I don’t want this to be a sob story. I do however, want this to be a story of learning, understanding, and self-love. I want to talk about practicing self-compassion for mental health. What is self-compassion? Well read this excerpt from Dr. Kristin Neff regarding self-compassion that is a beautiful introduction to self-compassion:
“Having compassion for oneself is really no different than having compassion for others. Think about what the experience of compassion feels like. First, to have compassion for others you must notice that they are suffering. If you ignore that homeless person on the street, you can’t feel compassion for how difficult his or her experience is. Second, compassion involves feeling moved by others’ suffering so that your heart responds to their pain (the word compassion literally means to “suffer with”).
When this occurs, you feel warmth, caring, and the desire to help the suffering person in some way. Having compassion also means that you offer understanding and kindness to others when they fail or make mistakes, rather than judging them harshly. Finally, when you feel compassion for another (rather than mere pity), it means that you realize that suffering, failure, and imperfection is part of the shared human experience. “There but for fortune go I.”
First of all, isn’t that excerpt fu**ing beautiful?! I don’t know about you but it gave me this overflow of warmth to know that I can make my pain and suffering go away by being more compassionate towards myself. Self-compassion is taking that concept of being kind towards others through difficult times, but towards ourselves to alleviate some of the suffering. In some way it then leads us to more of an understanding of our pain and allows us to make changes by reinforcing a positive mindset and view of our actual reality.
Anyway I need to be honest with you all. Lately I’ve been feeling very unhealthy. I had to leave my job, I’ve lost weight (and I’m already tiny!), I go to bed late and sleep in, my appetite is a mess, my anxiety is through the roof, and I’ve had random crying spells throughout the days. Also, my relationship is a mess, basically it no longer makes me happy.
Not to mention I’ve had a lot of new medical issues adding on to my decline in health. WHEW. Isn’t that a lot of heavy, toxic shit?! Excuse my language. Anyways, as a result I’ve been beating myself up constantly and not having the energy to follow through with what I’d like to. I have been very hard on myself and adding fuel to my already mountain of fire.
Where do I even go from here? The thing is, I know the things I have to do but I don’t want to do them. I give myself excuses and develop this negative self-talk that basically makes me fear moving forward and doing the things I need to do. I am completely hating myself instead of filling my soul up with positivity, love, and self-compassion.
I want to paint this picture because as many of my readers with mental health issues, it is DIFFICULT to get yourself out of a slump when you are wrapped up in so many unhealthy situations. But I want to talk about self-compassion anyways because as the saying goes, nothing changes if nothing changes. And OMG do I want to change.
Here are some ways we can practice self-compassion:
Be kind to yourself
This can be very difficult to do. Being kind to yourself is a way to let yourself off the map and tell yourself you are doing the best you can in the situation you are in. It is okay to fail and remember that no one has it together 100% so why should you beat yourself up for something that isn’t attainable?! Feel empathy towards yourself like you would a stranger or loved one going through difficult times instead of beating yourself up for not being good enough for something. Here is what Dr. Neff has to say about it:
“Self-compassionate people recognize that being imperfect, failing, and experiencing life difficulties is inevitable, so they tend to be gentle with themselves when confronted with painful experiences rather than getting angry when life falls short of set ideals”.
Understand bad memories
Instead thinking about a bad argument with a loved one, an emotional breakdown at work, the lady who frustrated you at the grocery store for walking slow, focus on what it was you NEEDED at that time. If you were arguing with a loved one, was it because you dislike them OR because at that time you needed to be heard?
And that lady at the grocery store, was she walking slow to piss you off or is it that you needed to be seen? Shifting your perspective about certain incidents that trigger you can be a way of setting them free and allowing them to no longer hold emotional value in your life. After you realize what it was you needed, you can work on that without the memory holding you back.
We are all human
This is a big one. Often, we start placing blame in our shortcomings by taking it out on ourselves and create this lifestyle and mindset that is full of frustration because “no one understands”. If no one understands then we isolate ourselves and close our own doors to the outside world. We think that nobody else can understand and by closing ourselves off, we are not being compassionate towards our own needs.
It is important to know we you are human, and it is okay to mess up and have issues. It isn’t okay for you to think that you are the only one suffering. I am sure MANY of you can relate to my personal story.
Be your own friend
When a friend or loved one is feeling blue, we attempt to console them by taking them out in the community or doing an activity together. As children we would play make believe and be content playing by ourselves, right? Right. So why is it when WE are feeling down, we attempt to do nothing for our own emotional needs? I for one, wrap myself up on the coach and I swear sometimes I think I just stare at a wall. But that’s probably my depression talking.
Regardless, we need to be our own friends! Experiences and adventure can increase our gratitude (read here). Appreciating new things can allow us to be more compassionate to our own dilemma’s because we start to see that we CAN heal and we CAN go on and things WILL be okay because we have the power to change by involving ourselves in healthier activities. So, take a yoga class, go on a walk, go get ice cream, take a pottery class, or travel. Be your own friend.
Make healthier choices
If we feel like crap, think we look like crap, and constantly doubt our abilities…well we are going to continue feeling like crap. One way to practice self-compassion is to love our body and take into consideration that we, as much as any one else is this world, deserve our love and attention. We are worthy and we should treat ourselves as if we are.
Making healthier choices through nutrition, fitness, and lifestyle are great actions to take to show our appreciation towards ourselves. You don’t have to shift all at once. For example, with my eating issues and body weight at this moment, all I could accomplish is to get myself some vitamins and probiotics to improve my gut health because I care about my health and I deserve to be happy. And that is a start to self-compassion.
Be a good person
The Law of Attraction states that energy flows where attention goes. If we are attacking ourselves and attacking and questioning others, well guess what is going to happen? Nothing good or positive that’s for sure. Focus your energy on being a good person towards others. If we are non-judgmental towards others, it will trasnfer to our own thoughts and feelings about who we are.
Feel your pain. Feel your emotions and then let them go. Here is what Dr. Neff has to say about feeling:
“Self-compassion is a practice of goodwill, not good feelings. In other words, even though the friendly, supportive stance of self-compassion is aimed at the alleviation of suffering, we can’t always control the way things are. If we use self-compassion practice to try to make our pain go away by suppressing it or fighting against it, things will likely just get worse.
With self-compassion we mindfully accept that the moment is painful, and embrace ourselves with kindness and care in response, remembering that imperfection is part of the shared human experience. This allows us to hold ourselves in love and connection, giving ourselves the support and comfort needed to bear the pain, while providing the optimal conditions for growth and transformation”.
Flow with consistency
Immerse yourself in something new, something you want to learn, or something you love and enjoy. Total absorption in what you’re doing can enhance positive emotions and create a feeling of accomplishment. This reminds you that you are able and you have the capability to accomplish whatever you set your mind to. It is also a great way to get out of your ruminative thoughts.
If you’re like me and can’t find where to start. Start small but the important thing is to treat yourself with loving kindness and remind yourself that you will get through this, just like you have gotten through other difficult situations.
Universities and colleges across the U.S. are preparing for potential outbreaks of monkeypox this fall as students begin returning to campus amid an upswing in cases nationally, marking another public health challenge for schools to manage after years of grappling with Covid-19.
Dr. Ina Park, a professor at the University of California San Francisco School of Medicine, told Forbes that while monkeypox “does pose a risk to students,” the risk is different from that posed by Covid-19 and there is not a concern about catching the virus through everyday activity or passing someone in a corridor.
The main issue is that students live together in close quarters and gather to socialize, including hookups where close contact like kissing, skin-to-skin contact and sex might happen, Park explained, adding that the virus could also potentially be transmitted through sharing clothing or sleeping in someone else’s bed.
Numerous universities told Forbes they are in contact with local and federal health authorities to plan their responses and some schools, such as Texas A&M University, said clinicians at student health services have taken part in CDC training related to the disease.
Other universities, including Georgetown University and NYU, said student health services are able to carry out the specific testing needed to diagnose monkeypox.
Disinfecting desks or public toilets—surfaces the monkeypox virus can live on—could be one way of minimizing the risk to students, Park said, as would vaccinating students who are men or transgender people who have sex with men and expanding access to all college students when supplies permit.
Evidence-based education—especially alerting people to “the fact that monkeypox is transmitted through intimate contact”—will be crucial, Dr. Marina Klein, a professor of medicine at McGill University, told Forbes, as well as training campus health services to be on the lookout for potential monkeypox cases.
Monkeypox primarily spreads through close physical contact, as well as contact with contaminated objects and surfaces like bedding or clothing. While infections are clustered among men who have sex with men—data suggests the outbreak is largely driven by sexual activity—there have also been cases in women and children and experts told Forbes there is a risk the disease could spill over into other groups and obviously these communities are not self contained and members also attend university.
Experts stress the importance of balancing the provision of accurate information about the risks of monkeypox and how it is spreading and avoiding stigmatizing the groups most affected. Campuses also face a number of unique challenges when managing disease outbreaks, the American College Health Association (ACHA), told Forbes, such as how to isolate people with limited housing available and managing the disruption a two-to-four week isolation period can cause to students. The organization said it is working to develop tailored guidance for campus settings.
What To Watch For
How universities communicate about monkeypox. Several universities told Forbes they are following guidance from local health departments and the CDC, though this advice does not specifically address university settings. Many universities have set up informational websites providing resources and guidance on the virus, while some like NYU, the University of Texas at Austin, Texas A&M University and the University of Michigan told Forbes they have also emailed staff and students about the outbreak and will provide updates as the situation evolves.
Other universities have gone, or plan to go, further in communication efforts: the University of Florida told Forbes it is increasingly promoting safe sex messaging and Texas A&M University said the school is pushing out information on the disease via social media and flyers in residence halls and high-traffic areas. Guidance and protocols are sure to evolve as the outbreak does; NYU spokesperson John Beckman told Forbes the university is “closely following developments” and staff at the student health center are on “heightened alert” to respond.
There are also broader impacts of monkeypox to be considered, Cornell’s director of media relations Rebecca Valli told Forbes, adding that the school is considering “the potential academic impacts and accommodations which may arise” should a student come down with monkeypox.
There have been 10,768 confirmed cases of monkeypox in the U.S., according to numbers from the Centers for Disease Control and Prevention. The overwhelming majority of cases have been among men who identify as gay, bisexual or who have sex with men and transmission is suspected to have occurred through sexual activity in most of those infected.
The World Health Organization , the White House and a number of local jurisdictions have declared the outbreak a public health emergency and a vaccination campaign is underway to target groups most at risk of the virus. Supplies of Jynneos, the only vaccine licensed against monkeypox in the U.S., do not come close to meeting demand for the shot and U.S. officials have greenlit a dose-saving strategy to stretch the stockpile.
Though the outbreak is largely, though not exclusively, limited to men who have sex with men and spread through sexual activity, concern has grown among officials that the disease could spread more widely. The close-contact campus environment, notably dorms, contact sports and sex, have flagged colleges as more likely to experience outbreaks. At least five schools—Georgetown University, George Washington University, the University of Texas at Austin, Bucknell University and West Chester University—have already reported monkeypox cases, according to STAT News.
McGill’s Klein said it is “inevitable” that monkeypox will spillover into populations other than men who have sex with men, which could happen more easily in situations where people are living in close quarters. “There is no need for panic,” Klein stressed, urging strong and sensible messaging on how monkeypox is transmitted and reinforcing “messages about how to be safe when having sex,” especially with casual contacts. “Making vaccines easily available in safe spaces for those at risk would also go a long way to helping stem any potential outbreaks on campus,” Klein added.
One of the first public health measures triggered by the onset of the COVID-19 pandemic was mass closure of daycares and schools. Indeed, the proximity with which students and teachers congregate in close quarters means that viruses are more apt to spread in such conditions, which made school closures a sensible means of slowing the spread of COVID-19.
Then, last week, news broke that an Illinois daycare worker tested positive for monkeypox. While the worker is isolating, it remains unclear how many children — if any — were exposed to the virus while the infected person was at work. The news raises questions over whether schools, daycares, and the like are safe — from monkeypox — for both workers and their charges.
“An adult at a day-care center in the Rantoul area has tested positive for a case of monkeypox,” Dr. Sameer Vohra, director of the Illinois Department of Public Health, said at a news briefing. “Screening of children and other staff is taking place now.” As parents gear up to send their children back to school, should they expect monkeypox outbreaks to occur in school and daycare settings?
The answer to that requires understanding the way that monkeypox spreads, and how it differs from COVID-19. Monkeypox symptoms start within two to three weeks after exposure to the virus. The primary mode of transmission for monkeypox is skin-on-skin contact or contact with contaminated items.
Currently, there are more than 7,500 confirmed cases in the United States, according to the US Centers for Disease Control and Prevention, which is nearly double the number of cases since late July. Last week, the Biden administration declared the monkeypox a public health emergency. While transmission is mostly occurring in adult men, in the United States there have been at least five reported pediatric cases.
Yet experts are optimistic about the safety of schools. Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California–Davis, told Salon he doesn’t anticipate K-12 schools to be particularly rife with outbreaks this school year.“Since transmission is primarily via prolonged skin to skin contact,” Blumberg said. “So of course children horse around and they might have skin to skin contact, but usually it’s not prolonged during most activities.”
Blumberg added that another way monkeypox could be transmitted in a school setting is via contaminated linens or bedding. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8.
“I suppose during nap time if kids are sharing bedding or linens, it’s possible that there might be transmission,” Blumberg said. “But most schools and daycares, for now, have their own dedicated area, their own dedicated space, for nap time.”
Dr. Katrine Wallace, an epidemiologist University of Illinois–Chicago, told Salon via email that monkeypox could potentially spread at school “by touching someone’s rash/lesions, exchanging body fluids via kissing or prolonged face to face contact, hugging, etc.”
“So, it’s best (for [monkeypox virus] and for COVID-19 reasons) to emphasize giving each other space in the classroom and not touching one another,” Wallace said. According to the CDC, monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox. It can also spread through sores that have been in contact with someone who is infected, or materials that have touched body fluids — for example, clothing or bedsheets.
Monkeypox may also spread through respiratory droplets when people have close face-to-face contact. However, experts say this is not the main mode of transmission. According to data from the World Health Organization, 91.4 percent of cases have been linked to sexual contact.
Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses. Understandably, this raises questions about college students in a university setting. “If students are having prolonged skin to skin contact with many others, such as having sex with multiple partners, that will be a risk factor for transmission,” Blumberg said. “And in that case, it’s easy to prevent transmission — if somebody has a rash, then they shouldn’t have prolonged skin to skin contact with others until they get that rash diagnosed and make sure it’s non-infectious.”
Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses.”It is important that colleges and universities are prepared to provide public health education/information about monkeypox to students, have testing/medical resources available to if students develop symptoms, and have an isolation protocol ready,” Wallace said.
Still, there are reasons to protect younger children from any exposure to monkeypox. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8, as noted by the CDC based on limited pediatric data on infection.
“Children who have monkeypox are at higher risk for severe disease and higher fatality rates have been reported in children less than eight years of age,” Blumberg said. “There’s a variety of complications that may occur, including inflammation of different organs, myocarditis, meningitis” — hence the concern about young children being infected.
Notably, there are vaccines for monkeypox, although supply is limited. As Salon previously reported, the U.S. has released the Jynneos vaccine against monkeypox from the Strategic National Stockpile. Meanwhile, those who received the smallpox vaccine before it stopped being regularly given in the 1970s will likely have protection against monkeypox. While the Jynneos vaccine isn’t being publicly offered to kids nor is it licensed for children, those who have been exposed to it can be vaccinated if it is recommended by the local health departments.
As noted by CDC, Jynneos has been used in studies as part of vaccines against other diseases including tuberculosis, measles, and Ebola. These studies included children as young as five months old, and were found to have no adverse health effects or safety concerns. For worried parents, Blumberg said it is a good idea to make sure that daycares and schools and policies are in place to prohibit potentially infectious staff and students.
“Most schools and daycares do have policies in place so that if somebody is suspected to be infectious to others, they are excluded — and for monkeypox, the key would be an undiagnosed rash,” Blumberg said. “There are many different infections that may cause rashes that may be transmitted to others — so schools and daycares should be pretty experienced with screening for rashes.”
Wallace emphasized how different monkeypox is from SARS-CoV-2, stating bluntly: “this is not COVID-19.””It spreads very differently and is nowhere near as contagious,” Wallace said. “If your child develops symptoms, definitely see a health care provider before sending the child back to school.”
Should we be swabbing our noses or our throats for at-home tests? Do rapid tests even detect omicron at all? Are PCR tests the only results we can trust right now?
Guidance about how to approach testing in the omicron era seems to be evolving by the day. A recent real-world study that followed 30 subjects likely exposed to omicron found that PCR saliva tests can catch Covid-19 cases three days before rapid antigen tests, which use nasal swabs.
These findings, which have not been peer reviewed, follow the Food and Drug Administration’s announcement in late December that, while they do detect omicron, rapid antigen tests may now have “reduced sensitivity.” But that doesn’t mean rapid tests don’t play a key role in our pandemic response going forward.
This is all confusing to a public that’s been pulled in several directions over the course of the pandemic when it comes to guidance and testing. Long delays for PCR test results, a shortage of at-home rapid tests, and the wait for more definitive science about the omicron variant have all made it more difficult to figure out when and how to to get tested. Nevertheless, public health experts say that, as more become available, rapid tests will be an increasingly vital tool for diagnosing Covid-19 and reducing its spread.
“We don’t want the perfect to be the enemy of the good”
So you might be wondering: What’s the point if rapid tests aren’t as accurate as PCR tests? Well, rapid antigen tests, which look for a specific protein on the Covid-19 virus, remain extremely effective at confirming positive cases. Put simply, if you test positive on a rapid test, you almost certainly have Covid-19.
If you test negative, in some cases, you might still test positive on a PCR test, which is much more sensitive because it tests for genetic evidence of the virus. Rapid tests may not pick up positive cases in people who have been vaccinated or who have recently recovered from Covid-19, since they may produce less virus, one expert told Recode.
Rapid tests can also reveal a positive case faster than the labs that process PCR tests, since they can take several days to share results with patients, especially during big waves of infection. Perhaps more importantly, rapid tests can indicate whether someone is contagious enough to spread the virus to others, which is what many people are most worried about.
“Given that a rapid antigen test is often the most feasible or available option for many, we don’t want the perfect to be the enemy of the good,” Joshua Michaud, the associate director for global health policy at the Kaiser Family Foundation, told Recode. He explained that every Covid-19 case that’s caught by someone who could take a rapid antigen test but not a PCR test is a win for public health.
Taking rapid tests more frequently also makes them more effective. Most at-home rapid test kits are designed to be conducted over the course of two days, which is why kits typically include two tests. Because each test is a snapshot of the moment it’s taken, multiple tests help reduce the chance of receiving a false negative.
Of course, all of this is assuming that you can get your hands on a rapid test. In the weeks since omicron started to spread, rapid tests have been incredibly hard to find in some parts of the country. These tests are out of stock because neither test manufacturers nor the Biden administration anticipated record levels of Covid-19 cases, which have boosted the demand for rapid tests.
How accurate are rapid tests when it comes to omicron?
The accuracy of a rapid test depends on how often you’re testing yourself and whether you want to identify a Covid-19 infection or measure your contagiousness. But if you test positive on a rapid test, you should trust the result, assume you’re infectious, and isolate for at least five days. If you test positive again after five days, the CDC recommends isolating for five more.
Rapid tests, however, are not perfect. Research indicates that antigen tests are less accurate than PCR tests — this has been the case since the beginning of the pandemic. PCR tests are processed in a lab, where sophisticated equipment can identify and amplify even the tiniest genetic evidence of the virus that causes Covid-19.
These tests are so precise that patients can actually test positive for weeks after they’ve recovered and are no longer contagious. The results of rapid tests, meanwhile, can vary based on how much virus is in a patient’s nose at the time the sample is taken and how far along they are in their infection.
Scientists explain the difference between rapid tests and PCR tests in two ways: specificity, which reflects a test’s false-positive rate, and sensitivity, which reflects a test’s false-negative rate. Both PCR and rapid tests have high specificity, which means that their positive results are very trustworthy. But while PCR tests tend to have near-perfect sensitivity, rapid antigen tests tend to have a sensitivity around 80 to 90 percent. This means that rapid tests tend to produce more false negatives than PCR tests do.
“Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much”Omicron makes testing even trickier. The sensitivity of rapid tests may be even lower for omicron cases, according to early research from the FDA and other scientists.
Another problem is that omicron may propagate more in the throat than the lungs, and it could take longer for Covid-19 to show up in nasal samples, even if someone is symptomatic. It’s possible that vaccinated people and people who have recently recovered from Covid-19 are noticing more false negatives on rapid tests because they tend to produce less virus overall.
“At-home tests are mostly effective when the person has high viral loads, a time when the person is more likely to transmit the virus,” Pablo Penaloza-MacMaster, a viral immunologist at Northwestern’s medical school, told Recode, “Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much.”
Separate studies from both the UK’s Health Security Agency and researchers in Australia found that antigen tests are as sensitive to the omicron variant as they were to earlier strains of Covid-19. Again, the FDA does still recommend rapid tests to diagnose positive cases, and test manufacturers say they’re confident in their products’ ability to detect omicron.
While early research indicates saliva tests might detect Covid-19 more quickly, right now most of the PCR tests and all of the available rapid at-home tests that have emergency use authorizations from the FDA use nasal samples.
How to use rapid tests in less-than-ideal circumstances
Which brings us back to the question of whether you should be sticking nasal swabs in your throat. There is evidence that saliva samples may be a quicker indicator of Covid-19 cases, but that doesn’t mean you should stop following the directions that come with your test kit.
The FDA says that people should not use rapid antigen tests to swab their own mouths. Some experts say you might consider doing so anyway, and point out that other countries, including the UK, have approved rapid antigen tests that use throat swabs and released very careful directions about how to do so.
“I personally do swab my throat and my nose to get the best sensitivity when I use over-the-counter tests at home,” Michael Mina, an epidemiologist at Harvard, said at a Thursday press conference. “There are risks associated with that, but the biology does tell us that they might be getting better sensitivity earlier.”
But the concern with rapid test kits right now is not that people are swabbing their noses, but how often they’re swabbing their noses. A single test could miss a Covid-19 case and produce a false negative, but taking two tests over a 24 to 36 hour period reduces this risk.
The more rapid tests you take, the more you reduce your chances of a false negative, and the more times you test negative over multiple days, the more confident you can be that you’re not spreading Covid-19.
Still, the biggest problem right now is that rapid tests are pricey and hard to find. Pharmacies have limited the number of test kits people can buy, and many are completely sold out. A single test can also cost more than $10, which means that testing yourself regularly gets expensive quickly. Opportunists have even hoarded tests and engaged in price gouging, which has exacerbated the shortage.
If you don’t have enough tests to test yourself regularly, it’s best to test yourself right before seeing vulnerable people, says Mara Aspinall, a professor who leads Arizona State’s testing diagnostic commons and a board member for the test manufacturer Orasure, told Recode. “I’m heading to a vulnerable person [or] I’m going into a health care setting, and therefore need to test right beforehand.”
For now, the best test kit is the test you can get (Wired has a handy list of the brands currently available). If you’re planning to go somewhere and don’t want to spread the virus, you should take one rapid test the day before traveling, and then a second test immediately before you go. If you only have one rapid test, take it right before you see people.
Testing yourself should become easier as more rapid tests become available. In addition to the 500 million free rapid tests that the White House will distribute beginning later this month, people with private insurance will also be able to get their rapid test purchases reimbursed starting next week. You should also check with your local health department, as they might be distributing free tests.
Even though the rapid test situation is still less than ideal, there are other strategies we can use to protect both ourselves and other people from Covid-19, like getting vaccinated, getting boosted, and wearing a mask. And if you do happen to find some rapid tests, go ahead and grab them. They might just come in handy, especially if you use them correctly.
Correction, January 7, 10:30 am: An earlier version of this story misstated in one instance the kind of false results that might appear more often on rapid Covid-19 tests among vaccinated people and those with immunity from recent infection. The false results are false negatives, not false positives.
Registered nurse Nvard Termendzhyan, center, sets up a table for Linda Calderon, right, as her twin sister Natalie Balli, far left, rests in her bed in a Covid-19 unit at Providence Holy Cross Medical Center in Los Angeles, California, on December 13. The sisters were admitted to the hospital on the same day, a few days after their Thanksgiving gathering.Jae C. Hong/AP
Earlier this month, with a new wave of Covid-19 cases looking likely after the omicron variant was identified, Rhode Island emergency doctors wrote their state leaders to warn that any new surge of patients would “lead to collapse of the state health care system.” In Kansas, patients in rural hospitals have been stuck in the ER for days while they wait for a transfer to a larger hospital with the capacity and resources to care for them.
With the fast-spreading omicron variant now upon us, some of the rhetoric around the pandemic has changed. Government officials, starting with President Joe Biden, are pointedly differentiating between the risks for vaccinated and unvaccinated people. This could create the perception that some places face more of a risk than others: Perhaps omicron will threaten rural communities (where vaccination rates are lowest) and their health systems, but perhaps more vaccinated cities and their hospitals will be better off.
Such thinking would be misguided. As convoluted and sometimes siloed as the US health system may seem at times, it is still a system. Patients transfer between facilities based on capacity or clinical need. If rural hospitals are shipping seriously ill patients to their urban neighbors, which already tend to run close to capacity even in normal times, a rural Covid-19 crisis could quickly become a crisis for everybody.
One hospital being overwhelmed isn’t a one-hospital problem, it’s an every-hospital problem. Even if your community is not awash with Covid-19 or if most people are vaccinated, a major outbreak in your broader region, plus all the other patients hospitals are treating in normal times, could easily fill your hospital, too. That makes it harder for the health system to treat you if you come to the ER with heart attack symptoms or appendicitis or any acute medical emergency.
Already, because of existing staffing shortages, rural hospitals are finding it difficult to find room for their patients at larger hospital systems. With omicron spreading rapidly, increasing the number of patients seeking care while sidelining health workers who have to quarantine, systemic overload may not be far off.
“When you have a Covid patient who needs ICU care, those hospitals are turning away patients,” Carrie Saia, CEO of Holton Community Hospital, located in a town of 3,000 people about 90 minutes east of the Kansas City metropolitan area, told me earlier this month. “We’re sending our patients farther away. Not because they’re full, they’re just out of staff.”
At earlier points in the crisis, large hospitals would limit transfers from smaller facilities in order to preserve their capacity to treat the most seriously ill patients. As a new wave driven by the omicron variant takes off, that could happen again.
As Karen Joynt Maddox, a practicing cardiologist and associate professor of medicine at Washington University in St. Louis, told me in August: “During Covid surges, we were told to limit transfers only to patients who had needs that could not be met at their current hospital (i.e. decline transfers because the family requested it, but equal services available at both places) because that was the only way we could make sure that we did have the ability to accept patients that only we (or another major referral center) could handle.”
The feedback loop works in reverse as well. Recently, the HCA hospital in Conroe, Texas, about 40 miles north of Houston, was dealing with such a staffing shortage in its emergency department that the facility temporarily asked ambulances to bypass it because the ED couldn’t handle any more patients, according to a spokesperson. Suddenly, hospitals in the heart of Houston were seeing an unexpected surge of patients who needed emergency care, causing long wait times at their facilities.
America’s hospitals are all in this together. So what can we do quickly to relieve the burden for all of our hospitals and prevent unnecessary deaths?
How we can all help hospitals handle a surge in omicron patients
Last week, the Biden White House detailed a new plan for helping hospitals handle the coming surge of Covid-19 patients. They are deploying emergency medical personnel to six states: Michigan, Indiana, Wisconsin, Arizona, New Hampshire, and Vermont. They are also planning to deploy another 1,000 military doctors and nurses in January and February, as well as ordering FEMA to work with states to add hospital beds. The White House also said it had 100,000 ventilators in the federal stockpile that could be deployed as needed.
Those policies could certainly help to alleviate the pressure on hospitals in places facing particularly acute crises. But the truth is, they can only do so much. US hospitals cannot suddenly grow the staff and physical capacity to handle another enormous surge of Covid-19 patients.
Infected medical workers add to the strain on hospitals. Hospitals have seen a spike in nurses and doctors testing positive; by late December, the El Centro Regional Medical Center, about two hours east of San Diego near the US-Mexico border, was seeing 5 to 10 percent of its staff either infected or being tested for exposure at any given time, according to CEO Adolphe Edward. Other hospitals have told me they are also seeing a growing number of workers test positive, which requires them to stop working and isolate.
The Centers for Disease Control and Prevention recently revised its isolation protocols for health care workers who test positive for Covid-19, shortening the standard isolation period from 10 days to 7 (if accompanied by a negative test). But that still takes doctors and nurses out of commission for several days if they contract the virus. (On Monday, the CDC released new guidelines for the general public stating that those who test positive can stop isolating after five days if they do not have symptoms.)
“You can send all the ventilators you want,” Roberta Schwartz, executive vice president at Houston Methodist Hospital, told me. “I have no one to staff them.”
Nearly 99 percent of rural hospitals said in a survey released in November they were experiencing a staffing shortage; 96 percent of them said they were having the most difficulty finding nurses. According to a September study commissioned by the American Hospital Association, the average cost of labor expenses for each discharged patient has grown by 14 percent in 2021 — even as the number of full-time employees has dropped by 4 percent.
“The only things I can think of could not be accomplished in two weeks,” Peter Viccellio, associate chief medical officer at Stony Brook University Hospital in New York, said. “We have a severe staffing shortage everywhere, and it’s not going to go away. It existed before Covid, and Covid just exacerbated it.”
Some policy changes — smoothing schedules that better distribute surgeries (and therefore patient volume) throughout the day or week, earlier discharges or more weekend discharges — could help. “But this won’t happen without a mandate,” Viccellio said.
“We won’t prevent future catastrophes because of a very simple reason. It requires that we think of the future and plan for it,” he added. “You can see how that’s working out. We can’t frigging plan for one month from now.”
More money from the federal government could also allow hospitals to beef up their staffing, said Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals, which represents critical access facilities. But all of these policies targeted directly to hospitals may only help at the margins. The American health system’s capacity is what it is — the time to act was long ago. Instead, the US health care system is behind many of its wealthy peers in the number of practicing medical staff in its hospitals.
So the quickest and surest action to prevent hospitals from being overwhelmed is actually to prevent people from needing to go to the hospital with Covid-19 in the first place, hospital leaders said. Get vaccinated — with three doses. Wear masks indoors in public places. Test before you see people who don’t live in your house.
Following the pandemic playbook can make a difference for hospitals bracing for another grim winter in this pandemic.
“The more we can help keep the public protected, the more we can keep our workers here,” Schwartz said, “and lessen the burden of this.”
I grew up in Ohio, lived in Las Vegas for a year and moved to Washington in 2011. I cover health care and other domestic policy. You’ll probably see me tweeting about Cleveland sports or the last movie I watched.
Gaslighting is a form of psychological abuse where an individual tries to gain power and control over you by instilling self-doubt. Allowing managers who continue to gaslight to thrive in your company will only drive good employees away. Leadership training is only part of the solution — leaders must act and hold the managers who report to them accountable when they see gaslighting in action. The author presents five things leaders can do when they suspect their managers are gaslighting employees.
“We missed you at the leadership team meeting,” our executive vice president messaged me. “Your manager shared an excellent proposal. He said you weren’t available to present. Look forward to connecting soon.”
In our last one-on-one meeting, my manager had enthusiastically said that I, of course, should present the proposal I had labored over for weeks. I double-checked my inbox and texts for my requests to have that meeting invite sent to me. He had never responded. He went on to present the proposal without me.
Excluding me from meetings, keeping me off the list for company leadership programs, and telling me I was on track for a promotion — all while speaking negatively about my performance to his peers and senior leadership — were all red flags in my relationship with this manager. The gaslighting continued and intensified until the day I finally resigned.
Gaslighting is a form of psychological abuse where an individual tries to gain power and control over you. They will lie to you and intentionally set you up to fail. They will say and do things and later deny they ever happened. They will undermine you, manipulate you, and convince you that you are the problem. As in my case, at work, the “they” is often a manager who will abuse their position of power to gaslight their employees.
Organizations of all sizes are racing to develop their leaders, spending over $370 billion a year globally on leadership training. Yet research shows that almost 30% of bosses are toxic. Leadership training is only part of the solution — we need leaders to act and hold the managers who report to them accountable when they see gaslighting in action. Here are five things leaders can do when they suspect their managers are gaslighting employees.
Believe employees when they share what’s happening.
The point of gaslighting is to instill self-doubt, so when an employee has the courage to come forward to share their experiences, leaders must start by actively listening and believing them. The employee may be coming to you because they feel safe with you. Their manager might be skilled at managing up, presenting themselves as an inclusive leader while verbally abusing employees. Or they may be coming to you because they feel they’ve exhausted all other options.
Do not minimize, deny, or invalidate what they tell you. Thank them for trusting you enough to share their experiences. Ask them how you can support them moving forward.
Be on the lookout for signs of gaslighting.
“When high performers become quiet and disinterested and are then labeled as low performers, we as leaders of our organizations must understand why,” says Lan Phan, founder and CEO of community of SEVEN, who coaches executives in her curated core community groups. “Being gaslighted by their manager can be a key driver of why someone’s performance is suddenly declining. Over time, gaslighting will slowly erode their sense of confidence and self-worth.”
As a leader, while you won’t always be present to witness gaslighting occurring on your team, you can still look for signs. If an employee has shared their experiences, you can be on high alert to catch subtle signals. Watch for patterns of gaslighting occurring during conversations, in written communication, and activities outside of work hours.
Here are some potential warning signs: A manager who is gaslighting may exclude their employees from meetings. They may deny them opportunities to present their own work. They may exclude them from networking opportunities, work events, and leadership and development programs. They may gossip or joke about them. Finally, they may create a negative narrative of their performance, seeding it with their peers and senior leaders in private and public forums.
Intervene in the moments that matter.
“Intervening in those moments when gaslighting occurs is critical,” says Dee C. Marshall, CEO of Diverse & Engaged LLC, who advises Fortune 100 companies on diversity, equity, and inclusion strategies. “As a leader, you can use your position of power to destabilize the manager who is gaslighting. By doing so, you signal to the gaslighter that you are watching and aware of their actions, and putting them on notice.”
If you see that a manager has excluded one of their employees from a meeting, make sure to invite them and be clear that you extended the invitation. If a manager is creating a negative narrative of an employee’s performance in talent planning sessions, speak up in the moment and ask them for evidence-based examples. Enlist the help of others who have examples of their strong performance. Document what you’re observing on behalf of the employee who is the target of gaslighting.
Isolate the manager who is gaslighting.
If this manager is gaslighting now, this likely isn’t their first time. Enlist the help of human resources and have them review the manager’s team’s attrition rates and exit interview data. Support the employee who is experiencing gaslighting when they share their experiences with HR, including providing your own documentation.
In smaller, more nimble organizations, restructuring happens often and is necessary to scale and respond to the market. Use restructuring as an opportunity to isolate the manager by decreasing their span of control and ultimately making them an individual contributor with no oversight of employees. Ensure that their performance review reflects the themes you and others have documented (and make any feedback from others anonymous). The manager may eventually leave on their own as their responsibilities decrease and their span of control is minimized. In parallel, work with human resources to develop an exit plan for the manager.
Assist employees in finding a new opportunity.
In the meantime, help the targeted employee find a new opportunity. Start with using your social and political capital to endorse them for opportunities on other teams. In my case, the manager gaslighting me had a significant span of control, and my options to leave his team were limited. He blocked me from leaving to go work for other managers when I applied for internal roles. I didn’t have any leaders who could advocate for me and move me to another team. I was ultimately forced to leave the company.
In some cases, even if you can find an internal opportunity for the employee, they won’t stay. They will take an external opportunity to have a fresh start and heal from the gaslighting they experienced from their manager. Stay in touch and be open to rehiring them when the timing is right for them. If you rehire them in the future, make sure that this time they work for a manager who will not only nurture and develop their careers, but one who will treat them with the kindness they deserve.
During the “Great Resignation,” people have had the time and space to think about what’s important to them. Allowing managers who continue to gaslight to thrive in your company will only drive your employees away. They’ll choose to work for organizations that not only value their contributions, but that also respect them as individuals.