With the identification that mental health is as important as physical health, LWM has been working over the past few years to increase the size and scope of our mental health curriculum. A specific focus on incorporating stress management has allowed us to encourage students to identify and manage the stress that patients and responders may face both during and after a rescue. Yet understanding stress and how to manage it are not unique to wilderness rescue; the current COVID-19 outbreak and the resulting uncertainty that each of us may face poses many of the same risks as any other stress injury. Any action we can take to limit the stress response in our body will improve our overall health during challenging times.
The body has two response systems that are utilized based on our interpretation of the world around us, the sympathetic and parasympathetic. Sympathetic responses are the reaction to stress, often termed fight or flight. Parasympathetic responses are the opposite and can be thought of as rest and digest. When the body interprets a stimulus as stressful, the sympathetic nervous system (SNS) becomes active, resulting in an increase in the heart and respiratory rates, sweating, and a potential of increased acuity of senses (e.g., vision and hearing). The SNS also decreases the activity of the digestive system. Initially, this response is caused by the release of the chemical epinephrine. Long term, in addition to the epinephrine, cortisol is released.
In the short term, stress is helpful - it allows for quick decision making and focus on completing tasks. In the long term, stress poses serious health risks as the body becomes fatigued, experiences poor sleep, and the immune system becomes dysfunctional, resulting in an increased risk of illness. The structure of the heart, vessels, and organs also can become damaged from the prolonged exposure to cortisol. The brain also changes and may result in emotional and cognitive effects such as development of negative thoughts and decreased focus, making day to day tasks more difficult.
Stress is managed through coping, ideally in a manner supports health in both the short and long term. Healthy coping leads to a reduction of the sympathetic response, allowing our body to engage the parasympathetic system. In times of significant stress, we can work to manage stress with a few concrete actions.
Meet Basic Needs
Identify the basic needs and separate those from the non essentials. Adding stress to your life by worrying about toilet paper is probably not the best use of your time. Meet the needs of food, water, and shelter first. If these needs are not met, seek services that can help you meet the needs. When the basic needs are met, occasionally remind yourself that those needs are covered and that you are safe, and then begin working to find solutions for the non-essentials.
Focus on the Things You Can Control
Focusing on the items that you have no control over will not help your brain slow down. Instead, work to identify the components of your current circumstance that you do have control over and work to address them.
If your current actions are causing stress, change your behavior. Turn off the constant stream of news updates. Set ground rules that meet the needs of all people in the house during the time of social distancing. Find ways to create routine in days that may lack structure.
If you are currently under order to stay at home, find ways that you can meet your needs within that space. Create a space in your home where you can be active and research an online resource that can provide direction in movement. Use available time to plan an adventure when it is safe to be outside again. Use online virtual tours to take in the sights of a national park or a webcam to watch wildlife movement. Move a chair to the window to allow more connection to the outside, and, if weather allows, open the window to allow fresh air into your space.
Find ways to build social support into your day. It is going to look different when socially distancing, but it is still possible. Increase the number of calls you make to loved ones. Schedule a virtual happy hour with friends. Make sure that you and your social network are actually communicating and not just scrolling through the photos people are posting. Last night my wife and I shared our dinner photos with friends and in return saw their dinner. It almost felt like we had a kitchen full of friends.
The uncertainty of the current health crisis creates the potential for significant stress in our lives. Take time over the next days and weeks to change focus, prioritize needs, and make social connections. Using these simple steps can help each of us reduce the impacts of long term stress and face the current challenges to the best of our ability.
Turning around due to risk while pursuing an objective is difficult. The choice contrasts the perceived risk with a very enticing reward. The difficult part is that the risks can be hard to identify and there is often no positive feedback for choosing the less risky path. We make choices to not ski a specific slope due to avalanche danger or to not climb a specific ridge due to the risk of a storm, but because the choices we make are intended to keep us safe, we rarely see the consequences of the things we choose not to do - we don't often see the avalanche path in an area we chose not to ski or see ridge we chose not to climb get struck by lightning.
Many years ago I led canoe expeditions on the coastal waters of South Carolina. One of the most difficult decisions I made was to not to make a big water crossing with a group of students during a storm. As a group of 10 people with a variety of abilities, we were in an exposed position in shallow water along a barrier island with a large incoming thunderstorm, with a half mile of open water between our position and a boat ramp with a waiting transport vehicle. We had to make the decision to stay along the shore, get into lightning position and wait, or make a run for the security of the vehicle. I so wanted to be in that vehicle. I was tired, we had been in storms for the past 12 hours, and I knew the van provided security that we did not have on the water. We followed the program’s policy regarding lightning, stayed in position and waited. After an hour of intense lightning, the storm broke up and we paddled to the van.
The feedback that I got from the students was all negative. They didn’t see the risk of making the crossing but they did experience the discomfort of the storm. The feedback from the program staff in the van was “that looked un-fun.” More than 15 years later, I wonder if we could have made the crossing and limited our exposure in that storm. However, I can’t think of that alternate decision without wondering what would have happened if a canoe flipped during the crossing or if someone had been struck by lightning when we broke program policy to “just get to the van.”
The art and science of decision making in our outdoor pursuits involves a combination of identifying all of the risks, seeing the consequences of those risks, and then making a decision based on our overall risk exposure, individual skillset, and risk tolerance. The more we understand about the given risk the better we can choose an acceptable level of risk.
With the current COVID-19 outbreak we find ourselves in a time of decision making about how to interact with the world. We are surrounded by a lot of poor information regarding the overall risk and many people have a ton of temptation due to increased free time. I have begun seeing photos of people out recreating on chair lifts and on trails using the tag #socialdistancing, and have watched online conversations where people are considering recreation-based road trips. It’s time for each of us to assess the real risk of the current health emergency to ourselves, our communities, and the rest of the world.
LWM is based in Bonner County, Idaho, population approximately 45,000. Our local hospital has 25 beds which include 4 in the intensive care unit (ICU). The Center for Disease Control (CDC) estimates are that most of the US population will contract COVID-19. If we conservatively assume that nearly half of the population contracts the virus, we will have 20,000 cases. Current estimates are that 80% of cases will be mild and not need hospital care. The remains 20%, or 4000 people, will need medical care. Again based on current estimates 25% of cases that need hospitalization will need the intensive care unit (ICU). That is 1000 people that need our 4 ICU bed. The statistics become more dire when noting that the estimated time in ICU is two weeks and half of ICU patients will need life support. Bonner County is not in a unique situation. It is hard to wrap your head around these numbers because to do so is to internalize that not everyone will have access to the care they need.
Assume you are going to interact with the virus. Furthermore, assume that you are probably not going to feel bad (i.e., have symptoms) when you do. The current “flatten the curve” mentality is about slowing the inevitable to limit the need of medical facilities at any given time. Each interaction we have with another person provides an opportunity to acquire the virus and then share it. Current estimates are that each person who carries the virus will spread it to an average of 2.2 people. Every interaction you have increases the chance that you have picked up the virus, with every interaction you have after acquisition risking further spread. The equation is simple, more interactions equals more potential spread. The spread is further amplified by being in contact with other people who have high levels of contact.
Similar to risk assessment in the backcountry, our decision of how to recreate over the next weeks will provide very little immediate feedback beyond the pros and cons of choosing to do any given activities. Unfortunately, the true risk in activity can feel abstract and unrealistic. I detailed the risk of numbers of people and the implications of space in the hospital system, because we have to be aware of the real risk to make function decision about our actions. I hope that we never see the full potential of this outbreak and that in a few years we look back and say we over reacted. I know today that I don’t want to be looking back in 20 years wondering if I could have done more to limit a rapid spread and resulting loss of life.
We know that recreation, particularly in times of stress and uncertainty, is important but it is up to each of us to work each day to adapt our actions in order to limit transmission. At LWM we are suggesting that we each consider the following guidelines for recreating in the current outbreak:
Originally posted 3/17/20, Edited 4/1/20