Dr. Rick Wallace is the Founder, CEO & Chief Life Mastery Strategist at The Visionetics Institute. He created the Visionetics concept for optimal personal development based on nearly three decades of academic study, research and experience in the areas of behavioral psychology, neuroscience, personal development, metaphysics, quantum physics, neuro-linguistic programming, psycho-cybernetics and spirituality.
Dr. Wallace is one of the leading minds in the area of personal change --- achieving an exceptional rate of success with his clients.
9 Signs of Low Self-Esteem and Strategies for Fixing Them
Following, you will find 9 signs of low self-esteem and some simple strategies for overcoming low self-esteem. Low self-esteem is practically an epidemic. We’re bombarded with images of impossible success and beauty on a daily basis. It’s hard to avoid making comparisons, and those comparisons never seem to work out in our favor. These unrealistic images that we place such gravity on have this impact because we lack the awareness of a healthy self-concept. Simply put, when you are genuinely cognizant of who you are in the world, you will not get caught in the trap of comparing yourself to others.
Add to that a few mean comments received in childhood, a workplace bully, and a few extra pounds, and your self-esteem can plummet. Social media has served to exacerbate the problem of collective low self-esteem. In a world where everyone is constantly presenting a weighted version of themselves that conveniently omits the struggles, setbacks, hidden battles, it can be easy for those reading these posts to become disenfranchised with their reality.
Fortunately, there is a way to recognize when your self-esteem has taken a hit — putting yourself in a situation to reverse the effects and develop a healthy and effective self-esteem.
Recognize the signs of low self-esteem:
Difficulty accepting compliments. If you have a hard time hearing someone say something nice about you, you might be suffering from low self-esteem. Most people enjoy receiving a genuine compliment, but those with a low opinion of themselves feel very uncomfortable being on the receiving end of praise.
The difficulty in accepting praise is the result of conflicting ideas. If you have a low opinion of yourself, the idea of someone thinking highly of you will conflict with that belief creating what is known as cognitive dissonance — mental discomfort. One of the most powerful weapons against the aversion to compliments is to change your self-talk. When you change the way you speak about yourself, it will reprogram your subconscious to see you in a different light, making it easier to accept compliments and embrace them.
Start by giving yourself compliments in the mirror. Keep doing this each day until the discomfort is greatly diminished. It is about repetition, not comfort. It will not be comfortable at first, but you must continue to do it daily.
Next, ask people if they like your shoes, new haircut, or your brand-new gas grill. People will almost always say they do. Enjoy the compliments. Using this methodology is a simple but effective way to solicit positive compliments.
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Overly sensitive to criticism. On the other hand, those with low self-esteem can’t handle criticism either. They tend to overreact and to take criticism too personally.
Even constructive criticism isn’t received positively. Do you bristle when someone offers a helpful suggestion for improvement? If so, your lack of self-esteem might be the reason. It would be best if you learned to see constructive criticism as an instrument of growth.
Ask someone for advice about how you could improve how you currently do something. Then, thank them for it and make good use of their feedback. Constructive criticism is simply feedback to be used for the purpose of intentional growth.
Fear of failure. Low self-esteem and avoidance are commonly found together. Those with low self-esteem expect to fail, and who is going to try to do something if they expect failure? Failure is inevitable at a foundational level. The idea is not to avoid failure but to learn from it. Those who are successful in the world are the ones who are able to take away key learning points from their failures. You will not successfully circumvent the challenges and vicissitudes in this life, leading to setbacks, disappointments, and delays. Your focus must be on how you will grow through them.
Do things that will likely result in failure and realize that it isn’t so bad. Apply for jobs you have little hope of landing. Ask a stranger out for coffee. The goal is not to become content with failure but to mitigate the aversion to it that paralyzes you.
People-pleasing behavior. While compliments are hard to handle, who doesn’t like the gratitude of others? When people show appreciation to someone with low self-esteem, that appreciation is soaked up like a dry sponge soaks up water. People-pleasing is done to feel a sense of value and worth. One of the problems of being a people-pleaser is that you are more at risk of being manipulated and exploited. You will also tend to lose yourself in other people’s worlds while losing your own sense of self.
Do what needs to be done without trying so hard to make others happy. Do something that makes YOU happy.
That doesn’t mean you shouldn’t consider the negative impact your words or actions can have on other people.
Difficulty prioritizing your own needs. When you think you don’t matter, you put everyone else above and ahead of yourself. If you’re regularly getting the short end of the stick, ask yourself why you continue to allow it to happen.
Put yourself first for a change. That doesn’t mean you have to take advantage of anyone. Think about what would be best for you and your life and give that a try for a while.
A lack of boundaries. People with high self-esteem have boundaries that they enforce religiously but calmly. If people are walking all over you and disregard any boundaries you attempt to enforce; your self-esteem might need a little work. A person with healthy self-esteem knows where to draw the line and will consistently enforce those boundaries.
Begin by saying “no” more often. Prioritize your time and your life by turning down requests that don’t fit in with your plans or are too burdensome.
Critical self-talk. Do you speak kindly to yourself, or are you hard on yourself? People with a healthy level of self-esteem tend to be kind and encouraging to themselves. Those with low self-esteem tend to be much more critical.
Monitor your self-talk and stop yourself when you speak poorly to yourself. Compliment yourself each time you catch yourself being negative toward yourself. This approach is not about being dishonest in your self-assessments but being more positive in how you approach and speak about them.
Underachieving. Does everyone consider you to be an underachiever? Being an underachiever is another sign that you likely don’t value yourself as much as you should.
Seek to improve some part of your life each day, even if it’s only in a small way. The goal is to ensure that you take action every day, no matter how seemingly insignificant that action may seem.
Difficulty giving an opinion even when asked. When your self-esteem is low, you think that your opinions don’t matter. You also want to avoid having your opinions judged by others, so you keep them to yourself.
Give your opinion whenever asked. See what happens. No matter what, there will always be those who disagree with you, or fail to see the value in your contribution. You cannot allow your efforts to be abated by the opinions of others.
Low self-esteem is common, but that doesn’t mean it’s normal. Recognize the signs of low self-esteem in yourself and your children and do something about it. Low self-esteem is extremely limiting.
Raising self-esteem is a great gift to give yourself and the ones you love.
Take advantage of the chance to work with Dr. Wallace one-on-one. Sign up for the 30-Day Holistic Transformation.
7 Common Lies to Stop Telling Yourself to avoid accountability and justify mediocrity and inactivity.
7 Common Lies to Stop Telling Yourself ~ We lie to ourselves each day. We tell ourselves that we’re going to start eating perfectly on Monday. We’re going to start a blog on January 1st. We blame our parents for our current financial mess even though we haven’t lived with our parents for the last 20 years. We live in a culture in which accountability is shunned.
Maybe we believe if we only had a swimming pool, we’d finally be happy, and that happiness would last forever.
The lies you tell yourself are the most damaging lies of all:
I’ll be able to pay it off next month, so it’s okay if I buy it now. Using debt to purchase anything is a serious matter. It’s easy to convince yourself that you’ll brown-bag your lunch for the next month or that you won’t go out for 30 days. However, we rarely seem to stick to these promises.
Debt has tremendous potential to snowball. Avoid using debt as much as possible.
I’ll start on Monday. Whether it’s a diet, a budget, an exercise plan, or any other undertaking, it’s a lie to tell yourself that you’ll start on Monday. Of course, Monday might not be your day of choice. Some people really prefer the first of the month or the first of the year.
If it’s worth doing at all, it’s worth starting right now. The adage “never put off for tomorrow what can be done today” has excellent validity. If it is worth doing, it is worth doing today. Putting something off for another time in the future is a form of procrastination.
It’s all my parents’ fault. There’s no doubt that some parents are lousy at the job of parenting. But you’ve had plenty of opportunities to put your life back on track. When you blame your present situation on the past, you limit your future. There is plenty you can do today to make your life better. Regardless of what your parents have done, you are going to have to own your destiny at some point.
If I just had _____, everything would be perfect. Once you have the money, body, job, or whatever else you think you need to have a “perfect” life, you’ll likely find something else that you have to have. There’s always another thing waiting behind the thing you currently want. You set yourself up for disappointment and despair when set finite declarations on your happiness and fulfillment. Both happiness and fulfillment are progressive journeys that last a lifetime. You must develop a lucid perspicacity of personal development so that you learn how to celebrate the process as much as reaching the milestone.
I’m different from everyone else. A lot of people believe there’s something wrong with them. And it’s not just something wrong with them; it’s something uniquely wrong with them.
Everyone is unique, but the similarities between people are far greater than the differences. You’re not that different, and it’s unlikely there’s anything wrong with you that can’t be managed. There is nothing that you will encounter that has not already been conquered by someone else. It may look a bit different in your situation, but the principal components will be the same. You should know that if someone else has done it, so can you.
It’s too late for me. For some things, it might be too late. But it’s not too late for a lot of things. Waiting longer than you should have can make a lot of things less convenient, but that’s not the same as being too late. It just means you’re going to have to work harder or endure more inconvenience.
There’s a penalty for waiting, but it’s rarely insurmountable. Did you know that 99 percent of Warren Buffet’s wealth was accumulated after his 50th birthday? You will have to be more committed, and you have less time to waver and waste time, but you can get it done.
The timing isn’t right. The timing is never right, and it’s never going to be right. Do it now while you can. Each day that you wait is another day of delay. You’re not going to live forever, and life never follows your plans anyway. Just do it. There is no such thing as perfect timing. The ideal time to start is the moment you know it needs to be done. Every second that you delay starting is a second wasted. You have 86,400 seconds in each day. How you use those seconds will directly impact your destiny and the outcomes in your life.
We lie to ourselves to make us feel better. Telling ourselves that we’ll start losing weight on the 1st of the month puts our minds at ease and allows us to eat poorly until that start date. We blame others for our challenges, so we can convince ourselves that it isn’t our fault. The word of the day is accountability
The lies you tell yourself make you your own worst enemy and stop you from making progress in your life. Be honest with yourself and give yourself a chance.
Are you an early bird? If so, good for you! If you’re not, you might want to consider trying out a new schedule. There are a lot of advantages to being an early riser.
Studies show that early birds are more productive and healthier.
It’s a great way to live. All you have to do is get up a couple of hours earlier. The benefits are worth the momentary discomfort each morning.
It’s healthier. Research finds that the sleep patterns of those that get up early are healthier. You might live longer by being an early bird. Spending less money on medical care is another bonus. I will not get into the details here: however, a wealth of pragmatic and empirical data illuminate the fact that early risers tend to live healthier lives.
It’s more natural. Most animals are active during daylight hours and asleep while it’s dark. We don’t see well in the dark, so we’re clearly not designed to be active at night. Darkness trigger the brain to release melatonin, which helps to promote healthy sleep.
You’ll be thinner. On average, early birds are leaner than night owls. Maybe it’s the late-night snacking that many night owls like to do. In addition to late-night snacking, those up during late hours are far less active than their daytime counterparts.
You’re more focused. There are fewer distractions early in the morning. You can get more done by having a greater level of focus. There’s no one around to intrude on your time. You get a jump on your day.
You’re in good company.The majority of highly successful people are early birds. You might become more successful if you wake up earlier and get started on your day. While there are always exceptions to the rule, most of the world’s most successful people are early risers. Harvard Biologist Christoph Randler discovered that early risers are more proactive. They are also more likely to anticipate problems and minimize them efficiently, which leads to more success, especially in the business world. A proactive mindset leads to increased productivity because you’re not standing by waiting to be told what to do next or how to handle a challenge. Instead, you’re anticipating needs, getting curious, and building confidence.[1]
You can enjoy the morning. When you have a few hours before you need to leave for work, you can take your time and enjoy the morning. See the sunrise. Listen to the birds. Enjoy a cup of coffee without being rushed. Relax while everyone else is rushing to get ready for work. You can prepare mentally, emotionally, and spiritually.
You get more accomplished. You could use the extra time to learn the guitar, read, write, exercise, journal, or get started on your work for the day. Studies show that early risers are significantly more productive.
Most people don’t accomplish much after 6:00 pm, so early risers have a day that is effectively longer. The night owls might spend as many hours awake, but more of their hours are spent on less productive activities. The early birds are sleeping while the night owls are playing.
You build willpower. It’s not easy to get up when you know you have time to sleep for another hour or three. It can be a bit of a challenge to get up earlier than necessary each day. However, you can apply the willpower you develop to other aspects of your life. A more effective word to use here would be self-discipline. Most people don’t need motivation or inspiration. What they need Is self-discipline.
You’re more confident. Knowing that you have a big head start on most of the rest of the people in the world can make you feel a little smug. You can be a couple hours ahead of your coworkers while they’re still brushing their teeth. In an increasingly competitive environment, you need all of the advantages possible.
Some of those coworkers will likely be working for you someday soon.
If you’re not someone that naturally likes to get up in the morning, there’s still hope. The key is to alter your bedtime and wake-up time a little at a time. Fifteen minutes each day is doable and sustainable. Or you could adjust by 15 minutes and keep that schedule for a week. The next week, add another 15 minutes. And so on.
Shifting your schedule to a couple of hours earlier will change your life in so many positive ways.
Consider how you spend the last two hours of your evening with your current schedule. Those hours might be fun, but they’re probably not productive. Imagine adding two hours of productivity, enjoyment, and reflection into each day of your life.
There are so many advantages to being an early riser that it would likely benefit you to give it a try. Avoid assuming that it would never work for you. You might be pleasantly surprised!
References
Garnett, L. (2021, July 25). The Scientific Reason Why Being A Morning Person Will Make You More Successful: The early bird catches more than the worm. Inc.com.
Thompson, D. (2021). Who Lives Longer — Night Owls or Early Birds? WebMD.
You Are Built for This! Your Current Reality Is Simply the Result of What You Chose to Focus On!
You are built for this. It is actually very simple; what you focus on is what you will feel. A great deal of our suffering is self-induced. We have trained ourselves to focus on the negative. We have an insatiable appetite for negativity. It has become increasingly easier to complain than to shift our focus and take action.
Yes, everyone has been through a situation where someone wronged them. Some of us have scars that run deep. Here is what I can tell you: The top tier of performers is full of people bearing scars. The scars don’t disqualify you from excelling. If anything they have prepared you to excel.
Here is where the problem lies, you are confusing fault with responsibility. Because what you went through was someone else’s fault, you think it is someone else responsibility to change your condition. Let’s be clear, despite what you have been told; life is not fair. In fact, life can be rather cruel if you don’t learn how to move on your own behalf and make decisions and take actions that benefit you. Your health is your responsibility. Your happiness is your responsibility. Your condition is your responsibility. Someone else may have put you there, but it is your responsibility, and your responsibility alone, to work your way out.
Stop waiting on someone to save you and save yourself. God equipped you with everything you need to overcome every challenge you will ever face. You are built for the battle. Stop looking for a free ride. Invest in yourself, or no one else will.
You are going to be the determining factor in whether or not you make it to your desired destination — not your haters, not your detractors, not bad luck, nor misfortune. If you work on yourself, none of those things can stop you.
The question is: How bad do you want it?
Are you willing to fight for it? Are you prepared to work day and night for it? Are you ready to confront the fear that is pushing against your desires? Are you prepared to go the distance? Are you willing to withstand the vicissitudes of life that are guaranteed to roll into your paradise just when you thought things were finally settling into place?
Secondly, protect your periphery — your circle — from energy vampires that seek to suck the life out of your dreams and desires. There are people out there who have made it their life’s work to tell others why they can’t do something. Protect your energy with every ounce of your being. Energy is the currency of the universe, don’t spend it on things that produce no return.
I told a client just last week that they were not obligated to give space to anyone who had not proven themselves worthy. Your spirit is an energetic presence; thereby, it is highly susceptible to the influence of the energy of others.
For your spirit to produce high vibrational energy on a consistent basis, it has to be free of toxic matter, which means it must be kept pure of low-vibrational influences like jealousy, envy, hatred, anger, bitterness, self-loathing, ungratefulness, and more.
Not everyone in your periphery means you well, and even those who do may lack the capacity to be a positive influence. It is your responsibility to protect your space and monitor those in your spacial and figurative periphery. You must take an inexorable and direct approach to build a pure and powerful circle. ~ Rick Wallace, Ph.D., Psy.D.
Free to BE Me Affirmation ~ I am free of the need to compare myself to others.
Free to BE Me Affirmation: I am my own person and comfortable in my own skin. I am happy with who I am and with what I am accomplishing. I appreciate others, but I avoid comparing myself to them. I do the best I can and enjoy my life to the fullest.
I know that everyone is different, so comparisons between people are foolish. The only competition I engage in is that between myself and my potential.
Therefore,I seek to be better than yesterday, last week, last month, or last year. I simply compare myself to my previous self in search of my potential self.
I am excited by seeing progress in my life. I live my life in a way that allows me to experience regular improvement. My push toward personal growth is intentional.
I am free of worrying about what others think of me. The opinions of others are their business. I focus on living up to my own standards.
I avoid judging others and ignore their judgments of me.
Comparing myself to others is insulting and injurious to myself. I am at my best when I focus on myself instead of on the results and opinions of others.
Today, I live my life my way and allow others to do the same. I strive to be better than yesterday and hope that others are doing the same. I am free of the need to compare myself to them. My focus is on my actions and my results. I live to be the version of myself!
Self-Reflection Questions:
What happens to my emotions and my effort when I compare myself to others? Is it useful?
Why do I feel the need to compare myself to other people?
Why is it unwise to make comparisons to other people?
Vision Boards: Why They Work and How to Create One
Everyone has heard of a vision board, but many people aren’t entirely clear on what one is or what it can do for them. A vision board is a visualization and reminder tool consisting of images, affirmations, and quotes that can inspire, motivate and encourage action.
Many people find vision boards a valuable tool in their quest to be successful and realize their dreams.
A vision board provides essential benefits, such as:
Motivation. A vision board is an easy, fast and effective way to boost motivation. Once a vision board is constructed, a quick glance can regenerate positive feelings and motivation instantly.
Take care in creating your vision board. The right vision board for you will generate positive feelings in you.
Focus. A vision board is a convenient reminder of what you’re trying to accomplish. Many people lose track of their goals before any significant progress is made. Vision boards serve as a constant reminder of your most important objectives.
When you create a vision board and place it in a space where you see it often, you do short visualization & goal-setting exercises throughout the day. You may not even realize you’re doing it. Seeing a constant visual reminder of your goals is how your subconscious mind stays focused on your goals.
A lack of financial literacy is the leading cause of perpetual financial strain!
Use these methods to create a compelling and exciting vision board:
Set your goals. A vision board requires a specific intention. If you don’t know what your intention is, it’s not possible to make an effective vision board. Be crystal clear on what you want to accomplish. This is the first step.
View the vision boards of others. There are so many different style designs and ideas, you’re certain to be inspired by viewing the vision boards of others. There are plenty of photos online that can spark your creativity.
Decide on a format. You could dedicate an entire wall to your vision. Or make a traditional poster. Perhaps a bulletin board is more your style.
There are even websites that provide vision board tools. With this option, you’ll be able to view your vision board from anywhere in the world.
Find pictures that represent your goals. A vision board is visual, so you’re going to need some photos, drawings, or paintings that represent your goals. Again, the internet is the easiest way to go if you have a printer up to the task. Otherwise, you’ll have to go old school and cut up magazines or use photos.
Pictures that don’t elicit an emotional response will have a limited impact. Choose wisely.
Choose words, quotes, or slogans. It can be effective to include text in your vision board. Certain words and quotes can also elicit strong emotions.
Organize everything. Do you like everything neat and lined up? Do you prefer the look of a collage? It’s up to you. Lay your vision board out a few different ways and choose what feels the best to you.
How to use a vision board effectively:
Look at your vision board at least twice each day. Just a few minutes is perfectly fine. Clear your mind and focus on the images and words that you’ve chosen to represent your objectives.
Visualize achieving those things. Imagine how great it will feel to finally have those items, experiences, and achievements in your life.
Add items that appeal to you. As the days pass, you’ll have new ideas and come across new pictures and text that you’ll want to add to your vision board. Do it! This is a process and not a one-time event.
List action steps you’ve identified as most effective. A vision board is motivating, but it’s insufficient when it comes to changing your life. The actions you take are ultimately what matters. Identify the actions that will make your vision board a reality and do them!
A vision board can be a powerful tool for bringing positive change to your life. A vision board is highly motivating and focuses your attention on what you want. Anyone can use this powerful tool to experience more success in life.
Attachment Theory in Relationships ~ What Is Your Attachment Style?
Attachment Theory in Relationships: Have you ever jumped from relationship to relationship every few months, wondering why you can’t find the perfect partner? Or maybe you’ve been left wondering why the partners you choose are always emotionally unavailable.
What if you knew that your relationship choices and the way you attach to others had been established since you were in the womb?
Attachment theory identifies the way you relate to and depend on others. Attachment theory also shows the patterns of how we show up in our relationships.
How does the way you attach to others affect your relationships today?
Although there is a lot of nuance and variability that goes into defining your individual attachment style, there are three general styles of attachment:
Avoidant. People with this attachment style see intimacy as a loss of independence. Because they see dependence or needing others as a weakness, they subconsciously tend to find fault in their relationships. Avoidants want to be close but push potential partners away as a means of protecting themselves.
Shift your belief: sharing experiences and closeness with others can bring happiness and meaning to your life.
Anxious. People with this attachment style crave physical and emotional closeness. Because they fear they are not good enough, they often worry about being betrayed or left by their partner. Being pushed away by their partner can make these people more anxious and increase their clinginess.
Shift your belief: you are good enough.
Secure. People with this attachment style are comfortable with intimacy. They are reliable, trustworthy, and consistent partners who know how to communicate expectations and respond to their partner’s needs.
Studies show secure attachment style indicates greater happiness and satisfaction in your relationships.
Do you identify with an anxious or avoidant attachment style? Research today shows that you are not cemented into that attachment style for life. Neuroplasticity is a little-known area of science that reveals that our brains are not hardwired in a way that we are locked into our personalities and behaviors for life. Studies into neuroplasticity reveal we are creating new neuro-synaptic connections in our brain every time we encounter new information. Therefore, you are not locked into your current attachment style.
You can make a conscious effort to have a secure attachment style. They are not necessarily set in stone.
If you are anxious or avoidant, you can take steps to have more fulfilling relationships and move towards a secure attachment style with greater fulfillment in your relationships.
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Merging Souls: Healing, Hope & Restoration in Modern Marriage
Consider these steps for more fulfilling relationships:
Understand what you need in a relationship. Make an effort to understand your needs. Learn to communicate and express them.
If you are avoidant, avoid talking down about your partner. Instead, tune in to what you need from the relationship.
If you are anxious, think about what you need and be able to communicate it.
Be in tune to when your attachment system might be activated. If you have an avoidant or anxious attachment style, you might confuse love with anxiety. Learn to associate love with feeling calm.
Make yourself available to your partner. Be reliable, consistent, and trustworthy. Check in with your partner regularly. Be a reliable rock your partner can turn towards.
Set aside time to communicate about how you feel in the relationship. How can you and your partner support each other? What do you need to be happy in the relationship?
Encourage your partner. Be the support net for your partner. Encourage and empower them in their goals and dreams.
Be willing to walk away if your partner cannot meet your needs. It takes two to tango. If you and your partner cannot come to a compromise to meet each other’s needs, it might indicate that you are incompatible.
Understanding your attachment style can help give you insight into how to have deeper and more fulfilling relationships.
When you take steps to understand what you need in a relationship and communicate how you feel regularly, both partners can feel secure and supported.
Relationships are a fulfilling part of life, and it helps to know you have someone encouraging on whom you can depend.
To learn how you can use neuroplasticity to help change or improve your attachment style, email LifeChange@rickwallacephd.link
The Ritualistic Path to Taming Anxiety is a powerful tool used to help manage anxiety at multiple levels. Many athletes are superstitious. They wear lucky socks or carry around a special bottle cap to help them win a match.
It may sound silly, but there’s some science to back up their habits. Research shows that rituals can be useful for soothing anxiety. That’s important because stress feels uncomfortable and hampers your performance. Developing a winning routine does not only help as it pertains to sports. Developing a positive routine can help ease stress, fear, and anxiety in any area in life.
At the same time, these repetitive actions can cause new troubles if they become excessive. Learn more about how to create your own safe and effective rituals that empower you.
Using Rituals to Relieve Anxiety
Whistling and flipping coins can help you to feel more in control. However, you may want to choose rituals that carry more meaning and deliver positive side effects.
Try these strategies:
Clear away clutter. Putting your surroundings in order is doubly beneficial. Moving around will make you feel calmer and your tidy desk and kitchen will help you stay peaceful.
Do housework. If you have more energy and time, move on to dusting and mopping. Rhythmic activities are especially comforting. You may even save money by doing your own chores instead of hiring a housekeeper.
Listen to music. Create playlists that work for you. You may prefer piano sonatas or country music. Singing and dancing help too.
Pet your dog. Studies show that interacting with animals promotes healing and lowers your blood pressure. Walk a neighbor’s dog or hug a stuffed animal if you don’t have any pets.
Check your posture. Take a deep breath and stand up straight. Your body will relax, and you’ll boost your circulation.
Dress up. Many rituals involve clothing because your appearance can affect your thinking. You may want to wear suspenders or any clothing that is comfortable and flattering.
Taking Practical Action for Anxiety
Your plaid socks won’t carry you to victory unless you know how to play baseball in the first place. It’s most beneficial to use rituals in moderation and combine them with practical action.
These activities enable you to take positive actions:
Accept your feelings. Trying to suppress your emotions can backfire. Allow yourself to feel nervous or confused.
Reframe your thoughts. You can shift your mindset while you validate your feelings. Imagine that you’re excited rather than anxious. Look for the positive aspects within any challenge.
Practice self-care. Cultivating your mental and physical health will make you stronger and more resilient. Eat a nutritious diet and exercise regularly. Sleep well and manage stress.
Work out. Physical activity is especially constructive for dealing with anxiety. Visit your local fitness center or set up a gym at home. Schedule a morning run or swim before a busy day. Do a few minutes of pushups or stretches after a difficult phone call.
Make time for reflection and prayer. Spirituality can help you transform obstacles into steppingstones for personal growth. Read scriptures connected with your religion or find poems and quotations that inspire you.
Keep a journal. Writing, drawing, and other creative activities help you to handle tension effectively. Use a journal to process your feelings and identify patterns that you want to change. You might want to explore other arts and crafts too.
Consider counseling. What if your anxiety is severe or you become so dependent on your rituals that they start to interfere with your daily life? Professional help is available. Talk therapy and medication may help you treat your symptoms and enjoy life more.
Put rituals to work for you when you’re dealing with an uncertain or challenging situation. Used wisely, they can restore your peace of mind and help you achieve the results you want.
A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities.
Objective:
To estimate the length of the incubation period of COVID-19 and describe its public health implications.
Design:
Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020.
Setting:
News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China.
Participants:
Persons with confirmed SARS-CoV-2 infection outside Hubei province, China.
Measurements:
Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization.
Results:
There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.
Limitation:
Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases.
Conclusion:
This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.
Primary Funding Source:
U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.Go to:
The Incubation Period of COVID-19 From Publicly Reported Confirmed Cases
Using news reports and press releases from provinces, regions, and countries outside Wuhan, Hubei province, China, this analysis estimates the length of the incubation period of coronavirus disease 2019 (COVID-19) and its public health implications.
In December 2019, a cluster of severe pneumonia cases of unknown cause was reported in Wuhan, Hubei province, China. The initial cluster was epidemiologically linked to a seafood wholesale market in Wuhan, although many of the initial 41 cases were later reported to have no known exposure to the market (1). A novel strain of coronavirus belonging to the same family of viruses that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), as well as the 4 human coronaviruses associated with the common cold, was subsequently isolated from lower respiratory tract samples of 4 cases on 7 January 2020 (2). Infection with the virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can be asymptomatic or can result in mild to severe symptomatic disease (coronavirus disease 2019 [COVID-19]) (3). On 30 January 2020, the World Health Organization declared that the SARS-CoV-2 outbreak constituted a Public Health Emergency of International Concern, and more than 80 000 confirmed cases had been reported worldwide as of 28 February 2020 (4, 5). On 31 January 2020, the U.S. Centers for Disease Control and Prevention announced that all citizens returning from Hubei province, China, would be subject to mandatory quarantine for up to 14 days (6).
Our current understanding of the incubation period for COVID-19 is limited. An early analysis based on 88 confirmed cases in Chinese provinces outside Wuhan, using data on known travel to and from Wuhan to estimate the exposure interval, indicated a mean incubation period of 6.4 days (95% CI, 5.6 to 7.7 days), with a range of 2.1 to 11.1 days (7). Another analysis based on 158 confirmed cases outside Wuhan estimated a median incubation period of 5.0 days (CI, 4.4 to 5.6 days), with a range of 2 to 14 days (8). These estimates are generally consistent with estimates from 10 confirmed cases in China (mean incubation period, 5.2 days [CI, 4.1 to 7.0 days] [9]) and from clinical reports of a familial cluster of COVID-19 in which symptom onset occurred 3 to 6 days after assumed exposure in Wuhan (1). These estimates of the incubation period of SARS-CoV-2 are also in line with those of other known human coronaviruses, including SARS (mean, 5 days; range, 2 to 14 days [10]), MERS (mean, 5 to 7 days; range, 2 to 14 days [11]), and non-SARS human coronavirus (mean, 3 days; range, 2 to 5 days [12]).
The incubation period can inform several important public health activities for infectious diseases, including active monitoring, surveillance, control, and modeling. Active monitoring requires potentially exposed persons to contact local health authorities to report their health status every day. Understanding the length of active monitoring needed to limit the risk for missing SARS-CoV-2 infections is necessary for health departments to effectively use limited resources. In this article, we provide estimates of the incubation period of COVID-19 and the number of symptomatic infections missed under different active monitoring scenarios.
We searched for news and public health reports of confirmed COVID-19 cases in areas with no known community transmission, including provinces, regions, and countries outside Hubei. We searched for reports in both English and Chinese and abstracted the data necessary to estimate the incubation period of COVID-19. Two authors independently reviewed the full text of each case report. Discrepancies were resolved by discussion and consensus.
For each case, we recorded the time of possible exposure to SARS-CoV-2, any symptom onset, fever onset, and case detection. The exact time of events was used when possible; otherwise, we defined conservative upper and lower bounds for the possible interval of each event. For most cases, the interval of possible SARS-CoV-2 exposure was defined as the time between the earliest possible arrival to and latest possible departure from Wuhan. For cases without history of travel to Wuhan but with assumed exposure to an infectious person, the interval of possible SARS-CoV-2 exposure was defined as the maximum possible interval of exposure to the infectious person, including time before the infectious person was symptomatic. We allowed for the possibility of continued exposure within known clusters (for example, families traveling together) when the ordering of transmission was unclear. We assumed that exposure always preceded symptom onset. If we were unable to determine the latest exposure time from the available case report, we defined the upper bound of the exposure interval to be the latest possible time of symptom onset. When the earliest possible time of exposure could not be determined, we defined it as 1 December 2019, the date of symptom onset in the first known case (1); we performed a sensitivity analysis for the selection of this universal lower bound. When the earliest possible time of symptom onset could not be determined, we assumed it to be the earliest time of possible exposure. When the latest time of possible symptom onset could not be determined, we assumed it to be the latest time of possible case detection. Data on age, sex, country of residence, and possible exposure route were also collected.
Statistical Analysis
Cases were included in the analysis if we had information on the interval of exposure to SARS-CoV-2 and symptom onset. We estimated the incubation time using a previously described parametric accelerated failure time model (13). For our primary analysis, we assumed that the incubation time follows a log-normal distribution, as seen in other acute respiratory viral infections (12). We fit the model to all observations, as well as to only cases where the patient had fever and only those detected inside or outside mainland China in subset analyses. Finally, we also fit 3 other commonly used incubation period distributions (gamma, Weibull, and Erlang). We estimated median incubation time and important quantiles (2.5th, 25th, 75th, and 97.5th percentiles) along with their bootstrapped CIs for each model.
Using these estimates of the incubation period, we quantified the expected number of undetected symptomatic cases in an active monitoring program, adapting a method detailed by Reich and colleagues (14). We accounted for varying durations of the active monitoring program (1 to 28 days) and individual risk for symptomatic infection (low risk: 1-in-10 000 chance of infection; medium risk: 1-in-1000 chance; high risk: 1-in-100 chance; infected: 1-in-1 chance). For each bootstrapped set of parameter estimates from the log-normal model, we calculated the probability of a symptomatic infection developing after an active monitoring program of a given length for a given risk level. This model conservatively assumes that persons are exposed to SARS-CoV-2 immediately before the active monitoring program and assumes perfect ascertainment of symptomatic cases that develop under active monitoring. We report the mean and 99th percentile of the expected number of undetected symptomatic cases for each active monitoring scenario.
All estimates are based on persons who developed symptoms, and this work makes no inferences about asymptomatic infection with SARS-CoV-2. The analyses were conducted using the coarseDataTools and activemonitr packages in the R statistical programming language, version 3.6.2 (R Foundation for Statistical Computing). All code and data are available at https://github.com/HopkinsIDD/ncov_incubation (release at time of submission at https://zenodo.org/record/3692048) (15).
Role of the Funding Source
The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious Diseases, the National Institute of General Medical Sciences, and the Alexander von Humboldt Foundation. The funders had no role in study design, data collection and analysis, preparation of the manuscript, or the decision to submit the manuscript for publication.Go to:
Results
We collected data from 181 cases with confirmed SARS-CoV-2 infection detected outside Hubei province before 24 February 2020 (Table 1). Of these, 69 (38%) were female, 108 were male (60%), and 4 (2%) were of unknown sex. The median age was 44.5 years (interquartile range, 34.0 to 55.5 years). Cases were collected from 24 countries and regions outside mainland China (n = 108) and 25 provinces within mainland China (n = 73). Most cases (n = 161) had a known recent history of travel to or residence in Wuhan; others had evidence of contact with travelers from Hubei or persons with known infection. Among those who developed symptoms in the community, the median time from symptom onset to hospitalization was 1.2 days (range, 0.2 to 29.9 days) (Figure 1).Open in a separate windowFigure 1.
SARS-CoV-2 exposure (blue), symptom onset (red), and case detection (green) times for 181 confirmed cases.
Shaded regions represent the full possible time intervals for exposure, symptom onset, and case detection; points represent the midpoints of these intervals. SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
Table 1. Characteristics of Patients With Confirmed COVID-19 Included in This Analysis (n = 181)*
Fitting the log-normal model to all cases, we estimated the median incubation period of COVID-19 to be 5.1 days (CI, 4.5 to 5.8 days) (Figure 2). We estimated that fewer than 2.5% of infected persons will show symptoms within 2.2 days (CI, 1.8 to 2.9 days) of exposure, and symptom onset will occur within 11.5 days (CI, 8.2 to 15.6 days) for 97.5% of infected persons. The estimate of the dispersion parameter was 1.52 (CI, 1.32 to 1.72), and the estimated mean incubation period was 5.5 days.Figure 2.
Cumulative distribution function of the COVID-19 incubation period estimate from the log-normal model.
The estimated median incubation period of COVID-19 was 5.1 days (CI, 4.5 to 5.8 days). We estimated that fewer than 2.5% of infected persons will display symptoms within 2.2 days (CI, 1.8 to 2.9 days) of exposure, whereas symptom onset will occur within 11.5 days (CI, 8.2 to 15.6 days) for 97.5% of infected persons. Horizontal bars represent the 95% CIs of the 2.5th, 50th, and 97.5th percentiles of the incubation period distribution. The estimate of the dispersion parameter is 1.52 (CI, 1.32 to 1.72). COVID-19 = coronavirus disease 2019.
To control for possible bias from symptoms of cough or sore throat, which could have been caused by other more common pathogens, we performed the same analysis on the subset of cases with known time of fever onset (n = 99), using the time from exposure to onset of fever as the incubation time. We estimated the median incubation period to fever onset to be 5.7 days (CI, 4.9 to 6.8 days), with 2.5% of persons experiencing fever within 2.6 days (CI, 2.1 to 3.7 days) and 97.5% having fever within 12.5 days (CI, 8.2 to 17.7 days) of exposure.
Because assumptions about the occurrence of local transmission and therefore the period of possible exposure may be less firm within mainland China, we also analyzed only cases detected outside mainland China (n = 108). The median incubation period for these cases was 5.5 days (CI, 4.4 to 7.0 days), with the 95% range spanning from 2.1 (CI, 1.5 to 3.2) to 14.7 (CI, 7.4 to 22.6) days. Alternatively, persons who left mainland China may represent a subset of persons with longer incubation periods, persons who were able to travel internationally before symptom onset within China, or persons who may have chosen to delay reporting symptoms until they left China. Based on cases detected inside mainland China (n = 73), the median incubation period is 4.8 days (CI, 4.2 to 5.6 days), with a 95% range of 2.5 (CI, 1.9 to 3.5) to 9.2 (CI, 6.4 to 12.5) days. Full results of these sensitivity analyses are presented in Appendix Table 1.
Appendix Table 1. Percentiles of SARS-CoV-2 Incubation Period From Selected Sensitivity Analyses*
We fit other commonly used parameterizations of the incubation period (gamma, Weibull, and Erlang distributions). The incubation period estimates for these alternate parameterizations were similar to those from the log-normal model (Appendix Table 2).
Appendix Table 2. Parameter Estimates for Various Parametric Distributions of the Incubation Period of SARS-CoV-2 Using 181 Confirmed Cases*
Given these estimates of the incubation period, we predicted the number of symptomatic infections we would expect to miss over the course of an active monitoring program. We classified persons as being at high risk if they have a 1-in-100 chance of developing a symptomatic infection after exposure. For an active monitoring program lasting 7 days, the expected number of symptomatic infections missed for every 10 000 high-risk persons monitored is 21.2 (99th percentile, 36.5) (Table 2 and Figure 3). After 14 days, it is highly unlikely that further symptomatic infections would be undetected among high-risk persons (mean, 1.0 undetected infections per 10 000 persons [99th percentile, 4.8]). However, substantial uncertainty remains in the classification of persons as being at “high,” “medium,” or “low” risk for being symptomatic, and this method does not consider the role of asymptomatic infection. We have created an application to estimate the proportion of missed COVID-19 cases across any active monitoring duration up to 100 days and various population risk levels (16).Figure 3.
Proportion of known symptomatic SARS-CoV-2 infections that have yet to develop symptoms, by number of days since infection, using bootstrapped estimates from a log-normal accelerated failure time model.
Table 2. Expected Number of Symptomatic SARS-CoV-2 Infections That Would Be Undetected During Active Monitoring, Given Varying Monitoring Durations and Risks for Symptomatic Infection After Exposure*
We present estimates of the incubation period for the novel coronavirus disease (COVID-19) that emerged in Wuhan, Hubei province, China, in 2019. We estimated the median incubation period of COVID-19 to be 5.1 days and expect that nearly all infected persons who have symptoms will do so within 12 days of infection. We found that the current period of active monitoring recommended by the U.S. Centers for Disease Control and Prevention (14 days) is well supported by the evidence (6). Symptomatic disease is frequently associated with transmissibility of a pathogen. However, given recent evidence of SARS-CoV-2 transmission by mildly symptomatic and asymptomatic persons (17, 18), we note that time from exposure to onset of infectiousness (latent period) may be shorter than the incubation period estimated here, with important implications for transmission dynamics.
Our results are broadly consistent with other estimates of the incubation period (1, 7–9). Our analysis, which was based on 181 confirmed COVID-19 cases, made more conservative assumptions about the possible window of symptom onset and the potential for continued exposure through transmission clusters outside Wuhan. Of note, the use of fixed times of symptom onset, as used in 3 of the 4 prior analyses, will truncate the incubation period distribution by either decreasing the maximum possible incubation period (if the earliest possible time of symptom onset is used) or increasing the minimum possible incubation period (if the midpoint or latest possible time of symptom onset is used). Therefore, using a symptom onset window more accurately accounts for the full distribution of possible incubation periods.
Although our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, longer monitoring periods might be justified in extreme cases. Among those who are infected and will develop symptoms, we expect 101 in 10 000 (99th percentile, 482) will do so after the end of a 14-day monitoring period (Table 2 and Figure 3), and our analyses do not preclude this estimate from being higher. Although it is essential to weigh the costs of extending active monitoring or quarantine against the potential or perceived costs of failing to identify a symptomatic case, there may be high-risk scenarios (for example, a health care worker who cared for a COVID-19 patient while not wearing personal protective equipment) where it could be prudent to extend the period of active monitoring.
This analysis has several important limitations. Our data include early case reports, with associated uncertainty in the intervals of exposure and symptom onset. We have used conservative bounds of possible exposure and symptom onset where exact times were not known, but there may be further inaccuracy in these data that we have not considered. We have exclusively considered reported, confirmed cases of COVID-19, which may overrepresent hospitalized persons and others with severe symptoms, although we note that the proportion of mild cases detected has increased as surveillance and monitoring systems have been strengthened. The incubation period for these severe cases may differ from that of less severe or subclinical infections and is not typically an applicable measure for those with asymptomatic infections.
Our model assumes a constant risk for SARS-CoV-2 infection in Wuhan from 1 December 2019 to 30 January 2020, based on the date of symptom onset of the first known case and the last known possible exposure within Wuhan in our data set. This is a simplification of infection risk, given that the outbreak has shifted from a likely common-source outbreak associated with a seafood market to human-to-human transmission. Moreover, phylogenetic analysis of 38 SARS-CoV-2 genomes suggests that the virus may have been circulating before December 2019 (19). To test the sensitivity of our estimates to that assumption, we performed an analysis where cases with unknown lower bounds on exposure were set to 1 December 2018, a full year earlier than in our primary analysis. Changing this assumption had little effect on the estimates of the median (0.2 day longer than for the overall estimate) and the 97.5th quantile (0.1 day longer) of the incubation period. In data sets such as ours, where we have adequate observations with well-defined minimum and maximum possible incubation periods for many cases, extending the universal lower bound has little bearing on the overall estimates.
This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Assuming infection occurs at the initiation of monitoring, our estimates suggest that 101 out of every 10 000 cases will develop symptoms after 14 days of active monitoring or quarantine. Whether this rate is acceptable depends on the expected risk for infection in the population being monitored and considered judgment about the cost of missing cases (14). Combining these judgments with the estimates presented here can help public health officials to set rational and evidence-based COVID-19 control policies.Go to:
Biography
•
Acknowledgment: The authors thank all who have collected, prepared, and shared data throughout this outbreak. They are particularly grateful to Dr. Kaiyuan Sun, Ms. Jenny Chen, and Dr. Cecile Viboud from the Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health; Dr. Moritz Kraemer and the open COVID-19 data working group; and the Johns Hopkins Center for Systems Science and Engineering.
Grant Support: By the U.S. Centers for Disease Control and Prevention (NU2GGH002000), the National Institute of Allergy and Infectious Diseases (R01 AI135115), the National Institute of General Medical Sciences (R35 GM119582), and the Alexander von Humboldt Foundation.
Disclosures: Dr. Lauer reports grants from the National Institute of Allergy and Infectious Diseases and the U.S. Centers for Disease Control and Prevention during the conduct of the study. Ms. Grantz reports a grant from the U.S. Centers for Disease Control and Prevention during the conduct of the study. Dr. Reich reports grants from the National Institute of General Medical Sciences and the Alexander von Humboldt Foundation during the conduct of the study. Dr. Lessler reports a grant from the U.S. Centers for Disease Control and Prevention during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0504.
Editors’ Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Justin Lessler, PhD, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205; e-mail, justin@jhu.edu.
Current Author Addresses: Drs. Lauer, Meredith, and Lessler; Ms. Grantz; Ms. Bi; Mr. Jones; and Ms. Zheng: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205.
Dr. Azman: Médecins Sans Frontières, Rue de Lausanne 72, 1202 Genève, Switzerland.
Dr. Reich: Department of Biostatistics and Epidemiology, Amherst School of Public Health and Health Sciences, University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003-9304.
Author Contributions: Conception and design: S.A. Lauer, K.H. Grantz, F.K. Jones, N.G. Reich, J. Lessler.
Analysis and interpretation of the data: S.A. Lauer, K.H. Grantz, Q. Bi, F.K. Jones, N.G. Reich, J. Lessler.
Drafting of the article: S.A. Lauer, K.H. Grantz, Q. Bi, F.K. Jones, A.S. Azman, N.G. Reich.
Critical revision of the article for important intellectual content: Q. Bi, F.K. Jones, A.S. Azman, N.G. Reich, J. Lessler.
Final approval of the article: S.A. Lauer, K.H. Grantz, Q. Bi, F.K. Jones, Q. Zheng, H.R. Meredith, A.S. Azman, N.G. Reich, J. Lessler.
Statistical expertise: Q. Bi, N.G. Reich, J. Lessler.
Collection and assembly of data: S.A. Lauer, K.H. Grantz, Q. Bi, F.K. Jones, Q. Zheng, H.R. Meredith.
This article was published at Annals.org on 10 March 2020.
* Dr. Lauer and Ms. Grantz share first authorship.Go to:
References
1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. [PMID: 31986264] doi:10.1016/S0140-6736(20)30183-5. [PubMed]2. Zhu N, Zhang D, Wang W, et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-733. [PMID: 31978945] doi:10.1056/NEJMoa2001017. [PMC free article] [PubMed]3. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)—China, 2020. China CDC Weekly. 2020;2:113-22. [PubMed]4. World Health Organization. Coronavirus disease 2019 (COVID-19): Situation Report – 38. 27 February 2020. Accessed at www.who.int/docs/default-source/coronaviruse/situation-reports/20200227-sitrep-38-covid-19.pdf?sfvrsn=9f98940c_2. on 28 February 2020.5. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). 30 January 2020. Accessed at https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) on 31 January 2020.6. The White House. Press Briefing by Members of the President’s Coronavirus Task Force. 31 January 2020. Accessed at www.whitehouse.gov/briefings-statements/press-briefing-members-presidents-coronavirus-task-force. on 1 February 2020.7. Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Euro Surveill. 2020;25. [PMID: 32046819] doi:10.2807/1560-7917.ES.2020.25.5.2000062. [PMC free article] [PubMed]8. Linton NM, Kobayashi T, Yang Y, et al. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data. J Clin Med. 2020;9. [PMID: 32079150] doi:10.3390/jcm9020538. [PMC free article] [PubMed]9. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020. [PMID: 31995857] doi:10.1056/NEJMoa2001316. [PubMed]10. Varia M, Wilson S, Sarwal S, et al; Hospital Outbreak Investigation Team. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285-92. [PMID: 12925421] [PMC free article] [PubMed]11. Virlogeux V, Fang VJ, Park M, et al. Comparison of incubation period distribution of human infections with MERS-CoV in South Korea and Saudi Arabia. Sci Rep. 2016;6:35839. [PMID: 27775012] doi:10.1038/srep35839. [PMC free article] [PubMed]12. Lessler J, Reich NG, Brookmeyer R, et al. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis. 2009;9:291-300. [PMID: 19393959] doi:10.1016/S1473-3099(09)70069-6. [PMC free article] [PubMed]13. Reich NG, Lessler J, Cummings DA, et al. Estimating incubation period distributions with coarse data. Stat Med. 2009;28:2769-84. [PMID: 19598148] doi:10.1002/sim.3659. [PubMed]14. Reich NG, Lessler J, Varma JK, et al. Quantifying the risk and cost of active monitoring for infectious diseases. Sci Rep. 2018;8:1093. [PMID: 29348656] doi:10.1038/s41598-018-19406-x. [PMC free article] [PubMed]15. Lauer SA, Grantz KH, Bi Q, et al. Estimating the incubation time of the novel coronavirus (COVID-19) based on publicly reported cases using coarse data tools. 2020. Accessed at https://github.com/HopkinsIDD/ncov_incubation. on 3 March 2020.16. Determining Durations for Active Monitoring. Accessed at https://iddynamics.jhsph.edu/apps/shiny/activemonitr. on 28 February 2020.17. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395:514-523. [PMID: 31986261] doi:10.1016/S0140-6736(20)30154-9. [PubMed]18. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany [Letter]. N Engl J Med. 2020. [PMID: 32003551] doi:10.1056/NEJMc2001468. [PubMed]19. Genomic epidemiology of novel coronavirus (HCoV-19). 2020. Accessed at https://nextstrain.org/ncov. on 29 January 2020.
What You Need to Know About COVID-19! Looking Beyond the Surface of the Covid-19 Corona Virus
There is no shortage of angles as it pertains to how the COVID-19
virus is impacting the world on a global scale. It has been my concern that the
media’s coverage of this pandemic has led to unnecessary panic and chaos. Panic
and confusion are often the results of the lack of knowledge and understanding
of a particular event. It is my goal to provide information and reasoning that
will help expand your knowledge surrounding this pandemic.
Allow me to begin by stating that it is not my intent to
marginalize the severity of COVID-19. The truth is that there is still much we
don’t know and understand about this virus. The lack of data and history associated
with COVID-19 has led many experts to err on the side of caution. I have
decided to look beyond the surface of Covid-19 in an attempt to add context to
the chaos.
Comparing
COVID-19 To the Common Flu
In an attempt to put things in perspective, many have
attempted to compare COVID-19 to the common flu — suggesting that the common
flu kills more people that COVID-19 has. Others have pointed back to the H1N1
virus (swine flu) of 2009-2010. While I have alluded to both these viruses, my
focus has been primarily on how the media reported on each. I hold the belief
that if the media had covered the H1N1 outbreak in the same manner that it is
handling the COVID-19 scare, we would have had mass hysteria in 2009. If the
public would get real-time coverage on the 23,000 deaths attributed to this flu
season, how would they respond? Basically, the media is controlling the narrative.
Currently, COVID-19 has led to more than 454,000 illnesses,
and 20,550 deaths and the number is growing. For comparison, in the U.S. alone,
the flu (also known as influenza) has caused an estimated 38 million illnesses,
390,000 hospitalizations, and 23,000 deaths this flu season (Centers for
Disease Control and Prevention).
When immunologists are questioned about why COVID-19 has
caused so much hysteria, although the flu seems to be a common and consistent
threat, they respond by pointing out the fact that the flue has been studied
for years. It is easier to predict how it will behave. The consensus among
these experts is that the unpredictability of COVID-19 is what makes it scary.
While an estimated 600,000 people will die worldwide as a result of the flu
this year, it is expected and thereby not worthy of media attention. The flu as
a season and scientists know when the season will peak and decline. It appears
that the predictability associated with the flu eradicates the panic that seems
to be fed by uncertainty. As long as deaths can be accounted for, they are
deemed acceptable.
Basically, despite the mortality and morbidity associated with
the seasonal flu, there is a level of certainty, according to Dr. Anthony
Fauci, Director of the National Institute of Allergy and Infectious Diseases.
Dr. Fauci says that the number of illnesses and deaths associated with the common
flu can be predicted pretty accurately, whereas the complete opposite can be
said for COVID-19. The limited perspicacity of how this novel virus operates is
the primary cause for concern among the experts. The problem with COVID-19 is
there is a lot of unknowns.
I can easily understand the importance of erring on the side
of caution here; however, the irresponsible manner in which the media covers
the outbreak is what concerns me most. When you add all of the people who
consistently share information that they have not confirmed, it is easy to see
why the panic is spreading so rapidly.
Symptoms
and Severity
Both influenza A and influenza B, as well as COVID-19, are
contagious viruses that cause respiratory illness.
Typical flu symptoms include cough, fever, muscle aches,
sore throat, stuffy or runny nose, headaches, fatigue, and even diarrhea and
vomiting. In most instances, flu symptoms come on quickly and will pass in two
weeks or less. In some cases, there can be complications, including pneumonia,
that exacerbate the impact of the virus. During this current flu season, an
estimated one percent of people infected have developed symptoms severe enough
to be hospitalized (translating to 60 hospitalizations per 100,000 people).
At this point, doctors and scientists are still attempting to
gain an understanding of the complete picture of disease symptoms and severity
with COVID-19. Reported symptoms have varied from patient to patient and range
from mild to severe, and include fever, cough, shortness of breath. The aches
and joint pain generally associated with influenza don’t appear to be shared in
COVID-19 cases.
“In general, studies of hospitalized patients have found
that about 83% to 98% of patients develop a fever, 76% to 82% develop a dry
cough, and 11% to 44% develop fatigue or muscle aches, according to a review
study on COVID-19 published February 28 in the journal JAMA. Other
symptoms, including headache, sore throat, abdominal pain, and diarrhea, have
been reported, but are less common. A less common symptom, loss of smell,
has also been reported in some COVID-19 patients, Live Science reported.
Another
recent study considered the largest on COVID-19 cases to date, researchers from
the Chinese Center for Disease Control and Protection, analyzed 44,672
confirmed cases in China between December 31, 2019, and February 11, 2020. Of
those cases, 80.9% (or 36,160 cases) were considered mild, 13.8% (6,168 cases)
severe and 4.7% (2,087) critical. “Critical cases were those that
exhibited respiratory failure, septic shock, and/or multiple organ
dysfunction/failure,” the researchers wrote in the paper published in China CDC Weekly.
A recent study of COVID-19 cases in the United
States found that, among 4,226 reported cases, at least 508 people, or 12%,
were hospitalized. However, the study, published March 18 in the CDC journal
Morbidity and Mortality Weekly Report (MMWR) is preliminary, and the
researchers note that data on hospitalizations were missing for a substantial
number of patients.
It’s
important to note that, because respiratory viruses cause similar symptoms, it
can be difficult to distinguish different respiratory viruses based on symptoms
alone, according to WHO.”[1]
Death Rate
The
typical death rate for the flu in the U.S. is 0.1%, and the current death rate
of COVID-19 in the U.S. is 1.87 percent. The death rate varies based
on environment and geographical location.
“In the study published February 18 in the China CDC
Weekly, researchers found a death rate from COVID-19 to be around 2.3% in
mainland China. Another study of about 1,100 hospitalized patients in China,
published February 28 in the New England Journal of Medicine, found that the overall death rate was slightly lower,
around 1.4%.”[2]
Transmission & Risk of Infection
The measure used by scientists to determine how easily a
virus spreads is known as the “basic reproduction number” or RO
(pronounced R-nought). The RO is an estimate of the average number of people
who will contract the virus from a single infected person. While scientists are
still working to determine the RO for the new coronavirus, the preliminary findings
estimate the RO to be between two and three — meaning that one infected person
will infect two to three others. It is essential to understand that the RO is
not a constant number. It can be impacted by the number of people an infected
person will come in contact with during the time they are contagious. A person
who comes in contact with more people than average will have a higher RO. It is
this potential increase in the RO that has scientists and leaders advocating
for social distancing.
“As of March 19,
there are 9,415 cases of COVID-19 in the U.S. Some parts of the country have
higher levels of activity than others, but cases have been reported in all 50
states, according to the CDC.
The immediate risk of being exposed to
COVID-19 is still low for most Americans; however, as the outbreak expands,
that risk will increase, the CDC said. People who live in areas where there is
ongoing community spread are at higher risk of exposure, as are healthcare
workers who care for COVID-19 patients, the agency said.
The CDC expects that widespread transmission
of the new coronavirus will occur, and in the coming months, most of the U.S.
population will be exposed to the virus.”
Conclusion
What
I can tell you about what I have been able to uncover about COVID-19 is that
much is left to be learned. The variances in how countries are testing for the
virus makes it impossible to make meaningful comparisons as to how different
regions are coping with the spread of the virus. Simply put, lower numbers do
not indicate fewer cases; it could be the result of fewer tests being administered.
My
concern is still the way the media is covering this outbreak. To this point,
the H1N1 pandemic of 2009-2010 was more prolific (in infections and deaths)
than COVID-19, but the level of panic and mass hysteria did not even come close
to what we are experiencing to this point with COVID-19. I am not suggesting
that we not take the outbreak seriously. My family and I are taking all of the
necessary precautions. What I am suggesting is that we learn as much as we can
about this virus so that we can put it all in proper perspective. Fear and
panic rob us of our ability to use critical thought and reasoning. It leaves us
to react instead of being proactive in being strategic in our planning and
responses. We place far too much trust in officials who have yet to prove they
are worthy of the trust we bestow upon them.
Empowerment
is achieved through awareness. The more you learn about any particular
situation, the less frenetic you will be as you experience it.
Protect
yourselves as much as possible. Don’t take unnecessary risks. Gather your
information from multiple sources and consider all the angles. Don’t become a
victim of your own biases concerning the virus. Be open to new truths, ideas,
and suggestions.
I
will continue to conduct research and gather information to share with you. So
keep checking back in. ~ Rick Wallace, Ph.D., Psy.D.
[1] Rettner, R. (2020). How does the new coronavirus
compare with the flu? Live Science.
