by Sanjay Gupta
Sleep Supports Immunity
Sleep is medicine.15 A compelling influx of scientific data shows how sleep acts as a natural drug (like exercise) to recalibrate our body, reorganize our mind and memory, and refresh our cells and tissues down to the molecular level. Sleep restores our body at every level from the brain down to the cells in our toes, so it’s no surprise that the relationship between sleep and worsening COVID outcomes is coming into clearer focus. Prolonged sleep deprivation has been found to decrease immune function, promote inflammation, raise levels of cortisol (a key stress hormone), and increase risk of chronic disease. We are learning that the number of circulating, policing immune cells actually peaks at night, which says a lot about the defensive power of sleep.
Sleeping well helps balance the hormones that regulate our biology and immune state; it also affects how well we feel and cope with daily stressors, how fast our metabolism runs, how robustly our brain operates and thinks, and even how our microbiome functions. While it’s hard to imagine our sleep having an impact on gut bacteria, new science shows a connection: A healthy microbial gut community helps us sleep and sleep better, and a good night’s sleep nurtures diverse, sanguine colonies.
Everyone’s sleep needs are different. In general, children need more sleep (ten to twelve hours) than adults (seven to nine). Quality, however, beats quantity. You can sleep for nine hours and still feel tired the next day if you haven’t banked enough refreshing deep sleep. The key is to have consistent sleep that moves through all the phases at night repeatedly in sync with the body and fosters a healthy sleep-wake cycle and circadian rhythm. If you want to really know how well you’re sleeping and whether you’re hitting deep sleep enough throughout the night, wearable devices and apps can help you track—quantify and qualify—your sleep.
Stress Sinks Immunity16
We all experience stress; it’s part of life, and it can even be healthy and motivating in many ways. It’s the toxic version that we need to minimize because the effects range from nuisances like headaches and bellyaches to problems in mental health like crippling anxiety and depression. Toxic stress is the kind that’s unrelenting, prolonged, and so psychologically troubling that it begins to affect our mood, biology, and ability to cope. When the stress hormones start pumping with no end in sight, lots of things can reshape the body, including the power of its immune system.
Stress physiology has come a long way in the past several decades. We have known for a long time about the cascade of events that occur in the body when it is under stress. But we are learning about new conditions tied to stress, including the very chronic conditions that exacerbate a COVID illness. For instance, unabated stress can hurt our microbiome. Experimental studies show that the toxic kind can stall digestion in the small intestine, which can lead to an overgrowth of bacteria there, which then compromises that delicate intestinal barrier. Unfriendly bacteria are then allowed to grow, crowding out the beneficial bugs—leading to dysbiosis and opening the door to a host of negative effects, some of which can result in chronic conditions in vulnerable people, including a prolonged case of COVID. Once again, this goes to show the interconnectivity of all the systems in the human body.
Build Mental Resiliency
It’s no surprise that all measurements—objective and anecdotal—have shown a rise in mental health challenges since the pandemic began. One of the early warning signs was the increase in phone calls to hotlines designed for reporting child and domestic abuse. According to the CDC, from August 2020 to February 2021, the percentage of adults with recent symptoms of anxiety and depression increased from 36.4 percent to 41.5 percent. The emotional toll on people has varied, with some people discovering strengths and others discovering the limits of their coping skills. A variety of factors determine how an individual is affected, including one’s age and life stage, childhood adverse events, race, gender, genetics, mental health history, exposure to discrimination and personal life circumstances, financial well-being, access to health care, as well as the range of struggles and losses they’ve suffered throughout the pandemic. Someone working the front lines in health care, for example, has experienced this event differently from, say, an established accountant who can remain safely sequestered in a home office and Zoom with clients.
The good news is that research has revealed that the majority of people who survive acutely stressful periods like wars, natural disasters, and catastrophes recover without long-term psychological issues. We may be more stressed out, depressed, and anxious than ever before, and every expert I’ve talked to has said that COVID will change society forever, but research on human resilience shows that people recover from pandemics faster than you’d expect. We have plenty of data showing a rapid recovery after the 1918 flu pandemic. Research also shows that the vast majority of us—about 90 percent of Americans—have experienced a traumatic event but only 6.8 percent of people will have posttraumatic stress disorder.17 And in follow-up studies of those with PTSD, their symptoms diminish dramatically within three months after the trauma, and almost two-thirds of them eventually recover. It’s important, and perhaps comforting, to know that trauma does not necessarily or automatically cause long-term mental illness. There can be psychological distress for sure, as well as sadness and anxiety, but these are normal, temporary reactions that for the most part are manageable. They may even play into the power of your mental resilience. We’ve all gotten this far in the pandemic, which can now help us build our mental bounce-back muscles.
When I wrote Keep Sharp, my focus was on the things we can do to build a resilient brain to avoid cognitive decline and dementias. Although I wrote it prepandemic, all of the ideas and strategies in the book—my five pillars of nourish, move, sleep, continually learn, and connect with others—remain relevant. But let me offer more specifics on how this guidance can be applied in this pandemic age.
The most important insight from all the years I spent researching for my book (which, admittedly, could have easily been titled Keep Resilient) is just as appropriate for pandemic times: Your brain is an incredibly pliable organ that can improve as you age. It is an extraordinary thing to consider. Although other organs typically decline through normal wear and tear, the brain can remain robust and actually grow new neurons and networks to support you and your endeavors no matter how old you are. I’ve met plenty of centenarians with weak hearts but hardy brains (and I’ve operated on brains that look to be on the brink of death but whose owners still think and form memories like a quick-witted youngster). This means the things you do every day can help you build a better, more pandemic-proof brain. The combination of restorative sleep and exercise, for instance, is an antidote to mental decline—matchless medicine we can’t get elsewhere. Sleep tidies memory, and physical activity pumps out substances in the brain that act like Miracle-Gro on brain cells, stimulating their growth and ensuring their survival. This allows us to continually learn new skills and explore new hobbies that are stimulating, de-stressing, and rewarding—all good things for staying mentally resilient. With the temporary loss of many activities that nourish our mental health, such as social gatherings, travel and vacations, and working in an office setting with colleagues, we’ve had to get creative. And that’s okay. Here are some additional tips:
Cut your consumption of media calories. Think about what media sources you’re following and how often you’re checking them. Instead of scrolling through endless headlines or binge-watching another TV show, call a friend and connect or go for a walk outside with a loved one. Nature loves to suck up your worries. Too much media consumption can make us feel that we’re losing control of our lives. Research shows that when we shift our focus to what we can control, we see meaningful and lasting differences in our well-being, health, and performance.
Maintain strict structure. Just as the body loves homeostasis, a stable equilibrium or balance across its systems, the mind loves predictability, order, and routines. This allows you to adapt quickly to unexpected changes
and challenges. Create daily to-do lists; set goals; organize your spaces including where you work; stick to a regular schedule for eating, exercising, and sleeping even on weekends; and commit to an end-of-day ritual that’s calming, such as reading, taking a warm bath, or walking through your neighborhood while listening to your favorite music.
Keep connections thriving. One of the more devastating epidemics that has surely arisen from the pandemic is loneliness. Since the start of the pandemic, 67 percent of Americans—two in three people—say they feel more alone than ever before, and many admit to crying for the first time in years.18 This breaks my heart and makes me want to emphasize with more passion than ever how important it is to call, video-chat with, email, or write letters to the people we care about. We need those deep conversations. Social support is proven to strengthen resilience by increasing our sense of control and self-esteem. Sociality also has positive neural outcomes: it actually deactivates circuits in the brain that trigger fear and anxiety. Put another way: When we connect with others, we hot-wire our brain’s calming centers while taming its emotional reflexes.
Use apps that help you practice mind-body medicine. From apps that help you meditate, to those that allow you to join online groups to share your experiences and socialize, there’s no shortage these days of programs to help you build resilience. Harvard University’s Center on the Developing Child maintains a website with links to national and international resources that can help with a variety of concerns related to the pandemic whether you have children or not: https://developingchild.harvard.edu/resources/covid-19-resources/.
Seek professional help. The explosion of telemedicine has made finding a licensed therapist often only a swipe or call away. As my favorite Olympian Michael Phelps says, “You don’t have to wait for things to get that bad. Therapy isn’t just for people struggling with serious mental illness.” He’s teamed up with the maker of an app that helps anyone find a qualified therapist easily, conveniently, and affordably because he knows personally that it sometimes takes a team effort to beat depression and anxiety. Pandemic-related stress aside, one in four people around the world experience a mental health issue, and more than half of American adults do not receive treatment. Professional treatment used to be exclusive, but no longer. And it’s there for our children as well. According to the CDC, the proportion of mental health–related emergency room visits for children ages twelve to seventeen increased 31 percent in 2020 compared with 2019. The CDC maintains a comprehensive parental resource kit online that is broken down by age group, from early childhood to young adults.
Use food to boost mood. The idea that you are what you eat applies to mental health too. In addition to microbiome research soaring in scientific circles, so is “nutritional psychiatry.”19 This burgeoning new field of medicine looks at the relationship between food and mental wellness with a nod to the microbiome’s role in this biological partnership. Good nutrition feeds and supports a healthy microbiome that ultimately has an impact on brain health, including the production of compounds in the body that foster optimal thinking and mental well-being. Scientists have long focused on how food affects our physical health, specifically our metabolism and heart health. But now the attention is turning to food’s surprising connection with mental health as a growing body of research points to how daily sustenance plays into our moods and brain biology. As comforting as our sugary, high-fat delights might seem when we’re stressed or depressed, large population studies reveal that people who eat a lot of nutrient-dense foods—more fruits and vegetables, nuts and seeds, beans and legumes, fish, eggs, and fermented products like yogurt—experience less anxiety and depression and report greater levels of happiness and overall life satisfaction. The food-mood connection may seem anecdotal, but we finally have well-designed studies to demonstrate the power of food in our moods and mental resiliency.20 This does not mean a kale salad and sardines can cure mental illness, but what we choose to eat is arguably one of the most underestimated and underappreciated ingredients to mental health. It won’t cost you more to switch to healthier foods either. In one of the recent studies to test the benefits of food on mental health, participants who switched from sugary cereals to oatmeal, pizza to vegetable stir-fries, and sausage to seafood lowered their weekly grocery bills.
Throughout the pandemic, we’ve been told that “we’re all in this together.” This slogan is fitting because we must maintain that mentality as we face future threats. And this often means making the pandemic-proof future a family affair.
CHAPTER 8 O: Organize Family
Learn How to Live Everyday Life Anew (with a Twist)
Will we ever look at a cough or sneeze in the same way again? How do we plan for parents in need of assisted living or a nursing home? How do we get our kids back on track in school? What should we know before taking a big trip? Does it make sense to spend more on health insurance to deal with any long-term effects from COVID?
We are all in this together, and every family would do well to get organized in ways they probably hadn’t thought about prepandemic. After speaking to infectious disease experts, social scientists, and many individuals who have suffered through COVID, I’ve put together a ten-point family checklist that addresses the best strategies for living with COVID, given it may be in our environment indefinitely. We all have to factor in COVID when making decisions now. As we return to a new normal mindfully, we will continue to grapple with uncertainty, the aftermath of the pandemic, COVID’s potential to resurge, as well as the possibility of a new maniacal pathogen arising and threatening the world. As I finished this book, I transitioned my Coronavirus: Fact vs. Fiction podcast to a new one, called Chasing Life. We’re all ready to imagine the next chapter of our lives and find a balance between self-care and productivity. It’s time to chase life again. And we have to start somewhere. Follow these ten COVID-friendly commandments to put you and yours in the best position to pandemic proof:
Keep Up with Checkups, Cancer Screenings, and Booster Shots
As the entire world faced off against an insidious globe-trotting virus, our focus temporarily drifted away from the chronic, noncommunicable health issues such as heart disease, cancer, diabetes, and dementia, which continue to affect millions of people and cost untold billions of dollars a year to treat. We must get back to our regular checkups and annual tests to treat and prevent these issues. And, yes, we are all anxious to put COVID in the rearview mirror, but we must not forget COVID’s potential to crop up again and again. Staying up to date with booster shots will be key to maintaining community immunity and preventing another pandemic.
Doctors and hospitals have learned how to protect patients from potential COVID exposures, so you no longer have to worry about deciding when and if to receive care or have elective surgery. If there’s a local outbreak, doctors and hospitals will snap alert, and you will simply have to follow their lead and abide by their safety measures.
Fill the Thriving Gap
The pandemic caused widespread slowdowns in our children’s educational trajectories while also amplifying gaps across racial and socioeconomic lines. This was most pronounced among students from disadvantaged homes, where access to remote learning with reliable Internet was difficult, if not impossible, or kids struggled with online platforms and lack of adequate parental supervision. It’s hard to be on Zoom all day long, learning and interacting, no matter how old you are. While it’s tempting to call it “learning loss,” that’s not the best term. Our kids may not have lost as much as we think and could have actually gained a lot in experiencing this pandemic. They may have lost time in a traditional classroom, but that doesn’t mean they lost skills, knowledge, memories, or the capacity for future wisdom. It was Plutarch who wrote, “The mind is not a vessel to be filled but a fire to be kindled.” And they are ready for a rekindling.
After speaking to superintendents in school districts all over the country, I am optimistic that we will address many of these gaps with public measures by of
fering high-dosage tutoring, extending school years, and partnering with community organizations. Make no mistake: None of this is ideal, but educators across the country have emphasized to me that they view the pandemic as an interruption and not a permanent regression in our kids’ education. Many school districts have led the charge to get kids back in school safely.
When I wrote and recorded the audio book Childhood, Interrupted, I spoke to child psychologists around the country to learn their concerns and their plans so that I could apply those lessons to my own three girls.1 For starters, they reminded me that the thriving gap, a much better term than learning loss, doesn’t include just the academic element. It’s also the social and emotional gap, especially for teenagers, who’d rather be with their friends than anywhere else. Especially as kids are increasingly vaccinated, make sure those social connections are nurtured once again.
“For both older and younger kids, they are remarkably resilient,” said scientist and psychologist Angela Duckworth who founded the nonprofit Character Lab to collect science-backed data to help kids thrive.2 “Sometimes people think that resilience is the exception—but it’s actually the rule.” According to Duckworth, it helps to frame the pandemic from a perspective that doesn’t dwell on the loss and brokenness, and instead, ask, What can I learn? and What can I do going forward? That small mental shift in a parent’s mind will shape how a child reacts and chooses to think about things. For example, literacy is the foundation to learning, and practicing literacy with your child is something every parent can do at home. Kids learn every day, whether they are in a traditional academic environment or on their computers in their rooms with classmates online, starting to ride a bike in the neighborhood, or playing video games with friends through the Internet. Learning is not binary; it’s complicated. Our kids will learn new skills they should have learned last year. Maybe that’s a good thing, because in years to come, we’ll likely find that our children are not only “caught up” with their learning but they’ve surpassed it because the pandemic bestowed on them an experience that teaches like nothing else can.
