At the moment the United States and the rest of the world are participating in an unprecedented experiment of being vaccinated for COVID-19 to end the pandemic without completely knowing long-term risks. The Federal Drug Administration (FDA) has authorized the emergency use for the vaccine based upon clinical trials that showing that the vaccine is highly effective in reducing or preventing COVID-19 disease and morbidity (FDA, 2021). Because it is an experimental procedure, it is necessary to monitor and follow-up everyone who is vaccinated in order to identify possible rare complications that could occur in the future. What has been reported is a very rare complication of anaphylaxis that may occur immediately after administration of the vaccine by Pfizer-BioNTech (4.7 cases per million) and Moderna (2.4 cases per million) (Shimabukuro, Cole, & Su, 2021); however, this data may under report the actual negative side effects. In the recently published prospectively study by Blumenthal et al. (2021) of 64,000 employees associated with Mass General Brigham (MGB) were actively followed through a multipronged approach including email, text message, phone, and smartphone application links. The complication rate of acute allergic reaction rate was 2.1% and the severe anaphylaxis reaction was 247 cases per million. This is 50 times higher than the previously reported results which depended on voluntary reporting instate of active all participants follow-up. Nevertheless, the benefits of vaccination far outweigh the risk of anaphylaxis, which was experienced within the first 15-30 minutes after the vaccination and treatable. What is disturbing is that at this moment, the USA does not have a systematic long-term follow up strategy for all the people who vaccinated to identify possible delayed long-term side effects since it depends upon voluntary reporting, however, rare. Thus, we are all part of an uncontrolled experiment in which I am also participating.
At the age of 76, I choose to be vaccinated after having assessed the risk-benefits reported in the published clinical studies (the possible harm caused by Covid-19 would be significantly worse than the possible harm caused by the short and long term side effects from the vaccine). It was confusing and challenging to figure out where the vaccinations were being offered. Luckily, I searched online to find a location where I could sign up to make an appointment for the first vaccination. After having successfully navigated signing up and getting an appointment for Thursday, I contacted the older couple who live nearby and asked if they already had a vaccination appointment. When they told me that they were unable to find a location, I shared with them the information for signing up on the website.
After having received the vaccination, I installed the V-safe app in my cellphone and answered the questions on the App survey; however, to participate, I had to opt in instead of having to opt out. Later on Thursday, I received the first text message from V-safe to which I responded by answering the short symptom questions. I reported that the site of the vaccination felt sore and tight and whenever I lifted up my left arm, I felt a dull ache and stiffness. It was slightly more uncomfortable than I had experienced two years earlier from a tetanus and diphtheria (Td) vaccine injection. That night I could not sleep on my left side since the deltoid area continued to feel sore and painful to pressure. The next day, I worked and did not look at my text messages. On Saturday morning, I realized that I had not responded to Friday’s check-in text message from V-safe. When I tried to response, the survey link embedded in the text message no longer worked. Thus, my discomfort that continued through Thursday night and Friday was not reported to the CDC.
As I still felt some slight tenderness, I also wondered how the older couple were doing since they had received the vaccine on the same day as I did. I called them to check on how they were doing and see if they had signed up with V-safe. They responded that they were doing well except for some soreness in the upper arm; however, they had not signed up for V-safe.
This experience brought to mind studies finding that when follow-up information depends voluntarily opting in, most people do not opt in. Thus, the follow-up data and reporting of possible negative side effects will be less reliable since it would reflect only a small subset of all the people who received the vaccine and are tech savvy. The CDC needs to revise their tracking strategy so that it is able to survey accurately the occurrence of side effects from everyone who gets vaccinated by enrolling them, unless they choose to opt out.
- Enroll people automatically unless they personally decide to opt-out. The enrollment process should be organized so that when an individual receives the vaccine, they automatically are enrolled. Automatic enrollment leads to much higher participation than a voluntary opt-in approach. The difference in participation has been demonstrated in many settings ranging from organ donations to signing up for 401K retirement plans. For example, in Austria, organ donation is the default option at the time of death, and people must explicitly ‘opt out’of organ donation. “In these so-called opt-out countries, more than 90% of people register to donate their organs. Yet in countries such as U.S. and Germany, people must explicitly ‘opt in’ if they want to donate their organs when they die. In these opt-in countries, fewer than 15% of people register” (Davidai, Gilovich & Ross, 2012). Similar results have been observed in employees’ enrollment in 401K saving plans (Nash, 2007). For example, in analyses of recent hires by Fortune 500 firms, 85.9% of new hires will participate in a 401 K retirement plan when they are automatically enrolled versus 32.4% if they have to voluntarily enroll (opt –in).
- The V-safe app needs to allow symptom data to be reported after the deadline. There needs to be an option to allow a delayed response. In addition, if the person did not respond to the automatic survey, the person needs to be contacted to identify the cause of the non-response.
- Longterm follow-up to monitor for possible adverse effects needs to be implemented. The minimum follow-up period needs to be two years to be able to monitor possible adverse effects that may be triggered by the vaccines. In theory, this could include “antibody-dependent enhancement” to another virus. This occurs when the immune response that has been previously activated makes the clinical symptoms worse when the person is infected a subsequent time with a different type of virus and that trigger an over-reaction, creating a cytokine storm. For example, when a person gets dengue fever and is infected a second time by a different strain of dengue, the person becomes much sicker the second time (Murphy & Whitehead, 2011). Some researchers are concerned that the vaccine in the future could cause an excessive immune reaction when exposed to another virus.
Without automatic enrollment and follow-up, the short and long-term general public safety data may be unreliable and will not accurately capture the actual frequency of side effects. The reported data may under report the actual risk. When independent researchers investigated medical procedures they often find find the complication rate three-fold higher than the medical staff reported. For example, for endoscopic procedures such as colonoscopies, doctors reported only 31 complications from 6,383 outpatient upper endoscopies and 11,632 outpatient colonoscopies. The actual rate was 134 trips to the emergency room and 76 hospitalizations. This discrepancy occurred because the only incidents reported involved patients who went back to their own doctors. The research did not capture those patients who sought help at other locations or hospitals (Leffler et al., 2010).
The data reported by the cellphone web-based app V-safe may represent possibly only 20% of the people vaccinate, biased to those who are healthier, more affluent, younger, and technologically adept. In order to be able to sign-up for V-safe and respond to the text messages, the person needs to be tech savvy, have a cellphone, and be able to respond to the text message during the same day the message is send.
Blumenthal, K.G., Robinson, L.B., Camargo, C.A., et al. (2021). Acute Allergic Reactions to mRNA COVID-19 Vaccines. JAMA. Published online March 08, 2021. https://doi.org/10.1001/jama.2021.3976
CDC (2021). V-safe After Vaccination Health Checker. Centers for Disease Control and Prevention (CDC). Accessed January 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html
Davidai, S., Gilovich, T., & Ross, L. (2012). The meaning of default options for potential organ donors. Proceedings of the National Academy of Sciences, 15201-15205. https://doi.org/10.1073/pnas.1211695109
FDA (2021). COVID-19 Vaccines. Accessed January 30, 2021. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines
Leffler, D.A, Kheraj, R., Garud, S., Neeman, N., Nathanson, L.A., Kelly, C.P., Sawhney, M., Landon, B., Doyle, R., Rosenberg, S., & Aronson, M. (2010). The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy. Arch Intern Medicine, 170(19), 1752-1757. http://archinte.jamanetwork.com/article.aspx?articleid=226125
Madrian, B. & Shea, D. (2001). The Power of Suggestion: Inertia in 401(k) Participation and Savings Behavior. ”Quarterly Journal of Economics, 116(4), 1149-87. http://www.jstor.org/stable/2696456
Murphy, B.R. & Whitehead, S.S. (2011). Immune response to dengue virus and prospects for a vaccine. Annu Rev Immunol., 29, 587-619. https://doi.org/10.1146/annurev-immunol-031210-101315
Nash, B. J. (2007). Opt in or opt out? Automatic enrollment increases 401(k) participation. Region focus, 28-31. https://core.ac.uk/download/pdf/6670505.pdf
Shimabukuro, T.T., Cole, M., & Su, J.R. (2021) Reports of Anaphylaxis after Receipt of mRNA COVID-19 Vaccines in the US—December 14, 2020-January 18, 2021. JAMA. Published online February 12, 2021. https://doi.org/10.1001/jama.2021.1967
As we emerge from the COVID pandemic and look forward to the New Year, we can bring joy and happiness though through simple acts of kindness.
I just received an email from the Rick Hansen Foundation that inspired me to share its recommendations. In 1957 at the age of 15, Rick Hansen injured his spinal cord and was paralyzed from the waist down. He is an inspiration for all of us. In these crazy times of sheltering in place, experiencing social isolation, anxiety, depression, racial bias, and also happiness and joy, he recommends the following TED talks to increase resilience, overcome racial bias, and achieve self-acceptance. Enjoy watching the talks as they suggest strategies to deal with adversity and offer hope for the New Year.
3 Secrets of resilient people by Dr. Lucy Hone, Co-director of the New Zealand Institute of Wellbeing & Resilience and adjunct fellow at the University of Canterbury in Christchurch, New Zealand.
How racial bias works-and how to disrupt it by Stanford University social psychologist, Jennifer L. Eberhardt
To overcome challenges, stop comparing yourself to other by wheelchair athlete Dean Furnes
Erik Peper and Amber Yang
“Instead of zoning out and being on my phone half the time. I felt more engaged in the class and like I was actually learning something.” -21 year old college student
Before the pandemic, roughly, two-thirds of all social interactions were face-to-face—and when the shelter-in-place order hit our communities, we were all faced with the task of learning how to engage virtually. The majority of students reported that taking online classes instead of in person classes is significantly more challenging. It is easier to be distracted and multitask online—for example, looking at Instagram, Facebook, Twitter, TikTok, texting, surfing the internet, responding to notifications, listening to music, or drifting to sleep. Hours of watching TV and/or streaming videos have conditioned many people to sit and take in information passively, which discourages them from actively responding or initiating. The information is rapidly forgotten when the next screen image or advertisement appears. Effectively engaging on Zoom requires a shift from passively watching and listening to being an active, creative participant.
Another barrier to virtual engagement is that communicating online does not engage all senses. A considerable amount of our communication is nonverbal—sounds, movement, visuals, physical structures, touch, and body language. Without these sensory cues, it can be difficult to feel socially connected on Zoom, Microsoft Teams, or Google Meet to sustain attention and to focus especially if there are many people in the class or meeting. Another challenge to virtual learning is that without the normal environment of a classroom, many students across the country are forced to learn in emotionally and/or physically challenging environments, which gets in the way of maintaining attention and focus. The Center for Disease Prevention (CDC) reported that anxiety disorder and depressive disorder have increased considerably in the United States during the COVID-19 pandemic (Leeb et al, 2020; McGinty et al, 2020). Social isolation, stay-at-home orders, and coping with COVID-19 are contributing factors affecting mental health especially for minority and ethnic youth. Stress, anxiety and depression can greatly affect students’ ability to learn and focus.
The task of teaching has also become more stressful since many students are not visible or appear still-faced and non-responsive. Teaching to non-responsive faces is significantly more stressful since the presenter receives no social feedback. The absence of social feedback during communication is extremely stressful. It is the basis of Trier Social stress test in which a person presents for five minutes to a group of judges who provide no facial or verbal feedback (Allen et al, 2016; Peper, 2020).
The Zoom experience especially in a large class can be a no win situation for the presenter and the viewer. To help resolve this challenge, we explored a strategy to increase student engagement and reduce social stress of the teacher. In this exploration, we asked students to rate their subjective energy level, attention and involvement during a Zoom conducted class. For the next Zoom class, they were asked to respond frequently with facial and body expressions to the presentation. For example, students would expressively shake their head no or yes and/or use facial expressions to signal to the teacher that they were engaged and listening. Other strategies included giving thumbs up or thumbs down, making sounds, and changing your body posture as a response to the presentation. Watch the superb non-judgmental instructions adapted for high school students by Amber Yang.
When college students purposely implement and increase their animated facial and body responses by 123% during Zoom classes, they report a significant increase in frequency of animation (ANOVA (F(1,70) = 30.66, p < .0001), energy level (ANOVA (F(1,70) = 28.96, p < .0001), attention (ANOVA (F(1,70) = 16.87, p = .0001) and involvement (ANOVA (F(1,69) = 10.70, p = .002) as compared just attending normally in class (see Figure 1).
Figure 1. Change in subjective energy, attention and involvement when the students significantly increase their facial and body animation by 123 % as compared to their normal non-expressive class behavior (Peper & Yang, in press).
“I never realized how my expressions affected my attention. Class was much more fun” -22 year old college student
“I can see how paying attention and participation play a large role in learning material. After trying to give positive facial and body feedback I felt more focused and I was taking better notes and felt I was understanding the material a bit better.” –28 year old medical student
These quotes are a few of the representative reports by more than 80% of the students who observed that being animated and responsive helped them to stay present and learn much more easily and improve retention of the materials. For a few students, it was challenging to be animated as they felt shy, self-conscious and silly and kept wondering what other students would think of them.
Having students compare two different ways of being in Zoom class is a useful assignment since it allows students to discover that being animated and responsive with facial/body expression improves learning. So often we forget how our body impacts our thoughts and emotions. For example, when students were asked to sit in a slouched position, they reported that it was much easier to recall hopeless, helpless, powerless and defeated memories and more difficult to perform mental math in the slouched position. While in the upright position it was easier to access positive empowering memories and easier to perform mental math (Peper et al, 2017; Peper et al, 2018).
Experience how body posture affects emotional recall and feeling (adapted from Alda, 2018).
1) Stand up and configure your body in a position that signals defeat, hopelessness and depression (slouching with the head down). While holding this position, recall a memory of hopelessness and defeat. Notice any negative emotions that arise from this.
2) Shift and configure your body into a position that signals joy, happiness and success (standing tall, looking up with a smile). While holding this position, recall a memory of joy and happiness. Notice any positive emotions that arise from this.
3) Configure your body in a position that signals defeat, hopelessness and depression (slouching with the head down). While holding this position, recall a joy, happiness and success. Do not change your body position. End this configuration after holding it for a little while.
4) Shift and your body in a position that signals joy, happiness and success (standing tall, looking up with a smile). While holding this position, recall a memory of hopelessness and defeat. Do not change your body position. End this configuration after holding it for a little while.
When body posture and expression are congruent with the evoked emotion, it is almost always easier to experience the emotions. On the other hand, when the body posture expression is the opposite of the evoked emotion (e.g., the body in a positive empowered stance while recalling hopeless defeated memories) it is much more difficult to evoke and experience the emotion. This same concept applies to learning. When slouching and lying on the bed while in a Zoom class, it is much more difficult to stay present and not drift off. On the other hand, when sitting erect and upright and actively responding to the presentation, the body presence/posture invites the brain to focus for optimized learning.
In a Zoom environment, it is easy to slouch, drift away, and become non-responsive—which can exacerbate zoom fatigue symptoms and also decrease our capacity to learn, focus, and feel connected with the people around us. Take charge and actively participate in class by sitting up, maintaining an empowered posture, and using nonverbal facial and body expressions to communicate. The important concept is not how you show your animation, but that you actively participate within the constraints of your own limitations. For example, if a person is paralyzed the person will benefit if they do the experience internally even though their body may not show any expression. By engaging our soma we optimize our learning experience as we face the day-to-day challenges of the pandemic and beyond.
I noticed I was able to retain information better as well as enjoy the class more when I used facial-body responses. At times, where I would try to wonder off into bliss, I would catch myself and try to actively engage in the class with body movements even if there is no discussion. Animated face/body was a better learning experience. –21-year old college student.
Leeb, R.T., Bitsko, R,H,, Radhakrishnan. L., Martinez, P., Njai, R., & Holland, K.M. (2020). Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep, 69,1675–
McGinty, E.E., Presskreischer, R., Anderson, K.E., Han, H., &Barry, C.L. (2020). Psychological distress and COVID-19–related stressors reported in a longitudinal cohort of US adults in April and July 2020. JAMA. Published online November 23, 2020.
Peper, E., Wilson, V.E., Martin, M., Rosengard, E., & Harvey, R. (unpublished). Avoid Zoom fa
Adapted from the book, TechStress: How Technology
is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, by Erik Peper, Richard Harvey and Nancy Faass.
Peper, E., Harvey, R., & Faass, N. (2020), TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley, CA: North Atlantic Books.
Go behind the screen and watch Inna Khazan, PhD, faculty member at Harvard Medical School and author of Biofeedback and mindfulness in everyday life: Practical solutions for improving your health and performance, interview Erik Peper, PhD and Richard Harvey, PhD. coauthors of the new book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.
Dr. Inna Khazan interviews Dr. Erik Peper about his new book Tech Stress. We talk about some of the ways in which technology overuse affects our health and what we can do about it.
Dr. Inna Khazan interviews Dr. Rick Harvey about his new book Tech Stress, the way technology overuse can affect adults and children, and what we can do about it.
We are excited about our upcoming book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, that will be published August 25, 2020.
Evolution shapes behavior — and as a species, we’ve evolved to be drawn to the instant gratification, constant connectivity, and the shiny lights, beeps, and chimes of our ever-present devices. In earlier eras, these hardwired evolutionary patterns may have set us up for success, but today they confuse our instincts, leaving us vulnerable and stressed out from fractured attention, missed sleep, skipped meals, aches, pains, and exhaustion and often addicted to our digital devices.
Tech Stress offers real, practical tools to avoid evolutionary pitfalls programmed into modern technology that trip us up. You will find a range of effective strategies and best practices to individualize your workspace, reduce physical strain, prevent sore muscles, combat brain drain, and correct poor posture. The book also provides fresh insights on reducing psychological stress on the job, including ways to improve communication with coworkers and family.
Although you will have to wait until August 25th to have the book delivered to your home, you can already begin to implement ways to reduce physical discomfort, zoom/screen fatigue and exhaustion. Have a look the blogs below.
How evolution shapes behavior
How to optimize ergonomics
Hot to prevent and reduce neck and shoulder discomfort
How to prevent screen fatigue and eye discomfort
How to improve posture and prevent slouching
How to improve breathing and reduce stress
How to protect yourself from EMF
Adapted from the upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, by Erik Peper, Richard Harvey and Nancy Faass.
While working in front of screens, many of us suffer from Zoom/screen fatigue, iNeck, shoulder and back discomfort, tired eyes, exhaustion and screen addiction (Peper, 2020; Fosslien & Duffy, 2020; So, Cheng & Szeto, 2017; Peper & Harvey, 2018). As we work, our shoulders and forearms tense and we are often not aware of this until someone mentions it. Many accept the discomfort and pain as the cost of doing work–not realizing that it may be possible to work without pain.
Observe how you and coworkers work at the computer, laptop or cellphone. Often we bring our noses close to the screen in order to the text more clearly and raise our shoulders when we perform data entry and use the mouse. This unaware muscle tension can be identified with physiological recording of the muscles electrical activity when they contract (electromyography) (Peper & Gibney, 2006; Peper, Harvey & Tylova, 2006). In most cases, when we rest our hands on our laps the muscle tension is low but the moment we even rest our hands on the keyboard or when we begin to type or mouse, our muscles may tighten, as shown in Figure 1. The muscle activity will also depend on the person’s stress level, ergonomic arrangement and posture.
Figure 1. Muscle tension from the shoulder and forearm increased without any awareness when the person rested their hands on the keyboard (Rest Keyboard) and during typing and mousing. The muscles only relaxed when the hands were resting on their lap (Rest Lap) (reproduced by permission from Peper, Harvey, and Faass, 2020).
Stop reading from your screen and relax your shoulders. Did you feel them slightly drop and relax?
If you experienced this release of tension and relaxation in the shoulders, then you were tightening your shoulders muscles without awareness. It is usually by the end of the day that we experience stiffness and discomfort. Do the following exercise as guided by the video or described in the text below to experience how discomfort and pain develop by maintaining low-level muscle tension.
While sitting, lift your right knee two inches up so that the foot is about two inches away from the floor. Keep holding the knee up in this position. Did you notice your breathing stopped when you lifted your knee? Are you noticing increasing tension and discomfort or even pain? How much longer can you lift the knee up?
Let go, relax and observe how the discomfort dissipates.
Reasons for the discomfort
The discomfort occurred because your muscles were contracted, which inhibited the blood and lymph flow through the tissue. When your muscles contracted to lift your knee, the blood flow in those muscles was reduced. Only when your muscles relaxed could enough blood flow occur to deliver nutrients and oxygen as well as remove the waste products of metabolism (Wan et al, 2017). From a physiological perspective, muscles work most efficiently when they alternately contract and relax. For example, most people can walk without discomfort since their muscles contract and relax with each step. However, you could hold your knee up for a few minutes before experiencing discomfort in those same muscles.
How to prevent discomfort.
To prevent discomfort and optimize health, apply the same concept of alternating tensing and relaxing to your neck, shoulder, back and arm muscles while working. Every few minutes move your arms and shoulders and let them relax. Interrupt the static sitting position with movement. If you need reminders to get up and move your body during the workday or long periods sitting in front of a device, you can download and install the free app, StretchBreak.
For more information, read and apply the concepts described in our upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. The book explains why TechStress develops, why digital addiction occurs, and what you can do to prevent discomfort, improve health and enhance performance. Order the book from Amazon and receive it August 25th. Alternatively, sign up with the publisher and receive a 30% discount when the book is published August 25th. https://www.northatlanticbooks.com/shop/tech-stress/
Peper, E. & Gibney, K. H. (2006). Muscle Biofeedback at the Computer: A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. Amersfoort: The Netherlands: Biofeedback Foundation of Europe. ISBN 0-9781927-0-2. Free download of the the book: http://bfe.org/helping-clients-who-are-working-from-home/