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After a lull in new COVID-19 cases over the summer, Canada and many other parts of the world are now experiencing a second wave of the virus – and it comes at a time that can be stressful for many under ordinary circumstances.

In Ontario, the latest surge – along with the restrictions to counter it – coincides with the transition from fall to winter, with its shorter days, longer nights, and the holiday season fast approaching.

Janet Ellis is an assistant professor in the University of Toronto’s department of psychiatry and psychiatrist at Sunnybrook Health Sciences Centre. She says it’s important to acknowledge students will likely be feeling added pressure and stress from COVID-19 – not just because of exams or assignments but because they are at a stage of life when they would normally be attending classes in person, socializing and involving themselves in new activities on campus, which are all more difficult to do amid the pandemic.

First-year residents will likely have been looking forward to this once-in-a lifetime opportunity to participate in university life, while final year students may feel as though something has been taken away from them, Ellis adds.

But Ellis says there are ways to cope. They include developing a routine, setting boundaries around work, being kind to yourself and others and limiting what’s come to be known as “doomscrolling” on social media and news media.

Ellis recently spoke to �Թϱ��� writer Geoffrey Vendeville about the many challenges of living with COVID-19 and what you can do to take care of yourself.

Why is this such a difficult time for everyone?

People are struggling with the fact that the whole world has changed. It's a shock. That said, the ability to adapt is one of humans' greatest attributes.

I think we've adapted but, in the course of adapting, there have been quite a few losses. There's been the loss of all sorts of rituals, especially for students. Some didn't have a high school graduation, or, if they did, it was virtual. No celebrations, no travel. They have also lost the ability to fully spread their wings and meet all sorts of different people, separate and individuate, at university. This is the time for strong peer connection, a sense of freedom and growth. Instead, they are expected to transition to online classes and have the discipline to maintain a solitary routine without the usual array of social activities or unrestricted access to exercise, sports or restaurants and friends.

If people are vulnerable, they're more likely to suffer from the loss of a lifestyle that would perhaps have provided more opportunity for growth and support. Instead, they're having to draw on inner resources to cope with isolation.

And, in general, even though we're all highly dependent on social media and the internet for connection, we also know from research that depression and anxiety go up the more time you spend on social media. So, it's a mixed blessing that we have it and we should be wary of it being our main connection with the outside world.

What is your advice for coping with the added pressure and stress of living through COVID-19?

In terms of COVID-19 stress, there may be an increase in financial stress, including loss of jobs for students, as well as family members, the threat of illness or being a vector of illness for a vulnerable family member.

My advice, in general, is in some ways quite prosaic and won't surprise you at all, because it involves trying to have a routine and to increase deliberate self-care. For students, this means trying to develop a routine around their online courses. Any of us who has done an online course will understand the challenge and self-discipline required. You're less accountable, you're not actually visible in the class necessarily. The goal is to try and establish a routine that, at the end of the day, gives you a sense of progression and satisfaction of having learned something.

It’s important to include healthy eating and daily connection into the daily routine – although many things are shut down right now – and find a way to exercise and find a change of scenery.

I've heard from many people that they're struggling to set boundaries between their personal and work lives.

Yes. There’s a New Yorker cartoon I love that says: “I can’t remember – do I work at home or do I live at work?”

Most students will have some of their routine determined by lectures. To start with, I would say it's very important to attend those lectures as if you're in person, if you can. It will give you a structure.

Like much of the advice in terms of work-home balance, especially with the blurring of boundaries with COVID-19, it’s important to ensure that you characterize and plan your day in terms of “work time” and your own “me time”.

Students may not necessarily have a nine-to-five schedule. Some people will no doubt have classes in the evening, but they can determine which part of each day is their own time. Maybe they can colour-code their calendar and they can schedule in their exercise and time to get out each day, as well as time for social connection.

I believe that it is important to have authentic connection with someone at least once every day, if not more than once a day, instead of aimlessly scrolling through social media, which can induce feeling as if in some way you’re missing out.

When you’re stuck at home, you can feel isolated, lonely, disconnected and perhaps even a bit of a loser in comparison to what you see on social media – because we all put our best face forward there.

Another piece of advice is not to spend hours scrolling through negative news. At the moment, we can all develop quite a compulsion looking for COVID-19 news and numbers. But I think our brains could all use a certain number of hours a day focusing on positive and more resilience-based things. Initially, there was a COVID-19 movement to take up a musical instrument, learn how to bake soda bread, a new language and so on. I am not suggesting that people should feel pressured, rather they should try to find an hour or two a day of enjoyable distraction that is also healthy or creative. People do not need to become multi-talented, but I think it would be helpful to have something that they genuinely enjoy, whether it’s cooking or some type of hobby.

This is also a time when students are preparing for exams, a stressful period at the best of times. What advice can you offer?

I would really acknowledge that we're asking a lot of our students at the moment. They have faced maybe proportionally more loss in terms of freedom and restrictions, considering their phase of life when they should be able to mix with their peers, and have all sorts of programming and experiences available.

I would suggest that students could come to understand that they’re part of this generation experiencing this historic time together and should try to help one other through it. Maybe form study groups, share notes or engage in other resilience-based activities such as taking turns in leading virtual exercise classes or music or sharing humour.

For example, at Sunnybrook, some of the non-psychiatry teams have had the most innovative ideas about keeping up morale. In the department of pathology, they made a cookbook out of everyone’s favorite recipes, in order to have a team activity that took people's minds off the negative.

I would add that during exams it’s more important than ever for students to be kind to themselves and to try to keep things in proportion. This too shall pass.

And if they are using a substance or struggling with mental health – seek help. It is important to keep an eye out for others who may be using more substance, isolating too much or visibly struggling with depression or anxiety. Encourage each other to get help, ask your peers how they are doing, try to include anyone who seems to be struggling in a virtual social group or distanced walk and talk.

Maybe one of the silver linings of COVID-19 will be that it has highlighted people’s stress and mental health so much that it will de-stigmatize checking in with one another. Maybe it will also help with setting limits and maybe not putting such high expectations and punishing yourself if you feel you haven’t done well enough. Maybe it will give all of us a sense of proportion and learn how important a skill it is to learn how to self-care.

How would recommend helping people who are struggling if you're in a position to help?

Ask the question – the genuine question: How are you really doing? Because of course we all have the social niceties of saying, “How are you? Fine.” It’s necessary to break through that and say this is a real check-in and that it is ok to answer honestly.

We know that, across the board, people are struggling more with mental health. It’s important to acknowledge that everyone is more vulnerable at the moment. Depression, anxiety and substance abuse are up across the board. This is no fun. Isolation is distressing and people are more bored.

We know that it is impacting youth disproportionately. I think partly it’s because of all the losses I’ve described and partly because of concerns about future impact on employment and the economy.

What has to come out of this somehow is an acceptance of that – and innovative ways of people finding resilience and drawing together to cope.

It’s essential to check in and recognize when people are distressed by COVID-19-related losses and, at the same time, really encourage ways of connecting and finding meaningful activities. Don’t lose your routine because “who cares what time you go to bed, because you can do work anytime” – or because of spending a vast amount of time on social media.

You need the reverse of that. You need to increase connection with friends and family, and have a routine, delineate your work time from me time. Every person may have a different way of truly connecting with people. Maybe it will be talking about yourselves or maybe it will be sharing an interest or going for a walk or doing an online workout session together, or studying together, plus the check in. Perhaps you could deliberately have a buddy to have a daily check-in and be honest about how you’re feeling and agree together on what you would do if one of you were to slip. Finding a sense of meaning in life – friends, family, a pet, schoolwork, helping others – and feeling connected and in a community are very protective. We cannot get through this pandemic solo. We need to get through it together.

Do you think it's useful to remind ourselves that this is temporary and that there is light at the end of the tunnel?

Absolutely. Because in the end, there will be some type of solution. We will get some life back, of course. For young people, perhaps more than older people, this must have seemed endless. And saying, “Hang on for another six months” may seem equally endless. But, of course, we can all hang on and we're going to come through this. It’s going to be part of our shared history.