The Stress of Coronavirus Is Triggering Your Flare
Here’s why anxiety exacerbates chronic conditions, plus what you can do to manage it all.
There are so many things that make life stressful, even when we’re not living in a global pandemic. But now that the novel coronavirus is here (and, according to experts, here to stay indefinitely), that “normal” level of stress has been replaced by something much bigger. You may find yourself worrying more often about your health, your finances, your loved ones, or your sense of security. These concerns are not only valid—they’re shared by millions of other people.
Unfortunately, for many of us living with chronic conditions, stress has an added downside: it can trigger symptom flares that might make your condition more difficult to deal with.
Before you go off stressing about your stress (whew!), read on to see how pros suggest you manage it all to stay healthy and happy.
How Stress Affects the Body
Acute stress, or short-term stress brought on by one specific event, increases your heart rate and tenses your muscles. It also makes your breathing shallower (which explains why people say “take a deep breath” to urge someone to calm down). Thankfully, your body usually knows how to handle it. “Humans are built for acute stress,” says Christopher Mosunic, PhD., psychologist and Chief Clinical Officer at Vida Health in San Francisco, CA. “Our fight-or-flight system kicks on and helps us through short-term stressors, such as the acute stress giving you the energy to get to the hospital with a fractured arm, or after you felt chest pains.”
Chronic stress, on the other hand, is much sneakier. It’s long-term and brought on by a variety of lifestyle factors, from financial insecurity to ongoing health concerns. “Chronic stress is horrible,” Mosunic says. “It hurts the mind and body in too many ways to list fully, but depression, anxiety, obesity, and diabetes are some of the most common effects.”
Chronic stress is tougher to spot because it affects you over months or even years. It can cause painful muscle tightness and headaches, hormonal shifts, lowered immunity, GI disruptions, and changes in libido – not to mention psychological issues like anxiety, depression, and burnout.
Who Is Especially Vulnerable?
We spoke with various specialists about how pandemic-related stress might be impacting their patients. Here’s who they said is most at risk.
If you have cardiovascular disease – Research has shown that people with heart conditions are at higher risk for serious illness if they contract COVID-19. That’s enough to make anyone feel worried. Salim Virani, M.D., a professor at Baylor College of Medicine in Houston, TX, explains that stress can literally stress out your heart. “We do know from prior studies that stress is not good for the heart, and too much stress can lead to a specific type of cardiomyopathy [a disease that can lead to heart failure],” he says.
In addition, when you’re constantly overwhelmed by your worries, you might be less likely to follow your treatment plan, Dr. Virani says. “Patients who have anxiety or depression may not be as adherent to the medications that they're on,” he explains. “If somebody is suffering from severe anxiety or depression, they may not be as likely to be physically active or take care of their diet.” Not to mention, coronavirus fears could prevent you from going to the hospital quickly if you are having chest pain or other concerning symptoms. Our advice: Please just go if you need to!
If you have diabetes – Folks with diabetes are another group at additional risk for severe COVID-19 infection, especially if their diabetes isn’t managed well. In a study in Cell Metabolism, researchers found a link between blood sugar control and COVID-19 mortality risk. Specifically, if your blood sugar is well-managed, you’re more likely to have a better outcome if you do contract COVID-19.
The stress of this pandemic could also be getting to you. “Stress comes in many forms, and how individuals deal with stress differs,” explains Robert Eckel, M.D., president of Medicine & Science at the American Diabetes Association in Arlington, VA. “This is most often the case for patients who are on insulin.” Stress can increase your blood sugar, which makes it tougher to keep your levels consistent without higher doses of insulin.
If you have psoriasis – Robert Brodell, M.D., professor and chair of the Department of Dermatology at the University of Mississippi Medical Center in Jackson, MS, explains, “Both emotional stress and physical stress conceivably could aggravate psoriasis.” The National Psoriasis Foundation lists stress as a trigger for psoriasis flares, especially in women. And while patients with psoriasis aren’t known to be at higher risk for COVID-19, there are concerns about whether immunosuppressive medications could make it tougher for people to fight the virus, Dr. Brodell says.
If you have rheumatoid arthritis – “Stress can aggravate RA symptoms, and symptoms of autoimmune disease, by triggering a flare or just diminishing one’s ability to cope with the symptoms,” explains Anca Askanase, M.D., director of Rheumatology Trials at Columbia University Medical Center in New York, NY. “People with RA are under enormous stress during this time of crisis.” Dr. Askanase notes that in addition to the typical stressors of living in quarantine, people with RA may be feeling concerned about the medications they are taking. Like psoriasis, rheumatoid arthritis is often treated using immunosuppressive drugs, which could potentially make it harder for your body to fight other infections.
If you have IBD – IBD is a frustrating catch-22. It can be detrimental to your mental health, which can in turn make your symptoms worse. “Studies have shown that patients with IBD are at increased risk for mental health issues such as depression and anxiety,” explains Sara Horst, MD, associate professor in the Division of Gastroenterology, Hepatology, & Nutrition at Vanderbilt University in Nashville, TN. “Also, data shows that if patients have mental health diagnoses and IBD, they are at increased risk of disease flare, surgeries, emergency department visits, non-adherence to their medication, and increased health care costs.”
How to Mitigate Stress and Manage Symptoms
All this information might sound bleak, but it’s important to know the impacts of stress on your chronic condition so you can be better prepared to manage it. “The best advice I can think of is to take each day as it comes; the big picture is overwhelming,” Dr. Askanase urges. “Eat healthy, exercise, meditate, but most importantly, keep your distance!” Follow health guidelines from reputable sources like the CDC to ensure you are lowering your risk of contracting COVID-19.
A licensed therapist or mental health professional can help you sort through your feelings about the pandemic and find some peace. “Try to understand why you feel stressed and figure out what you can do to decrease that sense of stress,” Dr. Brodell says. You may find comfort in practices like meditation, yoga, and regular exercise, all of which can have positive impacts on your overall mental health.
Pay attention to yourself as a whole human, not just as someone who deals with a chronic condition. Dr. Horst emphasizes how this helps her and other practitioners in the treatment of gastrointestinal disorders. “This includes discussing mental health with our patients and trying to make more services available to help if they are at risk,” she says. Your doctor can be a resource for you, especially if you’re worried your medications might be putting you at risk for COVID-19 complications. Talk to them about what you can do to stay safe and healthy.
Dr. Virani urges people not to delay care for their chronic condition due to their coronavirus fears. “Hospitals are taking precautions to make sure that you don't get the infection while you're there,” he says. “Call 9-1-1, if you need to call 9-1-1, the way you would have done if we were not in a COVID-19 pandemic. Stress should not affect you from seeking care that you should.”
And don’t forget to stay connected. Even though many of us are physically separated right now. “Humans are social animals, so it does make sense that we should be using technology to preserve social interactions, even as we distance ourselves physically,” Dr. Brodell says. Lean on support groups around you, including your family, friends, and fellow chronic warriors. They can provide the comfort of a listening ear and a shared experience, and remind you that as difficult as this is, we’re all in it together.
Stress Effects on the Body: American Psychological Association. “Stress effects on the body.” apa.org/helpcenter/stress-body
Stress and the Heart: Journal of the American College of Cardiology. (2009). Psychological Stress and Cardiovascular Disease.” ncbi.nlm.nih.gov/pmc/articles/PMC2633295/
Diabetes and COVID-19 Risk: American Diabetes Association. (2020). “COVID-19 FAQ.” diabetes.org/covid-19-faq
Blood Sugar Control Study: Cell Metabolism. (2020). “Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes.” sciencedirect.com/science/article/pii/S1550413120302382
Diabetes and Stress: American Diabetes Association. (2005). “Stress and Diabetes: A Review of the Links.” spectrum.diabetesjournals.org/content/18/2/121
Psoriasis and Stress: National Psoriasis Foundation. “Stress and psoriatic disease.” psoriasis.org/life-with-psoriasis/stress
Crohn’s and Mental Health: The American Journal of Gastroenterology. (2011). “Increased Risks of Developing Anxiety and Depression in Young Patients With Crohn’s Disease.” researchgate.net/profile/Annie_Guerin/publication/51093341_Increased_Risks_of_Developing_Anxiety_and_Depression_in_Young_Patients_With_Crohn%27s_Disease/links/0c960531873fdda1d2000000/Increased-Risks-of-Developing-Anxiety-and-Depression-in-Young-Patients-With-Crohns-Disease.pdf