Naltrexone is a drug developed initially to treat addiction to opiate-based drugs, such as heroin or morphine. It belongs to a class of medications called opiate antagonists.
When given at a much lower dose, it’s known as low-dose naltrexone (LDN) and has been used in the US to help with autoimmune conditions including multiple sclerosis (MS) since 1985. More recently, it’s been used in the UK and Europe.
How does naltrexone work?
Naltrexone is thought to work by inhibiting the body’s natural painkillers, called endorphins, which makes the body produce even more. People then feel an increased sense of wellbeing and reduced pain. The increased endorphins then act with the receptors to help regulate cell growth and immunity.
Can I get LDN for MS?
LDN can be prescribed for MS, but it is ‘off-label’, which means it is not what it is licensed for. This makes a lot of doctors unwilling to prescribe it. It is also known to help with symptoms of conditions like Crohn’s disease, fibromyalgia, ulcerative colitis and chronic fatigue syndrome.
Studies that have looked into treating MS with LDN have had mixed results, but there is a lot of anecdotal evidence that it improves symptoms like pain, spasticity, fatigue and depression.
Can I get LDN in the UK?
It’s tricky – most GPs will not prescribe LDN for MS because the National Institute of Health & Care Excellence (NICE) does not widely recommend it for this condition. However, some people pay privately to access it.
If you are unable to obtain an NHS prescription from your GP, your GP may be willing to write you a private prescription but will make a charge. You could also get in touch with a private specialist practice or one of the online GP services. You will be likely to be asked to provide them with a letter from your GP or neurologist confirming that you have MS, a summary of your medical history, including any other conditions you live with, and any existing medication you take.
The LDN Research Trust has a lot of helpful information on getting a prescription, and a list of practitioners who will prescribe the drug. Visit their website here ldnresearchtrust.org/
For more information about LDN you can download MS-UK’s LDN Choices booklet free
Georgi Gill is looking for people to take part - no experience needed!
Since my diagnosis of relapse remitting multiple sclerosis (MS) in 2003, I have found it difficult to describe my illness experiences to family, friends and colleagues. I learned the medical terminology for my symptoms. Yet dysesthesia, optic neuritis and cognitive dysfunction don’t communicate the feelings of living with numbness, blurred vision or fatigue. I am not alone in this – it is acknowledged within the MS community that many people have difficulty explaining our illness to those around us.
As a poet, words are my stock-in-trade so I am very keen to find ways of improving this communication shortfall. Accordingly, I have developed the Poetry and Multiple Sclerosis (P.a.M.S.) Study, at the University of Edinburgh, in which I am inviting people with MS to try writing poems about their illness so we can explore whether poetry may give us new ways to communicate our MS to those around us.
People living with MS in the UK may be eligible to take part in the P.a.M.S. study which is happening online. Participation involves up to two interviews with me, and attending relaxed poetry workshops where there will be opportunities to try writing poems. No previous poetry experience is required, although if people have written poems before, they are also welcome.
To find out more about the P.a.M.S. Study, take a look at our website. If you have any questions or would like to discuss taking part, all the contact details are on the site.
Feature Writer Ian Cook investigates an interesting theory
One of the curious consequences of the current Covid-19 pandemic is that it has re-awakened interest in viruses as a cause of multiple sclerosis (MS) and, particularly, coronaviruses, which cause the common cold as well as Covid-19.
Covid-19 is a member of the coronavirus family of viruses and, for a long time, it has been speculated that viruses may be the elusive environmental factor that, along with genes, cause auto-immunity that starts MS. For years researchers have looked at the Epstein-Barr virus (EBV) as the most likely culprit. But, is it possible that coronaviruses, or a particular member of this family of viruses is involved, rather than EBV? And could the current Covid-19 pandemic lead to renewed interest in coronaviruses as a factor in causing MS?
Research into coronaviruses and MS has been going on for at least 40 years and, during this time, much progress has been made in developing a theory about how a respiratory tract infection could lead to a neurological condition. A paper published in 2000 in the Journal of Virology titled “Neuroinvasion by Human Respiratory Coronaviruses” observed that upper respiratory tract infections of viral origin could be an important trigger of MS attacks. Moreover, it was said that coronavirus seasonal patterns fit the observed occurrence of MS relapses.
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Catherine Wakefield is our fundraiser of the month because even MS cannot stop her completing her My MS Marathon challenge on her purple wheels of steel
I have been living with relapsing remitting multiple sclerosis (RRMS) since I was diagnosed in 2012, which has in recent years developed into secondary progressive MS. One of the most frustrating symptoms for me has been the deterioration of my walking and mobility, which led me to purchase a purple rollator in 2017 to help me walk, I call it my purple wheels of steel.
About a month into lockdown, I was starting to experience cabin fever, and the realisation hit me that if I didn’t get off my sofa I may soon become welded to it! It seemed as good a time as any to get out with my purple wheels and attempt to stretch my legs and get moving… which I did! I started by walking a little lap of the village where I live, just around the village green and back as my daily exercise – it was hard, but I managed, albeit with a few trips and rests along the way! I took my 17-year-old son, Tom, with me (who’d been released early from A-levels) in case I had a fall, and we would often joke that as we no longer had a pet dog, he had to put up with taking his mother for a walk instead!
At around the same time, the marvellous Captain (later Sir) Tom started his amazing fundraising feat for the NHS, doing 100 laps of his garden with his rollator before his 100th birthday. This spurred me on, as although I’m no spring chicken, I’m only slightly more than half Sir Tom’s age, and if he could do it at 100, surely I could manage a few laps around the village green!
A couple of weeks ago, my friend Helen, who also lives with MS, put up a Facebook post advertising the My MS Marathon, an event raising funds for MS-UK’s counselling service and encouraging people to take part by thinking up an individual challenge based around the number 26 (as in the number of miles run in a marathon). Earlier that day, when my son and I had been slowly trundling around the village green, I’d asked him to measure the distance we covered on his phone, just out of curiosity, and it had been 1.4km (I did ask him to tell me in miles, but apparently he and his phone are too young to deal in miles, and can only cope with kilometres!). It got me wondering how many days it would take to walk 26 miles. So after I converted our daily distance to miles (my phone is older and understands the language of miles), which turned out to be 0.87, I multiplied it by 31 (fortunately the fundraiser was taking place in July, rather than February!) and by good fortune the sum was just over 26 and a half… so if I did my daily lap every day in July, without any days off, I could smash the marathon distance. It seemed too much of a coincidence not to act on, and before I knew it I’d set up a fundraising page, and committed to doing a marathon over 31 days in July… eek!
While I understand my marathon will be conducted at a much slower pace and will take much longer than those of more athletic participants, and there will certainly be a few trips along the way, I am feeling quite excited and counting down the days till the 1st July! Shortly before my MS diagnosis I completed the Great North Run, my first half marathon, I didn’t know then it would take me ten years to progress on to a marathon, or that I’d be walking rather than running, but I’ve got there in the end! (Fingers crossed!)
To start your own My MS Marathon challenge, visit mymsmarathon.ms-uk.org.
Can multiple sclerosis (MS) cause sleep problems? The answer is a resounding yes. Research by the charity Shift.ms recently found up to 85% of people with MS have sleep issues, which leads to fatigue, which is also one of the most common symptoms of MS. Fatigue and insomnia go hand in hand with MS, and so good sleep hygiene when you have the condition is important.
Here, nutritionist and author Rob Hobson shares his top tips for getting a decent night’s kip
In 1981, a Harvard Medical School professor, Dr Charles Czeisler, discovered that it is daylight that keeps our circadian rhythm, or body clock, aligned with our surroundings. Any light can suppress the secretion of melatonin, so try and keep your bedroom dark by using blackout blinds or investing in a sleep mask.
If you wake up during the night, then any light creeping through gaps in curtains and blinds can be a distraction preventing you from getting back to sleep. While any light can suppress the secretion of melatonin – the hormone that promotes sleepiness – it is blue light that has the greatest negative effect. This light is emitted from electrical equipment such as computers, mobile phones, notebooks and TVs.
If you do need a light on, then research has shown how red light has the least impact on melatonin production making this wavelength of light the most conducive to sleep.
You can buy red or pink bulbs to use in your bedroom and even strings of novelty lights, but these may not be to everyone’s taste. The next best thing is to use incandescent bulbs that give out diffused, warm light and can be controlled with a dimmer switch on side lamps. During the day, make sure you expose yourself to plenty of natural light as this can help to boost mood and make you feel more energized. It, in turn, can have a positive effect on your ability to sleep at night. But remember, when it’s time to sleep, it’s lights out!
If you want to prepare your body for a good night’s sleep, you need to chill out. When we think about the effect of temperature on our body it’s easy to assume that heat can help us to sleep.
Sitting outside in the midday sun or inside a hot study can leave you feeling dozy, but the tiredness you feel from high external temperatures during the day is a side-effect of your causes. In contrast, your circadian rhythm is very attuned to body temperature – it’s one of the functions it controls to help you fall asleep or stay awake. During the day, your body temperature rises naturally until late afternoon, at which point it then starts to fall. As you start to fall asleep your body temperature begins to lower by one to two degrees, which helps the body to conserve energy. The drop in temperature signals the release of melatonin to help induce relaxation and sleep by slowing the heart rate, breathing and digestion. If your sleep environment is too hot or cold, this can make it more difficult for your body to reach the optimal temperature required for a good quality of sleep.
Take a bath
While it may seem counterintuitive to what we’ve just discussed, many studies have shown that warming your body by bathing can help to promote sleep, but to harness these effects, timing is key. The best time to take a bath is at least one hour before you hit the hay, as this gives your body enough time to cool down to its optimum sleep temperature. Similar effects have been shown when showering or even soaking your feet in warm water to increase your skin and body temperature. Bathing has also been shown to help relieve anxiety and muscle stress, which can help with relaxation and sleep. Epsom salts are a good choice for putting in the bathwater, as they are rich in magnesium which helps to promote muscle.
Oils traditionally used for relaxation include lavender, bergamot and ylang-ylang. You can make bath time even more relaxing by burning candles and turning out the bathroom light. Listening to calming music or using a meditative app on your phone can also make bath time even more relaxing and offer an opportunity to calm a busy mind.
Restlessness and a busy mind can easily make falling asleep difficult. As you lie awake your mind can go into overdrive while you focus on the issues and worries impacting on your life, many of which you will unconsciously ruminate on all night. People who write down their thoughts, activities and tasks that need to be completed before they go to bed fall asleep much quicker than those who don’t. Keep a pad of paper and a pen next to your bed so you can jot down your thoughts before you go to sleep each night. As well as writing down your worries and stresses, include any unfinished tasks that need to be completed the following day, or make a to-do list.
If you wake up during the night and your mind starts to wander, read through your diary and to-do list, adding to it if you need to. Sometimes the best ideas can occur in the middle of the night, so be sure to keep plenty of space to jot these down. Don’t spend hours lying in bed trying to fall asleep. Instead, get up and sit somewhere quiet, keeping the lights down low. Use this time to help organize your thoughts by writing them down rather than letting them buzz around on repeat in your head.
The position you choose to sleep in could be a factor in your ability to sleep through the night. The most common sleep position – and the one recommended by many sleep experts – is foetal. If you choose to sleep this way you should favour the opposite side to the one of your dominance (in other words, if you’re right-handed, choose your left side). Not all experts agree on this though, with many suggesting that sleeping on your back is better for your health, even though this is the least popular position to sleep in. Establishing the best position for sleep ultimately comes down to comfort, and you can figure this out through trial and error.
Extracted from The Art of Sleeping by Rob Hobson (£9.99, amazon.co.uk)
MS-UK’s Head of Services, Diana Crowe reflects upon its latest report which gives valuable insight into the loneliness and isolation people living with multiple sclerosis can experience
Much of my time last year was spent exploring how people affected by multiple sclerosis (MS) experience loneliness and isolation and my findings are shared in our report that we have published this week. I don’t wish to repeat in this blog what is said in the report but rather reflect on my experiences whilst working on this project.
When I first started to scope out the work I realised that I needed to squirrel myself away at home one day a week to give me the time and space to research and read all of the amazing reports that had already been published and understand the landscape. This was a luxury to have this time (before we were all forced to work at home – thank you COVID-19!) but I soon discovered the irony of working on a project that was making me feel a little lonely and isolated from my colleagues.
As a community-led organisation, the next step was to reach out to the MS community to hear about their lived experiences. I always love this part of my job because it keeps me grounded and drives the passion that I have to really make a difference. We started by conducting an online survey which gave us a really good starting point and enabled us to drill down further into the challenges and barriers that the MS community were facing.
In the late summer, my colleague and I travelled the country on one plane, many trains and automobiles! We were so grateful to the MS Therapy Centres across the UK that opened their doors to us and enabled us to facilitate focus groups. The dynamics were different in each group – one was very emotional as people shared their experiences and tissues were needed and in others, we heard how some people used humour to deal with the challenges they faced. For example, someone pulled up their trouser leg to reveal a catheter bag and exclaimed ‘this is not a fashion accessory you know!’ We conducted telephone interviews with those we could not meet face to face and it was such a privilege to take this time and listen. Many cups of tea and cakes later we had a rich insight that has shaped the next steps you see in this report.
It has been a long time in the making and we had every intention of launching this report back in March but then we were all forced into isolation (thanks again COVID-19!) and we have all faced so many challenges both personally and professionally and it certainly did not seem appropriate at that moment.
However, this week is Loneliness Awareness Week and we felt this was the right time to share our work. This report and the recommendations within, build upon the work we are already doing and gives us a platform to develop new initiatives. This is just the beginning of what I hope will be an ongoing conversation and I encourage organisations to get in touch to talk about how we can build partnerships, learn from each other and keep this conversation alive. Only by working together can we tackle loneliness and isolation in the MS community.
MSer and HR expert Rebecca Armstrong reflects on how lock down could lead to positive progress in the workplace
During this period of lock down, the world has had to adapt overnight. Restrictions have meant that work for many has looked very different and employers have had to embrace this and put in place measures. In this article, I reflect on how this may help employers understand multiple sclerosis (MS) and similar conditions and, importantly, how this might create benefits for people with MS longer term.
When it comes to resilience (that is, the ability to bounce back) and how able we are to cope with changes, we could argue that MS gives us a head start. We have been training for this since diagnosis and are used to having to adapt to new circumstances, often with very little notice.
When we reflect on the last few months there are a few things that occur to me.
One of the most significant changes most employers were asked to make was to allow people to work from home if they could, and to support them to do so. This really challenged the mind-set of many employers who had, until that point, opposed working from home. Many felt that homeworking as standard practice was a bad idea, which was damaging to teams and that people may take advantage of the situation. In my experience of working with people who have MS to help them obtain reasonable adjustments, this has been a consistent barrier, with many employers reluctant to take the step.
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For Carers Week, Laura and Ryan from MS-UK’s Helpline explain what support is available for you
The theme of Carers Week this year is making caring visible. So often carers go about their day and others would not even realise what they carry on their shoulders. They may be out doing the shopping, yet worrying about the person at home they care for, all too often not thinking about themselves. Carers often don’t even identify with the label of being a ‘carer’.
It is so important that the role of the carer is recognised and also that they know where to go for support. We want carers to know there are organisations they can call when they need to chat or ask questions, there are support groups (online and in the community) that are just for them and there are people and organisations out there that care for carers.
Our Helpline would like to let all carers know they can call us when they need to. We are here for you, as well as the person living with multiple sclerosis (MS). We can provide an understanding listening ear, be at the end of the telephone or source you supportive information.
The kind of information we have sourced for carers has been things like
The role of an unpaid carer can be complex and we can help to work through issues at your pace, signposting to more specific organisations where it’s needed.
Our Helpline can be contacted by our freephone number 0800 783 0518, or via email and webchat.
Other great organisations who support carers are
The Carers Trust help to raise awareness of unpaid carers in the UK. You can use their website to search for carer services in your area.
Carers UK offer advice, information and support trough an expert telephone advice and support service. They help connect people through carers’ groups
Please get in touch, we are here if you need us.
Laura and Ryan
Ian and Jo Fletcher on being a husband-wife team when one of you is a carer
Ian Fletcher was diagnosed with multiple sclerosis (MS) in 2006. Only two years in to their relationship, the couple faced the challenge not only of managing his new health condition, but navigating their change in dynamic as Jo took on the role of his carer. “Initially I found it daunting to take responsibility for the many things that Ian did for us,” admits Jo. “As a couple you tend gravitate to taking on those jobs and roles in which you feel most confident. However, I've learnt so much and grown in confidence, doing things that I would once have avoided at all costs!”
“It was hard for me to admit that I needed Jo's help more frequently,” says Ian, “and I was unsure how Jo would cope. Over time my confidence grew as we learnt and faced new challenges and changes together.”
One of the biggest challenges was Ian handing over the apron strings to Jo, as Ian prided himself on his culinary skills. “I found I was unable to do things I had previously and felt frustrated. I really enjoyed making all our meals and impressed Jo when we met with my cooking! As MS progressed I took on a supervisory role and Jo now cooks our meals for us, with supervision.”
“As I took on this role, my skills improved and I found that I enjoyed cooking too, with lots of supervision!” says Jo.
Change and adapt
The couple say spontaneity is difficult, but they have learnt to be flexible with arrangements and commitments, allowing themselves more time and accepting that plans may have to change on occasion. “We discovered that we were unable to do some things and coming to terms with this was, and can be, challenging,” says Jo. “Over time, we have adapted to enable us to continue to enjoy many things we did before MS came along.
“We have been so lucky to travel to many countries together, but nowadays we face more limitations and there are many things to consider before deciding on a location. However, this hasn't stopped us and we have had some amazing trips in the UK and abroad (albeit with a little more forward planning). We continue to enjoy trips to the theatre, watching our beloved England team play rugby at Twickenham, and plenty of socialising with family and friends.
The couple have amazing family and friends who have been very supportive over the years and continue to be a major part of their lives.
They also have a lot of praise for the multidisciplinary team at East Suffolk & North Essex Foundation Trust. “The collaborative approach to the provision of Ian's care has been invaluable and we are so grateful to everyone in these teams who continue to support us,” says Jo.
Ian has been going to Josephs Court, the wellness centre at MS-UK, twice weekly for many years to build and maintain his muscle tone and strength. However, Josephs Court has had an incredible impact on his mental health and wellbeing too. “We greatly value the support from the incredible staff team at Josephs Court and wealth of information that has had such a positive impact on us both.”
Caring for Ian has come naturally to Jo, but she admits she’s had to work harder at caring for herself, too. “It has taken me time to accept that, on occasion, it's OK for me to have a quiet day and make time for myself, too. As a couple, and individually, we have strong family and friend networks. Thanks to our family I am lucky to be able to meet with friends regularly, which I value greatly.
We asked Ian and Jo what advice they would share for any couple beginning this kind of journey together and they said the following
· Listen to your body and allow yourself time to rest, when possible, when you know you need to
· Whenever possible, adapt your lifestyle to continue enjoyment of things that you love to do (albeit with more planning). Don't assume that something isn't possible
· Be honest with yourself, as a couple and others, about changes, challenges, your needs and wishes
· Keep your sense of humour and laugh together. There have been so many occasions when things haven't gone to plan or have gone wrong. However, often these challenges have been the memories that have made us smile and laugh in retrospect
· Accept that it's OK and natural to have good and bad days in your relationship, the same as any couple
· It is important to make time for one another, as any other couple would do. MS symptoms such as fatigue may impact on your daily lives and your ability to spend quality time together
· Don't place unrealistic expectations and pressure on yourselves. Talk to those around you in order that they understand your situation and can support you
· Don't assume responsibility for all things, as you each have different opinions and strengths. MS often deprives freedom of choice
· Take time for yourselves as individuals and stay connected with your interests
· Make plans, have goals, hopes and dreams
“We've faced many changes and challenges due to MS,” says Jo. “However, these experiences have strengthened an already strong bond. We have a greater understanding of one another as a result of our situation. We each have our own strengths and, as a team working together, we feel we can tackle anything.”
Guest blogger Janet Orchard charts living with MS and a pandemic in a foreign country
In Catalunya, Spain, strict lockdown started mid-March. One person per household could go once a day to the nearest place to buy essentials but it was preferred that everyone stayed home. The slogan “Yo me quedo en casa” (I’m staying at home) is everywhere.
Medicines, fruit, vegetables, fish, meat, cheese and, you’ve gotta love the Catalans, panellets, a delectable sweetmeat, are deemed essential.
The local police deliver medicines to the vulnerable and if it is your birthday (as it was mine) they will show up personally with a present. The only catch is you have to be under the age of 6 – a shame as there are some pretty cute cops around here!
As la nueva normalidad (the new normal) has been emerging, with armies of little vans ferrying fish from the nearby port, fields of locally grown organic produce, chicken and cheeses brought to the door all being part of life now I feel I can start to relax.
The food has, if anything, been slightly enhanced as the fishmonger and greengrocer decide which of their produce is the best and deliver it, both having known us for 20 years and familiar with our diet to manage multiple sclerosis (MS) (12 years Best Bet Diet, the last six years eating from the 90-day food list of the Ann Boroch Protocol (ABP)).
Phoning around to ensure adequate stocks of my arsenal of vitamin C, D3, zinc and antifungals has shown me that the minute another potential cure for el virus is mentioned, a few hours later all sources will have been depleted. Still, being a chocoholic, I have ensured I have enough 100 per cent cacao for a few months and carob seeds ready to plant. I know they are a legume and take six years or so to bear pods but it is good to know I have a fallback.
In Spain they have been prioritising the young as all hospitals, even the improvised hotels and pavilions, are full.
It has been a remarkable test of where I have got to. Six years ago I would have been a shaking, sobbing mess of brain-fog wondering how to cope and being sceptical as to whether I’d survive. Thanks to the ABP I am healthier than in my entire life and do not feel ‘elderly’.
Emerging from lockdown
Now, it looks like the worse of lockdown is over. Everyone is rather excited to see that as from 03 June, distanced gatherings of up to 15 people are permitted. No one was allowed out of the home, even for exercise, initially.
It became chaotic for families with children of varying ages as each one had to be exercised at a different time for up to an hour accompanied by an adult. Exercise hours are relaxed now apart from for the over 70s who still have set time slots, but now the no further than 1km parameter from the home rule is relaxed.
Bars and restaurants are re-opening with a 40 per cent capacity seating, toilets disinfected at least six times per day, no menus, oil, vinegar, salt or pepper on tables. Cinemas and theatres are at 30 per cent capacity. Pools must be accessed by prior appointment. Sunbathing is allowed with four square meter distancing. Everyone over the age of six must wear a mask on public transport and where a two-meter distance can’t be maintained.
Our peace will be over on June 21, just before San Juan our national holiday, as movement between regions should be allowed. This area is favoured by Barcelonans for their summer houses but has been off-limits as no one can cross-province boundaries.
Police cars with loudspeakers roamed the area reminding people to quedar en casa, local restaurants distributed free meals to the vulnerable, and roadblocks were in place to stop town-dwellers accessing their second properties. There was very little traffic either by road or air, and the wildlife in the area has enjoyed its freedom. The Catalans though have missed their abrazos (hugs). Everyone is fearful of the church bells tolling in honour of the fallen, but we have been spared the high numbers elsewhere in Catalunya with 19 people affected in our village.
Over the years I had got used to reading lists of what you miss from your pre-MS life. Now I am seeing numerous asking what is the worst thing that lock-down has prevented you from doing.
Instead of counting those angry and sad failures and interruptions to life, it is rather good to note the pluses.
All in all, lock-down has been as pleasant an experience as it could be thanks to the generosity of the Catalan tradesmen who, poor things, look absolutely worn out, yet still smiling.
Being spared food shopping has given me even more time to exercise, so I have gained from the situation. The most time-consuming part of el virus has been keeping up to date in the Catalan press on the latest movements whilst trying to ignore the political in-fighting as happens in all countries.
It will take a few months to form this nueva normalidad that is here to stay for a while.
Lockdown was the easy part. Rebuilding the economy will have far more devastating hoops to jump through.
Figures point to the already unhealthy as vulnerable. As in nature itself, the fit survive. For those of us who have been beavering away at healing all this time, it was not in vain. We have been actively working to improve our health. The large quantities of supplements we pour down, the exercise, the knowledge that we are on our way to living a life free from MS and the other conditions MS/candida has heaped on us will show their worth now.
We need to change, the world needs to change. Neither can be patched up indefinitely but need serious work, a revamp, just as I have learnt on the ABP. I am proud to have stuck to my guns and healed naturally in what was becoming an unnatural world. Swap the stress for excitement at what we can achieve both for ourselves and the planet.
Anyone not being proactive about healing from MS, I urge you to think about it. It’s your best present to yourself and the world. With a thoroughly healthy population, there would be far less strain on health services and such a widespread pandemic would be better managed.
Life continues though. Look outside. Learn from the birds, butterflies and other wildlife behaving as normal. Don’t get pulled into the doom and gloom. Breathe (in your own socially-distanced space). Relax those shoulders. Feel the negativity melt away. Smile.