Obsessive fears about leaving the house in the era of Corona
June 28, 2020 12:25 PM   Subscribe

I was already an obsessive worrier before COVID. Now it's like all my fears have been made real in the world. I also have a brand new case of agoraphobia. Sometimes I go days or weeks without leaving the apartment. I live in a populated area that is for the moment on the downward curve. We have a backyard in apartment of the building I would like to use but I may have to pass others indoors to get there. My question is twofold:

1) How dangerous it if I pass other masked tenants in the apartment on the way to the door? Can you point me to scientific research on this?

2) Any suggestions on how to deal with this issue in general. I don't want to do anything crazy but maybe one day I'll walk around the block again. (Please don't suggest medication, I know about those options.)

posted by captainscared to Health & Fitness (21 answers total) 16 users marked this as a favorite
This is a pretty good guide to the risks: Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis from The Lancet

basically, masks + very short duration of contact = low risk of transmission.
posted by chavenet at 12:56 PM on June 28, 2020 [15 favorites]

Where to Worry About Catching Covid-19, and Where Not To (Faye Flam, Bloomberg Opinion, May 15, 2020) (e.g. "The two drivers of the spread of the disease are close contact and crowding in closed spaces, says Muge Cevik, an infectious disease specialist at the University of St. Andrews in the U.K. [...] Cevik has been collecting and reviewing papers from around the world on disease transmission. “There are some trends emerging,” she says. “Spending time dining together, being in public transport,” might risk spreading the disease, but “going to a market briefly, for five minutes or a transient encounter while you walk or run past someone, those are low risks.”")

Know the risks: Where you are most likely to get coronavirus (Eden David, ABC News, May 16, 2020) (e.g. "Prolonged contact and lots of direct talking, breathing, and yelling between individuals increases the direct exposure to viral particles, which increases the likelihood for infection. [...] [Dr. Erin] Bromage said that the activities many typically view as highest risk for infection like grocery shopping might not be as risky if you're spending a brief amount of time at the store, you're avoiding other shoppers, not speaking directly with people, and the store restricts the number of people that can enter at a given time.")

How to Safely Work Out Outdoors During the Summer of COVID-19 (Claire Young, Inside Hook, Jun. 25, 2020, via Harvard T.H. Chan School of Public Health coronavirus news updates) (e.g. "Whether exercising vigorously or going for a walk, [Dr. I-Min Lee, MD, ScD, Professor of Epidemiology, Harvard T.H. Chan School of Public Health] says bring your mask and be ready to quickly pull it up.")
posted by katra at 1:06 PM on June 28, 2020 [5 favorites]

Question 1 has been answered very well by chavenet's link above. The short answer is if you pass by other masked tenants who aren't actively coughing or sneezing and you don't linger, the risks to you are very low.

Question 2. The best way to do deal with this is understanding the nature of this virus and having a bit of perspective. Realistically, to catch this thing you need to be in close proximity to a carrier for a sustained period of time. This is not ebola. Even if you accidentally touch a surface that has cough droplets or mucosal contents from a carrier, as long as you don't touch your own mucosal areas (eyes, nose, mouth) before washing or sanitizing you will be ok. You absolutely don't need to do anything "crazy" as you say. Wear a mask, avoid people who are actively coughing or sneezing, wash your hands frequently, and don't touch your face. When you come home, wash your hands, change into dedicated "home clothes" and take a shower if you really want to be sure.

When my colleagues and I were redeployed to the Covid ICU to treat actual Covid patients on ventilators, we were scared and anxious too--it's normal. But with proper precautions and PPE the infection rates among ICU staff is practically nil. So this virus is not some nebulous all powerful thing that gets people on contact. It's beatable and we know how to do it. Stay safe, but also stay calm--it's going to be a marathon and whatever you decide to do to cope with this thing has to be sustainable.
posted by reformedjerk at 1:15 PM on June 28, 2020 [56 favorites]

The previous comments have covered #1 pretty well. For #2, the CBT answer is exposure. Or, if you prefer marketing slogans from multinational corporations, just do it. Set a goal to go outside for five minutes today, then put on a mask and go stand outside. Stay six feet away from other people, don’t touch your face, and wash your hands when you go back inside. Then tomorrow, set a goal for six minutes. Then set a goal that you’ll walk to a corner and back. Keep upping the distance - the goal is to get outside of your comfort zone.

It may be helpful to keep in mind that you’re going to get a disease one way or the other. The long term effects of coronavirus aren’t fully known yet, but it does seem like it’s possible to recover and get back to normal. The long term effects of anxiety, though, are well-known, and potentially debilitating. And anxiety is pretty damn hard to recover from. You’re not doing yourself any favors by becoming a shut-in.
posted by kevinbelt at 1:21 PM on June 28, 2020 [6 favorites]

2) Any suggestions on how to deal with this issue in general. I don't want to do anything crazy but maybe one day I'll walk around the block again. (Please don't suggest medication, I know about those options.)

I used to have horrific agoraphobia. I got over it by repeatedly doing things that scared me, wait it out until calm, repeat. There's also a sort of decision point where you start telling yourself not to do X (go out) and that has to be the trigger for you to put your shoes on and go right away so you don't reinforce the anxiety by giving into it.

This process can be done with professional support as well, which I'd recommend if you have access to it. But generally, what you have to do is divorce your fear from your behavior until your brain has a reasonable set of "I did this and it was fine" examples to work from.
posted by Rock 'em Sock 'em at 1:22 PM on June 28, 2020 [11 favorites]

For item 2, timing is a useful thing to consider. What are the local rush hours like, do you have fellow tenants who tend to be heading to work at 7ish, or do you have neighbors with dogs who like to walk them early?

Another thing that's helped me is remembering that if I start to go into the laundry room/lobby/mail room and it's too peoply for me, I can turn around and leave, and try again later. No big deal. Sometimes I tell myself that I'm just going to see if it's busy and if I want to try dealing with it today.

It'll be helpful to wear a mask, of course, and maybe to carry wipes or sanitizer for touching shared surfaces. I'd rather use a wipe to open a door than stress about when I can next wash my hands.
posted by bunderful at 1:35 PM on June 28, 2020 [1 favorite]

Further data points for your first question: we're not going to get gold-standard, randomized clinical trial information on mask-wearing (it's very hard to test public health interventions this way), but there have been a handful of cases that illustrate that being around masked people with COVID-19 is not always enough to get you sick: These were both long and/or up-close exposures to people who definitely had symptomatic COVID-19, but there was no transmission. So, firstly: you can interact *closely* with a masked person with COVID-19 and not get the virus.

Secondly: If the virus is on a downward curve in your area, the chances that any of the people you are passing actually have COVID-19 is pretty low! My state is still seeing ~200 new cases a day (and dropping, yay!) which means let's say 5000-6000 infected people out of seven million in the state (if we assume that people are contagious for 3 weeks, which IIRC is a pretty conservative estimate). At least few hundred of those people are in the hospital (or long term care, or prison), plus more are probably too sick to leave their homes, plus more are quarantining appropriately. Even if there are 4,000 people in the state walking around outside with COVID-19, that's like one per every 1800 people. I do not come in close contact with 1800 people when I leave my home.

In order to get COVID-19 from someone, you would have to find someone walking around with COVID-19 (increasingly uncommon in your area) and spend enough time in close contact with them to get infected (which is actually harder than it seems).

You are (almost definitely) going to be OK! Go for a walk around the block and see how nice it is!
posted by mskyle at 1:55 PM on June 28, 2020 [9 favorites]

Masks work. They just do. Look at all the protests...everyone wore masks, and cases continued to drop in most places. Reopen the bars and restaurants and fill them with unmasked 20-somethings in party mode? Full outbreak again. I would be more concerned with what you're doing in this garden. Are you going to be sitting? Bring your own chair. Is it completely surrounded by walls? Are a lot of people hanging out there? Maybe that's not as outdoors as it seems. I've been walking the streets at night...my neighborhood is residential, but near a tunnel so there's lots of places with no one around and I can even take the mask off for a bit...its nice...think I might break out the rollerblades tonight. When there's no cars the streets are mine!
I was you a few weeks ago. Set up a chair by a window and watch people walking by. You'll feel better, trust me.
posted by sexyrobot at 2:09 PM on June 28, 2020 [5 favorites]

For the agoraphobia element, you could try having a listen of Hope and Help for your Nerves by Claire Weekes. I found it really helpful for anxiety, and she deals a lot with agoraphobia. Some of it is very dated (it's from the 1960s and she talks about housewives having agoraphobia because they're based at home and men having stress because of their roles in the workplace). But it's worth trying to see past that, because she was way ahead of her time in identifying techniques that have become popular recently within mindfulness etc - being aware of the way anxiety affects your body and manifests in your body, using that awareness to interupt and short circuit the spiralling of anxiety, overcoming agoraphobia through gradually increased exposure, etc.

She talks about anxious people having been 'sensitised' by a period of stress or nervous tension, and you could certainly see the corona era as having sensitised you, in a way that means you now need to recalibrate.

She was a brisk, but kindly Australian doctor and I kind of like her delivery in an old-school kind of way.
posted by penguin pie at 3:17 PM on June 28, 2020 [2 favorites]

Having some degree of agoraphobia is reasonable in the age of covid. Instead of criticizing yourself as an "obsessive worrier", you could mentally reframe this as "taking precautions".

To me, spending days/weeks at home sounds perfectly rational. I don't think it's necessary to use mental techniques to force yourself out of your comfort zone and go outside.
posted by cheesecake at 4:34 PM on June 28, 2020 [4 favorites]

Humans do significantly worse cut off from light and fresh air and social contact. There's a reason even the Colorado supermax allows the prisoners to exercise (singly) in a square open to the sky. Even Zeynep Tufecki, heroic voice for masking early on, has pointed this out. For some people, the risk of the virus may be so extreme that they judge they must expose themselves to these other harms to avoid exposure to COVID-19, and I'm certainly not going to critique anyone else's risk calculus for them unrequested. But it is completely wrong to treat exposing yourself to these other risks as simply "perfectly rational" "taking precautions," especially if the person already feels that there's an unhealthy aspect to their worries.
posted by praemunire at 4:49 PM on June 28, 2020 [9 favorites]

I'm doing what you're doing and I don't think it is obsessive. As far as the advice given it was good when it was given but this is a moving target so I try to stay as up to date as possible. Remember when masks were said to be unnecessary?

Can you get to a car without running into folks? If so, maybe you could get to a park or outside somewhere where there are no people. Nature is good and can help your attitude.
posted by charlesminus at 4:51 PM on June 28, 2020 [2 favorites]

One of the things I've been doing to make stressful necessary tasks less stressful is to optimize (when possible) my timing, and decide in advance what my boundaries are going to be.

So for you, you may need to observe (as best you can) traffic patterns in the hallway (but realistically, you know the highest traffic is likely going to be when people who must work outside their home are coming and going to/from work, plus maybe lunchtime if people who are home are using that as their going-out time) and pick a time that you are least likely to pass someone, and decide in advance how many people (or unmasked people) in the hallway is your limit before you turn around and go back to your apartment.

Me? I'd probably start by going late at night, after the after-dinner leg stretchers have gone home and everyone else is gearing down for the night. After 8pm, maybe 9. I think once you do that 2-3-4 nights, and actually get to enjoy your backyard outdoor space a little bit, you'll lose the worst of the edge about passing people in the hallway while still being appropriately mindful. You may get to a point where you feel like you can do a mid-morning or mid-afternoon trip with little other traffic, so you can get some sunlight.

I am entirely team "stay home except when you must go out" but that "must" to me includes carefully getting exercise, fresh air, and a change of scenery. If it will make you feel better for the duration of that walk, you can make yourself a DIY face shield and wear that over a mask, so that your mucous membranes are about as protected as safely possible.
posted by Lyn Never at 5:23 PM on June 28, 2020 [3 favorites]

(The postscript to that would be: if it simply does not ever clear your "acceptable risk" bar, and you don't go out, that's not anything wrong with you. It is a reasonable choice. It's just not one most people have, either for practical or mental health reasons, and if it is necessary to your well-being to go out, just do so as safely as you can.)
posted by Lyn Never at 5:44 PM on June 28, 2020 [2 favorites]

You've already received a lot of very good advice.

We all have different needs. I'm a home-bound introvert by nature, so while I'm very worried about the pandemic, the actual staying at home all the time part hasn't been upsetting to me at all -- it's what I'm normally inclined to do anyway, just turned up to eleven.

But since you're asking this question, what I'm hearing is that your current situation is causing you some unhappiness and you want to do something to change it.

While it is definitely a good idea for you to do more reading into the relative risks of transmission, so that an irrational fear of contracting the virus will not prevent you from doing things that you really need to do for your own safety and well-being (e.g. obtaining groceries or medication), I would also like to echo the sentiment that you don't have to push yourself to make non-essential trips outside right now.

It's fine to be cautious, and it's fine to wait.
posted by confluency at 2:07 AM on June 29, 2020 [1 favorite]

So much good advice already here. I am struggling with very similar fears and I want you to know that 1) you are not alone 2) you are brave (I know you are, because you are facing your fear and deciding what to do about it) 3)the fact that you are struggling with this does not mean you are "broken" or "weak" or anything like that. It is a perfectly rational and human response to an overwhelming situation.
Tell yourself this.
Be kind to yourself.
As you learn more about your needs and limits, you will learn when to listen to your internal warnings, and when you should ignore them and push through.
Small steps. One day at a time
I have found ACT based meditation, and loving kindness meditation very helpful. Also, knitting! It's remarkably soothing :)
Please know that this internet stranger is thinking of you and wishing you strength and joy.
posted by Zumbador at 5:56 AM on June 29, 2020 [1 favorite]

Viral load is a thing. Duration of time hanging out where you might be exposed to the virus increases your chances of getting it. One hour in the store on two different days puts you at less risk that two hours at the stone on one day. So it is to your advantage not to break your errands and appointments up over several days and not to try to get them done in one big long day of errands.

Are you a night owl? If you are I am going to suggest that you try taking a nightly foray out of the apartment all the way outside every night at some time when the hallways are most likely to be deserted. If you aren't a night owl, then try early Sunday and Saturday morning, five AM when the birds are chirping.

Kind of like playing pacman, see how far you can get without getting into a situation where you need to turn around and avoid other people. When blocked see if you can find another route to go in that direction, or change direction and see if you can go west instead of north. Of course, if you can't even get out of the building without getting within six feet of other people you don't have to turn around - you're wearing a mask, after all. It only counts once you are actually outside. Stroll around challenging yourself to get to the corner by zig zagging down the street. There's a negligible risk if you end up within six feet of someone else because you are outside, your area is getting safer and you will be wearing a mask and the time you will spend near them will be so brief. If you live in Texas the risk is a fair bit higher, but you said your area is on a downward curve.

Set an appointment time for this and do it every day at the time when it seems most likely that you will probably be able to get outside without meeting anyone. You really need to schedule it so as to ensure that you don't keep putting it off until a little later "when it might be safer." If you can't do it every day at least try and do it on both Saturday and Sunday morning when you're most likely to get the farthest.

Carry a magic talisman for the psychological benefits. If you are religious a holy symbol works, if not, see if having either a symbolic companion, or a symbol of your tribe makes you feel better. You could bring a photograph of someone you love or loved, like your grandmother or sister, or a drawing of your favourite Star Dew Valley love interest, or a special rock, or anything that has psychological resonance with you so that it could be a comfort.

Consider each expedition a success if you attempt it, no matter how far you get, so long as you get down the hall. It counts as a success if you get all the way to the door of your building and see that there is a cluster of people socializing on the outside steps and you have to give up at that point and never even get outside. You will have made the daily attempt. But don't give up unless you truly are blocked; look for a side exit that isn't blocked instead. It's not about how far you get, it's about getting as far as you can.

If you are nervous about walking around deserted streets at night, and are not a big threatening guy, see if you can spot someone who looks harmless, such as a guy walking a small dog, and walk around where they are in sight and if anyone attacks them you can grab your cell phone and call for help, or if anyone attacks you they will see and hopefully call on your behalf. If you need to linger to keep them in sight and don't want them to be nervous, either study your own cell phone as if interrupted by a call, or do obvious health and fitness exercises like Achilles tendon stretches. If you have exercise clothes you may want to put them on to signal that you are a harmless person out exercising and that you are fit and could ran away very fast or fight off an attacker. Of course if you are not reduced to sneaking out at three AM to get a low enough traffic density, you probably won't need the exercise gear and tendon stretches.

But make plans for what you can do when in a situation that makes you nervous such as bottle necks. You might want to cling desperately to normal and just walk through a group of unmasked people as you would have in the pre-Covid days but then if you do feel so sick from anxiety that you never want to go out again. So plan on doing something absurd, at least once every trip, and not pretend things are normal and your old routines are necessary. Be prepared to break some territorial boundaries you would normally not consider, such as going up onto someone else's steps to let a group go by, or detouring into the street around a parked car, or stepping into a parking lot.

If you have a family member or friends, make someone your accountability buddy, and tell them. "I've been in the house too long, so I am going out to get some exercise on Tuesday night." Then you've made a public commitment and are more likely to keep it.

If your area is considered safe enough for non essential shopping - according to the medical experts, not according to the politicians or the general public - reward yourself with small cheap items for getting out there. You could pick wild flowers, or grab a pack of gum at a convenience store, or you could order candy on line, have them delivered and let yourself have one cherry-chocolate every time you get as far as Delaney street, but only a regular boring creme filling chocolate if you don't get any farther than Clayborn. You probably aren't very motivated to eat chocolates, but the reward ritual helps when trying to motivate yourself. It's a psychological support. You could also simply call it "taking a walk before dinner" and use getting back from your foray outside as your cue to cook your supper.

Invent a new hobby that requires you to go outside, such as painting rocks and finding places to leave them, or spotting painted rocks if they do that in your neighborhood, or dog watching, or Pokemon-Go. Play scavenger hunts. You will stay out and keep walking until you have seen a red car, a blue car and a white car. Pick up some sidewalk chalk and set a goal of walking two blocks up and writing a cryptic or encouraging message on the sidewalk or on a suitable surface where it isn't going to annoy some building owner. Use little metrics and goals like this to push yourself a little farther. Most people find taking walks totally boring compared to the variety and intensity of huddling over their internet, so do things that make the walks more relaxing and amusing, like listening to a well chosen restful playlist as you walk.

Try and start this project today before you next go to bed. Getting started is the biggest hurdle you have to leap, followed by sustaining it. I challenge you today to put on a pair of shoes, open your apartment door and walk as far as either the elevator or the stairwell. Please don't go to bed without doing this - and it even counts if you put on the shoes and have a mask in hand and look out your door but then don't step outside because there was someone in the hall and they didn't go away. Open your door today and try it and you're on your way. That's all it will take, pushing and pushing against your boundaries.
posted by Jane the Brown at 7:19 AM on June 29, 2020 [3 favorites]

I wish people would stop saying "don't touch your face". it's not really possible to do unless you are a wearing a full face covering. Wear a mask in public. Wash your hands. Social distance, even out in public. Don't worry about touching your face, especially if you are wearing a mask, which requires you to touch your face even more.
posted by The_Vegetables at 11:04 AM on June 29, 2020

i have all sorts of suggestions for agoraphobia. i used to have it very, very badly, and have about 96% conquered it. however, absolutely none of them are useful or relevant in the age of covid.

did the agoraphobia start when covid did? or does it pre-date the pandemic?
posted by misanthropicsarah at 11:32 AM on June 29, 2020

Look, I don't know if this is helpful. I'm not sure how well it aligns with what you're asking about. There's plenty here about the studies showing what you can do to minimize risk and lots of info about fighting agoraphobia. But to add my two cents: Be kind to yourself. The situation right now is completely unprecedented, and we're all trying to make sense of it. It's a wreck. Being nervous and overwhelmed is totally understandable.

If I wear a mask, I protect others more than I help myself, and I am totally down for that. Social obligation etc. Then again, reading studies like the ones posted above are super helpful in ensuring the choices I make are as safe as possible for those around me. And calling people out is uncomfortable (respectfully, because you catch more flies with honey) and important. And the best I can do is walk on the far side of the sidewalk when I pass people irl who are acting irresponsibly.

If I stay home all day I'm miserable from lack of Vitamin D. The more I stay inside the more I lose my mind. It adds to my anxiety. Having a foster dog helped immensely...I have to leave my house, and I get to see how others are managing risk. Most people are making good choices. When they're not, I cross the street and I don't feel guilty.

Again, not sure if this is helpful. But please be kind to yourself and be understanding about how you're feeling. It is ok to feel a new kind of intense anxiety. But the more you can push yourself to get out and about, the happier you're feel, and the more willing you'll be to take more "risks" ("risks" in quotation marks because if you do it right, according to what others wrote, the risk is very low).

In summation:
-be kind to yourself
-wear a mask and wash your hand. Don't touch your face.
-don't be afraid to avoid people outside.
-minimize indoor social activities where you're in extended contact with others.
posted by violetish at 5:32 PM on June 29, 2020

I am also agoraphobic, but in all honesty, it's because nobody here is wearing masks or keeping their distance and my asshole neighbor goes outside to sneeze and cough twice a day. If everyone in your area is actually wearing masks and actually keep their distance from you, it might not be too bad? I'm unclear on "We have a backyard in apartment of the building I would like to use but I may have to pass others indoors to get there" actually means. Your backyard isn't attached to your apartment? Is it a group backyard for the complex? If I didn't have asshole neighbor sharing his droplets, i'd be using my patio because it's mine, but I don't think I'd want to use a shared backyard that's for the entire complex now. You can probably pass people in the halls if they are wearing masks, but I don't want to pass anyone who isn't these days, and who knows what everyone else sharing the backyard wants to do.

I still have to go outside once in a while when I absolutely have to, I haven't gone full panic attack yet. But when I go out it's armed for bear: layers of masks, crappy outdoor clothes, armed with sanitizer and wipes and trying my best to touch anything as little as possible. Mostly I'm just in my car making sure it runs, rather than taking a nice stroll with the maskless outdoors.
posted by jenfullmoon at 6:19 PM on June 29, 2020 [1 favorite]

« Older Do you have a recipe from a favorite book?   |   Can you find this scholarly paper on Internet... Newer »

You are not logged in, either login or create an account to post comments