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Many healthcare workers on the front lines of the coronavirus pandemic are struggling with sleep, a new study finds.

The researchers also found that those with insomnia were more likely to have depression, anxiety and stress-based trauma.

The study included nearly 1 600 healthcare workers who completed an online questionnaire between 29 January and 3 February at the peak of the Covid-19 outbreak in China.

Two-thirds (36%) reported insomnia symptoms. Overall rates of depression were much higher among those with insomnia (87%) than among those without insomnia (31%), and especially for moderate (23% versus 3%) and severe (17% versus 2%) depression.

Less educated may be more fearful

The percentages and differences between those with and without insomnia were similar for anxiety and stress-based trauma, according to the study published in the journal Frontiers in Psychiatry.

The most important factor associated with insomnia among healthcare workers was strong uncertainty about effective disease control among medical staff. Strong uncertainty was 3.3 times higher among those with insomnia than those without it, the findings showed.

Lower levels of education were also associated with insomnia. Healthcare workers with a high school education or less were 2.7 times more likely to have insomnia than those with a doctoral degree, according to the report.

Workers with less education may be more likely to be fearful, study co-author Bin Zhang, a professor at Southern Medical University in Guangzhou, China, and colleagues suggested.

Mentally and physically exhausted

“Typically, stress-related insomnia is transient and persists for only a few days,” Zhang said in a journal news release. “But if the Covid-19 outbreak continues, the insomnia may gradually become chronic insomnia in the clinical setting.”

The researchers noted that the healthcare workers in the study had high levels of stress in general because they were in close contact with infected patients who could pass the disease to them, they were worried about infecting their own family and friends, and they had to wear extensive personal protective equipment for more than 12 hours at a time.

“Under these dangerous conditions, medical staff become mentally and physically exhausted, and therefore experience an increased risk of insomnia due to high stress,” the study authors wrote.

READ | A lack of sleep affects your immune system – here’s how quality sleep can help you fight the coronavirus

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READ | Don’t let the coronavirus pandemic rob you of your sleep

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As deaths from coronavirus continue to mount, researchers are calling attention to another toll of the pandemic: the many people left behind to grieve, in a time of social isolation.

Losing a loved one is a traumatic event at any time. But experts say the ongoing crisis presents unique difficulties for people in mourning – from the suddenness of the loss, to the societal shifts happening around it.

And a huge number of people will be affected in the months to come.

“This will be a mortality shock that the US has never experienced,” said Emily Smith-Greenaway, an assistant professor of sociology at the University of Southern California, in Los Angeles.

Numbers are projections

Greenaway and colleague Ashton Verdery recently published an analysis estimating how many Americans might lose a parent or grandparent to the pandemic. The numbers are grim: If, for example, 10% of white and black Americans were confirmed to be infected, that could ultimately mean over 500 000 deaths – taking parents or grandparents from about 3.5 million people.

Greenaway cautioned that the numbers are projections, which necessarily require assumptions about the future. The latest “model” cited by the White House estimates that a little under 82 000 Americans might die of Covid-19 through early August.

But the bottom line, Greenaway said, is that the pandemic will take many lives, and those deaths will have a “ripple effect through families”.

What will that look like? Based on existing research, it’s likely many people will struggle to deal with their loss.

“The risk factors for a complicated, prolonged bereavement look almost like a script for what’s happening now,” said psychologist Robert Neimeyer, director of the Portland Institute for Loss and Transition, in Oregon.

He explained that one of the things that helps people cope with a loved one’s death is being present with them toward the end – sitting in the bedside chair for hours, handholding, expressing love, asking for forgiveness.

Dishonouring your loved one

“These things are denied to us right now,” Neimeyer said.

Physical distancing also means no memorial services, no hugs from family and friends – the rituals and basic human connections that help bereaved people get through.

“When you can’t have something that resembles a funeral,” Neimeyer said, “it can feel like you’re dishonouring your loved one.”

And it is not only people who lose someone to Covid-19 being affected, he noted: Anyone going through bereavement now could struggle.

It’s a bleak picture, but both Neimeyer and Greenaway said it’s important to prepare for it.

People are not powerless in the situation, Neimeyer said: “We’ll need to get creative about ways to mitigate the impact.”

Rituals are vital

In the near term, he said, families sheltering-in-place can still “construct a ritual to honor their loved one” – something as simple as lighting a candle and reminiscing. With videoconferencing, they can include relatives and friends.

George Bonanno is a professor of clinical psychology at Teachers College at Columbia University, in New York City. He agreed that the rituals people have around death are vital, and creating a “virtual” semblance of them may help.

But, Bonanno said, the pandemic is also creating a broad sense of loss – lost jobs, lost security, lost freedom, loss of the everyday social connections that make up people’s lives. And it’s likely to make the death of a loved one even harder, he said.

One reason is because everyone is experiencing those things at once, Neimeyer pointed out. So, at a time when the bereaved need support, friends and relatives are likely struggling, too.

That does not, however, mean you shouldn’t ask for help. “We can still reach out, and do it with an empathy for what others are going through, and compassion for ourselves,” Neimeyer said.

What do you say to someone in mourning? “That can be hard,” Bonanno admitted. “But generally, people need to hear, ‘How are you?’ ‘I’m thinking about you’, ‘I’m here’.”

Take breaks from the pain

And while processing pain is necessary, Neimeyer said, so are distractions.

One of the big challenges now is that the typical distractions – work, social life, daily routines – have been upended.

But those virtual connections may help fill the gap, particularly time with friends. In one study, Bonanno found that in both the United States and China, bereaved parents and spouses processed their grief less often with friends than with family or when alone.

“Maybe that’s partly because we just want to feel normal with our friends,” Bonanno said.

In fact, it’s important to take breaks from the pain and talk about ordinary things, he said. “It’s OK to let yourself be distracted. It’s necessary,” Bonanno said.

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READ | Certain health conditions increase risks for severe coronavirus cases

^{Image credit: Martha Dominguez de Gouveia, Unsplash}

It is hoped the antibodies recovered patients have built up will help clear the virus in others.

WHAT’S HAPPENING IN SA

Cases update: 

The latest number of confirmed cases is 5 951.

According to the latest update, 116 deaths have been recorded in the country.

The latest number of recoveries is 2 382.

So far, 217 522 tests have been conducted, with just short of 10 000 new tests conducted.

READ MORE | All the confirmed cases of coronavirus in SA

Latest news:

Police Minister Bheki Cele says some South Africans are not obeying lockdown regulations and warned Level 4 regulations could be reversed as Covid-19 has the potential of “wiping off humankind”.

Cele was speaking during a joint law enforcement operation in which cars were stopped to check for compliance in Krugersdorp on Friday.

As the country entered its first day of a Level 4 lockdown, physical distancing was not observed in some areas.

“I saw this thing of running, I think we will be making some form of recommendation to the National Command Council about it.

“Not just that, I saw … people running in clubs, walking with their dogs and they were even swimming – something that is [criminalised] in the regulations,” Cele said.

He added the police were calling on South Africans to refrain from breaking lockdown regulations and only conduct essential business.

“This is a problem… I don’t know if they are taking this matter seriously, they should be.

“The fact that we have arrested so many people who were drinking in their cars tells you that we will have to work hard, and by the way, remember what the president said – if things are not going a proper way, reversal is easy… From what we have seen, South Africa is misbehaving,” Cele said.

He added people’s actions currently suggested “we can forget about Level 3” and did not “deserve” the relaxation of restrictions.

“The flouting of regulations was not because people did not know about them,” Cele said.

READ MORE | WATCH: Reversal is easy, Cele warns after South Africans ‘misbehave’ on first day of Level 4

As Covid-19 infections and the death toll continued to rise in the Western Cape on Friday, the province’s premier, Alan Winde, said the exercise regulations for the level 4 lockdown “lacks common sense”.

This after many Capetonians – who made use of the relaxed regulations allowing walking, jogging and cycling between 06:00 and 09:00 – descended on public spaces, like the Sea Point promenade.

This raised questions about the adherence to physical distancing in a province with the highest number of recorded Covid-19 infections.

“Many residents in the Western Cape, just like the rest of the country, took up the opportunity to exercise in line with these new regulations promulgated by the national minister of cooperative governance and traditional affairs.”

“In many of the country’s high-density cities, abiding by these regulations during a set time has resulted in high levels of congregation in public spaces.

“This is the unfortunate result of regulations which, I am afraid, were not thought through and regrettably lack common sense.”

READ MORE | Level 4 lockdown: Exercise regulations lack common sense, says Winde

South Africans leapt at the opportunity to leave their homes on Friday as the nationwide coronavirus lockdown was phased down to Level 4. 

This meant a general easing of regulations, allowing people to exercise outside, and the reopening of certain shops, such as hardware and clothing stores, after five weeks of restrictions that plunged the country’s struggling economy deeper into turmoil.

In all major cities, South Africans flocked outdoors to get their exercise within the allotted time frame of 06:00 to 09:00, some bringing along their children and dogs, News24 reported. 

In addition, South Africans were out in their numbers to take advantage of the regulations that allowed them to shop for more than just the absolute essentials.

The issue of wearing face masks proved problematic, however, with several people not wearing them being turned away from stores and shopping malls, and several people exercising in public without masks.

“It is going to be mandatory to use a cloth mask as you step out of your home,” Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma said on Saturday. 

READ MORE: Just face it: No exercising or shopping without a mask

“Bizarre and irregular.”

This is how British American Tobacco South Africa (BATSA) described Cooperative Government and Traditional Affairs Minister Nkosazana Dlamini-Zuma’s reliance on 2 000 submissions to continue the government’s ban on the sale of tobacco products under the lockdown regulation.

Shortly after the news broke on Friday that it wants Dlamini-Zuma to amend regulations prohibiting the sale of tobacco products by Monday otherwise they will head to court, BATSA said in a statement it was “seeking urgent clarity on the decision-making process that led to the government imposing an indefinite ban on the legal sale of tobacco products”.

President Cyril Ramaphosa announced a new five-level risk-based approach to the lockdown last Thursday and explicitly stated the sale of cigarettes would be allowed under level 4 regulations, which took effect on Friday.

But, in an about-turn on Wednesday, Dlamini-Zuma announced the ban on the sale of tobacco products and cigarettes would remain in place.

She said this was done because 2 000 out of the 70 000 submissions on the regulations, which they received from the public, requested the continued ban.

“This approach was inconsistent with the president’s announcement which had already been arrived at under the established criteria and BATSA was already preparing for the resumption of sales,” read its statement.

“The minister cited 2 000 individual submissions received as a reason for this action. 

“This was, in itself, bizarre and highly irregular, principally because she did not give the tobacco industry, retailers, tobacco consumers and others supporting the lifting of the ban, the opportunity to comment on the proposed reinstatement of the ban. This was grossly unfair and unlawful.”

BATSA said a public petition seeking a lifting of the ban on legal cigarette sales were supported by around 400 000 people, dwarfing the 2 000.

READ MORE | ‘Bizarre and irregular’ – British American Tobacco on government’s tobacco ban

WHAT’S HAPPENING IN THE REST OF THE WORLD 

Cases update:

For the latest global data, follow this interactive map from Johns Hopkins University & Medicine.

Early on Saturday morning, positive cases worldwide were more than 3.12 million, while deaths were almost 214 000.

The United States had the most deaths in the world – nearly 65 000, while three countries had more than 24 000 deaths – France, Italy, and the United Kingdom.

READ MORE | All the confirmed cases worldwide

Latest news:

Last month, the American Food and Drug Administration (FDA) received a report that a 13-year-old consumed hand sanitiser packaged in a liquor bottle by a distiller.

The alcohol wasn’t denatured, so it tasted like regular drinking liquor, according to the FDA.

Now the agency is asking US companies to make sure that their sanitisers taste disgusting.

“It is important that hand sanitiser be manufactured in a way that makes them unpalatable to people, especially young children, and that they are appropriately labeled to discourage accidental or intentional ingestion,” FDA Commissioner Stephen M. Hahn said in a statement.

Companies around the country, many of them distilleries, have switched gears to meet a demand for hand sanitiser during the coronavirus pandemic, including the makers of Klipdrift and the Spier winery in South Africa.

In the US more than 1,500 new companies have registered with the FDA to produce the cleanser in the past few months.

READ MORE | US regulators want hand sanitiser to taste worse so people won’t drink it

Dozens of journalists have died worldwide from the novel coronavirus in the past two months, a press freedom organisation said on Friday, lamenting that media workers often lack proper protection for covering the pandemic.

Ahead of World Press Freedom Day on Sunday, the Press Emblem Campaign (PEC) warned that many journalists were putting themselves in harm’s way to report on the global crisis, with many falling ill from Covid-19 themselves in the process.

Since March 1, the PEC said it had recorded the deaths of 55 media workers across 23 countries from the virus, although it stressed that it remained unclear if all of them had become infected on the job.

“Journalists are at great risk in this health crisis because they must continue to inform, by going to hospitals, interviewing doctors, nurses, political leaders, specialists, scientists, patients,” PEC said in a statement.

READ MORE | More than 50 journalists die from coronavirus since March 1, says NGO

In late January, China instituted a lockdown for the 11 million residents of Wuhan, where the novel coronavirus outbreak originated. Fifteen other cities soon followed, and at its peak, China’s quarantine extended to 20 provinces and regions, according to the Wall Street Journal. Due to lockdown measures, some 200 million students transitioned to online learning in February, the Washington Post reported. On March 18, China reported no new local coronavirus cases for the first time since the outbreak and has gradually lifted restrictions in the weeks since.

While schools in nine mainland provinces had reopened for graduating students as of early April, according to the South China Morning Post, UNESCO’s data shows that most schools remain closed in larger regions. High school seniors in Beijing, Shanghai, and Guangzhou only just returned to school on April 27 to prepare for their college entrance exams.

BBC reported that China’s Ministry of Education is requiring that students have their temperatures checked at school entrances and that they display a “green” code of health via China’s smartphone health code program.

READ MORE | Plastic partitions and temperature checks – see how other countries are opening up their schools

LATEST HEALTH NEWS AND RESEARCH

The original list of Covid-19 symptoms included fever, cough, and shortness of breath. However, the US Centers for Diseases Control (CDC) recently updated this list to include six new known symptoms, reports Futurism:

 – Chills

 – Repeated shaking with chills

 – Muscle pain

 – Headache

 – Sore throat

 – New loss of smell or taste

The CDC’s website explains that Covid-19 symptoms may appear 2–14 days after exposure to the new coronavirus and that people experiencing the original symptoms (fever, cough, and shortness of breath), or a combination of these symptom, or at least two of the new symptoms, may have Covid-19.

Numerous recent studies have established that there are additional symptoms that infected people are displaying, apart from the main symptoms initially communicated.

READ MORE | Here are 6 new Covid-19 symptoms – and the US has added them to their guidelines

Vaccines associated with multiple infectious viral diseases, such as influenza (flu), measles, pneumonia and polio, have saved millions of lives in preventing sickness, disability and death. In fact, the World Health Organization (WHO) considers immunisation to be “one of modern medicine’s greatest success stories”.

And, according to CNN, many people who were part of the anti-vaccine movement and strongly took a stand against mandatory vaccines, are now slowly changing their minds. This is in light of the coronavirus pandemic, which has infected more than 3.2 million people and claimed the lives of over 228 000 worldwide, indicates the Johns Hopkins Coronavirus Centre.

Vaccines have come a long way since 1796, the first of which was developed by Edward Jenner against smallpox. Since then, scientific research has saved millions of lives with the development of vaccines against various infectious diseases worldwide. 

However, because scientists cannot prove that vaccines are 100% safe, anti-vaxxers believe we shouldn’t use them at all. This is known as the “perfectionist fallacy”, and experts caution that this viewpoint is dangerous and prevents herd immunity from happening, which ultimately helps to stop the disease from spreading.

READ MORE | Coronavirus pandemic causing some anti-vaxxers to think differently

As the southern hemisphere moves closer to winter, virologists are concerned about the upcoming influenza season. This may result in more people needing medical care for flu – including hospitalisation – while the health system is still battling the coronavirus. This may swing the pendulum in favour of SARS-CoV-2 by making it harder to control the pandemic, especially in Africa, which has recorded the lowest number of cases thus far.

There are many other respiratory viruses that circulate throughout the year. But the influenza virus can be deadly. Influenza epidemics occur in late autumn and winter – between May and August – in the southern hemisphere and during the rainy season, which may be year round in the tropics.

Most people who get influenza only have a mild illness: a fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. But influenza can also cause more severe illness. This includes lower respiratory tract diseases that cause difficulty breathing, such as bronchitis or pneumonia. These conditions may require hospitalisation or even be fatal.

These signs are very similar to those caused by Covid-19. It may create additional anxiety for patients and stress on the healthcare system this year. This is why it’s advisable that everybody get the influenza vaccine. It will not protect people from Covid-19, but it will reduce influenza-related illness and in effect ease stress on health services during this pandemic.

READ MORE | Coronavirus pandemic: why a flu jab is a good idea in countries heading into winter

HEALTH TIPS (as recommended by the NICD and WHO)

• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing

• Practise frequent hand-washing, especially after direct contact with ill people or their environment

• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus

• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.

READ MORE: Coronavirus 101 

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NHS England says all essential vaccinations are still being provided despite the coronavirus outbreak.

A third of the government’s 122,300 tests in 24 hours were sent in the post but not necessarily completed.

Whenever societies are placed under stress, conspiracy theories blaming this or that nefarious agent for secretly fomenting the threat inevitably arise.

It’s no different during the current coronavirus crisis.

Some of the evidence-free hoaxes circulating now include theories that the virus is a military bioweapon created in a Chinese lab; that it was made and even patented by tech billionaire Bill Gates; or that new 5G cellular phone towers are the real villain – either by transmitting the virus or by causing a “weakening” of the immune systems in people nearby.

In all of these conspiracies, the “powers that be” know all about this, but choose to keep silent.

Potentially life-saving behaviours

For the vast majority of Americans who don’t subscribe to these notions, an eye-roll is the most common response. But experts stress that while bogus, conspiracy theories can do real harm to Americans’ health.

In the context of a health crisis, conspiracy theories can lead devotees “to refuse to engage in behaviours that have been scientifically proven to be good for their health and the health of their communities,” explained Joanne Miller. She’s associate professor of political science and international relations at the University of Delaware.

That includes potentially life-saving behaviours such as social distancing, aimed at helping all Americans.

In cities across the United States, people who are convinced that the coronavirus pandemic is a hoax or, at the very least, exaggerated, are gathering in close-knit crowds to protest government restrictions – a sure way to help spread the virus, experts say.

And even when successful interventions against Covid-19 do arrive, conspiracy theorists may avoid them, Miller said.

“Conspiracy theories often, but not always, arise as explanations for an incredibly negative, surprising event, such as a pandemic,” Miller said.

“Such events often make people feel uncertain, anxious, and that they’ve lost some control over their lives,” she explained. “And one way to reduce feelings of uncertainty, anxiety and loss of control is to tie bits and pieces of information about the event into a nice, neat conspiratorial bow.”

Conspiracy theories also reject reality “in favour of some plot involving a group of people with malevolent intent that is deliberately kept secret from the public,” added Dr Joseph Pierre. He’s acting chief of the Mental Health Community Care Systems of the VA Greater Los Angeles Healthcare System.

Importantly, Miller said, those plotters are often pegged as powerful, criminal, and in search of political or personal gain.

Need for control

Both Miller and Pierre agreed that conspiracy theories have been around since the dawn of time. One reason is that they can “make us feel special about being privy to a secret truth that’s hidden from the rest of us ‘sheep’,” said Pierre.

Another is the human tendency to cite “omnipotent forces” to explain natural events, “similar to our collective need to believe in God”, he said.

“And then there’s the need for control, certainty and closure,” he added. “[Because] most of us find that believing that bad things happen randomly for no reason to be pretty unsettling.”

Miller seconded that thought.

“It’s very anxiety-producing to believe the truth about the virus,” she said. “That it occurred naturally, and that we don’t yet know how to stop its spread. So, one way to reduce that anxiety is to believe, for example, that 5G towers are spreading the virus. That gives us something to fight against.”

And that fight isn’t just rhetorical: This week, the Associated Press reported that anti-Covid-19 arsonists set fire to 5G cell towers across the Netherlands, the United Kingdom, Ireland, Cyprus and Belgium. Phone service was interrupted for thousands.

“It’s heart-rending enough that families cannot be there at the bedside of loved ones who are critically ill,” Nick Jeffery, CEO of wireless carrier Vodafone UK, said on LinkedIn, the AP reported. “It’s even more upsetting that even the small solace of a phone or video call may now be denied them because of the selfish actions of a few deluded conspiracy theorists.”

No easy answers

Celebrities can join the conspiracy theory bandwagon, adding to its legitimacy for some.

As noted by the AP, actor Woody Harrelson recently shared a video purporting to show Chinese people taking down a 5G tower. That film clip turned out to be old footage of pro-democracy protestors in Hong Kong pulling down a “smart lamppost” over surveillance fears.

So, what’s the solution? People being what they are, Miller and Pierre agreed that there’s no easy answer.

Conspiracy theorists are often suspicious of bureaucrats or scientists, so the best response to conspiracy theories is to quickly rebut them as they arise, and to try to engage believers in conversations aimed at re-establishing trust.

But, “it’s really difficult to debunk conspiracy theories with factual information,” Miller noted. “For a person who believes the theory, any factual information you provide can be turned on its head and be used as additional evidence for the conspiracy, [as in] ‘look how deep this goes!'”

What about Facebook, Twitter and other social media banning posts citing bogus theories?

“This is a tricky one, because it’s not clear where the line should be drawn,” Miller said. “On the one hand, a large majority of us might agree that certain posts are conspiratorial or push other types of misinformation and are therefore dangerous and should be taken down. But who gets to decide what’s conspiratorial?”

Pierre warned that, unfortunately, “misinformation is big business, whether for profit or for political gain. We also live in a country where free speech is a core national value. Together, that makes limiting the exposure of people to misinformation very challenging.”

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Clinics will need to prove they can offer services while protecting the safety of patients and staff.

Using the most advanced Earth-observing laser instrument NASA has ever flown in space, scientists have made precise, detailed measurements of how the elevation of the Greenland and Antarctic ice sheets have changed over 16 years.