Should I get a booster and when?

Yes. If you have not already done so, get your booster dose. Being fully vaccinated should now mean getting your booster as well, and that’s the best way to be well protected against any serious complications from COVID-19. In Ontario, you are eligible for a booster if you are 18 or older and your second dose was at least 84 days ago.

Why do we need boosters?

Two doses of mRNA vaccines did a good job of protecting us against SARS-CoV-2, the virus that causes COVID-19. Over time, though, immune systems’ response to vaccination can begin to fade. That’s why a booster dose is needed. After the Omicron wave passes, the strategy for long-term vaccination against COVID-19 will be revisited but for now getting your booster is the best protection we have.

I see there’s still people with boosters testing positive, so what’s the point?

Yes, people with two vaccine doses and even three vaccine doses can test positive for COVID-19. With other variants of COVID-19, the vaccines did a good job of both stopping transmission of the virus to vaccinated people and preventing serious illness in vaccinated people. With the Omicron variant, the vaccine doesn’t stop all transmission. But, vaccination is still extremely effective at preventing serious illness and hospitalization caused by Omicron which is the most important goal of vaccination and reducing the impact of the pandemic on our daily lives. By reducing disease severity, we preserve our healthcare system capacity, which means that fewer public health restrictions will be necessary over time and the overall impact of the pandemic on our daily lives will lessen.

I heard some people are getting a fourth dose? Who?

People with certain immunocompromising conditions like recent stem cell transplants or organ transplants were given a “three-dose primary series.” This means to be fully vaccinated, folks with these specific illnesses were given three doses whereas the general population had two. Some of these people are now eligible for a fourth dose — their booster. You can find more info here. If you had an organ transplant or stem cell transplants or are in active treatment for cancer, please speak to your healthcare provider or learn how to book at this provincial booking link. In addition, residents of long-term care homes are being offered a fourth dose of a COVID-19 vaccine. This is to offer additional ongoing protecting to this vulnerable population.

I had COVID recently – when should I get a booster?

Update February 7, 2022: Canada’s National Advisory Committee on Immunization (NACI) now recommends that any vaccinated Canadian who gets infected with SARS-CoV-2 should wait three months before getting a COVID-19 booster shot. Read more about these new recommendations.

If you had COVID-19 after December 15 in Ontario, you’ve likely had Omicron already. If this is the case, there is no rush in getting a COVID-19 booster. We do know that natural immunity can begin to wane within a few months and for this reason vaccination has still been recommended among those who have recovered from COVID-19 once they have fully recovered. The optimal timing for that booster is not yet known but usually it is recommended you get it by three months from the infection.

My kid is 15 and was vaccinated as soon as they were able. Now that was a long time ago! When can they get a booster?

In Ontario, the booster shot has not yet been approved for those 12-17. The CDC in the United States recently announced approval for this population and it’s likely Canada and Ontario will follow suit too. We will update this page once we have more information.

I heard it’s only Moderna right now in Ontario for adult boosters, and I want Pfizer. What should I do?

In Ontario there is currently a Moderna-first approach. Adults age 30+ receive Moderna for their third dose and those under 30 may receive Pfizer based on availability. With Omicron widely circulating and the strong evidence that vaccination greatly reduces the risk of hospitalization and poor outcomes irrespective of the vaccine brand received, please take the booster shot that is available to you right now.

Sunnybrook’s Vaccine Clinic is closed to the public as Sunnybrook is currently focused on vaccinating staff and their households. To find a vaccine clinic near you, visit Ministry of Health’s website or the City of Toronto’s website.

The post COVID-19 booster doses: Dr. Jerome Leis answers some common questions appeared first on Your Health Matters.

Burnout is understandable

Dr. Zaretsky says “it’s completely unsurprising” to hear feelings of burnout have increased during the COVID-19 pandemic, with higher rates seen in 2021 than 2020 in some cases.

“I think the burnout is caused by prolonged disruption in normal life interactions and experiences in routines and connection in particular,” he says. “It’s prolonged and it’s unpredictable, with no definitive end in sight. We’re talking about an almost two-year disruption in normal human society, so that is a predictable reason why burnout would occur.”

It’s an unpredictable virus, and the “waves” of infections or emerging COVID-19 variants and their impact can create a feeling of helplessness in people, and a feeling that it might never end.

“I think when people have an expectation that something is going to be resolved in three months and then it’s not resolved in three months, it’s not resolved in one year, it’s not even resolved in 18 months, that takes a toll on people,” says Dr. Zaretsky.

What it means to feel ‘burnt out’

While to the average person, ‘burnout’ generally refers to a feeling of being overwhelmed, Dr. Zaretsky says the term originated with the work of American social psychologist Christina Maslach, who researched burnout in the workplace. According to Maslach’s research, there are generally three components to burnout.

“One is emotional exhaustion: a person has physical and emotional exhaustion,” says Dr. Zaretsky. “The second is depersonalization: someone feels like they’re a robot. They don’t care as much about their job. The final component has to do with a reduced sense of personal accomplishment.”

While it’s not a psychiatric condition, Dr. Zaretsky says there’s ongoing research looking into the relationship between burnout and depression.

“People may experience this subjective state of burnout at work and, as it gets worse, it becomes actual clinical depression,” he says.

Clinical depression will lead to people not being able to function in other areas of their lives, Dr. Zaretsky says, and burnout could lead to depression in individuals who haven’t experienced depression before. Another potential impact of increased feelings of burnout can be seen in the workforce: people will make career decisions based on burnout.

“They may actually leave the workplace or they may switch from one type of work to another based on a wish to avoid the burnout or remove themselves from an environment they believe is toxic in terms of causing burnout,” Dr. Zaretsky says.

Managing well-being in face of burnout

The feeling of burnout in the midst of the ongoing pandemic is real for many people. Dr. Zaretsky says while there is no simple answer for how to cope, there are some things that could be helpful in protecting your overall wellness right now.

He says managing expectations and understanding the nature of pandemics in a rational way might provide comfort.

“What I have found most helpful is to read about previous pandemics, so I know as a fact that this pandemic will not go on for the rest of my life,” he says. “It gives me some sense of hope, some sense there is an end point.”

Dr. Zaretsky also says it’s important to exert control over the areas of your life where you have control.

“Maintain your routines, maintain social connections and activities [while respecting Public Health guidelines],” he says. “Look after your self-care, look after your sleep, try to protect against overwork.”

They are simple things, but he says they can provide some control and offer protection to your mental health during an uncertain pandemic.

Dr. Zaretsky also stressed that special attention should be paid to reducing loneliness, which has been tragically intensified in our society because of the pandemic. “Loneliness and being alone are not the same thing. You can be lonely even if you are in a crowded environment, and you can feel connected and content when you are physically isolated,” he says. “That is where things like volunteering, connecting with and actually being in nature and interacting with pets can be particularly helpful and emotionally healing.”

And while some days it may feel as though we’ve gone back to March 2020, Dr. Zaretsky says it’s important to remind yourself that isn’t true. There are effective vaccines now, new antiviral drugs and we know much more now than we did back at the outset of the pandemic.

“And we know that pandemics do end.”

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text:45645 (4:00 p.m. – midnight Eastern Time)

The post How to care for yourself if you’re feeling burnt out by COVID appeared first on Your Health Matters.

Long COVID and Sunnybrook’s COVIDEO

COVIDEO, funded in part by Ontario Health, is a program at Sunnybrook that has helped patients with mild to moderate cases of COVID recover at home with consultations over video or phone. Dr. Daneman is the co-lead of COVIDEO, along with Drs. Philip Lam, Nisha Andany and Adrienne Chan.

The doctors have now seen 9,000 patients through COVIDEO, and they are beginning to analyze some of the data. Patients diagnosed with COVID-19 at Sunnybrook are offered a 90-day in-person follow-up visit. Of the first 995 patients, 506 didn’t respond to the invitation, 266 responded and declined, saying they were back to health, and there were 206 patients who came in for the 90-day follow up. From that data, Dr. Daneman says they have been able to look at which symptoms are most persistent and how common they are.

He did caution these numbers are likely overestimates, and also says these are symptoms seen in individuals who were not hospitalized with COVID-19; hospitalized and critically ill patients would have a different recovery than people who had a mild to moderate case of the virus.

“Generally, if you read about long COVID in the news, people are going to be worried that everyone is left with terrible after effects, but the vast majority of people are back to normal health way before the three-month mark.”

Most common “long COVID” symptoms

Dr. Daneman says the most common symptoms seen in COVIDEO patients are similar to what is being seen elsewhere.

“Fatigue, number one,” he says. “Some kind of anxiety, depression, insomnia [is] pretty common. Headache.”

He also says some patients still experience loss of smell at 90 days and temporary hair loss, known as telogen effluvium, was common, although it’s a condition known to happen sometimes after an acute illness.

Some patients still had a cough or some muscle and joint aches. 

Recovery from long COVID

For people still battling COVID-19 symptoms months after their initial infection, they may understandably wonder when they will feel well again, and what they can do to help the process.

“One of the biggest things is time,” says Dr. Daneman. “We see this after almost any type of infection. That some people, a minority of people, can end up with some residual symptoms.”

He gives the example of a chronic cough following influenza or chronic fatigue after a bout of mono. And he says while it may be tempting to hunt for an “active, ongoing infection,” most often there is no infection remaining; the body simply needs time to recover.

“The trigger’s already gone and the body just hasn’t turned off the light switch that’s been turned on,” Dr. Daneman says.

Adopt healthy coping strategies

While Dr. Daneman is not a rehabilitation specialist, he says it’s important for people to find ways of coping and to find a “happy medium where they’re getting energizing activity, but not overdoing it.”

The COVIDEO program has some multi-disciplinary collaborations with the physiatry and rehabilitation departments to provide rehabilitation for Sunnybrook patients who are experiencing long COVID symptoms.

It might be difficult, but Dr. Daneman also recommends people don’t withdraw from their family, friends, work or hobbies because that could make mood or anxiety symptoms, or even physical symptoms, worse.

“It’s important to try as best as possible to find coping strategies and work toward the recovery because it will come with time,” he says.

The post When COVID-19 lingers: symptoms and recovery tips for COVID long haulers appeared first on Your Health Matters.

“Young people are experiencing a range of emotions including frustration, stress, anger, and anxiety,” says Dr. Amy Cheung, youth psychiatrist. “It is normal to feel many emotions throughout the pandemic, which is a complicated and uncertain time for everyone.”

Coping with fear or anxiety

When teens are feeling fear, worry or anxiety, it is important that they reach out for help.  These are challenging times and some teens may be finding it more difficult to cope throughout the COVID-19 pandemic.

“Teens can talk to caring adults or reach out to virtual walk-in counselling,” explains Dr. Cheung. “Just having a conversation about how a teen is feeling is a good start.”

If a teenager is already managing a mental illness and their treatment requires medication, Dr. Cheung says keeping their schedule is key to their health and well-being, “During this stressful time making sure they are taking their medication and seeing their health care providers regularly is very important – especially as the pandemic continues.”

It is also important to keep up with a regular routine to help bring some normalcy to the day. Having a routine can help people feel as that they have some control in this uncertain time.

Ensuring teens keep up with proper hygiene can help their mental health. Changing into regular clothes daily, rather than staying in pyjamas can help give them a sense of purpose and meaning.

“Self-care such as good diet, exercise, and a regular sleep routine are also important,” adds Dr. Cheung. “Relaxation and mindfulness strategies can be helpful as well.”

While staying current with news headlines is important, taking breaks by incorporating strategies for managing information overload can benefit the whole family and help reduce stress.

Signs a teen may be having a difficult time

Teenagers are grappling with a lot these days. There may be more outbursts, or a teen may be more withdrawn. There are some signs parents can keep an eye out for that may signal a teen is having a more difficult time managing changes day-to-day.

“Parents should watch for signs of poor emotional health such as crying, sadness, panic symptoms, poor sleep, appetite or fatigue,” says Dr. Cheung, “A teen may also express they have physical symptoms such as headaches and stomach aches.”

The pandemic may be intensifying existing mental health and addiction issues a young person may already be dealing with and trying to manage.

What can parents do to support their child?

Experts encourage parents to be open, honest and calm when addressing any issues. Most importantly, listen. Is a teen upset about COVID-19 itself or is there something else going on?

“Parents can listen to their teen to see what their concerns are,” says Dr. Cheung.  “It’s not always easy to know or explain what the issue is, I find many teens are not anxious about getting sick but stressed about school being online or missing their friends or about money.”

These aren’t always easy conversations to have but there are tips to help parents talk to their children about mental health and experts say it is especially important for parents to start the conversations, as teens may not want to confide in parents worried about disappointing them, and sometimes, it’s just tough to talk about needing help with mental health.

“Parents can also assess virtual walk in counselling to help their kids,” says Dr. Cheung. “Most pediatricians are also available by virtual appointments which can be scheduled online or on the phone.”

For more resources and information about COVID-19 from Sunnybrook experts read our blog.

If you or someone you know is thinking about suicide or in severe emotional distress, please call 911 or visit your local emergency department.

If you feel like you are in crisis or need somebody to talk to, community resources are here to help.

Crisis Services Canada

• 1-833-456-4566 (24 hours, 7 days a week toll-free)
• Text: 45645 (4 p.m. – midnight ET)

Kids Help Phone

• 1 800 668 6868 (voice)
• Text: 686868 (24 hours, 7 days a week)

ConnexOntario: Addiction, Mental Health, and Problem Gambling Treatment Services in Ontario

• 1-866-531-2600 (24 hours, 7 days a week)

Mental Health T.O. Virtual Mental Health Counselling

• 1-866-585-6486 (Monday – Friday 9:00 a.m. – 7:00 p.m. ET)

Toronto Distress Centre

• 416-408-HELP (4357), (24 hours, 7 days a week)

The post How to support young people during the COVID-19 pandemic appeared first on Your Health Matters.

She says several initiatives around virtual volunteer outreach are already having a positive impact on inpatients. One provides musical birthday greetings, recorded by volunteer Gemma Donn, who is also a concert violinist. Together with several of her musical colleagues, Donn records a customized greeting that includes singing. Amber Hall, a recreational therapist at the Holland Centre, then brings the recording to the patient’s room to safely view it on a sterilized iPad. “The patient watching the surprise video is then recorded, and this is combined with the original to create a keepsake the patient can watch over and over,” says Di Lella.

In another form of outreach, volunteer John Maxwell is leveraging the positive impact of his therapy dog Cooper. Maxwell takes a picture of Cooper outfitted with a special message specifically for inpatients on their birthdays. Hall then prints off a copy for the patient to keep and enjoy.

“With the suspension of volunteers onsite, these are ways our fantastic volunteers can continue to help,” says Di Lella. She adds that discussions are currently underway to expand the virtual volunteer experience. In the future, that might include other activities, like teaching patients to knit or explaining how to perform certain magic tricks over Zoom teleconferencing. While the realities around COVID-19 have changed our lives, Di Lella says the need for human connection will always be with us.

The post Virtual volunteer initiatives are having a positive impact at Sunnybrook appeared first on Your Health Matters.

Too much? Too little? Are you waking up in the middle of the night?

Are weird and vivid dreams, or nightmares disturbing your slumber?

As the COVID-19 pandemic continues, people are experiencing greater levels of stress and anxiety than ever before, which is taking a toll on people’s sleep. Experts say, in this time of distress, sleep should be a top priority.

“Good sleep can be beneficial for your physical and mental health,” says Dr. Mark Boulos, sleep expert and neurologist. “It can actually improve your immunity to help your body fight off illnesses.”

“During times of stress, it is very important to pay special attention to getting optimal sleep,” explains Dr. Ari Zaretsky, chief of psychiatry. “Sleep enhances both physical and emotional resilience to stress.”

Trouble sleeping during COVID-19

There is a lot to worry about lately and we are all facing a great deal of uncertainty which can affect normal patterns of sleep.

Sleep experts say insomnia may be more prevalent in times like these.

“Insomnia occurs when it is difficult to fall asleep and stay asleep,” says Dr. Boulos. “Sometimes people will fall asleep but wake up in the middle of the night and can’t get back to sleep. Elevated stress levels and information overload can cause sleep problems. In other cases, there may be medical issues causing insomnia such as sleep apnea or restless leg syndrome, and some medications can also interrupt a person’s sleep cycle.”

A change in routine can also make it difficult to fall asleep as many families are adjusting to a new way of life with self-isolation, children no longer attending school, and with more people working from home, or coping with unemployment. This disruption to typical daily schedules can lead to inconsistent bedtimes, wake times, or taking longer naps throughout the day which can impact normal sleep cycles.

Sleep problems: sleeping too much

In otherwise healthy adults, experts say eight to nine hours of sleep a night is typically a sufficient amount of sleep.

If you’re sleeping in more often than usual, your body may be catching up on sleep, but, if you or someone in your household is sleeping for hours and hours each day, something else may be going on.

“Most guidelines say more than nine hours of sleep over an extended period of time, could be a sign of a larger problem,” says Dr. Boulos. “Individuals who don’t want to wake up or get out of bed and spend large amounts in bed all the time may be dealing an underlying medical or psychiatric issue.”

“There is a well-known relationship between sleep disturbance and psychiatric conditions such as depression and anxiety disorders,” adds Dr. Zaretsky. “People should seek mental health assistance if their sleep disruption is prolonged and affects their functioning and also if this sleep disruption is associated with other psychiatric symptoms such as severe sadness, tearfulness, loss of appetite, emotional withdrawal, panic attacks or thoughts of death.”

Dreaming during the COVID-19 pandemic

Have you had strange dreams during the pandemic?

Worldwide, people are taking to social media and reporting having vivid dreams or nightmares and being able to remember them in detail.

Dreaming occurs during REM (rapid eye movement) sleep, a later stage of sleep when the brain is active.

“Dreams are usually a constellation of thoughts and memories from earlier in the day, and often earlier in life.  During this unusual time of a pandemic, lots of thoughts are going through people’s minds,” says Dr. Boulos. “When people dream, these thoughts can be combined; some dreams are related to reality, but others are not and are just made up in the mind of the person while they sleep.  With all these stressors going on, dreams may be quite unusual during COVID. Part reality, part fiction, inter-twined with stress, anxiety and worry.”

“If you are woken during REM sleep, you are much more likely to remember your dream,” says Dr. Zaretsky. “Psychologically, it is believed that nightmares are dreams that pertain to stressful issues that we have not been able to resolve. During the COVID-19 pandemic, many people are experiencing vivid dreams and nightmares as they face fear and uncertainty about the future. This is a normal human reaction.”

Tips for managing sleep during the COVID-19 pandemic

If you are a health care worker, sleep is incredibly important, especially if you’re doing shift work. Here are 10 tips to help healthcare workers get better sleep during COVID-19 and some tips for healthcare workers for coping at work and home during COVID-19.

Not only is getting a good night’s sleep “physically and mentally restorative” explains Dr. Zaretsky. It is beneficial for brain health, which can help improve productivity.

“Sleep is also extremely important for proper memory functioning and proper neural function,” he adds.

Here are some general tips to help with getting more quality ZZZZZ’s:

Keep a sleep schedule or routine

Having a routine creates structure to your day, which can be reassuring and provide some normalcy when everything else is so uncertain.

When planning your sleep schedule, remember to include some time to relax before bedtime to help your brain wind down. Establish a set bedtime and use an alarm to wake up at the same time each day. Stick to your routine and avoid hitting the snooze button to help regulate your day.

Naps

Sleep experts say brief power naps can be helpful if a person is getting less than six hours of sleep at night. A short power nap of about 10 to 20 minutes, earlier in the day rather than later in the afternoon, can help give your brain a boost. Being at home, it can be tempting to nap throughout the day or for longer periods of time, but this can get in the way of a good night’s rest. Bottom line: if you’re going to nap, keep it to less than 20 minutes and avoid napping in the afternoon.

Shutdown screens before bed

Power down devices an hour or two before bedtime. The blue light emitted from electronics disrupts your internal clock and delays the release of melatonin, a hormone that prepares your body for sleep. Try leaving your smartphone to charge in another room to help avoid checking the latest headlines in the middle of the night. Limiting screen time can help manage information overload during the COVID-19 pandemic and minimize watching distressing news before bedtime which can lead to feelings of stress and anxiety.

Other tips for improved sleep hygiene

Doing something relaxing before bedtime to help wind down can help improve your sleep, such as taking a warm bath, reading a book, listening to relaxing music or meditating. Eating nutritious meals, and avoiding caffeine and alcohol in the evening, can help foster good sleep hygiene.

Stay active

Regular physical activity and moderate aerobic exercise can help you fall asleep and get a better sleep at night. Experts say exercise is best earlier in the day and to avoid working out too close to when you’re going to bed. Exercise causes the body to release endorphins which can potentially keep you awake.  Finish your workout at least two to three hours before bedtime. Check out these tips for staying physically active while staying at home.

It is important to know you are not alone. People around the world are trying to cope with change and a new way of living. Whether you find comfort in spirituality, writing in a journal, finding ways to stay connected with family and friends while physically distancing, or by learning a new hobby, there are many different ways to manage your mental health, which can help lead to improved sleep.For more resources and information about COVID-19 from Sunnybrook experts read our blog.

If you or someone you know is thinking about suicide or in severe emotional distress, please call 911 or visit your local emergency department.

If you feel like you are in crisis or need somebody to talk to, community resources are here to help.

Crisis Services Canada

• 24-hour, toll-free 1-833-456-4566
• Text: 45645 (4 p.m. – midnight ET)

The post COVID-19: Sleep problems, dreams and nightmares appeared first on Your Health Matters.