The following article first appeared in Public Square Magazine.

Dr. Satterfield is a Physician-Scientist at the Mayo Clinic in Rochester, Minnesota. He is trained in internal medicine and a specialist in molecular virology with an emphasis in emerging infectious diseases.

Dr. Lybbert is board certified in family medicine with added certification in geriatric medicine. She works at Intermountain Utah Valley Senior Medicine Clinic. She has worked in assisted living facilities, VA clinics, outpatient geriatric primary care, and hospice care. The views expressed are their own.

The fear around this COVID-19 pandemic is both striking and understandable. Speaking from our expertise and experience in infectious disease and geriatric medicine, we share five recommendations that might be encouraging to those who find themselves terrified with the rapidly changing news—each suggestion based in research and clinical practice, and aimed at reinforcing greater public confidence and hope.   

1. Reject helplessness. 

Hard situations can be made harder when we don’t feel there’s anything we can really do to protect ourselves or work through something. Research confirms that individuals who feel passive, helpless, and without any choice are statistically more likely to struggle with despair and anxiety.  The idea that we are helpless in the face of this virus, however, is simply not true—with a variety of things any individual or family can do (in addition to important basics such as hand-washing and social distancing).

2. Keep an eye on stress.  

It’s well known that stress lowers immune response—especially chronic stress. The irony, then, is that some of the media messaging about coronavirus (particularly that which induces a state of constant panic) can inadvertently make people more vulnerable to catching any infectious disease.

The good news is we don’t have to allow that to happen—especially if we’re aware how chronic stress can predispose disease.  With that knowledge, any of us can take steps to reduce overall stress levels in our lives. Although it’s true we can’t and don’t typically have as much choice over the level of stress we experience, we do have more control over our response to that stress. Practices that help calm the mind and body (meditation, yoga, prayer, reading) and other relaxation techniques can help us train our stress response to be less reactive—with mindfulness support only one app away! (See here and here.)  

Speaking of stress, it’s also important to avoid group panic. Be cautious with social media – which can be a great help in gaining information about the rapidly changing environment during the outbreak – but it can also lead to spread of inaccurate information, fear, and stress depending on how one uses it.

Along with classic calming techniques, sometimes additional preparation does wonders for reducing stress. This can be a good time to explore having at least a 14-day supply of non-perishable goods in the event of needing them in a quarantine.

3. Reduce other immune weakeners. 

Stress isn’t the only thing that weakens the immune response. Many different aspects of our lifestyle—from poor diet and physical inactivity to inadequate sleep and social disconnection can also leave our immunity weakened.  According to a 2014 review, a diet high in saturated fat, salt, and sugar (which makes up so much of the modern Western/American diet) can negatively influence the immune system. So, something as simple as decreasing our intake of soda, processed foods, refined carbs, and anything high in sugar can help strengthen us. As Dr. Samer Blackmon puts it, “Believe it or not, what you put in your mouth serves as one building block to a strong immune system….The next time you reach for junk food, realize that you not only are affecting your weight, but you may be letting down your resistance to bacteria, viruses, and parasites.” 

Research has shown that sleepless nights can diminish your immune response too, making you more likely to catch a virus (and even harder to fight one off if you do). One experiment conducted at the University of California, San Francisco, tracked the sleep of healthy adults for 1 week with a wristwatch device. They were then isolated in a lab and had a live culture of a virus which causes the common cold sprayed in their noses (yes they agreed to this!).  They were then kept in the lab for another week and monitored to see whether they caught a cold. Remarkably, there was a “clear, linear relationship” between infection rates and amount of sleep in the week prior. In those with 5 hours or less a night the week prior to exposure, the infection rate was near 50 percent. In comparison, for the group with 7 hours or more a night, the infection rate was just 18 percent.   

So, get your sleep!  (Yes, that’s doctors’ orders – two doctors, to be exact). Oh, and by the way:  If and when a vaccine becomes available for the coronavirus, if you have more sleep you will also make a more robust immune response, meaning you’ll make more antibodies to the virus and be able to better fight off the real disease when you encounter it. Another study in 2002 demonstrated that those who had seven to nine hours of sleep before getting the flu shot generated a powerful response, whereas those with four to six hours had less than 50 percent of the immune reaction of the other group. 

It’s not just all of these classic physical health indicators (like sleep, diet, exercise, stress) that affect immunity, though. According to a 2014 study in the Journal of Neuroimmunology, increased anxiety associated with loneliness also leads to greater suppression of the immune system. That makes this an especially good time to strengthen your social network and reconnect with loved ones via phone, email, video call, etc.  

4. Prioritize immune strengtheners. 

Getting away from immune suppressors is great progress—but how can we also proactively strengthen our bodies as well? Once again, there are a number of well-accepted ways to gradually strengthen our immune functioning. Rather than just avoiding negative foods, for instance, we can fill our diets with more fruits and vegetables.  Dr. Samer Blackmon summarizes, “Eating a well-rounded diet high in pretty, colorful veggies and fruits will give your body the vitamins and minerals it needs to fight off illness.” Adding some immune-boosting foods into your diet, such as spinach, tumeric, almonds, broccoli, garlic, and red peppers, can also make a difference.

Overall, the more we increase lean proteins, healthy oils, and fresh fruits and vegetables in our diet (consistent with more of a Mediterranean diet), the more our food will reduce inflammation and disease in the body. (See also this review.)    

A 2014 study is one of many to suggest, as well, that regular, moderate physical activity can make you less susceptible to viruses. Aerobic exercise can be especially valuable as a way to boost the body’s immune system.  Not only do natural endorphins released help you stay mentally healthy through stressful times, but exercise can also help clean out our lungs, reducing your chance of picking up an airborne illness, according to the U.S. National Library of Medicine. The movement also causes white blood cells to circulate more rapidly, allowing your immune system to detect illnesses more quickly.

Get your movement outside as much as you can, in the soon-to-be spring weather.  The sun’s vitamin D is a well-known immune system supercharger, and soaking up a few rays is the most natural and efficient way to stock up on it.

And don’t forget the emotional and relational ways to boost immunity. Rather than just avoiding stress, we can actively seek out more reinforcing and encouraging messages found in literature, music, and spiritual traditions. Even just laughing a bit more can give your immunity a ridiculously easy boost.  And while social distancing from those who are ill can be essential, re-engaging and increasing connection with positive relationships can also bolster our physical health. A 2015 study in Psychological Science found that simply hugging someone can have a stress-buffering effect and reduce susceptibility to illness. 

5. Provide extra support to those most vulnerable.  

Regardless of the individual circumstances, this is a time to show compassion to victims of this difficult virus and their families. While doing that, it’s valuable to still recognize something important: viruses typically cause more severe symptoms in weaker immune systems.  We’ve discussed some of the common factors involved in weakening immunity. The immune system also naturally declines with age, which is why older people are most likely to succumb to this novel coronavirus (along with those facing underlying chronic health conditions or obesity).  This is helpful to keep in mind because contracting the virus is not uniformly fatal.

It should also prompt us to remember those who are most vulnerable in our communities and take what steps we can to protect and support them.  It is especially important to look out for elderly family members – both encouraging them to avoid large public gatherings, while also still making sure they have enough encouragement and support (even if only via virtual means to “visit” via Skype, Facetime, Duo, etc).

Responding to this crisis from a place of looking out for those who are most at risk, rather than from reactionary fear can be a way to decrease our feelings of helplessness and keep anxiety and despair at bay.      

Yes, the threats are real.  But rather than hand-wringing before 24-hour news about external threats every waking hour, let’s take advantage of this time (and threat) as an opportunity to make adjustments in our personal lives and family habits that can protect us all. 

There’s a lot we can do.  And as important as hand-washing and social distancing is, we can’t help but wonder what it would mean if our public health response focused on these additional ways to strengthen immunity as well.