COVID-19 is a powerful, multifaceted stressor. For many, it is literally life and death; for others, financial ruin or the threat of it or a combination of the two. Even if we are not afflicted with coronavirus or still have work, we must acknowledge that we are collectively witnessing death, disease, and loss while our lives are on hold.

For any single person, of course, this can be huge. It would be entirely expected if you feel it, too. This stress is exacerbated by isolation, the necessary remedy to control the spread of the virus. Layered on top of these other stressors, loneliness itself affects people about the same as smoking 15 cigarettes per day.

Shouldering all of this for months on a scale of many millions portends a second epidemic due to stress’ effects on mental and physical health. Although the coronavirus pandemic will eventually end, we need to act now to fortify our resilience and prevent the stress-related consequences of COVID.

On a behavioral level, stress can lead to depression and anxiety as well as anhedonia and sleep disturbances. It can cause cognitive errors and interfere with decision-making. Like when one person shoots at another because they didn’t cover their cough.

On a biologic level, stress accelerates aging, affects immune regulation, and increases inflammation. Clinically, stress can hamper the defense against viral infections. In patients with HIV, greater life stress was associated with a more rapid progression to AIDS.  Stress is also associated with higher risk of severe life-threatening infections.

We must anticipate, therefore, that stress can also worsen COVID-19, perhaps enhancing susceptibility to infection or worsening the disease in those infected.

Another consequence of stress is eliciting or exacerbating heart disease, diabetes, and asthma and other disorders. And as people are stressed, drug use to quench psychologic pain will increase (alcohol, opiates, etc.).

So while the responsible professionals focus on the virus and the economy, everyone needs to better manage their stress and fortify their resilience. This will help us be more calm, improve decision-making, and be healthier. And it may directly help with COVID-19.

Fortunately, there are four very effective ways to help people cope. 

The first method is meditation, a technique practiced in different ways that helps quiet the incessant chatter in our minds. These thoughts often surround fear and ego that, in turn, generate stress when we focus on them (e.g., “what will happen if I can’t work?” or “will we get infected?” or “I’m not good enough”).

The goal of meditation is to be more present and be aware of the thoughts, not judge or attach to them, making it easier to let them pass. Meditation is not intended to suppress negative thoughts or be distracted from real concerns like solvency or health. By being more present, the mind is more calm to better manage these problems. And by changing how your thoughts affect you, you will have a great skill to buffer against overreacting to future stressors and challenges.

Getting started is not hard and can be done in a variety of ways. It just takes a little practice; 10-20 minutes every day can make a huge difference. There is good evidence of how it changes our psychology and physiology.

The second practice is exercise. Exercise in many forms is well known to reduce stress. Aerobic exercise has been particularly effective as a stress reduction tactic that releases endorphins and affects inflammation.   

As gyms are closed, outdoor exercise in its many forms can be beneficial. Walking, gardening, running, dancing, and other forms can be managed even with social distancing. In addition to the exercise, being outside allows for appreciation of nature, a great tonic for a distressed soul. 

Many exercises also have a meditative aspect to them as they require focus and presence. Yoga, which combines meditation with stretching and fitness, can easily be done in the confines of your home.  

The third modality is kindness and compassion. There is extensive evidence that giving to someone else makes people feel good. That feeling, colloquially labeled the “helper’s high,” feels good because it activates reward systems in the brain. Caring about others is a potent stress reliever likely through creating positive connection.

There are many ways to be kind. Reach out to others. Call your neighbors, particularly those living alone. By letting someone know you are thinking of them, they know that they matter and are not alone. Or make a donation. By helping others you will also help yourself. 

Look for kindness, too. Seeing kindness triggers much of the same internal responses as doing kindness. 

Inspiring kindness content can also be found on Karmatube, Uplift TV, Humankind, and Good News Network. And related to kindness is gratitude practice, a proven way to relieve stress.

Finally, laughter is great for stress. Although Norman Cousins popularized the idea of laughter as therapy, the potential of laughter to decrease pain and stress and promote health was well known for centuries. Short laughter sessions decrease cortisol and like exercise, meditation, and kindness, increase endorphins. More time spent laughing yielded improvement in a marker of immune function associated with lower stress levels.

Laugh with others. Although coronavirus is highly contagious, so is laughter (and kindness); you can help each other experience its benefits.

We have been given the biology to help heal ourselves and be resilient. We just need to be kind to ourselves and reach for the tools to tap into it. This is very achievable with regular practice at little or no cost. And when the coronavirus epidemic ends (which it will), these same tools will be very useful in our everyday lives.

David Fryburg, MD, is the founder of Envision Kindness. For more information and a resilience resource guide, visit envisionkindness.org.