COVID-19 has a devastating effect not only on human lives and world economies, but also on our mental health. Some people find it difficult to adapt, especially now that it seems that the pandemic will never end. So today we decided to talk to Dr. Andrea Bernabé, the psychologist at Clínica La Siesta, to ask her some questions related to the pandemic, the COVID-19 depression, stress, and our emotional state in general.  – Good morning, Doctor. Please tell us a little bit about yourself and your experience in the field of psychology. – Good morning. I began my undergraduate studies in psychology at the University of Murcia and later made a specialisation at UCAM, in Murcia as well. In addition, I have taken different complementary and specialised courses at the universities of Murcia, Elche and Oxford, England where I lived for three years since 2013 to 2016. – To begin, we would like to make clear the distinction. What is the difference between the psychologist and a psychiatrist? When should you visit one and when the other? – The main difference is that a Psychologist and a Psychiatrist have different training. A psychologist studies a degree in Psychology and then makes a specialty in mental health and can help you with problems of emotions, thoughts, behaviour, among others. On the other hand, a psychiatrist studies Medicine and specialises in mental illnesses and can prescribe medicines for serious mental disorders and illnesses such as very serious depressions, paranoia, delusions associated with psychotic illnesses. – Did you have an increased number of patients with depression and/or anxiety after the COVID-19 pandemic has started and especially after the lockdown? What other problems related to these two factors have you encountered? – Yes, cases of illness or symptoms of depression and anxiety have increased since the pandemic began. In addition, in the case of other diseases or mental disorders we have also been able to observe that the main symptoms have worsened or new symptoms have appeared due to lockdown, fear, loneliness and the reduction of social or family encounters for precautionary reasons. – There are different extremes of people regarding COVID-19: people who obsess too much and people who care too little. Which one is more dangerous and what would you recommend to them? – Both extremes are dangerous: those who worry excessively could even make their illness worse if they experience symptoms of anxiety, paranoia etc., and those who do not worry could infect other people whom the illness could affect fatally. As I have said before, before any doubt, symptom or diagnosis of COVID-19, patients should consult with their family doctor for more information and specialised treatment and if they experience symptoms related to anxiety, depression or others, they should consult a psychologist. – How to overcome the fear of catching COVID-19 and get on with your life (and not catch COVID-19 depression instead)? – In the first place, the most important thing is to comply with the rules and instructions that the health authorities inform every day and in an updated way, such as, for example, using a mask, hand hygiene, maintaining social distance, reducing social contacts, respecting schedules of shops etc. If we still get sick with COVID-19 or we think it could be so, we must call or go to the corresponding health centre to make a diagnosis and stay home and do a correct and responsible quarantine. Depending on your state of health and how the disease has affected you, you should stay in bed for a while and eat as healthy as possible. On the other hand, if you have mild symptoms, you can take the opportunity to read, write, paint, watch movies or series or do any of your favourite activities or other activities that you wanted to do for a long time but did not have that time. It can be a time to do new things! – Is stress very dangerous? How would you recommend handling it? – Stress can be highly dangerous because it can trigger or activate new diseases in our body or make us somatise stress symptoms, for example, headaches, stomach pain, joint pain, muscle pain, bone pain, etc. It is advisable to follow a healthy lifestyle based on a healthy diet, physical exercise and find time for your hobbies. If you still cannot relax or have stress problems that you cannot handle yourself, I advise you to seek professional help. We will be delighted to assist you. – How can one tell apart depression from a consistently bad mood/emotional state? – Although a bad mood or irritable mood could be considered a symptom of depression, a depression is characterised by a set of symptoms such as lack of energy, difficulty sleeping or, on the contrary, sleeping excessively, feelings of sadness, worthlessness, guilt, self-hatred and lack or excess of appetite. So, we can say that bad mood by itself cannot be considered a depression, however, the bad mood, emotions and negative thoughts associated with it can be worked on. – Many thanks, Doctor, for your time and for the interesting professional insight.  If you are experiencing any problems coping with depression or anxiety, or any other psychological issues, do not despair, everything has its solution. You are welcome to request the consultation of Dr. Bernabé to help you to resolve these issues. You can request an appointment via our Android App, or leaving us a Facebook message or a Whatsapp message at +34 692 134 136. For more contact details, please follow this link.   

We have visited (having booked a prior appointment) the consultation office of Doctor Perea, General Practitioner at Clínica La Siesta, to inquire about certain aspects of COVID-19. He receives us very kindly in his office, which is spacious, airy, bright, and austere. We would say that he keeps a somewhat “sui generis” order of things. Between jokes he assures us that when he tried to adopt a more conventional order style, he hardly ever could find anything he was looking for. Dr. Perea has been working at the clinic for 28 years, and in this time he has seen everything. His motto is to always be attentive to the most probable and serious eventuality. He tells us that he was one of the first people who, just at the beginning of February, took preventive measures both personally and in his office. And that’s how he takes care of us today: protected (and protecting us) with pyjamas, a dressing gown, a hat, a face mask, gloves and a screen. It is not easy to work in these new conditions, but lowering security, he assured us, is not an option. Without further ado and duly accommodated, we proceed to the interview where Dr. Perea will answer the most frequently asked questions related to the COVID-19 pandemic and disease: The vaccine – As we all know, the COVID-19 vaccine has arrived, and the first vaccinations have already taken place. Some people are afraid of this vaccine because of the speed with which it has been developed and because of the new technique based on messenger RNA, giving genetic instructions to our cells. Is that fear legitimate? – This is a very good question. When we apply a vaccine, we are introducing the inactivated or attenuated virus, or a part of it, into the human body to produce a defensive immune response. Modern vaccines are made by introducing a fragment of mRNA (Messenger Ribonucleic Acid) capable of encoding one or more proteins of the virus and thus triggering the immune response. It is done in this way to reduce the danger of the vaccine (neither live nor attenuated virus is introduced), lower its cost, and increase its effectiveness. As far as we know, it can be safely said that mRNA does not enter the nucleus of cells during this process (ribosomes for protein synthesis are found in the cell cytoplasm), and consequently cannot integrate into the cell genome and cause genetic damage. Therefore, messenger RNA-based vaccines are safe in this regard.   – What other vaccines would you recommend having, and to whom, right now? – That of the flu, although its incidence this year is expected to be lower, and that of pneumococcal pneumonia, specifically the 13-valent conjugated polysaccharide, for the prevention of pneumonia and invasive pneumococcal disease in adults, all the more if they are older and if they have pathologies. The infection – Is it possible to get infected with coronavirus multiple times? – Yes, there are already several documented cases around the world, but it is quite sporadic.   – And, if the rapid test shows that antibodies remain in my blood, am I protected? – Yes, of course; in addition to memory T lymphocytes, which also provide immunity against reinfection.   – And the antigen test? – Does it play a role in ensuring that the person has protection against the virus? No. – Can animals also get the disease? – At the moment there is no evidence that animals play an important role in the spread of COVID-19. However, people who are infected, or suspected of being infected, should prevent contact with people and also with animals and pets.   – Is it true that there are no infections that pass from small children to parents? – The truth is that young children spread the virus to a lesser extent than we thought, and are less important in transmission than adults. The virus effects – Why are different people affected by this virus in such different ways? – It is due to the viral load developed from the first stages of the infection, which has to do with the activity of the cell membrane proteins (angiotensin-converting enzyme and others), the genetic constitution and the variability of lymphocyte antigens that is different in each individual, and, of course, to the previous pathologies that one has.   – Is it normal when it comes to a virus? – I would not say that the large variation in response to the virus is normal. And it is precisely a very large immune and inflammatory response that determines the severity of the most serious conditions (such as fulminant bilateral pneumonia).   – Why do smell and taste disappear? – It is due to the cytopathic effect of the virus on the mucous membrane and tissues, especially on the basal cells, many of which are olfactory sensory “neurons”.   – Is it possible to get them back? – The majority of patients recover their smell and taste in a few days or weeks.   – What are the after-effects of COVID-19 and why are they so different in different people? – The sequelae are very varied, predominantly respiratory, and especially serious and long-lasting, with uncertain evolution, in the most serious cases even require further ICU admission. The consequences of the virus are different for the same reasons that we pointed out about the variability of the disease symptoms in different individuals, and, in the event of a collapse of the health system, these consequences can even be fatal. Preventive measures – What is the prophylaxis of COVID-19? Is it possible to prevent the disease or reduce the probability of contagion with some practices other than the use of masks and personal hygiene? – I would summarise it in wearing a face mask, washing your hands frequently, avoiding meetings where food or drinks are consumed and ventilating the rooms as much as possible. Microdroplets, or Flügge, represent the main transmission factor despite face masks and screens.   – Disinfection tips: how should we use the hand sanitisers? (e.g. Is it true that hand sanitisers only work if you apply about 3 ml, not less, of sanitiser and rub for 30 seconds, not less?) – Yes, since the time of action of an antiseptic is as important as the technique of use and the potency of the compound itself. – Do we have to disinfect food with bleach (lejía)? – The food inside the packaging should not be disinfected, except for the usual fruit and vegetable washing (in which 12 drops of purifying water bleach per liter of water ensures disinfection). It is recommendable that the packaging itself is cleaned using a cloth and a surface cleaner capable of deactivating the virus before storing it in cupboards or the refrigerator.   – Is it safe to go to the gym / theatre, etc.? Is it more advisable to live a more or less normal life or to lock yourself at home until all this situation related to COVID-19 passes? – My advice would be to attend to necessary tasks and work, go out to shop and visit the doctor, and avoid social events and meetings that you can go without. About Spain – Why do you think Spain is one of the countries so highly affected by COVID-19? – COVID-19 is the responsibility of the Government of Spain both because it is a public health problem that transcends the autonomous communities, and because it is a foreign health issue. The causes that Spain has been so impacted are ultimately due to errors in the forecast and management of the health crisis by the Government. During the first wave, there was concealment of information and a serious omission of the duty to prevent (permissiveness for public acts and demonstrations) and to provide the material and human means to fight the pandemic. This led us to record numbers of the infected and deaths, and the need to drastically shut down the economy. For its part, the Lancet confirms that the de-escalation of the first wave was precipitous and without the system of trackers and tests put in place as was recommended by international scientific institutions and the WHO. This has led us to the second wave, in which it appeared that the scientific committee that advises the Government does not exist, that each autonomous region has managed itself in its own way, and that the real technicians were actually only in the Community of Madrid. I predict that there will be a third wave after Christmas. To prevent it, I advise all those who are going to have reunions during these holidays to do twice the rapid test for antibodies in the blood and antigens in the respiratory tract (available at Clínica La Siesta). Treatment and tests – Could you give us your professional opinion about the use and controversy surrounding Hydroxychloroquine? – According to data from the AEMPS (Spanish Agency for Medicines and Health Products): – It is a drug with a well-known safety and efficacy profile that is used as an indicated treatment against malaria and different autoimmune diseases. – Hydroxychloroquine has been shown to be effective against SARS-CoV-2 in in vitro studies but there is still no solid scientific evidence on its efficacy against COVID-19 in humans. – In Spain there are currently 16 authorised clinical trials throughout the national territory. In all of them, an intermediate safety analysis has been requested from the promoters. – There is no data to indicate that the incidence of adverse reactions from the use of hydroxychloroquine has increased in COVID-19 patients. – Patients who are already taking hydroxychloroquine within or outside of clinical trials for COVID-19 as well as patients undergoing chronic treatment with these drugs should continue taking them and, in any case, maintain their usual follow-ups with their doctors. Therefore, it is not currently an approved drug for use against COVID-19.   – Who should get tested for coronavirus? – Those who have compatible symptoms, those who have been in contact with COVID-19 patients / positives, and those who have to undergo surgical interventions or hospital treatments. – Thank you very much, Doctor, for attending us and for the advice you have provided. – Thank you very much for your interest.

It is an undeniable fact that in the times of the COVID-19 pandemic we went out much less, trying to avoid contact with other humans. Now that summer is over, we may be going out even less. However, staying at home longer than usual can contribute to the decrease in the levels of vitamin D that we have in the body. What levels of Vitamin D in the blood are considered normal?In Spain, the references are as follows: Deficiency: <10. Insufficiency: 10-30. Sufficiency: 30.01-100. Toxicity: >100. Vitamin D, vitamin D2, or vitamin D3?Vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol) are simply two different forms of vitamin D. The former is formed in the skin under the influence of ultraviolet rays in sunlight and also comes from animal sources. The latter comes from plant sources. They are measured in international units. How is vitamin D synthesised? Vitamin D is formed in the skin when it is exposed to sunlight, through ultraviolet B rays, which help synthesise vitamin D. These rays cannot pass through glass, clothing or sunscreen. On the other hand, it can enter the body along with certain foods. First of all, these are fatty sea fish, fatty dairy products and egg yolks. However, if you are deficient or insufficient in this vitamin, you cannot get enough of it from food or sunlight alone (on top of that, ultraviolet rays can also be dangerous). For example: the daily intake of vitamin D is contained in 20 egg yolks. Therefore, taking vitamin D supplements is the best option in case of deficiency or insufficiency. Furthermore, in practice, milk and dairy products do not always contain vitamin D or contain only its insignificant traces, so their consumption, unfortunately, cannot guarantee the coverage of our needs for this vitamin. Why is it a good idea to try and avoid vitamin D deficiency and insufficiency? The main function of vitamin D is to regulate the metabolism of calcium and phosphorus. It helps the absorption of these elements from the intestines, thus participating in the growth and maintenance of bones and skeleton. If this vitamin is lacking in the body, a person can develop rickets and osteoporosis. On the other hand, in almost all organs and tissues, there are receptors for vitamin D. Therefore, it has a large number of functions not only related to the development and growth of bones. It also plays a role in the development of the nervous system. With its deficiency, sleep disturbances and cognitive disorders such as memory impairment can occur. In adults, it can contribute to the development of Alzheimer’s and Parkinson’s diseases, or senile dementia. In many cases, people with vitamin D deficiency are at increased risk of developing cancer, cardiovascular diseases, infectious diseases, and many others. Its deficiency is also one of the factors that increase tissue resistance to insulin, contributing to the development of diabetes. This prohormone is also a powerful agent for reducing chronic inflammation. Some peculiarities to take into consideration. Elevated vitamin D levels can lead to functional vitamin K2 deficiency. In this case, since vitamin K2 regulates calcium transport, calcium does not reach the bones and is deposited in the arteries and soft tissues, which can lead to hardening of the arteries. So, if you take vitamin D, you create a higher demand for vitamin K2 in your body. Both vitamin D and K2 work together to strengthen your bones and improve the health of your heart. Therefore, if you are taking vitamin D via supplements, you also need to intake extra vitamin K2. Who needs vitamin D the most? An increased need for vitamin D arises from a lack of ultraviolet radiation, naturally dark skin, old age, vegetarianism and adherence to low-fat diets, indigestion, pregnancy and lactation, a period of intensive growth and development. These people need additional vitamin D. Therefore: – Pregnant or breastfeeding women: vitamin D deficiency during pregnancy leads to inadequate formation of the fetal immune system. – Children: in children, vitamin D deficiency leads to a sharp deterioration in anti-infective protection. Frequent illnesses can be a consequence of this vitamin’s deficiency or insufficiency. – Older people: ageing skin loses its ability to synthesise vitamin D, and older people are most at risk of developing all kinds of previously mentioned diseases. And so now what? Taking a walk in the sun for just half an hour a day would be enough in our area in Spain to activate vitamin D, provided that its intake from the diet or through supplements is adequate. At Clínica La Siesta, we carry out the 25-hydroxy vitamin D (25-OH Vitamin D) test, which is considered the most effective way to measure the amount of this vitamin in the blood. If in doubt, you can consult our GP to determine if you need to check your blood vitamin D level. By knowing exactly what levels of vitamin D you have in your blood, you can take appropriate action. Only the doctor can assign the doses of supplements necessary for each particular case, since it will depend on the level of vitamin D already present in the blood, the person’s lifestyle, their nutrition and the climate of the country of residence. In addition, an overdose of vitamin D can also have serious adverse health consequences, so it is best to consult your doctor. To make an appointment at CLS, please contact us by email info@clinicalasiesta.com, by calling us at +34 966 784 195, or by writing us a WhatsApp to +34 692 134 136.