Month: March 2020

Adolescents are likely to be strongly affected by public health emergencies such as the novel coronavirus (COVID-19). Public health directives to reduce transmission have likely meant cancellations of organized sport teams and recreational activities, missed celebrations, cancelled school trips, reduced or lost employment, loss of opportunities to socially engage with peers, and loss of in-class academic learning – proms, graduations and exams may soon follow. These impacts, combined with indirect exposure to the virus through social and TV media coverage, may challenge their coping skills in very significant ways.

The stressors of COVID-19 come during a period of great physical, social and emotional change for adolescents.  At a time when they are forming identities, beliefs and values, they may be more likely than adults to act impulsively, push boundaries and assert their invincibility.  These latter behaviours may make them particularly vulnerable to contracting an infectious disease like COVID-19. 

Some Reactions to Expect

In general, most teens are strong, sensible and have good social support systems that will help them cope and respond well to distressing events. Nevertheless, a major stressful event or public health emergency can have many effects on teens. Some common reactions include:

• Worries, fears, and anxiety about their safety and the safety of family and friends
• Fear of other major emergencies
• Negative ideas about and mistrust of others, particularly those of different backgrounds
• Increase in disruptive behaviours, for example arguing, defiance, angry outbursts
• Increased crying, sadness or depressed feelings
• More difficulty concentrating or paying attention
• Variations in energy levels – either less active and tired, or more active, impatient and agitated
• Problems sleeping – either sleeping too much or not enough
• Problems eating – either eating too much or not enough

How to Help

Teens need the adults in their lives to pay attention to their feelings and reactions. Remember that:

• teens can cope with stressful situations, and you can help them.
• they will express their feelings in different ways, both directly and indirectly.
• teens need your assurances that they are safe and that you will be there for them if they feel upset.
• teens will be impacted by the ways in which they see parents and other adults handle the situation, so it is important to be mindful of your own reactions and engage in good self-care.

This experience of lockdowns, forced closures, and physical distancing is new for most people in today’s world.  Your teens are likely in the house more during this pandemic than they have been for a long time and will be again after the pandemic has settled; cherish this time with each other.

Don’t over-react. Many of the reactions that teens may show at this time, including a certain amount of moodiness and arguing, can be normal features of adolescence. You should, however, pay attention to behaviours that are new and to any that are really disturbing to you and show understanding and support. If the behaviours are dangerous or seriously disruptive, or if they don’t improve after a few weeks, parents, family members or teachers should help the teen to get help.

On the other hand, teenagers may pretend not to be affected or concerned in an effort to convince themselves they are invincible or to appear “above it all” and “cool.” In reality, they may be scared, confused, worried and in need of your help.

Here are some suggestions on how to help your teenagers cope:

Grief and Loss. Grief includes shock, denial, anger, numbness, sadness, and confusion; it is a normal response to loss of all kinds, including those associated with the real or feared losses during public health emergencies. Nothing like COVID-19 has ever happened before in most of our lifetimes. Because of the changes to our daily lives as a result of COVID-19, teens are missing once-in-a-lifetime events, such as school trips to Europe, graduations, proms, and there is no way to stop or rewind the clock so that they can have these moments back. While loss of life may trump the loss of a prom, losing out on milestone events is significant and painful for everyone.  Let them talk to you about what they are missing; don’t dismiss their concerns and distress. Hear them and understand that these are big moments in their lives and let them grieve the loss of these experiences. Explain that it can take time to get over a loss and encourage them to be patient with themselves and with others.

Honest Reassurance. Offer reassurance based on the real steps that are being taken to address the situation and explain the importance of following public health directives such as physical distancing.  Admit that there are things you just don’t know, including how long the current situation will last. However, don’t hesitate to tell them that many people are working to ensure everyone’s safety, and that by following public health directives we decrease the chance that anything will happen to them or you.

Listen to what they have to say about the events and how they perceive them. Provide them, as best you can, with factual information and help them distinguish opinion from fact. Try not to lecture or interrupt.

Humour. When dealing with difficult circumstances, watching or listening to something humorous can be helpful. However, some teens may crack jokes about tragedies in “an unconscious effort to distance themselves from their fears”.  Discourage disrespectful jokes while not cutting off lines of communication.

Anger. Teens, and people in general, may feel angry about what they have lost. Anger is often based on feelings of threat, fear, helplessness and vulnerability. Turn the conversation to the underlying feelings; tell them how you feel and options to best deal with these feelings.

Affection. Be patient with teens and with yourself. Find simple, daily ways to show teens that you love them — hugs, words of praise, fun time together.

Comforting Friends. If teens have friends who have been directly affected by COVID-19, help them find ways of comforting them; they may avoid talking to them out of fear of causing more pain. They may need help to know how to offer comfort and support, especially in these times of physical distancing.

Social Media and TV Coverage. Both you and your teenager may want to limit exposure to news coverage of the virus.  Teens should not be shielded from the facts about the virus but watching too much new coverage can put them, and anyone for that matter, in an emotionally overloaded, anxious state. Watch TV news coverage together and talk about what you are seeing, hearing, and feeling.

Maintain Family Routines. Maintain family routines, particularly around sleeping and eating. Schedules help: waking up at a set time, schoolwork, leisure time, outside time when possible.

For most of us, times of stress may not be good times to make important decisions.  If teens are quite upset by COVID-19 events, encourage them to take the time they need to think through any big decisions.

Appropriate Adult Behaviour and Responses. Talk to teens about what you think and feel about the circumstances related to the virus so they can understand them better. They will gain confidence to deal with their own feelings if you show them that you have strong feelings and that you can cope with them in healthy ways.

Vulnerable Teens. Stressful events and an ongoing climate of uncertainty and worry can have a greater impact on teens who are vulnerable. This may include teens who have experienced serious bullying, difficult family separations, deaths in the family, family violence, sexual assault, a traumatic refugee experience, clinical depression, an anxiety disorder or other mental illness, a history of drug/alcohol abuse, self-injury or suicide attempts. Some vulnerable teens may experience a return or worsening of mental health problems or unhealthy behaviours, up to and including suicide attempts.

Teens, Technology and Physical Distancing

Disasters and emergencies are often times when people and communities would normally come together in friendship and social support.  COVID-19 however is different because we cannot physically come together.  While we must keep physically distant from each other to reduce spread of the virus, we don’t have to keep our social distance.  We just have to engage with others in a different manner; one with which teens are usually more familiar than their parents!  

One of the ways to stay connected socially while physically distancing is by staying connected online. In fact, physical distancing requirements may have little impact on the current generation of teens who are used to socializing through their cell phones, tablets and apps like Houseparty and Snapchat.  Online contact can help teens stay connected to their peers, especially if teens can videochat with their friends or co-play mobile games with their friends.

Online contact can also allow teens to stay connected with family members and loved ones who are far away and/or may be challenged by the physical distancing requirements. In this case, teens can be a helpful source of connectedness and support for loved ones, particularly those who may be elderly or vulnerable.

During physical distancing, school websites and libraries can make use of technology to help students complete online-based schoolwork; online resources may also be used for virtual extracurricular classes, science projects, and Lego challenges.

Helpful Activities for Teens

Teens can benefit from participating in activities that can help them feel better while still maintaining physical distancing, such as:

• Relaxing Activities. Encourage activities like reading, listening to music, taking a walk, riding bikes, etc.
• Diaries and Drawing. Some teens benefit from writing their thoughts and feelings in a diary, or drawing/painting about their feelings.
• Recreational Activities. Vigorous physical activities and sports help reduce stress, and make people feel more alert, happy and energetic. While many teens have lost participation in organized sports, they may still be able to practice or play their favourite sport at home, or take up a new physical activity, such as biking or running.

Families can also embrace this time by engaging in activities together such as: tackling household projects previously put on hold, doing chores, painting or re-decorating a teen’s room, trying out new recipes, exercising together, playing board games and doing puzzles, watching movies, and going for family walks.

When to Seek Help

Some teens may be more at risk for a persistent or strongly negative response, or even for suicidal behaviours. Be watchful and prepared to seek professional help if your teen shows some of the responses listed below and keep communication open by checking in to see how they are doing. They may benefit from talking with a health professional such as a psychologist, social worker, physician, nurse or psychiatrist who can help them understand and deal with how they are feeling.

• Behaviour problems
• Learning problems
• Angry outbursts
• Withdrawal from family and technology-based connectedness to their friends
• Frequent nightmares or other sleep disturbances
• Physical problems such as nausea, headaches, weight gain or loss
• Feeling very anxious or afraid
• Ongoing sadness or depression
• Hopelessness about life or the future
• Increased risk-taking or problems with the law
• Abuse of alcohol, street drugs, medicines or solvents
• Suicidal thinking or behaviour

Where do I go for more information?

To obtain important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html or your local health authority.

Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:  https://cpa.ca/public/whatisapsychologist/PTassociations 

Kids Help Phone:  https://kidshelpphone.ca/

 

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lisa Votta-Bleeker, Deputy Chief Executive Officer, Canadian Psychological Association.

Date: March 31, 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

 

Infectious diseases, like any life stressor, challenge the way we cope. Whether we learn about them on television or experience them personally, we can feel upset, fearful and anxious as a result, both for our own personal safety and that of our family, friends, colleagues, and community. Stressful events can also bring up feelings and memories of previous traumatic events thereby compounding the distress that we feel.

The Novel Coronavirus (COVID-19) is one such infectious illness that currently poses significant risk to public health and we are all challenged by it. It is important to remember that it is normal to be emotionally affected by events like wide-spread illnesses, and that there are steps we can take to help us cope.

The information that follows is intended to help people cope psychologically in the face of health risks like COVID-19. It does not convey important information that you should know about how the virus is contracted, its signs and symptoms, how to decrease your risk of contracting the virus and how the virus is treated. For  important and up to date information about COVID-19 visit  the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

While people vary in their response to a crisis, for one like COVID-19, it is likely that more people will see impacts on their mental health and well being than will suffer serious physical effects of the illness. People who may respond more strongly to the stress of a crisis include:

• Older people and people with chronic diseases who are at higher risk for COVID-19
• Children and teens
• People who are helping with the response to COVID-19, like doctors, nurses, and other health care providers, or first responders
• People who have mental health conditions including problems with substance use
• People who tend to worry – particularly about their health, or who have experienced a previous or recent traumatic event
• People who live alone or have few social supports

Assessing and Coping with Risk

Stress during an infectious disease outbreak can include:

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Increased use of alcohol, tobacco, or other drugs

 

Taking care of yourself, your friends, and your family can help you cope with stress and helps to make your community stronger. Coping strategies can include:

• Staying informed and taking guidance from experts to help you most accurately assess your personal risk of getting physically sick. Consulting expert sources such as infectious disease practitioners, family physicians or nurse practitioners, public health hotlines, or government websites (such as Health Canada, Public Health Agency of Canada, Centre for Disease Control, and the World Health Organization) for information.[1]
• Following the health and safety guidelines of such agencies as the Public Health Agency of Canada and Health Canada to minimize your risk of contracting the virus. Remembering that the media reports things that go wrong, or exceptional events, more often than things that go right, or common events. We hear about and pay more attention to the few people who might have been made very sick or who have died from an illness than we do about the many more people who have successfully recovered from an illness.
• Balancing gathering information and heeding safety guidelines to reduce risk with not letting the gathering of information or the attention to safety guidelines unduly preoccupy you.

Things to Keep in Mind about Stress

It is important to remember that:

• People are strong and resilient, and generally have the skills they need to cope with the stressors they will face in a lifetime.
• Not everyone reacts to the same event in the same way and not everyone shows their distress in the same way.
• The ways in which children and communities cope and react to a stressor are influenced by how they see parents, caregivers and community leaders cope and react.

Taking Care under Times of Stress

Taking care of yourself:

• Hearing about the pandemic repeatedly can be upsetting, so take breaks from watching, reading, or listening to news stories, including social media.
• Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
• Connect with others. Talk with people you trust about your concerns and how you are feeling – even when engaging in social distancing.
• Maintain as normal a routine as possible, including engaging in activities you enjoy.
• Call a health or mental health care provider if stress gets in the way of your daily activities for several days in a row.

Taking care of your family:

The threat of illness can be particularly upsetting to children and teens. Children and teens react, in part, to what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children.

There are many things you can do to support your child or teen

• Given them the opportunity to talk about their concerns about the outbreak, tell them the truth, reassure them, and let them know they can count on you.
• Let them know it is ok if they feel upset or scared and talk to them about ways to cope with their feelings.
• Limit your family’s exposure to news coverage of the event, including social media.
• Try to keep up with regular routines to the extent possible. If schools are closed, create a schedule for learning activities and relaxing or fun activities; if organized activities are cancelled, try to engage in the activity (or an adaptation of the activity) at home.

 

If you notice that your child or teen’s behaviour has changed significantly, discuss the situation with them. Behavioural changes such as the ones below might also suggest a need to contact a regulated health care professional for additional help.

• Excessive crying or irritation in younger children
• Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
• Changes in sleeping patterns (too much or too little) or appetite (eating too much or too little)
• Excessive worry or sadness
• Unhealthy eating or sleeping habits
• Irritability and “acting out” behaviors in teens
• Poor school performance or avoiding school
• Difficulty with attention and concentration
• Avoidance of activities enjoyed in the past
• Unexplained headaches or body pain
• Use of alcohol, tobacco, or other drugs

Taking care of people impacted by quarantine

Quarantine – or isolation from others for a period of time – is an important public health tool used to prevent those who are infected or who may be infected from infecting others.  It involves being confined to your residence, with little or no direct contact with other people. Not surprisingly, almost everyone finds this to be upsetting, albeit to varying degrees.

During quarantine, it is important to maintain a connection with the outside world. This can be done by using the telephone, the Internet and social media. Although it may not be as good as seeing people face to face, it allows you to maintain meaningful contact with people.

When coming out of quarantine, people may experience different feelings, including:

• Mixed emotions, particularly relief
• Fear and worry about your own health and the health of your loved ones
• Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
• Sadness, anger, or frustration because friends or loved ones may have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
• Guilt about not being able to perform normal work or parenting duties during quarantine
• Other emotional or mental health changes

 

For friends and loved ones of people in quarantine, although your contact with someone in quarantine may be significantly reduced, it is important to be reassuring and listen in a compassionate way. Contact him/her as often as is appropriate, thereby limiting their feelings of isolation. Talk to other people you trust about how you feel in response to the situation.

 

Most people will be able to handle quarantine without serious difficulty; however, some may have some significant mental health problems coping while in quarantine or when released. If this is the case, consult a regulated) health professional with mental health expertise who can assess the situation and provide the necessary care.

When Psychological Distress Becomes Too Much

Stressors such as the risk of illness associated with a pandemic will affect people differently. We can be affected psychologically (e.g., feeling worried), as well as physically (e.g., sleeping poorly). Stressors that are beyond our personal control are especially difficult to cope with well. Signs and symptoms that might signal a psychological problem or disorder for which professional help might be beneficial include:

• Sleeping poorly, too much or too little
• Avoiding others, even within the confines of social distancing
• Experiencing headaches, stomach problems, neck or back pain
• Crying
• Talking less
• Feeling anxious, depressed or having panic attacks
• Feeling angry, guilty, helpless, numb, or confused
• Thinking about or watching too much television on COVID-19 or pandemics
• Not wanting to get out of bed
• Having difficulties concentrating
• Excessive eating
• Drinking more alcohol or taking more prescription drugs
• Having little patience
• Feeling overprotective of loved ones

 

It is important to remember that most of us have had some of the signs and symptoms listed above at one time or another, and that COVID-19 has led to increased stress for most people.  If you have a number of these signs and symptoms and they

• persist beyond a couple of weeks
• persist to the point where you are not able to carry out the home or work-related activities permitted by social distancing advisories
• are accompanied by intense feelings of despair or helplessness or suicidal thoughts

 

you are well advised to consult a regulated health care professional such as a psychologist, your family physician, a nurse practitioner, psychiatrist, or other mental health provider.

Where do I go for more information?

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:  https://cpa.ca/public/whatisapsychologist/PTassociations

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Lisa Votta-Bleeker, Deputy CEO, Canadian Psychological Association.

Date: March 20, 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

[1] https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html; https://www.cdc.gov/coronavirus/2019-ncov/index.html; https://www.who.int/

COVID-19 has demonstrated profound impact on the health of individuals and communities and on the delivery of health services, at precisely the time when health services are what individuals need, both for their physical and mental health.  Health care leaders and governments are advising and requiring changes to all manner of services so that face-to-face contact between people is minimized in the service of flattening the curve of virus transmission.

In recent years, there has been a burgeoning interest in digital services that support telepsychology and growing evidence that psychological treatments can be effectively delivered in this format[i]. However, embracing telepsychology can be daunting, especially for private practitioners who do not have institutions on which to rely for assurance about the privacy and security of any digital service they employ. Further, there are unique skills, competencies and considerations to practicing telepsychology.  Concurrently, however, with COVID-19, psychology practitioners are challenged to provide continuity of care to their patients.  Telepsychology would certainly enable them to deliver services without the COVID-19 transmission risks when services are delivered face-to-face.

Psychology Organizations and COVID-19:

1. Some of Canada’s regulatory bodies of psychology across the country have issued information and updates about COVID which practitioners can consult:
   1. College of Psychologists of Ontario http://www.cpo.on.ca/Templates/Default-Inner-Page.aspx?id=2262
   2. College of Psychologists of British Columbia https://collegeofpsychologists.bc.ca/covid-19-updates/
   3. Psychological Association of Manitoba https://www.cpmb.ca/
   4. College of Psychologists of New Brunswick https://www.cpnb.ca/2020/03/18/information-to-members-re-covid-19/

2. The CPA, as well as some of Canada’s provincial and territorial associations of psychology, have also posted resources about COVID-19:
   1. Canadian Psychological Association https://cpa.ca/corona-virus/
   2. Psychologists Association of Alberta https://psychologistsassociation.ab.ca/
   3. British Columbia Psychological Association https://www.psychologists.bc.ca/blog/covid-19-resources-preparedness
   4. Association of Psychology of Newfoundland and Labrador http://www.apnl.ca/
   5. Ontario Psychological Association http://www.psych.on.ca/

Resources and Factors for Practitioners to Consider when Employing Digital Services

1. Be informed about the skills, considerations and competencies of practicing in the digital world. This would be important for you as the service provider and for any student or other provider who delivers the service under your supervision. The following link posts a number of recent article and guidelines on the topic https://kspope.com/telepsychology.php

2. BMS, the insurance broker who provides the professional liability insurance program to CPA members and the provincial and territorial member associations of the Council of Professional Associations of Psychology (CPAP), along with Gowling WLG, the preferred legal provider that services the program, have authored an article on continuity of care and virtual health services. This article is specific to the Canadian context and practitioners are well advised to review it https://cpa.ca/docs/File/Insurance/COVID-19_Telehealth%20Resource_2020%20(PSY).pdfIt covers key topics such as
   • Being licensed where you are practicing from and where your services are received.
   • Ensuring your professional liability insurance is in place to cover you from where you deliver service and where it is received.
   • Ensuring the privacy and security of any digital platform you employ and that you collect informed consent from your patients to deliver services to them in this manner.
   • Ensuring that any other means of communicating with patients (e.g. email) enables you to comply with applicable privacy legislation.
   • Whether or not you provide telepsychology services during the time of pandemic, you should consider all means of continuity of care for your patients.

3. The Canadian Psychological Association (CPA), the Association of Canadian Psychology Regulatory Organizations (ACPRO), and the Association of State and Provincial Psychology Boards (ASPPB) all have guidelines on telepractice that practitioners are advised to consult.https://cpa.ca/aboutcpa/committees/ethics/psychserviceselectronically/

   http://www.acpro-aocrp.ca/documents/ACPRO%20Model%20Standards%20for%20Telepsychology%20Service%20Delivery.pdf

   https://www.apa.org/practice/guidelines/telepsychology

4. The regulatory bodies of psychology in Canada’s Maritime provinces have a Memorandum of Understanding around telepsychology practice across their jurisdictionshttp://www.nsbep.org/mou-with-memorandum-of-understanding-telepsychology-now-includes-all-maritime-provinces/

5. The American Psychological Association (APA) has posted its Office and Technology Checklist for Telepsychology Services. https://www.apa.org/practice/programs/dmhi/research-information/telepsychological-services-checklist Informed consent checklist for telepsychology services https://www.apa.org/practice/programs/dmhi/research-information/informed-consent-checklist

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Karen Cohen, CEO, Canadian Psychological Association.

Date: March 18, 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

[i] https://psycnet.apa.org/record/2014-50698-007

http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1271635&dswid=6311

The Novel Coronavirus (COVID-19) is an infectious illness that currently poses significant risk to public health and is rapidly changing the work landscape in Canada.  The current recommendations from the Public Health Agency of Canada (PHAC; https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html) about social distancing have an obvious impact on our work lives.

Many employers in Canada are recommending that non-essential employees work from home.  This step ensures not only that potential person-to-person transmission of COVID-19 is reduced in the workplace, but also reduces the need for people to take public transit to get to work.  Schools – including colleges and universities – are also closed or being closed to curb the spread of COVID-19, which will likely lead to parents and children sharing “workspaces” for an extended period of time.  The information that follows is intended to help people understand the basics of working from home, as well as some ideas for managing home environments, especially ones with children!

Your work environment

In order to effectively work from home, it is important to establish an environment that is conducive to doing so.  The needs of your individual work environment will likely vary, but some basics to consider include:

• Dedicated workspace: When at all possible, try to set up a dedicated workspace where you can store your documents, have conference calls or virtual meetings, and generally separate your work responsibilities from your home and/or caregiving responsibilities.

 

• Appropriate technology: Being effective when working remotely requires that you have the technology necessary to perform your tasks.  Consider your work needs with respect to communication (e.g., access to your office voicemail, headset and webcam for virtual calls), appropriate software on your laptop or other devices, access to any files that you may need at work, as well as sufficient internet connectivity to manage your day-to-day business. Confirm with your employer, that you have the support and resources to meet all privacy and security requirements of your work when working from home.

 

• Comfort and quiet: it is important for your workspace to be comfortable and quiet to minimize distractions and encourage you to visit your workspace when required – a challenge in a shared space!

Setting a schedule for work and life

As noted above, the COVID-19 pandemic will likely require parents, their partners, and their children, to share “workspaces” for a longer period of time than is typical for them.  Although most people can imagine working around each other’s schedules for a day or two, managing a balance between multiple people’s schedules in the same space may be challenging for some.

People are driven by routines, and disruptions to those routines can be stressful.  This is true for adults, and doubly-true for children. When working from home, having a set schedule that approximates your (and your children’s) typical schedule can be helpful to ensure that you maintain your productivity and a sense of normalcy for your children.

The separation of your home and work schedules (or home and school schedules) is typically easier when those locations are physically separate.  Here are some suggestions for sharing space:

• Maintain a consistent routine when possible: this includes sleep-wake times, exercise, and work/school schedules. Establishing and maintaining these routines will help everyone maintain a sense of normalcy.  It is also helpful to establish a coordinated schedule for everyone (you and your children) to ensure that you are able to maximize the time that you can dedicate to your work without impacting your children’s care.

 

• Don’t use extra time for work: given the sharing of spaces between work and home, it can be easy to feel the need to “check-in” to our workspace outside of our normal work hours to complete a small task. It is important to also have boundaries with ourselves regarding work and home life.

 

• Take breaks: although this may sound intuitive to many people, it is important to practice self-care and remember to take breaks. Breaks are likely more automatic in an office environment when others can suggest a walk or a coffee, but they are just as important when working from home.  Breaks can help you rest your eyes from long hours in front of a computer screen, re-orient you to important tasks, or just give your brain a break and let you check on your family.

 

• Be flexible: Although this may sound counterintuitive when trying to maintain a consistent routine, be prepared to be a little bit flexible with respect to the hours you are “at work”. Your coordinated schedule may not fit into a typical 9-5 workday, and that is okay as long as a balance between your work needs and your family’s needs is being maintained.

 

• Understand your employer’s expectations: Have a clear understanding from your employer about whether work from home changes any of your usual responsibilities or their expectations.

Maintaining good communication and boundaries

Sharing space with your children and other family members during these times will require increased attention to boundaries and the maintenance of open communication.  Everyone in your family wants to get their needs met and ensuring that you have established clear boundaries with everyone will support the sustainability of your work-from-home environment over the long term.

• Good communication: This means good communication with your colleagues and your family.  With colleagues, you may need to “over-communicate”; let them know that you may be interrupted during meetings, but that you will try to manage the situation as best as you can (having a strategy for quickly managing this, such as reaching out to a partner for help (if possible), or having a snack/bottle/activity ready for children will help).

 

• Good boundaries: This also means setting good boundaries between yourself and your family, and yourself and your colleagues.  For family members, with the help of a schedule (see above), it will be important to ensure that your work time is protected as best as it can be.  This can be as simple as trading off childcare duties with your partner (if possible), or establishing a “do not disturb” signal for your children.  With colleagues, it is important to emphasize that you will “log-off” outside work hours, meaning that you can set end enforce the expectation that you will not be checking work emails/messages outside the hours you have set as your “work” hours.

Keeping children entertained or engaged during work hours

Although establishing a good work environment, good communication, and an effective schedule are helpful, it is also important that your children are entertained and/or engaged while you are working.  How to do this will depend greatly on how old your children are; what works to entertain a toddler will generally not work for a teenager.  What follows are some points to consider for some of the major age groups:

• Babies and toddlers: Young children generally require the most attention and flexibility from their parents. It might be helpful to plan for meetings or tasks that require your full attention during your children’s naps, attend virtual meetings with your camera disabled so you can feed or hold your child while on a call or in a meeting, or if possible, plan to trade off responsibilities with your partner around important work engagements.  Again, any of these steps will require good communication with your family and colleagues regarding your current work-from-home situation.

 

• Early and elementary school-age children: Working from home for an extended period of time with school-age children will likely mean balancing their schoolwork and other activities with your work schedule. It may be helpful to set a schedule with your children around expectations for schoolwork vs. free time.  It will also be helpful for your children to know when and how they can communicate with you (e.g., make up a fun way to communicate, along with reasonable expectations for response time).  Other strategies, such as relaxing limits on screen time during an important meeting, having a “boredom box” filled with fun activities and toys that your children can access during your workday, or even sending your children outside to play (if it is safe to do so) will allow for increased productivity for you.  Finally, allowing children access to online educational tools or setting up supervised video-chatting between them and their friends might help alleviate some of their boredom and leave you with more time for work and yourself.

 

• Middle-schooler and teenagers: As children mature, it is often appropriate (and helpful) to get them to participate more actively in setting their schedules and managing their daily tasks and expectations. Creating a schedule that they can independently follow, setting daily goals regarding school and housework, and setting boundaries around your work time will be helpful.  Finally, discuss appropriate screen time limits, bedtimes, and ways for your child to stay physically active and connected with friends and peer groups, even if virtually.

Where do I go for more information?

To obtain  important and up to date information about COVID-19, visit the Public Health Agency of Canada (PHAC) website at https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

If you are having difficulties with managing a prolonged self-isolation, you can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, please visit:  https://cpa.ca/public/whatisapsychologist/PTassociations

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Stewart Madon, Accreditation Registrar and Ethics Officer, Canadian Psychological Association.

Date: March 17, 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

What is food allergy?

If your child has a food allergy, their immune system misinterprets a certain food as harmful and reacts by triggering an allergic reaction. Almost 500,000 Canadian children under 18 years of age have an allergy to food (Soller et al., 2015). The severity of allergic reactions to food is unpredictable and symptoms may range from itchy skin and hives to anaphylaxis. Anaphylaxis is a potentially life-threatening reaction that can affect different parts of the body. Food is one of the most common causes of anaphylaxis in children.

According to Health Canada, the “priority food allergens” or most common foods triggering an allergic reaction are egg, milk, peanut, fish, crustaceans (e.g., lobster, shrimp) and molluscs (e.g., scallops, clams), sesame, soy, tree nuts, wheat and triticale (hybrid of wheat and rye), and mustard.

Food allergy currently has no cure, and therefore, it can be thought of as a chronic medical condition that requires long-term management.

How is anxiety related to food allergy?

Some of the physical symptoms of an allergic reaction (e.g., trouble breathing, dizziness, lightheadedness, feelings of panic, abdominal pain, diarrhea, nausea, vomiting) can be very similar to what we feel when we are anxious. This similarity can make it difficult for some children to tell the difference between feeling unwell because they are having an allergic reaction to something they have eaten, versus having a non-life-threatening experience of feeling anxious.

Managing a food allergy requires a high degree of awareness and vigilance. Exposure to a food that you are allergic to carries risk and can have significant health consequences. At the same time, eating and drinking are essential activities we must do every day to stay healthy and they can’t be avoided! Some anxiety keeps people on guard and helps them to stay safe; too much anxiety can get in the way of our happiness and ability to function each day.

If some anxiety is expected (and even helpful!), how do I know when anxiety related to food allergy has become a problem?

Vigilance about exposure to food allergens is very important to keep children safe, therefore, some anxiety is expected. However, when the anxiety begins to interfere significantly with your child’s involvement in age appropriate activities and/or affects their behaviour, it is considered a problem. For example, the fear of having contact with an allergen may lead some children to make extreme changes in their behaviour to try to avoid this risk altogether. Parents must pay attention to potential changes that may indicate that their child’s anxiety is causing them problems.

What kinds of behaviours might mean that professional support is needed for my child?

• Refusing to attend school or extreme resistance to get there in the morning
• Refusing to participate in extracurricular activities (e.g., birthday parties, playdates, attending lessons away from home)
• Becoming clingier or experiencing distress about being away from caregivers
• Excessive label reading and/or an excessive amount of questions about whether foods are safe to eat
• Excessive hand washing
• Extreme, unnecessary restrictions in eating and drinking
• Significant changes in mood, sleep, or other behaviours

Parents managing a food allergy often worry a lot about their child’s safety and they may experience heightened stress due to the need for constant planning and vigilance to prevent exposure to allergens. Parents need to educate caregivers at school and other settings about how to keep their child safe (and then trust these adults to put the necessary safety procedures in place).

It is important to keep in mind that your child learns from you and models their own behavior after yours, so high levels of parental anxiety and stress can have a negative impact on children. If you find you are spending a lot of time worrying about your child’s food allergy and safety, and it’s impacting your behaviour or ability to function at home or work, you may benefit from meeting with a psychologist specializing in the treatment of adult anxiety.

How can psychologists help children and their families who have a lot of anxiety due to their food allergy?

Psychologists can assist with many aspects of the management of anxiety related to a food allergy.

Cognitive-Behavioural Therapy (CBT)

CBT is a well-studied treatment that has been demonstrated to be effective in treating anxiety in children and youth. CBT is most often used with children 8 years of age or older, but it can also be modified (with a focus on parental involvement) for children as young as preschool age. CBT can help your child learn the relationships between anxiety and unhelpful thoughts and behaviours. Then, your child can be taught ways to think about challenging situations in a more realistic and manageable way. Your child can also be taught strategies to help them identify and better cope with the physical symptoms of anxiety.

Using these strategies, your child can then practice doing activities they are fearful of (like going to playdates or eating something after checking the label a few times instead of many times) in steps that are gradual and safe. This is called behavioural exposure and is an important part of the treatment of anxiety. Psychologists may consult with other health professionals (e.g., allergist, nurse, dietitian) to learn more about specific allergies and to help develop a treatment plan that will be safe and tailored to the unique needs of your child.

CBT is also commonly used with adults to address anxiety that is unrealistic and impairing. Using this treatment approach, caregivers can be taught to recognize unhelpful thinking patterns about their child’s food allergy, learn ways to manage their own anxiety in a more helpful way, and decrease unnecessary interference caused by anxiety related to the allergy.

Self-Advocacy

Psychologists may also help with self-advocacy (e.g., helping your child to be comfortable asking questions about food ingredients and labels, or refusing to eat foods that may put him/her at risk). These skills are important to develop to increase independence, also because bullying is commonly experienced by children with a food allergy (Lieberman et al., 2010).

Oral Immunotherapy

Psychological support may be needed for families exploring or undergoing oral immunotherapy (OIT), a potential treatment for some individuals with food allergy. OIT is a medically supervised treatment in which a person eats small amounts of the food they are allergic to (their allergen) in clinic/hospital and home settings. The amounts of the food allergen are given in gradually increasing doses until the person can eat a certain amount without having a reaction, so long as they are on this treatment. This will help protect them if accidental exposure to the food allergen occurs.

For OIT, families must go from fearing exposure to a specific food with potentially life-threatening consequences and completely restricting exposure, to encouraging a child to eat small amounts of that same food in a supervised way. Understandably, this can result in increased anxiety for the whole family. Psychologists can assist families with decision-making related to whether this potentially life-changing treatment is worth pursuing or continuing, for those undergoing treatment. They can also help children and their caregivers learn tools to manage anxiety they may experience during treatment.

Maintaining a Balance

Individuals with a food allergy must work to avoid their food triggers while also maintaining a high quality of life. A psychologist can help families achieve balance between following prescribed safety practices (e.g. avoiding the food allergen, having an emergency plan, carrying an epinephrine auto-injector such as an EpiPen® when age appropriate) and continuing to participate in activities that are important to the family.

Where can I find more information?

1. Visit these websites for additional information:

• Managing Feelings of Anxiety (Food Allergy Canada website)
• Allergy’s High Anxiety: How to Tame Kids’ Fears of Food Reactions (Allergic Living article)

2. Consult with a registered psychologistto find out if psychological interventions might be helpful to you and your family. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, visit https://cpa.ca/public/whatisapsychologist/PTassociations.

References

• Lieberman, J. A., Weiss, C., Furlong, T. J., Sicherer, M., & Sicherer, S. H. (2010). Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma & Immunology, 105, 282-286.
• Soller, L., Ben-Shoshan, M., Harrington, D., Knoll, M., Fragapane, J., Joseph, L., Clarke, A. E. (2015). Adjusting for nonresponse bias corrects overestimates of food allergy prevalence. The Journal of Allergy and Clinical Immunology: In Practice, 3, 291-293.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Joanne Gillespie, IWK Health Centre, and reviewed by Food Allergy Canada.

Date:  March 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets:  factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

What is COVID-19?

COVID-19 is a new coronavirus that is rapidly spreading throughout the world. According to the WHO, it is classified as a pandemic. Most people (80%) experience mild symptoms, although the virus is most harmful to seniors (over 65 years of age) and people with compromised immune systems (e.g., with cancer, chronic inflammatory conditions like rheumatoid arthritis) and pre-existing medical conditions (e.g., cardiovascular disease, uncontrolled hypertension or diabetes, and chronic lung diseases).

How is COVID-19 transmitted?

Similar to seasonal flu, people can get infected with COVID-19 if they inhale water droplets containing the virus, such as when someone sneezes on them, or by touching a surface contaminated by the virus (e.g., a hand-railing) and then touching their nose or mouth or rubbing their eyes.

What should you do if you think you have COVID-19?

The following symptoms may appear 2-14 days after exposure.

• Fever
• Cough
• Shortness of breath.

If you think you have been exposed to COVID-19 or if you develop symptoms (e.g., a fever or respiratory symptoms like such as cough or difficulty breathing), isolate yourself, stay home and call your healthcare provider and/or local health authority immediately (see: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/2019-novel-coronavirus-information-sheet.html#pha). You will be asked to describe your symptoms and travel history. They will advise you on how to get tested and/or treatment.

If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, follow the steps below, as outlined by the Public Health Agency of Canada (PHAC) and the Centers for Disease Control (CDC), to help prevent the disease from spreading to people in your home and community.

• Stay home (except to get medical care in case of symptom deterioration)
• Avoid using any form of public transportation
• Separate yourself from other people and animals in your home
• Wear a facemask if you are sick (wearing masks does not protect you from others who may be sick)
• Cough and sneeze into your arm or elbow
• Immediately dispose of used tissues
• Clean your hands often
• Avoid sharing personal household items (particularly towels)
• Clean all “high-touch” surfaces every day
• Monitor your symptoms and seek prompt medical attention if your illness is worsening (e.g., difficulty breathing)
• Call ahead before visiting your doctor

What is the best way to keep safe?

Currently, there is no vaccine for COVID-19. Human behaviour is key to the spread of COVID-19, and behavioural strategies may help to reduce transmission. The best way of protecting yourself is to wash your hands regularly with soap and water before and after meals and after touching ‘public’ surfaces (like doorknobs or handles).  Keep your hands away from your face and cover your coughs and sneezes (e.g., coughing into your arm). The recommended way of doing these things may be different than how you are used to doing them.  Using evidence-based behavioral strategies may help you adapt your daily routines to keep you safer:

1. Up-skill how you wash your hands: Washing our hands is often part of our daily routines already, but to be effective in preventing transmission of the virus, most of us probably need to wash our hands better and for longer:
   • Make sure you have soap or alcohol-based* hand sanitizer available; if you’re worried about dry hands, bring moisturiser with you (*alcohol content should be 60% or higher)
   • Wash your hands for at least 20 seconds. Humming a song (e.g. happy birthday) that lasts that long may help with timing. (“If I’m washing my hands, I will hum happy birthday!”)
   • Put soap on the back and front of your hands, under your nails and between your fingers
   • Make it more salient: consider making it more memorable by telling yourself “when washing my hands, I will wash them as if I just cut up a jalapeno and need to take out my contact lenses!”
2. Social Distancing: Social distancing is a term applied to certain actions that are taken by Public Health officials to stop or slow down the spread of a highly contagious disease, and ensure our public health system can continue to meet the demands placed on it. The figure below depicts the critical role that social distancing can play to reduce the spread in a short period of time. Social distancing is one of the most effective measures for reducing the overall speed of transmission, to protect and preserve the capacity of the healthcare system to care for severe cases. Social distancing is specific to limiting physical/in-person connections. It is important to stay connected to each other through other means to maintain our connections and support one another (email, phone, social media)
   
   Social distancing measures include limiting large groups of people coming together, closing buildings, and canceling events.  Examples of social distancing measures can include: suspending classes in or closing schools, modifying hours of operations for services, changing workplace practices to allow flexible shift plans and tele-work, closing theatres, cancelling large scale indoor and outdoor events (e.g. sporting events, concerts, parades, festivals), and suspending or limiting transportation means.
3. Am I really touching my face that much? Yes! To be transmitted, COVID-19 needs access, and that is usually through your nose, mouth or eyes. Over the course of the day, most people touch their face a few dozen times, often without realizing it. Potentially effective behavioural strategies to stop touching your face are:
   • Use ‘if-then’ plans to ‘program’ that automatic part of your brain to be more aware of when you touch your face to curb this behaviour. For example, “If I find myself resting my hand on my chin, I will remind myself that I want to stop the spread of COVID-19”.
   • Ask your family/friends/coworkers to monitor and give you feedback on how often you touch your face without realizing it; make a game out of it to track each other, aiming to touch your face less. You might be amazed at how often you touch your face without realizing it.
4. Replace handshakes and kissing cheeks: Shaking hands and kissing cheeks are common ways of greeting in Canadian society. Developing alternative ways of friendly connection during the COVID-19 outbreak. Bumping feet, elbows, or bowing could avoid transmission while maintaining our important social connections. While initially a bit awkward, explaining why may help to normalize it.
5. Restrict all non-essential travel until further notice:
   • Canada’s chief public health officer, Dr. Theresa Tam, is advising all Canadians to postpone or cancel all non-essential travel outside of Canada until further notice.
   • If you plan to travel, stay informed of Canadian travel advisories as well as those for your travel destination.
   • If you are flying, confirm travel policies and restrictions with your airline (this includes ensuring return or alternate flights can be secured should flight restrictions change).
   • Ensure you have appropriate health and travel insurance – including cancellation insurance ‘for any reason’.
   • When considering whether or not to travel, keep in mind that local and foreign travel restrictions and border controls are changing everyday. If you do decide to travel, be aware that borders could close at any time and you may be forced to extend your stay.
6. Get the vaccine once it becomes available: Current estimates by the World Health Organization (WHO) are that developing a vaccine is at least 18 months away. When a vaccine is made available, it is important to make the time to get vaccinated for yourself, as well as for those who can’t be vaccinated due to medical and other reasons. We can help everyone stay safe if all of us get vaccinated, because we won’t spread infection. This is called “herd immunity.” When it comes to vaccination, ensuring the greatest amount of community coverage is key for optimal prevention and protection of vulnerable populations (seniors, those with health conditions).

Psychological reactions to COVID-19: Why are they important?

Psychological factors play an important role in how people and communities respond to illness and manage its spread.

Some people under-respond to the threat of COVID-19. These people think the danger is exaggerated.  Under-responders may not practice good hygiene, they don’t get vaccinated, and they don’t stay home if they’re sick; these behaviours help infection to spread. To accurately assess the risks of COVID-19, check out the websites of the PHAC, WHO or CDC (see below for links to updated resources). Under-responding could spread infection to family and friends.

Some people over-respond to the threat of COVID-19. These people become highly anxious about the infection and may go to great lengths to keep themselves safe. They may become xenophobic (i.e., needlessly frightened of foreign people), may needlessly wear protective masks (while wearing a mask may prevent you from spreading your infection to others, masks are not effective in preventing you from catching an infection from someone else), and may hoard supplies of food and other necessities. Over-responding by one person seeds fear in others because fear is contagious, so the more you see people buying toilet paper makes you believe that toilet paper may run out, leading you to rush out and stock up (needlessly). Moreover, if you hoard food, toilet paper, or hand sanitizer that you are not likely to need for example, then other people in your community have less access to them.

What can people do to stay calm but remain appropriately vigilant?

1. Listen to the advice of health authorities such as PHAC, the WHO and CDC for more local information about if/how COVID-19 is spreading in your area. See resources below.
2. Change your habits around washing hands, touching your face, socializing and coughing – see behavioural strategies above.
3. Some degree of concern is reasonable if it leads you to be proactive and take appropriate precautions, like staying home or social distancing, hand washing and sanitizing, and refraining from unnecessary travel. Otherwise, you should feel confident about carrying on with your everyday life as usual, with some minor adaptations. For example, if you typically go to the gym for your workout, consider going for a walk or a run in your neighborhood. If you go to a restaurant, skip the buffet and order a la carte. As long as there is no evidence of ‘community transmission’ (which is transmission of the virus from person to person through community contact rather than contracting it through travel), you should feel confident about maintaining several aspects of your routine, including going out.
4. Keep things in perspective by consulting sources of information that are balanced and evidence-based, such as the PHAC, the WHO, and other credible sources (see links below). Remind yourself that the graphic images on the Internet, or the rumors on social media, may exaggerate the actual threat. The images of empty shelves in supermarkets are compelling visuals but are not necessarily common and may be confined to certain areas. No one is posting images of full shelves and calm shoppers because those images aren’t newsworthy. If you feel anxious when following news media or social media, limit your exposure.
5. Fear is contagious. If you act frightened or engage in panic buying, then others will react with fear as well. You have a responsibility to your loved ones, friends, and the rest of the community to deal with the COVID-19 outbreak in a sensible, reasoned manner. Try to “lead by example”.
6. Remind yourself that the current crisis will pass, and life will return to normal.

Where can I get more information?

• Further advice for behavioural strategies to reduce transmission: https://blogs.bmj.com/bmj/2020/03/03/behavioural-strategies-for-reducing-covid-19-transmission-in-the-general-population/
• Up to date case tracking worldwide and in Canada using Johns Hopkins interactive tracker: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
• Guidance that is regularly updated from trusted sources:
  • Public Health Agency of Canada: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
  • World Health Organization: https://www.who.int/health-topics/coronavirus
  • US Centres for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/
• The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. By S. Taylor (2019). Newcastle upon Tyne: Cambridge Scholars Publishing.
• It’s Not All in Your Head: How Worrying About Your Health Could be Making You Sick – and What You Can Do About It. By G.J.G. Asmundson & S. Taylor (2004). New York: Guilford Press.

How can I tell whether I should seek professional help for COVID-19-related stress or anxiety?

Look for warning signs such as the following:

• Persistent anxiety, worry, insomnia, or irritability.
• Needlessly avoiding social contacts to the point that you become unnecessarily isolated.
• Persistently checking your body (e.g., taking your temperature many times each day) or persistently seeking reassurance about your health from doctors, friends, family, or the Internet.
• Performing excessive or unnecessary hygiene precautions, such as wearing a facemask at home or repeatedly washing your hands when there is no need to do so.
• Abusing alcohol or drugs, or overeating, as a way of coping with stress.
• Feedback from friends or family that you seem unusually worried or stressed out.

How can I get help with stress or anxiety?  Psychological treatments can be very effective, sometimes more effective than medication, in helping people recover from anxiety.  To find a psychologist, you can consult the psychological association in your province or city.  A list of them can be found at https://cpa.ca/public/whatisapsychologist/PTassociations. Your local hospital, community health clinic, local public health department, or primary care provider (e.g., family doctor or nurse practitioner) may also be of assistance.

This fact sheet has been prepared for the Canadian Psychological Association by Steven Taylor, Ph.D., R.Psych., Department of Psychiatry, University of British Columbia, Kim Lavoie, Ph.D., FCPA, FABMR, Montreal Behavioral Medicine Center (MBMC) and Department of Psychology, University of Quebec at Montreal (UQAM), and Justin Presseau, Ph.D., Clinical Epidemiology Program (Ottawa Hospital Research Institute), and School of Psychology and School of Epidemiology and Public Health (University of Ottawa).

Prepared: March 12, 2020
Updated: March 13, 2020

Your opinion matters! Please contact us with any questions or comments about any of the Psychology Works Fact Sheets: factsheets@cpa.ca

Canadian Psychological Association

Tel: 613-237-2144
Toll free (in Canada): 1-888-472-0657

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[i] https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

[ii] https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html