Dealing with sleep problems during home confinement due to the COVID-19 outbreak: practical recommendations from a task force of the European CBT-I Academy
E Altena et al, Journal of Sleep Research, 4 April 2020
A recent study found that residents of Wuhan, China, who had a better sleep quality and woke early less frequently during the worst of the COVID-19 outbreak had lower post-traumatic stress symptoms (PTSS); which suggests that helping individuals to improve sleep quality during long periods confined at home will reduce the prevalence of PTSS.
Researchers from the European Academy of Cognitive Behaviour Therapy for Insomnia have said that “being forced to stay at home, work from home, do home schooling with children, drastically minimise outings, reduce social interaction or work many more hours under stressful circumstances, and in parallel manage the attendant health risks, can have a major impact on daily functioning and night time sleep.”
Exposure to daylight, lowering of stress levels and incorporating physical activity into daily routines are all important ways to improve stress, but become a challenge when housebound and faced with financial and future uncertainty.
Some of the author’s general recommendations for dealing with sleep problems during social distancing or self-isolation are:
- try to maintain the same wake up and bedtime routine
- schedule a brief period of time each day to write thoughts down and reflect upon current worries
- use bed only for sleep and sex
- turn devices off before going to bed
- use social media during the day to connect with family and friends and sharing of humorous and positive information
- keep busy with activities that you enjoy
- limit the time you spend following COVID-19 news
- exercise regularly, preferably in daylight
- try to get natural daylight each day
- eat less if you are less active during the day
For a more complete list, here’s the article.
And if you would like to contribute to Australian research determining the ‘Impact of a global pandemic on sleep and wake behaviour,’ here is more information.
Social distancing strategies for curbing the COVID-19 epidemic
S Kissler et al. Digital Access to Scholarship at Harvard, March 2020
Public health interventions to slow infections of novel coronavirus include testing, contact tracing, quarantine and social distancing. These measures aim to help reduce the burden on strained health care systems and “flatten the curve,” especially when other medical interventions (i.e. medical treatment and vaccination) are not yet available.
The authors of this study found, using mathematical modelling, that to effectively manage the epidemic in the US in the absence of medical interventions, recurrent social distancing measures may be needed until 2022.
Their model took into consideration that COVID-19 will likely be subject to seasonal influences similar to influenza, with more infections of the novel coronavirus occurring in autumn and winter; and thus, “a winter peak for COVID-19 will coincide with peak influenza, further straining health care systems,” the authors advise. This is a view the authors of recently released Australian modelling agree with, although they haven’t included seasonal influences in their modelling to date.
The findings of this study should be used as information only; it has not yet been subject to a peer-review process and the modelling is based on the likelihood that everyone has an equal chance of coming into contact with a potentially infectious person.
While long-term intermittent social distancing may be needed to sustain the demand for critical care within its current limits, this will place a significant social and economic burden on societies.
The authors conclude that, “to shorten the SARS-CoV-2 epidemic and ensure adequate care for the critically ill, increasing critical care capacity and developing additional interventions are urgent priorities.”
Analysing wastewater to detect community spread of COVID-19
Individual testing for SARS-CoV-2 infection has been limited, meaning that reported estimates of infections are likely to be far lower than is actually the case.
So that governments can develop appropriate interventions and policies to manage the spread of COVID-19, it is important to have a better understanding of the prevalence of the virus in communities.
Researchers in the US analysed samples from a Massachusetts wastewater treatment plant, and based on the number of SARS-CoV-2 viral particles they found, estimated that there was a higher prevalence of the virus than the clinical cases confirmed in that community.
They suggest analysis of wastewater may “provide population-level estimates of the burden of SARS-CoV-2” in locations where testing individuals may be limited.
The researchers were motivated to conduct this study based on evidence from China where SARS-CoV-2 virus particles were found in faecal samples.
Researchers in the Netherlands have recently posted a preprint of a study to MedRxiv, where they also identified SARS-CoV-2 particles in wastewater, supporting the research in the US.
Both of these wastewater analysis studies are yet to be peer reviewed, and results should be interpreted with caution. However, they highlight that more longer-term studies should be conducted with the aim of finding a method that may help to more accurately determine the population-level spread of COVID-19.
COVID-19 and risks to the supply and quality of tests, drugs and vaccines
P Newton et al, The Lancet, 9 April 2020
“The COVID-19 pandemic threatens a global surge in substandard and falsified medical products, not just for those directly related to COVID-19,” the authors write.
In this commentary for The Lancet, the authors describe some of the ways in which the supply and quality of all kinds of medications will be hampered as people rush to find a vaccination and treatments for the novel coronavirus.
Supply chains are being disrupted for candidate drugs (e.g. hydroxychloroquine) and also for medications for other illnesses that are being repurposed to use for COVID-19; all without sufficient evidence to support their use as intervention against COVID-19.
And what is likely to occur as a result is an increase in falsified or substandard medications that have not been through rigorous testing procedures; and false statements about their effectiveness. This has already been seen with widespread misinformation about the effectiveness of chloroquine and hydroxychloroquine against COVID-19, resulting in fatal overdoses. See here and here.
If the efficacy of medications is found, it is then important that distribution of them is strongly regulated to ensure they are affordable and accessible world-wide; and not at the expense of access to other medical products (e.g. HIV diagnostics), particularly in low-resource settings, the authors conclude.
COVID-19: testing times
N Beeching et al, BMJ, 8 April 2020
Testing for SARS-CoV-2 is a key recommendation of the World Health Organisation (WHO).
However, UK authors of this editorial in the BMJ advise there is insufficient access to testing kits world-wide, along with confusion among health professionals about interpretation of test results.
Currently, the diagnosis of SARS-CoV-2 relies on swab tests detecting the virus in body fluids. This is most accurate if a combined swab is taken from the nose and throat when the first symptoms emerge.
Other diagnoses tests include detecting viral RNA by molecular methods; however, considerable equipment and expertise is needed and this method is not very efficient.
Antibody tests, via blood obtained from a finger prick, can be used to identify if someone has already had COVID-19. It is not known how long after the infection the antibodies will be detected, but the antibodies may be detected from the second week of infection.
In Australia, testing for the novel coronavirus is via nasal and throat swabs. While it has been reported that Australia has ordered 1.5 million antibody tests, it has not yet been reported if they have arrived or in use.
Both swab and antibody tests may provide incorrect diagnoses for COVID-19. With virus shedding being intermittent, a single negative swap may need repeating. Also, antibody tests may have poor specificity. This makes it a challenge for health professionals to interpret results.
The authors say that “wide availability of testing for antibodies would be a game changer.” By identifying people who have already been infected, assuming they have developed a level of immunity, they may be able to return to work.
Antibody testing will also be able to provide more details about the true prevalence of COVID-19 in communities.
In summary, interpreting diagnoses of SARS-CoV-2 depend on the timing of testing during infection, the site where the sample is taken from and in recognising that viral shedding is intermittent and variable (so multiple tests may be required). However, more testing kits are required worldwide for this to occur; as was also acknowledged by WHO Director-General Dr Tedros Adhanom Ghebreyesus in his media briefing on 8 April, summarised below.
WHO Director-General’s opening remarks at the media briefing on COVID-19
WHO, 8 April 2020
Dr Tedros, Director-General of the World Health Organisation (WHO), addressed the media, providing an outline of the milestones and key activities undertaken to manage the outbreak of the novel coronavirus, in the first 100 days since being notified of the first cases in China.
“It’s incredible to reflect on how dramatically the world has changed, in such a short period of time,” he said.
By 10 January, an Incident Management Support Team had been created to coordinate WHO’s response, and guidance was provided to countries about testing and managing likely cases of COVID-19.
WHO declared a public health emergency of international concern on 29 January after the first cases of COVID-19 outside of China were reported.
A United Nations Crisis Management Team was activated in early February and since then, WHO have been working in five key areas to manage the pandemic.
Firstly, he said, they have been supporting countries to build their capacity in preparation and response, in particular preparing health systems to be able to respond.
Secondly, they have worked to provide accurate information and guidance, by regular media briefings, partnerships with social media platforms, and activating the world’s leading experts in epidemiology and infectious diseases.
Thirdly, they have been working to ensure there are adequate medical supplies for health workers, including shipment of 2 million items of PPE and 1 million testing kits. Dr Tedros acknowledged that more was needed.
Fourth, they have been training and mobilising health workers on their OpenWho.org platform.
And, fifth, WHO has fast-tracked research and development. More than 90 countries are collaborating to find effective therapies.
Dr Tedros advised that these five areas would continue to guide their work moving forward; and that is was important to protect the most vulnerable populations in societies around the world.
He acknowledged that it was team effort and their “focus has been on working with countries and with partners to bring the world together to confront this common threat together.”
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow her on Twitter: @AlisonSBarrett. Croakey thanks Alison Barrett for providing this column as a probono service to our readers.