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Pandemic fatigue, we all have it. However, it is affecting children more than adults in many cases.

Pandemic fatigue by definition is the mental exhaustion caused by being in a state of heightened awareness and alertness in the face of COVID combined with the uncertainty of how the pandemic will develop. Parents are struggling to continue to juggle working from home and teaching their kids who are doing online school. Healthcare workers are getting burned out from the stress of working with COVID patients and seeing the numbers of infected patients continue to go up.

Kids are becoming more anxious and depressed, not just about isolation and not seeing their friends, but I'm having parents bringing their kids to me about anxiety over things they've never been anxious about before. This is especially true because just as COVID numbers started to increase locally, we also had a major earthquake. I have some patients who if they get a cold are asking me if they're going to die. I have others who are terrified of germs and think they will get COVID if someone touches their dog or they will change their clothes as soon as they get home from being out of the house, even if they just went to a store.

People are tired of wearing masks. People are tired of physically distancing, of not having normal life milestones being able to be celebrated in the way we have done for years. So since this is not showing any signs of slowing down anytime in the immediate future, how can you help your children do the best they can while dealing with COVID in the long haul?

First, continue to make mask wearing fun. I've said it before, and I'll repeat it again. If the mask is something fun, kids will want to wear them more. Have fun characters on their masks. Let the kids have enough variety in their masks that they can coordinate them with their outfits. That's exactly what my younger son does every day. His teachers comment all the time about his cool masks and how they match what he's wearing.

For hand sanitizers, have seasonal scents. If your child doesn't have eczema and they're not sensitive to different fragrances, let them choose what they want to smell on their hands all day long.

Empower kids. Let them know it's okay to tell family members and friends that if they just aren't masked or they're not social distancing, then your kid can't play with them. It's okay to remind others of the rules. Just make sure it doesn't turn into a daily battle and they don't turn into the germ police.

Let kids connect with friends online. I know we didn't use to be a video game family, but when the pandemic hit and schools went online, I caved. I bought an Xbox for my boys and I let them have a certain amount of time to play with friends every day. It helps them still feel connected to their friends, but in a safe way. It also lets them get a break from school and just play and be kids.

Finally, remember that it's okay for them to be bored and figure out new things to do. It's okay to let them cry, even if they can't tell you what they're sad about. It's okay to have breakdowns and just get angry and need you to hug them until they're screaming turns into crying and then I'm sorrys. As long as your child isn't disrespectful or violent, let them express their emotions. Then, if they want to talk about their feelings, if they don't want to, that's okay. Let them have their space. The bottom line is everyone is feeling pandemic fatigue in one way or another. If we all help each other, then we will get through this together.

Interviewer: Sheltering in place because of COVID-19 can increase anxiety and also the feelings of isolation, which are already a threat to older adults.

Gerontologist Dr. Mark Supiano is the Chief, Division of Geriatrics at U of U Health. And if you have a loved one that's 65 or older, that's at high risk, they've been staying at home, how can you keep engaged with them and make sure that they remain mentally healthy? We think about the physical aspects. We don't always think about the mental aspects. Explain what you mean by that.

Dr. Supiano: So, Scot, we're very concerned about the deleterious effects of sheltering in place, particularly for people that were alone already. So this is only heightening their sense of loneliness. We know that loneliness itself is a risk factor for bad outcomes for health. So if you're not able to feel connected with other people because of the physical restraints or physical restrictions that were now imposed on people, those risks could really further escalate.

So in terms of anxiety levels, so what we can do to try to lower these risks or make people feel more connected, making sure that those connections still happen even without physical connections, whether you can do that virtually through a simple telephone call, through a video chat with some platform, but maintaining your connections with family, with friends. Have a daily call. Make sure that you're connecting with someone on a daily basis, that someone is checking in with you.

Interviewer: Being a grandparent is a joy for many, many people that has been kind of taken away, right? You're not able to interact with the grandkids as much, which would also lead to the things we're talking about. Do you have any tips for how that could take place in a safe way?

Dr. Supiano: So I'm in that same boat actually. So my grandchildren are in various parts of the country, and I have not seen them for months. And unfortunately, it will be several months more before we'll have that opportunity.

So maintaining video or, you know, telephone, video chat, we're living on FaceTime and those connections are very important. For people that have the families closer to them, there are still ways that you can interact with your family members while adhering to the recommendations about maintaining physical distance. So it's time and density and protective equipment. Minimizing the time of that interaction, maximizing the distance, so the density, make sure that there are a few people, that you're keeping at least six feet apart, and wearing a mask and making sure that everyone is masked to minimize those risks.

So those types of interactions can still happen, but you need to be careful that the restrictions that we've talked about are still in place and also that your family members, your children or the grandchildren have not been lax about their protective measures. So if they've been out in a group, if they've been out at a party, or with, you know, a group of their friends and there were 100 people there, they're potentially a carrier, and I'm not sure I would want that person, that family member getting close to me.

Interviewer: Which brings up a great point, right? There's a lot of . . . we're learning more and more that asymptomatic carriers, there's a lot more of those out there. So you might not be experiencing any symptoms at all, but you could be spreading it and that would be . . .

Dr. Supiano: Exactly. So if you've had a potential exposure, you should stay away from your older family member.

Interviewer: Yeah. So part of it comes from me realizing what my situation and being honest about that, and part of it is also implementing these protective things. What could I tell somebody in my life who is an older adult? You gave us some ideas of I could, you know, maybe make a phone call, do a video chat. Are there some other pieces of advice that I could give, like a parent or a grandparent, as to how to stay mentally healthy?

Dr. Supiano: So great question, Scot. I think the first point, and this comes from our mental health experts who have been careful to point out, for all of us to hear, that right now it's okay not to be okay and just recognizing that as a fact that everyone's in this together. We'll get through it together. And if you're not okay right now in terms of heightening anxiety and stress, everyone else is experiencing this too, and right now, it's okay not to be okay.

Interviewer: And especially your loved one, if they express that feeling, I think it's normal for us to say, "Oh, it's not going to be that bad," and dismiss it. Probably not do that right now.

Dr. Supiano: I think it is that bad right now. We need to acknowledge that and kind of give people that ability to be open about those feelings. With that, though, there are some tips that have been promoted to try to minimize the anxiety and stress.

One of them is, although we want people to be informed, minimizing the constant stream of bad news and anxiety-inducing news that you may be seeing on your television, through your social media, and other means. Take some stress breaks. Take care and attend to your wellness, which is another factor. And making sure that you're getting exercise. It's hard to do if you're sheltering in place at home, but getting some regular exercise every day, ideally now that the weather's improved to be outside, you're away from other people, getting sunshine, fresh air, but more importantly getting that exercise is a very important stress reducer and can really go a long way in helping with anxiety.

Make sure you're getting enough sleep. So sleep deprivation related to anxiety is going to feed on this even more. So making sure that you're getting restorative sleep. Relax, doing other activities that you enjoy, maybe not watching TV right before bed as an example, and then maintaining those connections with others are the things that would be recommended.

Interviewer: Yeah. You gave me some great ideas there of some questions next time I talk to people in my life. Just to make sure they're sleeping okay and make sure that they're getting their needs met and make sure that they're getting out and getting some exercise. So that's a great list. I love to ask the experts, you know, at the end of the interview. You're the expert, so like what's the one thing you would want somebody to take away after listening to us talk today?

Dr. Supiano: So I'll take two.

Interviewer: All right, you can.

Dr. Supiano: Just I'll do them quickly. So first, if you're over age 65, you're at high risk and be extremely vigilant about these precaution measures. Secondly, social distancing is not physical distancing. So maintain your physical distance but don't be socially isolated. And make sure to maintain those connections.

As COVID concerns increase, so do the questions parents have about keeping their children safe.

One question I've gotten several times is, "Can I still breastfeed my baby during COVID-19?" Moms are often anxious anyway about their babies, and a lot of what is in the news is increasing everyone's anxiety right now. I've had several moms ask me if they can transfer their anxiety to their babies by breastfeeding. The good news is no. Actually, continuing to breastfeed their babies will help their anxiety, and it's a great bonding experience for both mom and baby. Also, by breastfeeding, they are still getting their babies all the good immune system boosters found in breast milk.

A lot of new moms also find that breastfeeding isn't as easy as they make it look in the movies. I know it was a struggle for both of my boys. I had five lactation specialists working with me, and it just wasn't happening. I needed to supplement with both, but I felt so bad. The bottom line is keep breastfeeding as much as you can. Pump and give him a bottle if you have to. That's what I ended up doing, and I still had to supplement. And if you need help, there are many resources available. Talk to your pediatrician about what is best for you and your baby.

You wake up at 2:00 in the morning. You can't take a deep breath and your chest hurts and your heart is pounding. Is this coronavirus, or is it a panic attack?

These are anxious times. Economic insecurity, worries about friends, and the 24-hour news cycle of death and disaster elevates everybody's stress hormones. Increased anxiety sets off the alarms of your sympathetic nervous system, your fight or flight system. Your heart rate increases. Your muscles tighten. You start to breathe faster. These can be symptoms that anxiety can cause all day long or just for a short period of time, and this is anxiety or a state of anxiety. These can be symptoms that anxiety can cause all day long.

However, sometimes for no good reason, the body is suddenly flooded with the stress hormone called norepinephrine, and these symptoms are amplified. This is called a panic attack. You can't catch your breath. You can't seem to take a deep breath. Your heart is pounding out of your chest, and you may have chest pain or feel that there's a heavy weight on your chest. You're pretty sure you're going to die.

These symptoms were often confused with the symptoms of a heart attack. Panic attacks come on suddenly and heart attacks come on suddenly, so it's not uncommon for emergency rooms to see younger people who come in with symptoms of a heart attack who leave with the diagnosis of a panic attack. Of course, the long-term consequences of a panic attack are different than a heart attack, and the management is different.

Now, however, in the days of the COVID-19 epidemic, we're hearing the symptoms of infection that include rapid breathing, feeling that you can't take a deep breath, heart pounding, and pain or pressure in your chest. So how can you tell the difference? Of course, if you're in the emergency room, we have the tests and equipment that can help us to quickly sort this out.

The first is to take a history. Have you had a fever? A fever is common with COVID-19 and rarely seen with panic attacks. People with panic attacks can get sweaty as can people with fever when it breaks, but the body temperature doesn't spike usually with a panic attack.

Have you had a cough? Cough is common for COVID-19 but not in panic attacks. Have you had muscle aches and pains over the past several days? That's common for COVID-19 and not so much for panic attacks. Did all this come on all of a sudden? Which is rare for COVID-19 that usually builds up over a day or so. Panic attacks come on all of a sudden and usually only lasts less than 30 minutes at their worst.

Then in the ER, we have this little amazing device that we can put on your finger to measure your oxygenation. If that's normal, then your difficulty breathing isn't likely to be COVID-19. We can also get a chest x-ray, which would be normal in a panic attack, but not in the case of severe shortness of breath from COVID-19. Of course, we can get a cardiogram to help rule out a heart attack, and we can take your temperature. Actually, that was done in triage before you even got into the emergency room, as was the pulse ox, that cute little thing on your finger.

But you aren't in the ER. You're at home in bed in the dark thinking you're going to die, or maybe it's in the middle of the day or maybe you're driving. If you're driving, pull over immediately. If you're in bed, get up and sit upright in a comfortable chair. If you're not alone, get someone to help and be with you and tell them how you're feeling. Take some slow, deep breaths all the way in for a count of four, hold for four, all the way out for a count of four, hold for four. If you can't do it for the four count, do it for three or speed up to four. Do that 10 times and count them.

Then ask yourself the questions: Do you have a fever? Have you had a fever? You can take your temperature if you have a thermometer at home, and it really helps to have a thermometer at home. If you're too stressed to find the thermometer, maybe someone could help you. No fever? This is good, 10 more breaths. Do you have a cough? Have you had a cough in the last couple of days? If not, that's a good sign, 10 more breaths. Did this come on all of a sudden, or have you had weakness and muscle fatigues and fatigue for several days? No? That's a good sign, 10 more breaths.

How are you doing? Check in with yourself from toes up. How are the bottom of your feet on the floor feeling? How are your toes feeling? How are your knees feeling? How's your butt feeling in that chair? Take time to check out each part of your body. It will give your anxious brain some work to do. Mostly okay? That's good.

So if you're feeling better and you've answered to yourself no to all these questions, you're probably having a panic attack. If you answered yes to fever and cough and the symptoms are getting worse over the past couple of days, call your clinician or the ER and they can send you where you should be seen. If there's any other way, please do not drive yourself. If you can't get someone to drive you and you cannot breathe slowly and you're still have pain or pressure in your chest, call 911 and the EMTs will come to help.

These are difficult times. Gloom and doom is part of everyday news cycle. Please, turn off the news for a while every day. Get out and walk about in a physically distanced way. The phrase "socially distance" isn't the right one. Physically distance is right thing. Exercise is one of the best things for long-term therapies for anxiety. Reach out for friends on the phone. Stay connected. Call us if you need us and thanks for joining us on The Scope.

Dr. Jones: Anxiety in young women is on the rise and is there any wonder why is this happening and what can we do? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health Care and I'm anxious about anxiety and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Anxiety is a very common and perhaps the most common mental health concern in the United States. About 40 million Americans have anxiety disorders and women are twice as likely to be diagnosed with anxiety than men. College health centers are seeing a dramatic increase in anxiety in their students. One recent study of 63,000 college students found that there were five times as many young adults with high levels of anxiety compared to college students in the 1930s. So are we just more aware of mental health issues? Are young women more willing to seek help and, therefore, get counted?

As the pace of life and social media increased anxiety in young women, the truth is probably all of the above, but let's drill down on some of the causes, the consequences, and what to do. Firstly, there is evidence that the way a child responds to stressors may be both genetic and epigenetic. That means there are inherited genes that can contribute to overreacting the stimulus. But these genes have been around for a long time. So why is there more anxiety now?

The epigenetic story is that genes are modified by early stressors in early fetal development and early childhood development. Moms who are exposed to high levels of stress give birth to babies that are more likely to overreact to stressors. Children who have high levels of stress in their lives, poverty, homelessness, instability in their home life, have an increased chance of having anxiety and attention problems as adolescents.

Secondly, the environment of children and young adolescents is increasingly stimulating social media which may not be very supportive, bullying in schools, TV, increasingly dramatic news coverage, and video games that are violent and stimulating can contribute to high levels of stress hormones. Kids are getting less sleep and consuming more caffeine than ever before. Increasing use of some stimulants for attention disorder may also increase anxiety in kids who may not be taking it appropriately.

Thirdly, there is clearly an awareness in the schools and colleges that more kids have anxiety. Giving it a name lets us count it in adolescents. An increasing availability of medications to treat anxiety allows adolescents to state care. What is the bad part of anxiety for young women? Firstly, it feels awful and limits a young woman's ability to focus on the task at hand: school or work or healthy relationships.

Secondly, young women may self-medicate with alcohol or sedating drugs like opiates or Valium-like drugs that they obtain from friends or a family medicine cabinet. Young women who self-sedate in social settings are more likely to be sexually abused or overdosed.

So what should we do? The first thing is recognition of the problem. This goes back to the RULER project for emotional intelligence. "R" is for recognize. When you feel it, understand that you've felt this way before and you've survived it before. "U" is for understand what the triggers are and if the anxiety is about something that's really dangerous or not really dangerous. Label it. When you give that feeling the correct name, you can learn about it.

Express it. "E" is for express it. Let others know how you're feeling so they can learn more and help you. And "R" is for regulate it. Okay. How do you regulate anxiety? A healthy diet with less bad fats and high-sugar carbs and less caffeine can be helpful, actually, for everything. Eat regularly in small meals. Exercise vigorously four times a week with healthy friends, if possible. Get your sleep. Yes, if you're anxious, you can't sleep. But when you're not so anxious, make sure you get the sleep your brain needs.

Get more phone-free time. Are you addicted? It's time to withdraw from the stimulus of your social media and get some exercise. Every time that little beep goes off or the little buzz in your pocket, it makes your stress hormones go up. Practice mindfulness and deep breathing. Many studies have found that these practices can be helpful for anxiety. The old saying, "just take a deep breath," comes from some basic neurobiology of stress hormones. Take that deep breath and keep doing it for several minutes.

There are many websites to help with mindfulness training and breathing techniques. There are several good websites for young women, girlshealth.gov is one here in the US. One I really like comes from Australia. jeanhailes.org.au is a website for women's health issues. The AU is the Australia part. If you Google "anxiety young women Jean Hailes," you'll get to a terrific website on symptoms and healthy self-treatments for anxiety. anxiety.jeanhailes.org.au, and click on "Young Women."

Get help. Talk therapy can give you skills to break your anxiety. You will probably always have some level of anxiety, but the goal is to give you the toolbox to tune down a level of anxiety hormones so you can live a less stressed life. If your therapist isn't able to help you get control, medication taken daily that isn't addictive can help and it's approved for adolescents. You have the power to feel better and if that isn't working, we can help.

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