Morgan Noll
Updated April 10, 2020
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It’s hard to catch your breath in the midst of a global pandemic—especially when respiratory issues are one of the primary symptoms of coronavirus (COVID-19). As someone with asthma (which is one of the higher risk conditions for the illness), I’ve found myself constantly monitoring my breathing, reaching for my inhaler, and wondering if my breath is getting shorter—or if I’m just reacting to the weight of the news. So many people across the world are in the same place as me, whether they’re putting a microscope to their breathing or something else, and are repeatedly questioning: Am I sick? Is this a symptom? Is this normal?

In the midst of a global health crisis, personal health concerns can quickly become all-consuming. What’s worse, this stress and anxiety can put a strain on both our mental and physical health.

Dr. Harry Oken, internal medicine specialist, professor of medicine at University of Maryland, and member of Persona Nutrition’s Medical Advisory Board, likes to tell his patients that “how you feel is how you think, and how you think is how you feel.” So if you’re obsessing and falling into negative thought cycles, there’s a good chance you’re not going to feel very well. But if you’re thinking more positively and working to control those thoughts, “your brain will actually help you surf the waves,” Dr. Oken says.

He also offers up a helpful analogy to the health anxiety many of us are currently experiencing. “If you’re alone in a big house and you’ve never been there before, you may be starting to hear noises,” Dr. Oken says, “You may hear a bump or a crack or a squeak and say, ”What’s going on? Is somebody here?’ The more you listen, and the more in tune you are with those things that you’re noticing, the more that can elevate your state of anxiety.

The same is true with your body. If you’re constantly checking your symptoms and worrying about minor cracks or squeaks (aches and pains, etc.), you can find yourself in an unhealthy cycle of panic. Dr. Oken tries to offer reassurance to his patients by asserting that “when something’s really wrong, you’ll know it.”

We talked with Dr. Oken and other health experts about how to tell the difference between coronavirus symptoms and those caused by stress and anxiety, and for advice on how to manage your mental health during the coronavirus pandemic.

How can you tell the difference between coronavirus symptoms and symptoms of stress and anxiety?

The Centers for Disease Control and Prevention maintains that the primary symptoms of coronavirus are fever, cough, and shortness of breath. The government site also identifies difficulty breathing as one of the emergency warnings indicating that you should seek medical help.

Hillary Lin, an internal medicine physician with virtual health platform PlushCare, says she has spoken to countless patients who have experienced shortness of breath or panic attacks from worrying about the illness. “This can feel like you have the coronavirus,” she says. “However, mental stress-induced shortness of breath tends to come on more quickly, then subside when you’re feeling calmer.”

If you have true shortness of breath, Dr. Oken says, regular breathing will be a struggle, like when you get up and go to the bathroom. “If you cannot speak full sentences without gasping for air, that is a sign you need medical help,” Dr. Lin adds.

You can test your breathing with simple exercises. Dr. Oken recommends taking a deep breath in and counting to 20. If you can only hold for 10 seconds or so, that’s an indicator that something could be wrong. If you feel anxious and start to hyperventilate, he recommends sitting down in a quiet room with your eyes closed, focusing on taking slow, deep breaths. If you start to calm down and your breathing returns to normal, then you’re okay.

Dr. Lin also notes the link between asthma and anxiety. “When you have anxiety, you could cause asthma attacks due to the stress response,” she says. “In reverse, if you use your albuterol rescue inhaler too much—several times a day—it can make your heart beat faster which leads to anxiety, even panic attacks.”

Other common symptoms of coronavirus—like digestive issues, nausea, and loss of appetite—can also be common responses to stress and anxiety. When you have a physical illness, Dr. Oken explains, your symptoms will likely persist throughout the night. So if you’re not waking up with shortness of breath or stomach issues, then your symptoms may be a result of mental exhaustion rather than coronavirus.

If you have serious concerns, you should seek medical help, starting with telemedicine services. These distinctions between mental strain and physical illness are not to encourage you to push your symptoms aside, but instead to emphasize the importance of managing your stress and anxiety for the benefit of your overall health.

How to manage your mental health during the coronavirus pandemic:

1Keep your immune system balanced.

Dr. Oken notes that there are four pillars of a balanced immune system: nutrition, exercise, sleep, and stress management. The first three are standards in conversations of health, so most people know what to do already (eat more fruits and veggies, get your body moving, and get six to eight hours of sleep at night). But if you’re chronically stressed, these healthy habits can’t carry all the weight. Stress has been shown to weaken the immune system and make the body more vulnerable to infection. “Think of the immune system as a platform that’s nice and steady,” Dr. Oken says. “If anyone of those pillars is off, it tips the platform and makes our immune system more vulnerable.”

2Stop constantly checking your symptoms.

Whether it’s with a thermometer or a Google search, constantly checking your behavior is unproductive, Dr. Oken says. “It gives you transient reassurance and it causes you to believe that you need to keep checking…The more you monitor, the more questions you’re going to have, and you’ll become more fearful and continue to panic.

3Check in on your mental well-being.

While pulling out a thermometer every hour on the hour might not be the healthiest habit, clinical psychologist and wellness expert Dr. Carla Marie Manly encourages people to check their psychological temperature throughout the day. Morning, noon, and night, ask yourself, “How am I doing?” “What do I need?” “What am I feeling?”

Dr. Manly also emphasizes how important it is to do these self check-ins without judgment. Whether you have an existing mental illness or you’re experiencing anxiety and depression for the first time, just know that what you’re feeling is human. Anxiety, sadness, anger, and grief are all perfectly normal responses to the current crisis, and one of the first ways to cope with those emotions is to recognize and accept them.

It’s also important to check on your daily habits and notice how they’ve changed throughout the pandemic. “This is a time period where new addictive behaviors can begin or existing addictive behaviors can worsen,” Dr. Manly says. If you’re repeating a habit—like drinking or eating too much, or overusing a substance—for over 21 days, it can become hardwired into your neurobiology, according to Dr. Manly.

4Restrict your news intake.

When you check in with yourself, notice how the news is making you feel, too. “It’s important for [you] to turn off the news and see how [you] feel and see if you feel less anxious,” Dr. Manly says. If you do find some relief when the news is out of mind, then this indicates it’ll be better for your mental health to limit your intake.

If you feel the need to keep up with the news more often, Dr. Manly recommends limiting your sensory input. Reading print or digital articles is her first suggestion, since you can control your pace of consumption and there’s no auditory stimulation involved. Radio is second best, and television takes last place, as it can be the most anxiety-inducing with both sounds and visuals. If you prefer to listen to the news instead of reading, Dr. Manly suggests at least turning it down to half volume.

5Distract yourself.

With social distancing and increased time indoors, you might be finding yourself with a lot more time to sit with your thoughts. While that can be a good thing, it’s important not to stew in your stress. Dr. Oken recommends watching a show or movie, reading, talking with friends, or writing a letter.

Dr. Manly’s mantra? “If it feels good and soothing, do more of it. If it feels overstimulating or anxiety-inducing, do less of it.”

6Practice calming exercises.

If you notice yourself getting panicky or feel your heart rate increasing, try out the simple methods Dr. Manly provides for calming down the nervous system.

  • Weigh yourself down with either a weighted blanket or by holding a heavy rock or sandbag.
  • Do a forward fold and let yourself hang there with your arms dangling.
  • Sit and focus on your breath. Inhale to a count of four and hold, then release to a count of four and repeat.
  • Put an ice cube in your mouth. (“This breaks the neural circuits that are hardwired for panic,” Dr. Manly says.)
  • Throw a small ball back and forth in your hands from side to side.

7Get outside.

Just as a lack of sunlight can lead to seasonal depression in the winter months, this extra time inside due the pandemic can take a toll on your mental health. Even if it’s just a trip to the mailbox and back, getting a daily dose of daylight can play a crucial role in boosting your mood and overall immune system. Studies have shown that those with low vitamin D levels are more susceptible to respiratory infections, colds, and the flu. So open up a window, go for a socially distanced walk with a friend, head to the roof or fire escape—do whatever you can to soak up some sun each day.

8Establish a mantra with your housemates.

Like a virus, stress can be contagious. Whether you’re living with roommates or family members for the time being, open up a conversation about how you can all manage your stress together and be mindful of each other’s needs. Dr. Manly recommends co-creating a mantra for your home so that you can all co-exist in respectful and healthy ways. “This is your opportunity to use your compassion muscle where it matters most and where it matters most is always home, now more than ever,” Dr. Manly says.

As information about the coronavirus pandemic rapidly changes, HelloGiggles is committed to providing accurate and helpful coverage to our readers. As such, some of the information in this story may have changed after publication. For the latest on COVID-19, we encourage you to use online resources from CDC, WHO, and local public health departments, and visit our coronavirus hub.