Being socially active has many positive effects on the brain, including areas that have to do with memory. So, as you can, try to interact with friends and family more often.

Build Your Own Website or Portfolio

The upside of building your own professional website or portfolio will vary from one person to the next, and with the intent. But if there’s any arguable reason not to invest in yourself in this way, cost isn’t it. The hosting price for a low-end (though still professional-looking) website can be less than $10 per month; for those willing to make a longer-term commitment, requesting and registering the domain name is often free.

What you can do with even the simplest of websites, however, is almost limitless.

Chief among those options for a job-seeker is the use of a website as a digital resume of sorts. But a website can provide a potential employer with work-related details that might otherwise be difficult to present with just one sheet of paper.

In that same vein, a website could serve as a repository of past work for individuals who offer services on a regular basis. Writers, artists and architects are just some of the people who benefit from being able to publicly showcase their work.

And naturally, any entrepreneur with e-commerce ambitions will want to develop a website, and spring for a few more of the bells and whistles required to do business online.

Hire a Career Coach

Sometimes it’s difficult to push yourself to the proverbial next level, whatever that might mean in your given field. Stagnation can sap creativity, and disappointment can quell drive. It’s all too easy to become complacent and resign yourself to doing the exact same thing until it’s time to retire.

A career coach might be just the kick in the pants you need.

But first, you need to understand what a career coach is, and what it isn’t. Career coaches aren’t headhunters. They also can’t tell you what sort of job you should be seeking. And they most certainly won’t be able to help if your impasses are personal rather than professional in nature.

A career coach can, however, help you identify your strengths and weakness as other people see them, assist you in formulating a career-advancement strategy and advise you on how to make a successful career change.

They’re not necessarily cheap. On a per-hour basis, they can charge anywhere between $75 and $250. Some ask for a longer-term, multimonth commitment that can cost a total of anywhere from $1,000 to $2,500.

But they can be worth the outlay. A promotion-related raise or a job offer with a new employer can easily fund such an investment within just a year.

Read Books

There’s a universe of great information floating around, ready to be gleaned. Much of it can’t be found at your workplace. Instead, it’s at a bookstore – or, for the more economically minded, a library.

The statistics on the matter are nothing short of amazing. Fast Company says the average CEO reads 60 books per year. Ben Eubanks, human resources analyst with Brandon Hall Group, believes “people who are successful are often crazy about reading. They make time for that because they understand how important it is, and it’s kind of like a secret weapon.” However, a person in the United States only reads between two and three books per year, most of those purely for pleasure.

A lot of that has to do with time available, but if you have recreational time you aren’t spending on reading, you might consider re-allocating it to hitting the books.

The upsides? Aside from the knowledge and perspective gained from teaching yourself about something new, reading also expands your vocabulary and opens up opportunities to discuss new ideas with your boss (current or prospective). There’s something powerful about being able to say, “That’s something I was just reading about the other day.”

One word of caution: Reading a work-related book just for the sake of being seen reading a work-related book can easily backfire. Most experienced managers can spot an effort get the wrong kind of attention. They might not like the tactic. Just read a book on faith that it will eventually matter, even if that means with a different employer.

By: James Brumley

Source: https://getpocket.com/

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Why Some COVID-19 Infections May Be Free of Symptoms But Not Free of Harm

Scientists are studying the potential consequences of asymptomatic COVID-19 and how many people may suffer long term health problems. Eric Topol was worried when he first saw images of the lungs of people who had been infected with COVID-19 aboard the Diamond Princess, a cruise ship that was quarantined off the coast of Japan in the earliest weeks of the pandemic.

A study of 104 passengers found that 76 of them had COVID but were asymptomatic. Of that group, CT scans showed that 54 percent had lung abnormalities—patchy grey spots known as ground glass opacities that signal fluid build-up in the lungs.

These CT scans were “disturbing,” wrote Topol, founder and director of the Scripps Research Translational Institute, with co-author Daniel Oran in a narrative review of asymptomatic disease published in the Annals of Internal Medicine. “If confirmed, this finding suggests that the absence of symptoms might not necessarily mean the absence of harm.”

One recent study estimated that a staggering 35 percent of all COVID-19 infections are asymptomatic. “That’s why it’s important to know if this is a vulnerability,” Topol says.

But Topol says he hasn’t seen any further studies investigating lung abnormalities in asymptomatic people in the more than a year and a half since the Diamond Princess cases were first documented. “It’s like we just gave up on it.”

He argues that asymptomatic disease hasn’t gotten the attention it should amid the race to treat severe disease and develop vaccines to prevent it. As a result, scientists are still largely in the dark about the potential consequences of asymptomatic infections—or how many people are suffering those consequences.

One stumbling block that scientists worry could keep them from truly understanding the scope of the problem is that it’s incredibly challenging to pinpoint how many people had asymptomatic infections. “There’s probably a pool of people out there who had asymptomatic disease but were never tested so they don’t know they had COVID at that time,” says Ann Parker, assistant professor of medicine at Johns Hopkins and a specialist in post-acute COVID-19 care.

Still, there is some evidence that asymptomatic disease can cause serious harm among some people—including blood clots, heart damage, a mysterious inflammatory disorder, and long COVID, the syndrome marked by a range of symptoms from breathing difficulties to brain fog that linger after an infection. Here’s a look at what scientists know so far about the effects of asymptomatic COVID-19 and what they’re still trying to figure out.

Heart inflammation and blood clots

Just as imaging scans have revealed damage to the lungs of asymptomatic individuals, chest scans have also shown abnormalities in the hearts and blood of people with asymptomatic infections—including blood clots and inflammation.

Thrombosis Journal and other publications have described several cases of blood clots in the kidneys, lungs, and brains of people who hadn’t had any symptoms. When these gel-like clumps get stuck in a vein, they prevent an organ from getting the blood it needs to function—which can lead to seizures, strokes, heart attacks, and death.

There have been relatively few of these case reports—and it’s unclear whether some patients might have had other underlying issues that could have caused a clot. But the Washington State researchers who reported on one case of renal blood clot write that it “suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.”

Meanwhile, studies also suggest that asymptomatic infections could be causing harm to the heart. In May, cardiac MRI scans of 1,600 college athletes who had tested positive for COVID-19 revealed evidence of myocarditis, or inflammation of the heart muscle, in 37 people—28 of whom hadn’t had any symptoms, says Saurabh Rajpal, a cardiovascular disease specialist at the Ohio State University and lead author on the study.

Myocarditis can cause symptoms such as chest pain, palpitations, and fainting—but sometimes it doesn’t produce any symptoms at all. Rajpal says that while the athletes in the study were asymptomatic, “the changes on the MRI were similar to or almost the same as those who had clinical or symptomatic myocarditis.”

Although these chest scans are worrisome, Rajpal says that scientists don’t know yet what they ultimately mean for the health of asymptomatic patients. It’s possible that myocarditis might resolve over time—perhaps even before patients know they had it—or it could develop into a more serious long-term health issue. Long-term studies are necessary to suss that out.

The athletes’ heart inflammation might also be completely unrelated to their COVID-19 infection. Scientists would need to compare the scans with a set taken just before an individual was infected with COVID-19. So that, Rajpal says, will still need to be teased out.

Long COVID

Additionally, people with asymptomatic infections are at risk of becoming so-called COVID-19 long-haulers, a syndrome whose definition has been hard to pin down as it can include any combination of diverse and often overlapping symptoms such as pain, breathing difficulties, fatigue, brain fog, dizziness, sleep disturbance, and hypertension.

“There’s a myth out there that it only occurs with severe COVID, and obviously it occurs far more frequently in mild COVID,” Topol says.

Linda Geng, co-director of Stanford Health Care’s Post-Acute COVID-19 Syndrome Clinic in the U.S., agrees. “There is actually not a great predictive factor about the severity of your illness in the acute phase and whether you will get long COVID,” she says. “And long COVID can be quite debilitating, and we don’t know the endpoint for those who are suffering from it.”

Studies attempting to assess how many asymptomatic infections account for long COVID symptoms have varied. FAIR Health, a healthcare nonprofit in the U.S., found from an analysis of healthcare claims that about a fifth of asymptomatic patients went on to become long-haulers. Another study, which is under peer review, used data from the University of California’s electronic health records and estimated that number could be as high as 32 percent.

Melissa Pinto, a co-author of the latter study and associate professor in the Sue & Bill Gross School of Nursing at University of California Irvine, says the researchers examined healthcare records of people who tested positive for COVID-19 but hadn’t reported symptoms at the time of infection—only to come in later with symptoms associated with long COVID-19. To ensure they were identifying long-haulers, the researchers screened out anyone with a preexisting illness that could explain their later symptoms.

“This is not from another chronic disease,” she says. “These are new symptoms.”

But it’s unclear how accurate any of these estimates might be. Pinto says that some long-haulers are wary of seeking care after having their symptoms dismissed by physicians who weren’t familiar with long COVID-19 syndrome. That’s why she believes that the rates of asymptomatic infections among long-haulers are an underestimate.

Anecdotally, Geng and Parker both say that while they’ve seen plenty of patients with mild symptoms that initially went unrecognised, they’ve had little experience treating patients who were truly asymptomatic.

“We saw many patients who didn’t think they had symptoms except in retrospect because they found out that they had tested positive,” Geng says. “Because they’ve had these long unexplained symptoms of what’s presumed to be long COVID, they think, well, maybe that wasn’t allergies.”

But she thinks that most people who were truly asymptomatic are unlikely to have gotten tested and therefore wouldn’t think to consult a specialist in post-COVID-19 care if they started experiencing unexplained symptoms like brain fog and dizziness.

Parker says that ultimately physicians are still trying to understand the broad symptoms seen in long-haulers. “When a patient comes to see us, we do a very thorough evaluation because we still don’t know exactly what to attribute to COVID and what might be a pre-existing underlying syndrome,” she says. “The last thing I want to have happen is to say to a patient, yes, this is because you had COVID and miss something else that we could have addressed.”

Mysterious inflammation in children

Physicians have also seen troubling clinical manifestations of asymptomatic COVID-19 in children. Early in the pandemic, reports emerged of a rare and mysterious inflammatory syndrome similar to Kawasaki disease that typically sets in weeks after an initial infection.

“Six weeks down the line these people, especially children, will develop inflammation throughout their body,” Rajpal says.

The condition—now called multisystem inflammatory syndrome in children, or MIS-C—typically causes fever, rash, abdominal pain, vomiting, and diarrhoea. It can have harmful effects on multiple organs, from hearts that have trouble pumping blood to lungs that are scarred. It is typically seen among children under 14, although adults have also been diagnosed with this syndrome.

MIS-C is incredibly rare. Kanwal Farooqi, assistant professor of paediatrics at Columbia University Vagelos College of Physicians and Surgeons, says that less than one percent of paediatric COVID-19 patients present with some type of critical disease—and MIS-C is just one of them. However, asymptomatic infections do play a role in the syndrome: A recent study of 1,075 children who had been diagnosed with MIS-C showed that three-quarters had originally been asymptomatic.

But there’s reason to hope that this syndrome might not cause long-term effects in patients, symptomatic or otherwise. Farooqi was the lead author on a recent study of 45 paediatric patients showing that their heart problems—which ranged from leaky valves to enlarged coronary arteries—mostly resolved within six months.

“That is reassuring,” Farooqi says. Still, she recommends administering follow-up MRI scans even to patients whose heart troubles seem to have resolved to make sure there’s no longer-term damage, such as scarring. She also says that it’s “really reasonable” to be cautious about asymptomatic infections and encourages parents to have their child evaluated if they have any persistent symptoms even if the original infection was mild or asymptomatic.

“What’s important is that we can’t right now say that there are no consequences,” she says.

Calls for more studies

Scientists caution that there’s still so much we don’t know about the potential harm of asymptomatic infections. Many have called for more rigorous studies to get to the bottom of the long-term effects of asymptomatic disease, why those effects occur, and how to treat them.

Rajpal points out that his study was only possible because the Big 10 athletic conference requires athletes to get tested every few days. Regular testing is key for uncovering asymptomatic cases, he says, which means that most data on asymptomatic disease is likely to come from healthcare workers, athletes, and other workplaces with strict testing protocols.

It’s also unclear what could be causing these lingering side effects. Scientists hypothesise that it could be an inflammatory response of the body’s immune system that persists long after an infection has been cleared. Others suggest there could be remnants of the virus lingering in the body that continue to trigger an immune reaction months after the COVID-19 infection peaked.

“This is all unchartered, unproven, just a lot of theories,” Topol says.

Yet even if asymptomatic infections aren’t linked in high rates to death and hospitalisation, Pinto and others say it’s important to keep in mind that long COVID-19 symptoms can be debilitating to a patient’s quality of life.

“Even if people survive, we don’t want them to be having a lifelong chronic disease,” Pinto says. “We don’t know what this does to the body, so it’s not something that I would want to take my chances with.”

The bottom line

With so much we don’t know about the long-term effects of asymptomatic COVID-19, scientists insist it’s better to err on the side of caution.

“The full impact can take years to show,” Rajpal says. Although the chances are slim that an individual with asymptomatic infection will have a really bad outcome, he points out that the continuing high rate of infections means that more people are going to suffer.

“Even rare things can affect a lot of people,” he says. “From a public health perspective if you can reduce the number of people that get this infection, you will reduce the number of people who get severe outcomes.”

Parker agrees, adding that it’s particularly important to prevent infection now as the more transmissible Delta variant drives surges in cases and hospitalisations across the country.

“We have had an amazing breakthrough in terms of the rapid development of effective and safe vaccines,” she says. Although Parker and other scientists remain uncertain of the health effects of asymptomatic COVID-19, “we do know that vaccinations are safe and effective and available.”

By Amy McKeever

Source: Why some COVID-19 infections may be free of symptoms but not free of harm | National Geographic

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What It’s Like To Have Breakthrough COVID

The contagious nature of the Delta variant has meant breakthrough COVID cases are on the rise. Seven people tell us what it was like to have one.

In case you hadn’t already heard, COVID-19 numbers are ticking up again, even among people who are vaccinated. While unvaccinated people in the U.S. are contracting COVID at a much, much higher rate than those who’ve gotten the vaccine, the contagious nature of the Delta variant has meant breakthrough cases are on the rise, too.

Cities like Los Angeles have already reinstated mask mandates in response, while New York City has begun imposing vaccine mandates for people who wish to visit bars, restaurants, and gyms. Meanwhile, case numbers continue to climb. We spoke to seven people from around the United States about their breakthrough COVID experiences—the symptoms, the testing process, and how they’re feeling post-quarantine.

Do you know how you were exposed to COVID?

Brian Morgan, 48, Los Angeles, CA: I got my first dose of Moderna in January 2021 and my second February 2021. COVID symptoms started July 20th. I have an idea of where I think I may have gotten it, but it was definitely during the time where California’s government said it was safe to gather indoors without masks. I was at a few large indoor gatherings without a mask a week before the new mask mandates went into place.

Kyle O’Flaherty, 29, Brooklyn, NY: The weekend before I got sick, full admission, I had a bunch of social engagements kind of all stacked together: two birthday parties on Friday, a wedding on Saturday, and then like a day party on Sunday outdoors. Most of the things were in big spaces, I wouldn’t call anything necessarily “enclosed.” But they also kept me up late. I didn’t get a lot of sleep.

Daniel Merchant, 25, Brooklyn, NY/Portland, OR: I got vaccinated on April 7th at a public vaccination drive in Co-Op City, Bronx, right when the vaccine was made available to 18+ people. I got the J&J vaccine. I knew that I’d been exposed because three to four days before I started showing symptoms I was at a funeral, and then right after I started showing symptoms, I found out that my grandpa’s wife, who was there, tested positive (she’s a breakthrough case as well). Really unfortunate timing, because I went to another funeral the day before I found out I was exposed, so I had to text a ton of people that they’d been exposed too. Only one other person got it (also a breakthrough case!) which is a huge relief, but still a nightmare.

Jacob Hill, 42, Gonzales, LA: I was in meetings with one of the only other people who is vaccinated in my workplace, my boss. He got Johnson and Johnson, I had the Pfizer vaccine. We were in his office Tuesday and Wednesday, less than six feet apart and no masks;  he calls me Thursday morning and says, ‘Hey, man, I’m running a fever.’ I was like, ‘Oh my god, like, all right, I’ll kind of start watching myself for symptoms.’ Then he went to get a COVID test and he was like, ‘Look, I’m positive, you’re gonna have to isolate.’ The next day is when the headache started.

Marc Dweck, 30, Brooklyn, NY/Jersey Shore, NJ: For the summer, we live with family in New Jersey—there’s 16 of us in the house. We’re not sure who got it first. I was the first one to test positive, but a few people in the house weren’t feeling well before me. So who knows?

Silena Palazzola, 25, Los Angeles, CA: The first time I heard about a friend getting it was this last month—and I couldn’t tell you which one of my friends gave it to me, because two of them independently got it, and then I was exposed to both of them. They made the calls, that awkward, ‘Hey, she had a great time seeing you this weekend, but also you might want to go get tested and give people a wide berth for a few days.’

Chantal Smith, 38, Brooklyn, NY: I got vaccinated in April and I actually got Johnson&Johnson. My boyfriend was vaccinated in April, and he got Moderna. In mid July, I went to the US Virgin Islands in the Caribbean. You had to show a PCR test before you flew, and they had a mask mandate there. Flying back, we had an incident on the plane where someone wasn’t wearing a mask correctly and was sort of being belligerent. They actually got kicked off the plane—the police had to come on, and it was just a big pain in the ass. Two days later, my boyfriend started to complain that he felt like he had a summer cold.

What were your initial symptoms?

Smith: First, I had itchy eyes. The next night, I started to feel really sick—I had body aches and was feeling like I had a fever. I was like, this feels exactly what I felt like after I got vaccinated. I woke up the next day and said to my boyfriend, ‘Look, I think we should both go get tested.’

O’Flaherty: On the first day, I woke up tired and was tired at work. I had an ear infection and post-nasal drip on the left side, both of which are common for me. But later that night, my throat felt a little… interesting. The next day, I woke up tired again, but I still went into work. In the middle of the day, I started getting a headache and feeling that kind of hot, cold sensation. As soon as that happened, I just cancelled the rest of my day.

Merchant: I first started experiencing symptoms at the very end of July, maybe July 31st? I had a bit of a runny nose, some sneezing, and it felt like I had a minor sinus infection or allergies (not unusual when you’re in Oregon in the summertime). I realized I was fucked when I was making dinner with my mom, cooking something that involved garlic, lime, jalapeños and chili paste and I couldn’t smell a thing. Stuck my face in a bag of coffee, nada. Right after that, I told my parents to stay away from me.

Morgan: Mostly body aches, but later light sniffles and sore throat. After a week or so, I started developing a lack of smell and taste. I can taste basic sweet/sour/salty sensations now, but nuances of flavor are still diminished. Sense of smell is starting to come back, but still diminished.

Palazzola: I started feeling a tickle in my throat and then after three days of that, I was like, oh no, it’s getting worse.

What kind of test did you get, and where did you do it?

Merchant: I’ve had a few PCR tests post-vaccination. Another friend of mine was a super super early breakthrough case (like late April) so I got one at CityMD on Manhattan Ave in Greenpoint. My most recent PCR test (which confirmed that I had it) was OHSU in Portland.

Palazzola: I went into a Carbon Health urgent care center and did a rapid and it came back positive within an hour.

Dweck: I work in the wholesale industry; two weeks ago, I wasn’t feeling well, so I decided not to go to the office. I went to the doctor, the doctor said it was most likely an upper respiratory infection so there was no need to get tested, but if I wanted to, sure. So I got tested. The following morning, as I was waiting for results, I lost taste and smell. Then I knew that it was going to be a positive.

Morgan: Test was super easy here in LA. I got a nasal PCR test at a public testing site. Almost no wait on a Thursday morning.

Smith: I went to a CityMD urgent care in Williamsburg. There were a bunch of people outside.

O’Flaherty: I rode a bicycle to get tested at my doctor’s office, so it wasn’t like I was doing that badly. The irony is, I did have an ear infection. That’s one of the first things they found. It just happened to coincide with positive COVID.

Hill: We have a hospital here called Our Lady of the Lake Ascension. I called them, told them what my symptoms were, and they scheduled a test for me in the parking lot. I went there and I was like… number 170 in line. There were so many people there. And we’re not in a city—this is a small town.

What were your symptoms and how long did they last?

Morgan: All symptoms were pretty mild. In general, it felt like a very minor cold or flu. Body aches lasted maybe 4-5 days total. Sniffles and sore throat started a little later and lasted about 3-5 days. Lack of smell and taste is slowly coming back.

Palazzola: My symptoms got progressively worse for the next three or four days. I had a really bad sore throat—like, where swallowing anything hurts—and crazy fatigue. Then I got a little bit of congestion, but not much.

O’Flaherty: I was laid out for a bit. I quarantined for 10 days, but I was in a place where I would have called out sick from working for at least three if not four of those days, even in a world where there was no COVID. I was sweating through four or five t-shirts in a night,  massive headaches, massive sinus pressure, not really a cough but lots of post-nasal drip. There were a couple days when I got back to work after I was negative and everything was fine, but I was just working half days, and then I’d come home and take a nap. I required tons of sleep.

Merchant: I couldn’t smell a goddamn thing. Strangely enough, I didn’t lose my sense of taste at all. Fair amount of sneezing, and a runny nose + sinus pressure. A few times I felt a little out of breath, but I didn’t have any crazy coughing fits. A little bit achy here and there. I felt absolutely exhausted for a while. I slept like 12-14 hours for like 4 days straight, which is really unusual for me. I’d say I had symptoms for a week.

Smith: It was maybe five or six days of just feeling that achy, tired, fevery sort of feeling and then a cough and a runny nose—but it was more of a body thing.

Hill: The day after my boss called is when the headache started. It’s funny because like, on a scale of one to 10, it was probably a three—nothing too punishing, just nagging.  I think I ran a fever overnight once, because I woke up and I was sweating, but after that zero fever. Then I started getting a little bit stuffy in the nose, but that’s as far as it ever went with me. The stuffiness started to subside about four days into it, and that’s when I lost my taste and smell. That stayed gone for about another six days and then that came back. Nothing else for the entire duration.

Dweck: The first night I saw symptoms before I got tested, I had the chills, fevers, night sweats—exactly how I felt when I got vaccinated, which was sort of a red flag for me. And then I continued to have that and I wasn’t able to sleep for like four days in a row. I had body aches, congestion, fever throughout, just felt like garbage. As soon as I was able to sleep on the fourth night, I started to feel a little bit better and continually got better.

How are you feeling now?

Hill: I still feel a little bit foggy sometimes and I still feel pretty fatigued in the mornings—like my batteries are still a little bit lower than they should be. That’s got to be an after effect of COVID because I’m a real morning person.

Merchant: I’m finishing my isolation period today, and I feel pretty much completely normal, minus my smell, which has recovered maybe 20 percent? I can smell really strong odors, but it’s definitely not where it used to be. My guess is that it will come back with time (I really, really hope so).

Dweck: I still feel kind of weak and lethargic sometimes. My whole family got it, and we were all vaccinated, and our kids got it, who weren’t vaccinated unfortunately, because you can’t vaccinate babies. It’s annoying, but everyone’s doing good. Thank God.

Smith: For all intents and purposes, I’m better but I still feel kind of like shit. Every morning I wake up and I feel like I’m hungover even though I haven’t even had a drink. I’m coming into the third week of feeling like that—my boyfriend said he feels like he’s 60 percent better, and I’m maybe 80 to 90 percent better. We’re hoping that the next few days or the next couple of weeks, it’s going to go away, because it’s just been going off forever.

Morgan: Other than the lack of smell, I feel 100 percent recovered. Maybe even a little extra energy than before contracting COVID? I’ve heard of this effect with others, as well… increased energy post-recovery.

Any advice for people worried about breakthrough COVID?

Smith: If you have a scratchy throat or something that you’re not sure about, get tested. It is a pain but it’s free.

Morgan: On a spiritual level, just allow it and don’t resist that you have it. Don’t dwell on fear or negative effects. Have compassion for yourself and others during this challenging time. We’ve been given an opportunity to come together in a time when many forces are trying to divide us. Choose love and understanding and try to see yourself reflected in the people you encounter.

Hill: Wear the mask, take your precautions. But then again, if you’ve had the vaccine, go out and live your life. Take all the safety precautions, but if you’ve been vaccinated, you’re in pretty good shape. It’s just gonna take 10 days out of your life, that’s all.

Dweck: Trust the medical professionals that are recommending whatever care or procedures they’re recommending, for sure. And I’d definitely recommend getting vaccinated, because who knows—I could have been the person who ended up having to go to the hospital, instead of just being at home and not feeling well.

Merchant: I think it’s totally reasonable to reconsider how much we’ve been socializing, and that we’ve got a long way to go before things truly get back to normal, but I don’t think it’s helpful to freak out about it. The data shows that the vaccines are crazy effective at preventing serious illness, and we should rely on that rather than random anecdotes about people who got sick.

O’Flaherty: I have my own physical therapy practice, so I’m super active, and pretty fit. And I’m glad I had the vaccine—that was my biggest surprise, was being like, Oh, OK. This is what it’s like having it even with the vaccine.

Source: What It’s Like to Have Breakthrough COVID

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The Invisible Addiction: Is It Time To Give Up Caffeine?

After years of starting the day with a tall morning coffee, followed by several glasses of green tea at intervals, and the occasional cappuccino after lunch, I quit caffeine, cold turkey. It was not something that I particularly wanted to do, but I had come to the reluctant conclusion that the story I was writing demanded it. Several of the experts I was interviewing had suggested that I really couldn’t understand the role of caffeine in my life – its invisible yet pervasive power – without getting off it and then, presumably, getting back on.

Roland Griffiths, one of the world’s leading researchers of mood-altering drugs, and the man most responsible for getting the diagnosis of “caffeine withdrawal” included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the bible of psychiatric diagnoses, told me he hadn’t begun to understand his own relationship with caffeine until he stopped using it and conducted a series of self-experiments. He urged me to do the same.

For most of us, to be caffeinated to one degree or another has simply become baseline human consciousness. Something like 90% of humans ingest caffeine regularly, making it the most widely used psychoactive drug in the world, and the only one we routinely give to children (commonly in the form of fizzy drinks). Few of us even think of it as a drug, much less our daily use of it as an addiction. It’s so pervasive that it’s easy to overlook the fact that to be caffeinated is not baseline consciousness but, in fact, an altered state. It just happens to be a state that virtually all of us share, rendering it invisible.

The scientists have spelled out, and I had duly noted, the predictable symptoms of caffeine withdrawal: headache, fatigue, lethargy, difficulty concentrating, decreased motivation, irritability, intense distress, loss of confidence and dysphoria. But beneath that deceptively mild rubric of “difficulty concentrating” hides nothing short of an existential threat to the work of the writer. How can you possibly expect to write anything when you can’t concentrate?

I postponed it as long as I could, but finally the dark day arrived. According to the researchers I’d interviewed, the process of withdrawal had actually begun overnight, while I was sleeping, during the “trough” in the graph of caffeine’s diurnal effects. The day’s first cup of tea or coffee acquires most of its power – its joy! – not so much from its euphoric and stimulating properties than from the fact that it is suppressing the emerging symptoms of withdrawal.

This is part of the insidiousness of caffeine. Its mode of action, or “pharmacodynamics”, mesh so perfectly with the rhythms of the human body that the morning cup of coffee arrives just in time to head off the looming mental distress set in motion by yesterday’s cup of coffee. Daily, caffeine proposes itself as the optimal solution to the problem caffeine creates.

At the coffee shop, instead of my usual “half caff”, I ordered a cup of mint tea. And on this morning, that lovely dispersal of the mental fog that the first hit of caffeine ushers into consciousness never arrived. The fog settled over me and would not budge. It’s not that I felt terrible – I never got a serious headache – but all day long I felt a certain muzziness, as if a veil had descended in the space between me and reality, a kind of filter that absorbed certain wavelengths of light and sound.

I was able to do some work, but distractedly. “I feel like an unsharpened pencil,” I wrote in my notebook. “Things on the periphery intrude, and won’t be ignored. I can’t focus for more than a minute.”

Over the course of the next few days, I began to feel better, the veil lifted, yet I was still not quite myself, and neither, quite, was the world. In this new normal, the world seemed duller to me. I seemed duller, too. Mornings were the worst. I came to see how integral caffeine is to the daily work of knitting ourselves back together after the fraying of consciousness during sleep. That reconsolidation of self took much longer than usual, and never quite felt complete.


Humanity’s acquaintance with caffeine is surprisingly recent. But it is hardly an exaggeration to say that this molecule remade the world. The changes wrought by coffee and tea occurred at a fundamental level – the level of the human mind. Coffee and tea ushered in a shift in the mental weather, sharpening minds that had been fogged by alcohol, freeing people from the natural rhythms of the body and the sun, thus making possible whole new kinds of work and, arguably, new kinds of thought, too.

By the 15th century, coffee was being cultivated in east Africa and traded across the Arabian peninsula. Initially, the new drink was regarded as an aide to concentration and used by Sufis in Yemen to keep them from dozing off during their religious observances. (Tea, too, started out as a little helper for Buddhist monks striving to stay awake through long stretches of meditation.) Within a century, coffeehouses had sprung up in cities across the Arab world. In 1570 there were more than 600 of them in Constantinople alone, and they spread north and west with the Ottoman empire.

The Islamic world at this time was in many respects more advanced than Europe, in science and technology, and in learning. Whether this mental flourishing had anything to do with the prevalence of coffee (and prohibition of alcohol) is difficult to prove, but as the German historian Wolfgang Schivelbusch has argued, the beverage “seemed to be tailor-​made for a culture that forbade alcohol consumption and gave birth to modern mathematics”.

In 1629 the first coffeehouses in Europe, styled on Arab and Turkish models, popped up in Venice, and the first such establishment in England was opened in Oxford in 1650 by a Jewish immigrant. They arrived in London shortly thereafter, and proliferated: within a few decades there were thousands of coffeehouses in London; at their peak, one for every 200 Londoners.

To call the English coffeehouse a new kind of public space doesn’t quite do it justice. You paid a penny for the coffee, but the information – in the form of newspapers, books, magazines and conversation – was free. (Coffeehouses were often referred to as “penny universities”.) After visiting London coffeehouses, a French writer named Maximilien Misson wrote, “You have all Manner of News there; You have a good fire, which you may sit by as long as you please: You have a Dish of Coffee; you meet your Friends for the Transaction of Business, and all for a Penny, if you don’t care to spend more.”

London’s coffeehouses were distinguished one from another by the professional or intellectual interests of their patrons, which eventually gave them specific institutional identities. So, for example, merchants and men with interests in shipping gathered at Lloyd’s Coffee House. Here you could learn what ships were arriving and departing, and buy an insurance policy on your cargo. Lloyd’s Coffee House eventually became the insurance brokerage Lloyd’s of London. Learned types and scientists – known then as “natural philosophers” – gathered at the Grecian, which became closely associated with the Royal Society; Isaac Newton and Edmond Halley debated physics and mathematics here, and supposedly once dissected a dolphin on the premises.

The conversation in London’s coffee houses frequently turned to politics, in vigorous exercises of free speech that drew the ire of the government, especially after the monarchy was restored in 1660. Charles II, worried that plots were being hatched in coffeehouses, decided that the places were dangerous fomenters of rebellion that the crown needed to suppress. In 1675 the king moved to close down the coffeehouses, on the grounds that the “false, malicious and scandalous Reports” emanating therefrom were a “Disturbance of the Quiet and Peace of the Realm”. Like so many other compounds that change the qualities of consciousness in individuals, caffeine was regarded as a threat to institutional power, which moved to suppress it, in a foreshadowing of the wars against drugs to come.

But the king’s war against coffee lasted only 11 days. Charles discovered that it was too late to turn back the tide of caffeine. By then the coffeehouse was such a fixture of English culture and daily life – and so many eminent Londoners had become addicted to caffeine – that everyone simply ignored the king’s order and blithely went on drinking coffee. Afraid to test his authority and find it lacking, the king quietly backed down, issuing a second proclamation rolling back the first “out of princely consideration and royal compassion”.

It’s hard to imagine that the sort of political, cultural and intellectual ferment that bubbled up in the coffeehouses of both France and England in the 17th century would ever have developed in a tavern. The kind of magical thinking that alcohol sponsored in the medieval mind began to yield to a new spirit of rationalism and, a bit later, Enlightenment thinking.

French historian Jules Michelet wrote: “Coffee, the sober drink, the mighty nourishment of the brain, which unlike other spirits, heightens purity and lucidity; coffee, which clears the clouds of the imagination and their gloomy weight; which illumines the reality of things suddenly with the flash of truth.”

To see, lucidly, “the reality of things”: this was, in a nutshell, the rationalist project. Coffee became, along with the microscope, telescope and the pen, one of its indispensable tools.


After a few weeks, the mental impairments of withdrawal had subsided, and I could once again think in a straight line, hold an abstraction in my head for more than two minutes, and shut peripheral thoughts out of my field of attention. Yet I continued to feel as though I was mentally just slightly behind the curve, especially when in the company of drinkers of coffee and tea, which, of course, was all the time and everywhere.

Here’s what I was missing: I missed the way caffeine and its rituals used to order my day, especially in the morning. Herbal teas – which are barely, if at all, psychoactive – lack the power of coffee and tea to organize the day into a rhythm of energetic peaks and valleys, as the mental tide of caffeine ebbs and flows. The morning surge is a blessing, obviously, but there is also something comforting in the ebb tide of afternoon, which a cup of tea can gently reverse.

At some point I began to wonder if perhaps it was all in my head, this sense that I had lost a mental step since getting off coffee and tea. So I decided to look at the science, to learn what, if any, cognitive enhancement can actually be attributed to caffeine. I found numerous studies conducted over the years reporting that caffeine improves performance on a range of cognitive measures – of memory, focus, alertness, vigilance, attention and learning.

An experiment done in the 1930s found that chess players on caffeine performed significantly better than players who abstained. In another study, caffeine users completed a variety of mental tasks more quickly, though they made more errors; as one paper put it in its title, people on caffeine are “faster, but not smarter”. In a 2014 experiment, subjects given caffeine immediately after learning new material remembered it better than subjects who received a placebo. Tests of psychomotor abilities also suggest that caffeine gives us an edge: in simulated driving exercises, caffeine improves performance, especially when the subject is tired. It also enhances physical performance on such metrics as time trials, muscle strength and endurance.

True, there is reason to take these findings with a pinch of salt, if only because this kind of research is difficult to do well. The problem is finding a good control group in a society in which virtually everyone is addicted to caffeine. But the consensus seems to be that caffeine does improve mental (and physical) performance to some degree.

Whether caffeine also enhances creativity is a different question, however, and there’s some reason to doubt that it does. Caffeine improves our focus and ability to concentrate, which surely enhances linear and abstract thinking, but creativity works very differently. It may depend on the loss of a certain kind of focus, and the freedom to let the mind off the leash of linear thought.

Cognitive psychologists sometimes talk in terms of two distinct types of consciousness: spotlight consciousness, which illuminates a single focal point of attention, making it very good for reasoning, and lantern consciousness, in which attention is less focused yet illuminates a broader field of attention. Young children tend to exhibit lantern consciousness; so do many people on psychedelics.

This more diffuse form of attention lends itself to mind wandering, free association, and the making of novel connections – all of which can nourish creativity. By comparison, caffeine’s big contribution to human progress has been to intensify spotlight consciousness – the focused, linear, abstract and efficient cognitive processing more closely associated with mental work than play. This, more than anything else, is what made caffeine the perfect drug not only for the age of reason and the Enlightenment, but for the rise of capitalism, too.

The power of caffeine to keep us awake and alert, to stem the natural tide of exhaustion, freed us from the circadian rhythms of our biology and so, along with the advent of artificial light, opened the frontier of night to the possibilities of work.

What coffee did for clerks and intellectuals, tea would soon do for the English working class. Indeed, it was tea from the East Indies – heavily sweetened with sugar from the West Indies – that fuelled the Industrial Revolution. We think of England as a tea culture, but coffee, initially the cheaper beverage by far, dominated at first.

Soon after the British East India Company began trading with China, cheap tea flooded England. A beverage that only the well-to-do could afford to drink in 1700 was by 1800 consumed by virtually everyone, from the society matron to the factory worker.

To supply this demand required an imperialist enterprise of enormous scale and brutality, especially after the British decided it would be more profitable to turn India, its colony, into a tea producer, than to buy tea from the Chinese. This required first stealing the secrets of tea production from the Chinese (a mission accomplished by the renowned Scots botanist and plant explorer Robert Fortune, disguised as a mandarin); seizing land from peasant farmers in Assam (where tea grew wild), and then forcing the farmers into servitude, picking tea leaves from dawn to dusk.

The introduction of tea to the west was all about exploitation – the extraction of surplus value from labor, not only in its production in India, but in its consumption by the British as well. Tea allowed the British working class to endure long shifts, brutal working conditions and more or less constant hunger; the caffeine helped quiet the hunger pangs, and the sugar in it became a crucial source of calories. (From a strictly nutritional standpoint, workers would have been better off sticking with beer.) The caffeine in tea helped create a new kind of worker, one better adapted to the rule of the machine. It is difficult to imagine an Industrial Revolution without it.


So how exactly does coffee, and caffeine more generally, make us more energetic, efficient and faster? How could this little molecule possibly supply the human body energy without calories? Could caffeine be the proverbial free lunch, or do we pay a price for the mental and physical energy – the alertness, focus and stamina – that caffeine gives us?

Alas, there is no free lunch. It turns out that caffeine only appears to give us energy. Caffeine works by blocking the action of adenosine, a molecule that gradually accumulates in the brain over the course of the day, preparing the body to rest. Caffeine molecules interfere with this process, keeping adenosine from doing its job – and keeping us feeling alert. But adenosine levels continue to rise, so that when the caffeine is eventually metabolized, the adenosine floods the body’s receptors and tiredness returns. So the energy that caffeine gives us is borrowed, in effect, and eventually the debt must be paid back.

For as long as people have been drinking coffee and tea, medical authorities have warned about the dangers of caffeine. But until now, caffeine has been cleared of the most serious charges against it. The current scientific consensus is more than reassuring – in fact, the research suggests that coffee and tea, far from being deleterious to our health, may offer some important benefits, as long as they aren’t consumed to excess.

Regular coffee consumption is associated with a decreased risk of several cancers (including breast, prostate, colorectal and endometrial), cardiovascular disease, type 2 diabetes, Parkinson’s disease, dementia and possibly depression and suicide. (Though high doses can produce nervousness and anxiety, and rates of suicide climb among those who drink eight or more cups a day.)

My review of the medical literature on coffee and tea made me wonder if my abstention might be compromising not only my mental function but my physical health, as well. However, that was before I spoke to Matt Walker.

An English neuroscientist on the faculty at University of California, Berkeley, Walker, author of Why We Sleep, is single-minded in his mission: to alert the world to an invisible public-health crisis, which is that we are not getting nearly enough sleep, the sleep we are getting is of poor quality, and a principal culprit in this crime against body and mind is caffeine. Caffeine itself might not be bad for you, but the sleep it’s stealing from you may have a price.

According to Walker, research suggests that insufficient sleep may be a key factor in the development of Alzheimer’s disease, arteriosclerosis, stroke, heart failure, depression, anxiety, suicide and obesity. “The shorter you sleep,” he bluntly concludes, “the shorter your lifespan.”

Walker grew up in England drinking copious amounts of black tea, morning, noon and night. He no longer consumes caffeine, save for the small amounts in his occasional cup of decaf. In fact, none of the sleep researchers or experts on circadian rhythms I interviewed for this story use caffeine.

Walker explained that, for most people, the “quarter life” of caffeine is usually about 12 hours, meaning that 25% of the caffeine in a cup of coffee consumed at noon is still circulating in your brain when you go to bed at midnight. That could well be enough to completely wreck your deep sleep.

I thought of myself as a pretty good sleeper before I met Walker. At lunch he probed me about my sleep habits. I told him I usually get a solid seven hours, fall asleep easily, dream most nights. “How many times a night do you wake up?” he asked. I’m up three or four times a night (usually to pee), but I almost always fall right back to sleep.

He nodded gravely. “That’s really not good, all those interruptions. Sleep quality is just as important as sleep quantity.” The interruptions were undermining the amount of “deep” or “slow wave” sleep I was getting, something above and beyond the REM sleep I had always thought was the measure of a good night’s rest. But it seems that deep sleep is just as important to our health, and the amount we get tends to decline with age.

Caffeine is not the sole cause of our sleep crisis; screens, alcohol (which is as hard on REM sleep as caffeine is on deep sleep), pharmaceuticals, work schedules, noise and light pollution, and anxiety can all play a role in undermining both the duration and quality of our sleep. But here’s what’s uniquely insidious about caffeine: the drug is not only a leading cause of our sleep deprivation; it is also the principal tool we rely on to remedy the problem. Most of the caffeine consumed today is being used to compensate for the lousy sleep that caffeine causes – which means that caffeine is helping to hide from our awareness the very problem that caffeine creates.


The time came to wrap up my experiment in caffeine deprivation. I was eager to see what a body that had been innocent of caffeine for three months would experience when subjected to a couple of shots of espresso. I had thought long and hard about what kind of coffee I would get, and where. I opted for a “special”, my local coffee shop’s term for a double-​shot espresso made with less steamed milk than a typical cappuccino; it’s more commonly known as a flat white.

My special was unbelievably good, a ringing reminder of what a poor counterfeit decaf is; here were whole dimensions and depths of flavour that I had completely forgotten about. Everything in my visual field seemed pleasantly italicised, filmic, and I wondered if all these people with their cardboard-sleeve-swaddled cups had any idea what a powerful drug they were sipping. But how could they?

They had long ago become habituated to caffeine, and were now using it for another purpose entirely. Baseline maintenance, that is, plus a welcome little lift. I felt lucky that this more powerful experience was available to me. This – along with the stellar sleeps – was the wonderful dividend of my investment in abstention.

And yet in a few days’ time I would be them, caffeine-tolerant and addicted all over again. I wondered: was there any way to preserve the power of this drug? Could I devise a new relationship with caffeine? Maybe treat it more like a psychedelic – say, something to be taken only on occasion, and with a greater degree of ceremony and intention. Maybe just drink coffee on Saturdays? Just the one.

When I got home I tackled my to-do list with unaccustomed fervour, harnessing the surge of energy – of focus! – coursing through me, and put it to good use. I compulsively cleared and decluttered – on the computer, in my closet, in the garden and the shed. I raked, I weeded, I put things in order, as if I were possessed. Whatever I focused on, I focused on zealously and single-mindedly.

Around noon, my compulsiveness began to subside, and I felt ready for a change of scene. I had yanked a few plants out of the vegetable garden that were not pulling their weight, and decided to go to the garden centre to buy some replacements. It was during the drive that I realised the true reason I was heading to this particular garden centre: it had this Airstream trailer parked out front that served really good espresso.

This article was amended on 8 July 2021 to include mention of the Turkish influence on early European coffeehouses.

This is an edited extract from This Is Your Mind on Plants: Opium-Caffeine-Mescaline by Michael Pollan, published by Allen Lane on 8 July and available at guardianbookshop.co.uk

By

Source: The invisible addiction: is it time to give up caffeine? | Coffee | The Guardian

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Critics:

Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is the world’s most widely consumed psychoactive drug. Unlike many other psychoactive substances, it is legal and unregulated in nearly all parts of the world. There are several known mechanisms of action to explain the effects of caffeine. The most prominent is that it reversibly blocks the action of adenosine on its receptors and consequently prevents the onset of drowsiness induced by adenosine. Caffeine also stimulates certain portions of the autonomic nervous system.

Caffeine is a bitter, white crystalline purine, a methylxanthine alkaloid, and is chemically related to the adenine and guanine bases of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). It is found in the seeds, fruits, nuts, or leaves of a number of plants native to Africa, East Asia and South America, and helps to protect them against herbivores and from competition by preventing the germination of nearby seeds, as well as encouraging consumption by select animals such as honey bees. The best-known source of caffeine is the coffee bean, the seed of the Coffea plant.

Caffeine is used in:

  • Bronchopulmonary dysplasia in premature infants for both prevention and treatment. It may improve weight gain during therapy and reduce the incidence of cerebral palsy as well as reduce language and cognitive delay. On the other hand, subtle long-term side effects are possible.
  • Apnea of prematurity as a primary treatment, but not prevention.
  • Orthostatic hypotension treatment.
  • Some people use caffeine-containing beverages such as coffee or tea to try to treat their asthma. Evidence to support this practice, however, is poor. It appears that caffeine in low doses improves airway function in people with asthma, increasing forced expiratory volume (FEV1) by 5% to 18%, with this effect lasting for up to four hours.
  • The addition of caffeine (100–130 mg) to commonly prescribed pain relievers such as paracetamol or ibuprofen modestly improves the proportion of people who achieve pain relief

Teaching Your Kids How to Resolve Conflict Without Fighting

You know how we have epiphanies as we grow older? One of the most profound ones for me has been the realization that just because someone doesn’t agree with what you’re saying at the moment doesn’t mean that they don’t agree with you all the time or that they don’t like you anymore.

This simple realization has had a huge impact on my life.

Just recently, my parents and brother were in town for my daughter’s birthday. We were at dinner the night before her party, and my brother hadn’t put his phone down the entire half hour we’d been seated. I made a comment on this – that it’s not pleasant to share a meal with someone that can’t take their eyes away from their smart phones – and he stormed off, refusing to engage in any conversation.

This isn’t the first time he’s had a violent outburst of anger over a small conflict. As his family member, it upsets me that this happens so frequently.

While I tried to make amends over text message (the only way he was willing to communicate), I noticed something in what he was saying – he thought that any criticism of his actions was a criticism of him. He thought that if I respected him, then I would not say anything negative to him. And worst of all, he thought that disagreeing meant we couldn’t be friends.

I started to wonder why this might be. Did we not have good examples of conflict resolution growing up? Did we witness violent outbursts of anger? When I think back on it, I can’t remember my parents ever arguing. And while that may seem like a good thing, I think that may be where the problem lies.

In order to know how to handle conflict in a productive and healthy manner, we need models of healthy conflict resolution. While on one hand fighting and inflamed emotions only create pain, on the other, never seeing adults disagree means our children don’t know how to deal with conflicts at all.

Productive arguments and even conflict are good, and can bring us closer when handled well. Among the many things we teach our kids, how to resolve conflict without resorting to either drama or fighting, or just simply sweeping it under the rug to fester, is very important.

Here are some ways we can teach our kids to argue in a way that builds connections, instead of destroying them –

1. Teach that disagreement and conflict do not mean that the relationship is damaged or in jeopardy

Our children need to know they are loved unconditionally. This is true in our homes, in school, and on the playground. It is far too common for individuals to view a disagreement as the undoing of a relationship. It is entirely possible to have opposing views and to still get along.

When your child comes home after a disagreement with a friend, listen to the grievances, and remind your child that their relationship with their friend remains intact.

Saying “I see, you didn’t like it that Mila wouldn’t share the swing with you” places the burden on the action; saying “it sounds like Mila was being mean today” places the burden on Mila.

This important distinction does two things:

  1. it helps your child understand that it was the action, not the friend, which was truly upsetting and
  2. it promotes a growth mindset.

Your child will learn that Mila’s actions do not define her completely. If the negative feelings are linked directly to your child’s friend instead of the action, your child may incorporate that image of Mila as always being mean. By linking the feelings to the action, your child will be more likely to understand that having one disagreement does not mean that Mila will always be “mean”.

You can also teach your child this truth by affirming it whenever the two of you disagree. Be careful and intentional with the language you choose.

Instead of criticizing your child (“you’re being disruptive”), make it clear that it is the behavior that you are unapproving of (“the way you are banging your silverware on the table is disrupting our family dinner”).

This can help your child take an outside perspective of the behavior or disagreement. Instead of aligning him or herself with the behavior in opposition to you, he or she can align with you in opposition to the behavior. Which makes it easier to teach kids how to resolve conflict in a healthy manner and brings us to our next strategy…

2. Instill in your child a sense of family and friends as teammates

There’s nothing worse than feeling like you’re outside of a group. Being ostracized in time out or left out of a game of tag can be debilitating for a child. We want to belong. And one of the things that can make us feel like we don’t belong is having a fight.

I noticed this in my communication with my brother. He felt rejected because of our disagreement, when in reality I only meant to point out a behavior that was hindering our ability to connect. I should have been more careful to make it clear that it wasn’t him that I had a problem with, but was the behavior instead.

One way we can do this with our children and other adults is reminding ourselves and each other that we are on the same team. When your child is disrupting dinner time, saying something like “we all want to have a meal together and spend time with each other” reminds him or her that you have the same goal.

Back to our example of Mila not sharing her swing – this is a good time to explain that individuals often have different ideas of the same goal. In this example, our goal on the playground is to have fun and play together. Mila is expressing this goal by swinging. How else can we meet this goal together? How can we cooperate, rather than compete, to find different options for reaching the same goal? Can we take turns with one on the swing and the other pushing her 10 times and then switch places so both of us can have fun?

This is the sort of conversation that may be difficult to have with young children, but if we are able to open our children’s minds to seeing different ways to get the same thing accomplished, and ultimately look for a win-win solution, we have done them a great service for their lives to come.

3. Encourage your child to recognize the emotions that come to the surface during a conflict

When we don’t view each other as teammates, we may come to assume that the other person has bad intentions or is trying to hurt us. Where does this come from?

Most often, it is a defense against the pain and fear of being rejected. These emotions are quick to come to the surface in any conflict – our stomach gets tight, we sweat, our heart pounds. We are afraid of what the other person – our partner, a friend, a coworker – might say.

In order to protect ourselves against these scary feelings, we often fight back. We lash out instead of taking a moment to recognize our own vulnerability.

We can help our children recognize this cascade of thoughts and feelings by verbalizing it for them and asking them how they feel.

When you see anger rising in your child, place a hand on their shoulder and ask them what they’re feeling. The touch will help them feel safe and grounded, and the answer to your question may help them step out of their escalating anger and fear.

If they have trouble finding the words to describe their emotions, help them out. Say “it seems like you’re feeling angry/scared/frustrated”. Giving them a variety of words to express their emotions and helping them understand the more complicated ones will give them tools of emotional intelligence that they can use throughout their lives to build healthy relationships. This primer from The Natural Child Project has suggestions on how to observe and verbalize the emotions that arise from a difficult situation.

Once the emotions are identified, help them dig deeper to explore the causes of these emotions: “you felt frustrated when Mila wouldn’t share the swing with you”, or “did you feel scared that she may not be your friend if she didn’t share?”

By now, your child will probably start to be more calm and able to think through a healthy solution for how to resolve conflict. This is a good time to use our first two strategies: reminding your child that the disagreement does not mean that the friendship is over, and that there may be other ways to view the situation so that you can reach your shared goal together.

4. Model these strategies every chance you get

There is no greater teacher than the world around us, and our children are sponges, absorbing all of our actions and words as the blueprint for their lives.

A lot of pressure? Maybe.

But that’s one of the beauties of parenthood – it pushes us to be our best selves.

I mentioned above that my brother and I never saw our parents disagreeing. How were we meant to learn how to disagree if we never saw it happening? It seemed to us that disagreeing was something so bad that it had be hidden, if it happened at all. But disagreements happen, and there’s no way to avoid them. What we can avoid is an inability to deal with conflict in a healthy manner.

For example, having a disagreement with your spouse is not a time to run to another room and argue in hushed tones. Instead, use it as a teaching moment for your child and for yourself.

Saying “when you forget to go to the grocery store, I feel disrespected” gets to the heart of the issue much more than angrily shouting “you’re so forgetful!”

It also helps your spouse recognize the impact of their actions on you – it is highly unlikely that he or she neglected to go to the store out of any disrespect for you – and it helps you recognize that you may be experiencing emotions that are more about your own reaction than about the actions of your partner. According to nonviolent communication pioneer Marshall Rosenberg, “what others do may be a stimulus of our feelings, but not the cause”.

Modeling this behavior is hugely instructional for our children. They get to see us being vulnerable, and they start to see this honest discussion of emotions as a normal and healthy part of our interactions with each other.

The 2-Minute Action Plan for Fine Parents

At the heart of teaching healthy conflict-resolution skills is a deep understanding of our own reactions to conflict. Just as we discussed helping your child recognize his or her emotions, we need to practice this ourselves.

The next time you disagree with your child, your spouse, your coworker, or your friend, notice how your body feels. Our bodies can often teach us a lot about our emotions. Do you hunch over, taking a protective stance out of a feeling of fear? Do you immediately cross your arms, unwilling to move forward hand-in-hand with the other person?

Identifying the tension in your body is the first step to letting it go. See if you can relax into your own vulnerability. Remind yourself that this is not a fight-or-flight situation, but rather an opportunity to understand each other more deeply and to forge an even stronger relationship.

The Ongoing Action Plan for Fine Parents

If you are inclined to write, you can take the 2-minute action plan a step further. Keeping a daily stream-of-consciousness journal can be a wonderful tool for unraveling our thoughts, feelings, actions, and the connections among the three.

Julia Cameron pioneered this idea in The Artist’s Way, calling the ritual “Morning Pages”. While it was originally meant to clear the mind to make room for creativity, the Morning Pages practice can also be used to clear your mind of any clutter or complicated thoughts, to make room for full, authentic engagement with the world and your family.

When it comes to conflict, a writing practice can help you understand your own reactions to difficult situations. This in turn helps us connect with and better understand our children. This high level of empathy is crucial for helping our children learn to understand their emotions related to conflict and disagreement, and one of the best ways to cultivate empathy is by being vulnerable ourselves. From that place of kindness and empathy, we can teach our children to deal with these moments in a way that fosters continued harmonious relationship at home, at school, and for the rest of their lives.

By: 

Tiffany Frye is the co-founder of nido durham (www.nidodurham.com), a coworking space with childcare in Durham, NC. She supports and mentors parents who want to craft a career that fits around their lives and honors their parent-self as well as their professional-self. You can connect with Tiffany at tiffanymfrye.com or on Twitter @nidodurham.

Source: Teaching Your Kids How to Resolve Conflict Without Fighting – A Fine Parent

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Thabet, A. A., Vostanis, P. and Karim, K. 2005. Group crisis intervention for children during ongoing war conflict. Psychiatry, Vol.14, pp. 262-269.

Four Causes For ‘Zoom Fatigue’ & Their Solutions

Even as more people are logging onto popular video chat platforms to connect with colleagues, family and friends during the COVID-19 pandemic, Stanford researchers have a warning for you: Those video calls are likely tiring you out.

Prompted by the recent boom in videoconferencing, communication Professor Jeremy Bailenson, founding director of the Stanford Virtual Human Interaction Lab (VHIL), examined the psychological consequences of spending hours per day on these platforms. Just as “Googling” is something akin to any web search, the term “Zooming” has become ubiquitous and a generic verb to replace videoconferencing. Virtual meetings have skyrocketed, with hundreds of millions happening daily, as social distancing protocols have kept people apart physically.

In the first peer-reviewed article that systematically deconstructs Zoom fatigue from a psychological perspective, published in the journal Technology, Mind and Behavior on Feb. 23, Bailenson has taken the medium apart and assessed Zoom on its individual technical aspects. He has identified four consequences of prolonged video chats that he says contribute to the feeling commonly known as “Zoom fatigue.”

Bailenson stressed that his goal is not to vilify any particular videoconferencing platform – he appreciates and uses tools like Zoom regularly – but to highlight how current implementations of videoconferencing technologies are exhausting and to suggest interface changes, many of which are simple to implement. Moreover, he provides suggestions for consumers and organizations on how to leverage the current features on videoconferences to decrease fatigue.

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Covid Fatigue: how our brain affects our motivation to follow safety precautions — the strain of following safety precautions for the past six months to prevent the spread of COVID-19 is getting to many of us. Some people are becoming lax and even resistant to wearing masks or practicing physical distancing. Why do we lose the motivation to follow safety guidelines, even when the threat of danger is still there? Experts say our brain is part of the problem – and the solution. Dr. Joe Bienvenu explains how our brain causes us to be desensitized and how we can train ourselves to develop safe habits to continue protecting ourselves and others. #JohnsHopkins #CovidFatigue
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“Videoconferencing is a good thing for remote communication, but just think about the medium – just because you can use video doesn’t mean you have to,” Bailenson said.

Below are four primary reasons why video chats fatigue humans, according to the study. Readers are also invited to participate in a research study aimed at developing a Zoom Exhaustion & Fatigue Scale (ZEF) Scale.

Four reasons why

1) Excessive amounts of close-up eye contact is highly intense.

Both the amount of eye contact we engage in on video chats, as well as the size of faces on screens is unnatural.

In a normal meeting, people will variously be looking at the speaker, taking notes or looking elsewhere. But on Zoom calls, everyone is looking at everyone, all the time. A listener is treated nonverbally like a speaker, so even if you don’t speak once in a meeting, you are still looking at faces staring at you. The amount of eye contact is dramatically increased. “Social anxiety of public speaking is one of the biggest phobias that exists in our population,” Bailenson said. “When you’re standing up there and everybody’s staring at you, that’s a stressful experience.”

Another source of stress is that, depending on your monitor size and whether you’re using an external monitor, faces on videoconferencing calls can appear too large for comfort. “In general, for most setups, if it’s a one-on-one conversation when you’re with coworkers or even strangers on video, you’re seeing their face at a size which simulates a personal space that you normally experience when you’re with somebody intimately,” Bailenson said.

When someone’s face is that close to ours in real life, our brains interpret it as an intense situation that is either going to lead to mating or to conflict. “What’s happening, in effect, when you’re using Zoom for many, many hours is you’re in this hyper-aroused state,” Bailenson said.

Solution: Until the platforms change their interface, Bailenson recommends taking Zoom out of the full-screen option and reducing the size of the Zoom window relative to the monitor to minimize face size, and to use an external keyboard to allow an increase in the personal space bubble between oneself and the grid.

2) Seeing yourself during video chats constantly in real-time is fatiguing.

Most video platforms show a square of what you look like on camera during a chat. But that’s unnatural, Bailenson said. “In the real world, if somebody was following you around with a mirror constantly – so that while you were talking to people, making decisions, giving feedback, getting feedback – you were seeing yourself in a mirror, that would just be crazy. No one would ever consider that,” he added.

Bailenson cited studies showing that when you see a reflection of yourself, you are more critical of yourself. Many of us are now seeing ourselves on video chats for many hours every day. “It’s taxing on us. It’s stressful. And there’s lots of research showing that there are negative emotional consequences to seeing yourself in a mirror.”

Solution: Bailenson recommends that platforms change the default practice of beaming the video to both self and others, when it only needs to be sent to others. In the meantime, users should use the “hide self-view” button, which one can access by right-clicking their own photo, once they see their face is framed properly in the video.

3) Video chats dramatically reduce our usual mobility.

In-person and audio phone conversations allow humans to walk around and move. But with videoconferencing, most cameras have a set field of view, meaning a person has to generally stay in the same spot. Movement is limited in ways that are not natural. “There’s a growing research now that says when people are moving, they’re performing better cognitively,” Bailenson said.

Solution: Bailenson recommends people think more about the room they’re videoconferencing in, where the camera is positioned and whether things like an external keyboard can help create distance or flexibility. For example, an external camera farther away from the screen will allow you to pace and doodle in virtual meetings just like we do in real ones. And of course, turning one’s video off periodically during meetings is a good ground rule to set for groups, just to give oneself a brief nonverbal rest.

4) The cognitive load is much higher in video chats.

Bailenson notes that in regular face-to-face interaction, nonverbal communication is quite natural and each of us naturally makes and interprets gestures and nonverbal cues subconsciously. But in video chats, we have to work harder to send and receive signals.

In effect, Bailenson said, humans have taken one of the most natural things in the world – an in-person conversation – and transformed it into something that involves a lot of thought: “You’ve got to make sure that your head is framed within the center of the video. If you want to show someone that you are agreeing with them, you have to do an exaggerated nod or put your thumbs up. That adds cognitive load as you’re using mental calories in order to communicate.”

Gestures could also mean different things in a video meeting context. A sidelong glance to someone during an in-person meeting means something very different than a person on a video chat grid looking off-screen to their child who just walked into their home office.

Solution: During long stretches of meetings, give yourself an “audio only” break. “This is not simply you turning off your camera to take a break from having to be nonverbally active, but also turning your body away from the screen,” Bailenson said, “so that for a few minutes you are not smothered with gestures that are perceptually realistic but socially meaningless.”

ZEF Scale

Many organizations – including schools, large companies and government entities – have reached out to Stanford communication researchers to better understand how to create best practices for their particular videoconferencing setup and how to come up with institutional guidelines. Bailenson – along with Jeff Hancock, founding director of the Stanford Social Media Lab; Géraldine Fauville, former postdoctoral researcher at the VHIL; Mufan Luo; graduate student at Stanford; and Anna Queiroz, postdoc at VHIL – responded by devising the Zoom Exhaustion & Fatigue Scale, or ZEF Scale, to help measure how much fatigue people are experiencing in the workplace from videoconferencing.

The scale, detailed in a recent, not yet peer-reviewed paper published on the preprint website SSRN, advances research on how to measure fatigue from interpersonal technology, as well as what causes the fatigue. The scale is a 15-item questionnaire, which is freely available, and has been tested now across five separate studies over the past year with over 500 participants. It asks questions about a person’s general fatigue, physical fatigue, social fatigue, emotional fatigue and motivational fatigue. Some sample questions include:

  • How exhausted do you feel after videoconferencing?
  • How irritated do your eyes feel after videoconferencing?
  • How much do you tend to avoid social situations after videoconferencing?
  • How emotionally drained do you feel after videoconferencing?
  • How often do you feel too tired to do other things after videoconferencing?

Hancock said results from the scale can help change the technology so the stressors are reduced.

He notes that humans have been here before. “When we first had elevators, we didn’t know whether we should stare at each other or not in that space. More recently, ridesharing has brought up questions about whether you talk to the driver or not, or whether to get in the back seat or the passenger seat,” Hancock explained. “We had to evolve ways to make it work for us. We’re in that era now with videoconferencing, and understanding the mechanisms will help us understand the optimal way to do things for different settings, different organizations and different kinds of meetings.”

“Hopefully, our work will contribute to uncovering the roots of this problem and help people adapt their videoconference practices to alleviate ‘Zoom fatigue,’” added Fauville, who is now an assistant professor at the University of Gothenburg in Sweden. “This could also inform videoconference platform designers to challenge and rethink some of the paradigm videoconferences have been built on.”

If you are interested in measuring your own Zoom fatigue, you can take the survey here and participate in the research project.

By Vignesh Ramachandran

Source: Four causes for ‘Zoom fatigue’ and their solutions | Stanford News

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For Facebook Moderators, The Soul-Crushing Job Must Go On

What in some cases can be truly disturbing content, moderators are the invisible, human grease that keep the social media machine running. It’s grueling but essential work that happens behind the scenes.

 

The message was for Mark Zuckerberg. “Without our work, Facebook would be unusable. Its empire collapses,” the founder of the social media titan was told in a letter sent last year and signed by more than 200 people.

“Your algorithms cannot spot satire. They cannot sift journalism from disinformation. They cannot respond quickly enough to self-harm or child abuse,” the missive went on to say. “We can.”

The we, in this case, are social media content moderators. Employed not only by Facebook, but also Twitter, TikTok, YouTube and all the other major digital platforms, they are the clandestine guardians of what a contemporary network puts out. It’s a crucial profession, but one that’s also goes largely unseen.

Moderators are sacrificed in the chase of the illusion of complete editorial automation.

“I believe that the most difficult aspect is the condition of total invisibility in which they are forced to work — for safety reasons, but also to minimize the importance of human work,” says Jacopo Franchi, author of the book Obsolete. “Today, it is impossible to establish with certainty whether a moderation decision depends on the intervention of a man or a machine. Moderators are sacrificed in the chase of the illusion of complete editorial automation.”

Speed is of the essence, silence is golden

Because technology fails to grasp the way we mean some of our words — and who knows if it will ever understand them — platforms still need someone to hide the dirt under the carpet in the eyes of the billions of subscribers and advertisers. Someone, in other words, needs to take that stuff down before it infects too many monitors and smartphones.

Digital moderators are men and women without specific skills or specializations, and of any ethnicity and background. They’re absolutely interchangeable workforce. To be hired, you just need to be immediately available, have a stable connection and some nerve.

They sift through and possibly delete the millions of anonymous daily posts, videos and stories reported by users. Such content includes child pornography, hate messages, fake accounts, hoaxes, revenge porn, cyberbullying, torture, rape, murder, suicide, local wars and live massacres. These rivers of mud escape the fallible dam of algorithms, and can end up making unspeakable horrors viral. These are the people that resolve machine selection errors, even if everything must appear, to the end user, to be a uniform and indistinct projection of artificial intelligence.

It’s essential and misunderstood work. It’s also, in many ways, barbaric. “I was paid 10 cents per piece of content,” writes Tarleton Gillespie in his Custodians of the Internet. “For this amount I had to catalog the video, published by ISIS, of a boy who had been set on fire.”

A former moderator said that Facebook even keeps track of their bathroom breaks.

The custodians work at a frenzied pace, deleting up to 1,500 pieces of content per shift. This happens one at a time, following the guidelines provided by the companies, the changing Community Standards (which the moderators refer to as the Bible).

If a post is in a language they don’t know, they use an online translator. The important thing is to be fast: They have a few seconds to determine what needs to be removed from our feeds. Valera Zaicev, a former moderator and one of the major activists in the battle for rights in this category, said that Facebook even keeps track of their bathroom breaks. Nobody knows anything about their mandate, forced as they are to silence by martial confidentiality agreements.

“Content moderators are an example, perhaps the most extreme, of the new forms of precarious work generated and directed by algorithms,” says Franchi. “Nobody can say how many there are: We are talking about 100,000 to 150,000 moderators, but it has never been clarified how many of these are hired full time by companies, how many are hired with temporary contracts by subcontracted agencies and how many instead are paid piecemeal on the ‘gig working’ platforms.”

Always answering to the algorithm

At Facebook, the most protected moderators in the United States have a stable contract paying about $15 per hour. But there are also roughly 1,600 moderators employed by the contractor Genpact in Hyderabad, India, where they are paid $6 dollars per day, according to Reuters.

The latter are part of a reserve neo-industrial army that responds at the platform’s disposal, thanks to outsourcing companies like TaskUs — people in unspecified corners of the globe, paid peanuts for one gig after another.

They face immense body and mind fatigue, commanded by an algorithm, a mathematical-metaphysical entity that never stops, and makes for an authoritarian leader.

“It is an algorithm that selects them on LinkedIn or Indeed through deliberately generic job offers,” says Iacopo Franchi. “It is an algorithm that organizes social content that can be reported by users. It is an algorithm that plans review queues and it is often an algorithm that determines their score on the basis of their ‘mistakes’ and decides on their possible dismissal.”

Yes, if they are wrong in more than 5% of cases, they risk getting the boot.

For those who manage to keep their jobs, it’s essential to disconnect completely in their free time. “There are thousands of moderators in the European Union and all of them are working in critical conditions for their mental health,” says Cori Crider, director of Foxglove, a pressure group that assists them in lawsuits.

In 2020, Facebook paid $52 million to thousands of moderators who had developed psychological problems due to their work.

Few last more than a few months on the job before being fired for disappointing performances or leaving by their own volition because they are no longer able to observe the evil of the world without being able to do anything other than hide it.

For those who manage to keep their jobs, it’s essential to disconnect completely in their free time.

The aftermath can be heavy. The accumulation of bloody visions traces a deep furrow. Who else has ever plunged so deeply into the abysses of human nature?

“Exposure to complex and potentially traumatic contents, as well as information overload, is certainly a relevant aspect of their daily professional experience, but we must also not forget the high repetitiveness of their tasks,” says Massimiliano Barattucci, work psychologist and professor of organizational psychology.

“Unlike another new job, that of delivery couriers, content moderators are exposed to all sources of technology-fueled stress,” he adds. “And this helps to understand their high turnover and burnout rates, and their general job dissatisfaction.”

Alienation and emotional addiction to horror could be just around the corner. “A progressive cynicism can arise, a habit that allows you to maintain detachment from the shocking content they see in their work,” says Barattucci. “They may develop disorders such as insomnia, nightmares, intrusive thoughts or memories, anxiety reactions, and in several cases, PTSD.”

One day, in the Facebook center of Phoenix, Arizona, everyone’s attention was caught by a man who threatened to jump from the roof of a nearby building, a former moderator tells The Verge. Eventually, they discovered he was a moderator, a colleague of theirs: He had walked away during one his two allowed breaks. He wanted to log off the horror.

Source: For Facebook Moderators, The Soul-Crushing Job Must Go On – Worldcrunch

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