A conversation hosted by Maureen Merrill on behalf of Siyan Clinical with Dr. Setu Vora, a sleep expert, and Dr. Anish Shah, a psychiatrist. Watch or listen to this discussion on the causes of sleep issues during the COVID-19 pandemic. They also discuss points of care to stay mentally fit and healthy during the crisis.
Interviewer: Tiffany Morgan, Project Manager for Siyan Clinical Research
Interviewee: Dr. Anish Shah, CEO at Siyan Clinical Research and Project Director for Project Hope
Topic background: Substance Abuse and COVID-19
The COVID-19 pandemic has us all reeling, and a lot of people are facing unexpected challenges. Unfortunately, people in recovery from substance use disorders are disproportionately affected, and those who rely on opioid replacement therapy (ORT) to manage opioid addiction will face additional risks and challenges as society learns how to adapt to the pandemic.
1. Can you give us a bit of background on the nature of addiction in relation to the current COVID-19 pandemic?
To understand the potential consequences of COVID-19 on people with substance use disorders, it might be helpful to understand some of the things that happen in the brain during addiction. And, although coffee isn’t a drug of abuse, it has some very similar effects that most people will be familiar with, so it’s a useful analogy.
Do you remember the first time you had coffee? If you were like me, you were bouncing off the walls. Now, lots of us need a cup or two every morning to get out the door. Some of us might even get a headache if we don’t have our coffee.
When we need to drink more coffee to get the same effect, we’ve developed tolerance. And if we get a headache without coffee, it’s because our brains have become dependent on caffeine and without it, we have caffeine withdrawal. These symptoms: tolerance, dependence, and withdrawal, are hallmarks of addiction.
Drugs of abuse hijack the reward system, which releases dopamine in response to pleasurable stimuli. Normal stimuli (food, water, sex) cause some dopamine to be released, and the brain remembers that those are good things. Drugs of abuse cause dopamine to flood the brain, which leads the brain to incorrectly deduce that the drug has a really positive effect on health and wellbeing.
With regular drug use, addiction can become impossible to manage. Opioids (e.g. heroin, oxycodone, fentanyl), alcohol, benzodiazepines, cocaine, and nicotine are among the most challenging drugs to quit, and withdrawal symptoms can persist for months, even years after someone quits. For many people, relapses aren’t driven by a desire to use; rather, a desire to avoid withdrawal symptoms is the primary motivator.
People who are in recovery from substance use disorders often find support and solidarity by participating in treatment groups and 12-step programs. These programs can’t make withdrawal any less miserable, but when people who are going through withdrawal are surrounded by peers who understand what they’re going through, it can make the process a little less daunting.
We’re still learning how coronavirus interacts with substance use disorders, but evidence suggests that people with respiratory damage or disease are at increased risk for serious, even life-threatening COVID-19 symptoms. Smoking, vaping, and inhaling other drugs exposes delicate respiratory tract tissues to harmful chemicals. When someone with smoking-related respiratory tract damage gets COVID-19, their lungs are less able to manage and recover from the virus [2].
People with opioid use disorder face a different kind of risk when they get COVID-19. Opioids act by slowing brain function in certain areas, including the part of the brain that controls breathing. Since chronic respiratory disease impairs lung capacity, someone who uses opioids is at risk for dangerous respiratory depression (slow, irregular breathing). Experts believe that COVID-19 will similarly increase the risk for potentially fatal overdoses [2].
Because it attacks the lungs, the coronavirus could be an especially serious threat to those who smoke tobacco or marijuana. People with methamphetamine use disorder may also be vulnerable due to its effects on respiratory health.
Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these pose unique challenges regarding transmission of the coronavirus to law enforcement officials and jails [2].
Coronavirus attacks our lungs and causes problems with oxygen flow to our body. Since opioids act in the brainstem slowing down our breathing, their use not only puts people at risk of life-threatening overdose, it may also cause a harmful decrease in oxygen in the blood in turn causing increase mortality with patients with opioid abuse.
Although many treatment centers currently remain open for limited business, the requirement for social distancing makes getting care challenging. Treatment groups that may normally have a couple dozen participants are now limited to very few patients and a counselor. Many therapy groups and 12-step programs have suspended meetings altogether, leaving members without support. For some people, this will dramatically increase the risk that they will relapse.
People who want to start treatment face new barriers to care as well. Rehab facilities that used to admit new inpatients regularly are now offering intensive outpatient and telehealth treatment almost exclusively [3].
Our clinic currently offers group therapy via telehealth. I understand remote group therapy lacks the personal connection of in-person sessions; however, virtual group dynamics do develop given some time. It is important for those in recovery to have consistency with their program, especially during times of high stress and uncertainty as we are in now.
Among drugs of abuse, opioids like heroin and oxycodone are singularly addictive and notoriously hard to quit. In some cases, debilitating withdrawal symptoms can persist for years, making long-term recovery very challenging. Three highly effective FDA-approved medications are available to treat opioid use disorder (OUD): buprenorphine, methadone, and naltrexone [4]. However, access to these medications is strictly regulated by the federal government, and many patients who would benefit from a prescription are unable to get one.
Substance abuse and mental health disorders often go hand-in-hand, with depression, anxiety, and post-traumatic stress disorder being among the most common comorbidities. People who have been successfully managing symptoms associated with a psychiatric disorder may not be prepared to deal with the dramatic societal upheaval and widespread fear that COVID-19 is causing.
As people feel like they are losing control of their lives, drugs and alcohol can seem like an escape. People who have lost jobs are at particular risk, and it is possible that we will see a sharp increase in homelessness among people with substance use and mental health comorbidities.
Unfortunately, in a time when more people than ever need access to substance abuse treatment and mental health care, fewer and fewer options are available. Telehealth options can provide support for some people, but social isolation, fear of COVID-19, rising unemployment and falling access to healthcare mean that people who are recovering from substance use disorders face a very real relapse risk, with all of the long-term ramifications that go along with it.
Social isolation, fear of being infected by the coronavirus, rising unemployment, economic distress and falling access to healthcare are some of the key issues that global community is experiencing at this time. We have seen rise in clinical depression, anxiety disorder, post-traumatic stress disorder and obsessive compulsive disorder. I also see some of the psychotic illness may also increase with time.
Moreover, we always have to vary about increase in suicide and overdose related deaths. This is truly a worrisome scenario. Paradoxically, I have also seen few patients doing better during initial shelter at home orders, as they are close to their loved one and have social support through their family.
As we progress, certain factors will increase causing a societal strain including: COVID-19 cases, hospitalization, deaths and more over largely unknown factors such as treatment availability, predictability about future outbreaks, limited testing resources and also overall economic distress to global community. We as a community, government agencies and providers need to worry and think about increase in psychiatric issues and need for resources for mental well-being.
Coping through in current pandemic is a very important issue that one should pay attention to. Coping mechanisms are key in preventing development of full-blown psychiatric illness episodes.
One of the key messages I would give it to listeners is please do not ignore your emotional struggle, accept them, take one healthy action to solve these problems. I however will also say that if you experience serious depression, uncontrollable anxiety, concentration and memory issues, continue restless feelings, sleep problems or if you see yourself turning into unhealthy coping such as use of alcohol or illicit substance please contact your mental health providers.
I tell all the community members who has preexisting depression, anxiety or any diagnosed psychiatric illness is to stay connected with their mental health providers. If you have a provider who you are working with over the years or have contacted in the past than please call them to set up an appointment. You can also call your insurance company to give you a list of providers who provide services through telehealth.
We at Siyan Clinical have a large staff of licensed mental health providers including psychiatrists, Nurse Practitioners, Physician Assistant, psychotherapists delivering evidence-based behavioral healthcare remotely. If you are interested in scheduling an appointment please call us at 707-206-7268 or you can visit us on www.siyanclinical.com or HopeMat.org.
This is a relatively novel process for most of our patients. Telehealth process is fairly easy way to stay in contact with your provider and receive treatment for your mental health and substance abuse issues. In telehealth, you can do a video call with your provider and speak to them about what you are experiencing. Provider can evaluate psychological symptoms, provide psychotherapy, prescribe medication if needed in telehealth sessions. Most telehealth software or applications can be downloaded on smartphone, tablets or desktops. You generally get a link on your phone or email from your provider and once you click on it you join them in the session.
Our recommendation for all our patients is to stay home during this crisis. We are fortunate that most of our patients have been able to recognize the importance and utilize Telehealth. We have very few patients (less than 1%) who are very sick and can’t manage any audio-visual communication comes to our clinic. We have implemented protocol for essential business given to us by Sonoma county. We keep 6 feet distance and sanitize our clinic every few hours. We also take temperature for all visitors and all staff wear face masks at this time.
These are difficult time for all of us as global community. I remind to myself daily that this crisis makes all of us feel helpless, vulnerable and takes us to thinking about a journey unknown…I think during this time what can I could do today to decrease my worry and concern. I also remind myself that our community in Sonoma County has had many catastrophic experiences like wildfires and I find remembering that this crisis will also pass and we will be fine puts things into perspective.
I am also inspired by learning through struggle and success stories of lots of my patients, employees and family members. I cherish when they succeed or accomplish during this time.
We will emerge stronger through current pandemic crisis. I schedule 15 minutes a day for an introspection session with myself. I ask myself what is in my control? What is not in my control? I make a list of items in my control and take some actions about them. I feel accomplished most days.
For more information, please visit our website at www.siyanclinical.com or www.HopeMat.org.If you are interested in scheduling an appointment please call us at 707-206-7268 or you can email us at psychresearch@siyanclinical.com.
Stay safe, be well. Take care of yourselves and each other!
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Disclaimer: This product was supported [in part] by grant number TI081478 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The content of this publication does not necessarily reflect the views or polices of SAMHSA or the U.S. Department of Health and Human Services (HHS).
References:
Maureen Merrill: Hello. Dr. Anish Shah and I will be talking today. My name is Maureen Merrill. I’m a psychologist and performance coach who works on Dr. Shah’s Team. He is a psychologist and the head of Siyan clinical in Santa Rosa, California. He’s also however, developed an intense interest in public health, so the stress symptoms he’s been seeing in his patients, he has translated that into what it means for all of us and our social responses to the crises we have.
What drives you to integrate these areas of expertise? How did you begin to see the connections and bring them into your home base as a psychiatrist?
Dr. Anish: Thank you, Maureen. That’s a good question, and it all goes back to my work in my medical school and internship training in India. I saw a lot of cases of tuberculosis, measles, mumps, rubella, and tetanus, when polio and many of these illnesses could be prevented by a vaccine, and we did a lot of work back then regarding educating the public about vaccines and the various disease states. I have also seen a lot of families suffering from chronic viral as well as bacterial illnesses, which could simply be prevented by taking the vaccine. That really intrigued my interest in primary prevention. When I say primary prevention, I mean that we prevent the disease state before it ever happens.
Our healthcare system in the United States and globally is more geared towards secondary and tertiary prevention methodology. That means when we have a disease, when we get sick, we get treatment. When we get complications, we get treatment, but with primary prevention, we do things to prevent disease, and that has been my core interest: preventing mental health illnesses through primary prevention strategies and also in general disease state.
So when the COVID vaccine came about, it automatically increased my interest and invigorated me. I was interested in just working somewhere along the line, so we can just look into getting fair control over the Pandemic and achieve the herd immunity that we all have been wishing to have for quite a long time.
Maureen Merrill: Yeah, we definitely want to learn more about how that is working. And you’ve mentioned that 2020 saw an enormous spike in mental health issues. I know you’ve been extremely busy in your practice with this. Why is that exactly? And what kinds of issues are you seeing in particular here in the North Bay?
Dr. Anish: 2020 has been one of the most difficulty years globally, in the United States and also in the North Bay. As you can imagine, the Pandemic and Pandemic-related psychosocial issues have impacted a lot of people from a mental health perspective. We have had shelter-at-home, closure of schools, economic impact, and healthcare impact.
Our social paradigm just changed completely in 2020. And on top of that, in 2020, we had an election. We also had a civil unrest moment, the Black Lives movement and many other things that have happened. Here in the North Bay, we have had at least two to three episodes of wildfires related to various natural causes. It’s been a tough time in the North Bay in 2020, to say the least.
What is Pandemic Fatigue? How does it work?
Maureen Merrill: A lot of trauma, I guess. You’ve talked about Pandemic Fatigue, and I think that resonates, but I think on the face of it, the first thing I thought was, “Oh, it just means “I’m so over this. I’m really tired of this. I’m tired of the restrictions and the worry and the upheaval.” But now I’m understanding from talking to you that it’s more about our reaction to the ongoing stress of the Pandemic. So Pandemic Fatigue, is it a syndrome? How does it work?
Dr. Anish: a good question, Maureen, we all are experiencing Pandemic Fatigue at this time, so basically what it is is this state of being worn out by the recommendations and precautions and restrictions related to the Pandemic thereby leading one to abandon all precautions and social distancing norms that have been laid out by public health authorities. Then we all experience a typical mindset, which I call mental health or Pandemic Fatigue. It’s a typical set of symptoms that one develops, and when that happens, wild behavior increases, and then we end up having more damage and symptoms.
Symptoms of PANDEMIC FATIGUE
Some common symptoms of pandemic fatigue are trouble focusing, feelings of helplessness, sleep problem, being withdrawn from others, racing thoughts, and easily snapping or becoming argumentative or Irritable. These are some of the typical symptoms of pandemic fatigue that we see in individuals, in our patients, and in society in general at this stage of the Pandemic right now.
What are Racing Thoughts?
Maureen Merrill: You mentioned racing thoughts. Is that when you’re trying to get to sleep and you can’t stop thinking, or is that a daytime thing, or is it both?
Dr. Anish: Right. A good question. Racing thought typically means that your mind kind of wanders. It goes from one thought to another thought, and sometimes we all have worries about one thing.
The other thing we know is our thoughts race. They just kind of run many miles an hour, many miles a minute, and one just shift from one thought to another thought to another. And it’s sort of a state of a worry, you know. It’s a state where we are not able to stay in a tranquil or peaceful state of mind.
Tips to Avoid Mental Illness
Maureen Merrill: I was looking at some notes from a conversation we had about a year ago and of course we had just barely heard of COVID, but the fires had happened in the North Bay. People were evacuated and there was a lot of worry. Even back then, you were talking about the widespread stresses and the effects on people, families, workers, jobs, and that you were observing stress effects from the fires, and we’re not getting our usual rituals and routines that help us cope with stress. So what do we do?
Dr. Anish: A good question. It all leads to my initial thought that I had said in this interview about primary prevention catching issues earlier and taking proactive actions, and I’m going to tell you a few very simple strategies that can help someone develop or prevent someone from developing a mental illness or a psychiatric syndrome. First of all, watch out for your physical health, diet, nutrition, sleep and exercise for maintaining your physical health. Really important, please pledge to take action on all these four elements.
Limit your news intake. No more than one hour, and always try to use a reputable source for information. There is lot of disinformation going around right now, and that is a cause of major stress and general stress. Also in times of psychiatric syndromes, such as major clinical depression or anxiety disorder, others try to pursue activities that would lower your stress, like yoga breathing or maybe participating in some joy-producing activities or hobbies that you like. Enjoying a comedy show or meeting with your friends… Communing with nature is also a very healing element in one’s ability to lower stress.
Try to do something that lowers the stress is a third thing, like connecting with others. You know, even if you are not able to meet, send some notes, speak to people online, participate in discussion groups, meet with your family and friends with virtual different methods. Try to avoid isolation.
When you have feelings that are sad or depressing or anxiety provoking, and when that sense of helplessness develops, I say, focus on what you can do to better accept that feeling. Be kind to yourself about having those feelings and then see that there is a thing or two you can do to shake off those negative thoughts or feelings. I will always say, take COVID precautions, COVID precautions not only help you safeguard physical health, but also mental health. Those are some of the really basic strategies that I would ask that listeners consider following through with to prevent major mental health issues through this Pandemic.
Maureen Merrill: So even people who are normally following good health practices could be experiencing that stress. And it seems to me the lack of usual comforts and refreshments and things that we do in our routines that comfort us are not as available to us as they were.
Dr. Anish: Yeah, right, right. Correct
Journey from losing Focus to Gaining Back.
Maureen Merrill: May I ask you personally, have you noticed anything in yourself, like losing focus or thoughts racing that I have?
I definitely have found myself not as focused, and I do notice that what you said about the news is so true that I hadn’t thought of it being a junkie. It actually does sort of bring me down if I have too much of it. Have you noticed that among yourself or your family and friends?
Dr. Anish: Well, I see this all the time among my patients, you know? All this impact of news and excessive use of social media, especially the disinformation through WhatsApp, trying to go through sources which are not reliable, and an excessive attachment to what is going on around us, to an extent that it is not information for our wellbeing, but it’s just an obsession.
I have seen patients, family members, losing their sleep, losing their focus. Frankly, I have been through the journey myself, too. When the Pandemic came in March and April, when there was so much to learn so much to know, and so much was unknown, I was looking at various resources throughout the day, and it kind of, after a couple of weeks. I kind of felt that fatigue, and I kind of felt that my focus was wearing off for those two weeks. So, that happens to normal people. When you have excessive connection or access to use your time in exploring various social media news and information, when this misinformation adds to those, then it becomes really a big, big tragedy.
Believe in Hope
Maureen Merrill: Dr. Shah, you mentioned there’s hope. Tell us about the hope. Why should we have it? What have we got to believe in and hope for now?
Dr. Anish: The biggest hope that we have got in 2020, in the last months, was the COVID-19 vaccine. And that is a huge gift that came our way from the scientific community. Kudos to all of them who developed this vaccine in record time. We have now two emergency-use authorized vaccines from Pfizer and Moderna. These vaccines are really the gift that we got in 2020. They prevent serious COVID infections and that is also the right step in the direction of getting the herd immunity, meaning that 70 to 75% of our population getting immunized with the vaccine and then this virus, this pathogen no longer is the public health issues that we all have had a struggle in 2020.
So I think the vaccine has been the biggest hope that I see in 2021
Maureen Merrill: I’m really interested in the one, two, three on the vaccines. What do I really need to know as a non-medical person? And, what should I be looking out for and mainly be aware of?
Dr. Anish: So the first time a person is infected with the virus, it takes several days to weeks for our body to sort of get all the germ-fighting tools to get rid of the infections. After we get rid of the infection, our immune systems remember how we fought and we have memory T lymphocytes, we have antibodies, B lymphocytes, that help us protect from getting another box of infection in near future. Now COVID-19 vaccines help our body develop the immunity to the virus and there are several vaccines, some are MRN vaccines, some are vaccines made of inactivity wild components, and what all they do is to supply our body with memory T lymphocytes, B lymphocytes, and then our body remembers how to fight this virus in the future. It typically takes a few weeks for the body to produce the T lymphocytes and B lymphocytes after we receive vaccination, therefore it is possible that a person could be infected with the virus that causes COVID-19 just before or just after vaccination. Then they get sick because the vaccine did not have enough time to provide protection. So, that possibility also is there when you are using a vaccine.
Maureen Merrill: that’s a new word to me, lymphocytes, lymphocytes. So, that’s something that we develop in order to fight the disease or the infection.
Dr. Anish: Right. I mean in a laymen terms, we can say these are the soldiers. These are our immunity blocks. They help us fight an infection.
No Fear in Getting Vaccine
Maureen Merrill: Okay. So can you assure me that I shouldn’t have reluctance or doubts about getting a vaccine? Is there anything I should have any doubts about?
Dr. Anish: First of all. Let me assure you that both Pfizer and Moderna vaccine have done a phenomenal job with a placebo-controlled trial. Pfizer had 43,000 participants and Moderna had about 30,000 participants. The second part is if you look at the side-effects profile after vaccinations, they’re very mild. The common issues are pain at the injection side, a little bit of a headache, low-grade fever, malaise, and things of that nature. Some people have a little bit of nausea and GI disturbances, One of the scariest things some people experience is when they get a fever, but one has to remember that a fever is a normal symptom when our body is developing immunity. So it’s nothing to worry about. And the other part is that vaccines are 90 to 95% effective. They have excellent, excellent efficacy data. So those are two really, really reassuring aspects, about the vaccine.
Dr.Anish Sharing his Vaccine Experience
Maureen Merrill: Okay. So if I have those symptoms, can I expect them to go away fairly quickly?
Dr. Anish: Well, yes. Most definitely just to share with you my experience. When I took my vaccine, my symptoms went away in 24 hours. I had a little pain at my injection sight. I also had a mild headache, and within 24 hours, everything was gone for me. Some of my colleagues and some of the other patients have reported symptoms until two or three days.
They usually go away. Now, keep in mind, there’s also a little bit of a concern in the media, and then some patients have that worrying story about having a severe allergic reaction. One has to understand that these allergic reactions are very common. When you take medication, like penicillin, or when you take medication like sulfur drugs, other vaccines, when that happens, sometimes with flu vaccines, we have a treatment for that. These allergic reactions can be treated very safely with medication and other therapeutics that we have available right now. Moreover, the vaccine protocol currently asks us to monitor patients for 15 minutes after they get the vaccine. So if they were to have any severe allergic reaction, Such as Anaphylaxis , we can treat it right there.
Maureen Merrill: Okay. So even a severe reaction is something that’s not new and can be treated with usual methods?
Dr. Anish: That’s correct. That’s correct. Yes, Yes.
Things to do after getting Vaccine.
Maureen Merrill: After I get the vaccine, do I still need to wear a mask and distance from other people? And what if my whole family or my whole office is vaccinated? Can we dispense with the protocols or what?
Dr. Anish: That’s a good question, Maureen, and I get asked that all the time. Do we need social distance after vaccines? My answer is yes. And here is the reason why: First, both of the vaccines have two doses. Pfizer has both the doses that needs to be given three weeks apart. Moderna has the protocol of having two doses four weeks apart, so, it takes time for our body to develop immunity. It doesn’t happen right away after one takes the vaccine. The second aspect which we need to learn more and get more data at our disposal is about the transmissibility and the vaccines. We don’t know yet whether the vaccine prevents transmission of the virus from one individual to another individual. To just elaborate that a little bit more, when we get a vaccine, we develop antibodies, and some of the antibodies reach our nasal mucosa and they kind of stand guard there and help prevent infections too. We don’t know as yet if that antibody pool in the nasal mucosa is enough to prevent viral transmission from one individual to another. So those parts are still unknown, and hence, I’ll say to all my listeners, that we still have a little while to go with the mass social distancing.
Maureen Merrill: what kind of conditions need to be present before we can take our masks off and relate normally?
Dr. Anish: The entire scientific community is rooting for that herd immunity that we are all longing for. What it means is when we have 70 to 75% of our population immunized with vaccines, then this virus no longer is a problem. At least not a public health problem for us. I see some of the norms of what we have right now sort of rescinding at that point. but, we still have a long way to go before that.
Maureen Merrill: I was hoping we had better news, but it’s still not bad. You talked about this light at the end of the tunnel, which is about hope, and I’m wondering if that hope and optimism helps with the personal stress, and public health overall is at least we know that there is a light. I heard a little saying that if you see the light at the end of the tunnel, it reminds you you’re still in the tunnel.
Dr. Anish: Yeah, that’s correct. It’s a tunnel and unfortunately it’s a long tunnel, but yes, there is a light at the end of the tunnel and that’s what we all are hoping for in 2021, I say to everyone, “Hope, optimism, kindness, staying positive, and having the ability to look through shades of gray are the biggest protective factors when it comes to COVID-19 pandemic and mental illness.” So if you have those traits, if you develop those traits and if you work towards it, you are definitely going to do well with this pandemic and the road ahead.
Maureen Merrill: It sounds as if you think maybe we were going to learn from this too. In ways it will be valuable regardless of whether there’s a crisis happening. Of course, maybe there’s always a crisis.
Dr. Anish: Right Yeah. It’s been a learning journey for all of us. Our perspective about healthcare or perspective about relationships and many positive things have come up from this crisis among ourselves here and globally.
Maureen Merrill: Well, as I mentioned, we’re going to show a slide with your contact information, and everyone should note that your website Siyan Clinical has links to your various articles and the tips that you’ve developed for dealing with Pandemic Fatigue and Pandemic-related stress, and also signs to watch out for when you need professional help and so on. I must ask you though, this silver lining that we just talked about a little bit, what is that silver lining or overall social good you see can come from this? It’s been so devastating and everything we’ve been through as a community? Obviously, at the end of it we’ll feel good about it being the end of it, but something of value that we might be able to carry forward into our lives beyond it.
Dr. Anish: Well, the silver lining, the most important one is really get rid of this Pandemic in 2021. This all will go away. and there is a light at the end of the tunnel and that’s my optimism in 2021 moving forward. However until that time I would tell our listeners that you stay safe and stay healthy. COVID precautions and social distancing are difficult, as a result of Pandemic Fatigue that we just discussed, but, I guess that’s still an impactive preventive strategy to curb this pandemic. And I urge everyone to please look out for the vaccine and take it as soon as it is available to you.
Please call your primary care physician. Please call your local public health department to find out how you could get access to the vaccines in upcoming weeks. That is going to be the ultimate strategy that’s going to help us move forward in 2021.
Maureen Merrill: I think that calls to mind the issue that I really have to reach out to find the vaccine if I’m not in the medical profession directly and not a frontline worker. So I need to connect with my provider to see where I can get it. Right?
Dr. Anish: Yes, that’s correct.
Maureen Merrill: They’re not coming to me on it. Good advice for any time of life. I’m sure. So thank you, Dr. Shah. Another enlightening session. It’s been therapeutic for me actually, and I think it’s been helpful to everyone. Thank you so much. We’re looking forward to seeing more information through these links that we’re showing. I really mean this, Dr. Shah, you take care.
Dr. Anish: Thank you, Maureen. You take care too.
Substance Abuse and Mental Health Services Administration (SAMHSA) &