Simple initiatives can support the immune system for children and adults.

Calm, lack of stress or lack of chronic anxiety supports and strengthens the immune system, and contributes to improved general health; resistance to infections, decreased complications, improved recovery times and prognosis, which is supported by longstanding well established evidence-based research.

Simple initiatives can support the immune system, such as regular:

1. Calm and positive mental state

2. Calm and positive environment

3. Laughter, fun, enjoyment

4. Positive engagement with loved ones, supportive seniors or peers

5. Engagement in normative activities (details mentioned)

6. Relaxation in fresh air with nature and/or animals

7. Exercise

8. Sufficient sleep

9. Hydration

10. Health food options such as fresh fruit and vegetables.

#GlobalHealthPlan #Systemic #covid19 #coronavirus #Health #FirstDoNoHarm #calm #stress #anxiety #prognosis #immunesystem #resistance #complications #recovery #laughter #normalcy #relaxation #nature #animals #exercise #sleep #hydration #food

Simple initiatives can positively impact on mental state.

Chronic anxiety or stress is a well established evidence-based and significant risk factor for mental health and general health; lowers the immune response, significantly increasing susceptibility to infections and worsening prognosis.

Simple initiatives can positively impact on mental state. Consider your immediate environment and be creative regarding your options. Many children and adults comment on their favourite activities in this context, effective strategies to precipitate and maintain calm:

1. Regular time in nature or in the garden or tending or enjoying indoor plants.

2. Planting a fruit or vegetable garden, learning as you go.

3. Quality time with pets and animals.

4. Learning about new food types and experimenting with new recipes on your own or with your family.

5. Enjoying a drawn out meal in a pleasant setting, such as outside, or with a certain theme such as Italian.

6. Creating a calm environment with good music.

7. Reading a relaxing and good book or magazine.

8. Enjoying a favourite hobby such as birdwatching, fishing, swimming or learning about sailing.

9. Learning a new skill such as salsa, ballroom dancing or yoga (with the help of online experts or old movies).

10. Watching relaxing movies.

Balance and boundaries are important to maintain a calm mental state.

It is important to stay up to date with current governmental advice regarding health and travel, however, it is essential that you arrange regular ‘time outs’ where you only focus on positive and relaxing themes.

#covid19 #coronavirus #Health #calm #anxiety #stress #risk #immunesystem #prognosis #simple #strategies #timeouts #positive #animals #nature #balance #boundaries

Protecting high and low risk groups equally is essential.

We cannot cause harm to one group to protect another group.  Please consider recent statistics published relating to lockdown and increased risk and harm in the context of the general public and vulnerable children (WHO, Unicef, NSPCC, Children’s Commissioner’s report England, NCMEC, MIND, Samaritans, Young Minds and Oxfam).  

High risk individuals in the context of covid-19 (due to eg age, compromised immune systems or underlying medical problems), require different protocols to facilitate equal protection.

It is essential to protect high risk and low risk groups equally and ensure that both groups have access to risk reducing and protective tools and initiatives from a bio-psycho-social context.  Normalcy and liberty are important and evidence-based protective factors for both groups.  Different risk groups can be provided equal protection, but this cannot occur by applying uniform, indiscriminate or ‘blanket’ measures to the general public. 

Doctors have been protecting high and low risk groups equally in many contexts and medical domains for several decades in Health.  

Significant fear, stress, chronic anxiety, negativity and hostility have been reported in the context of debates relating to covid-19.  Most medical doctors would agree that these markedly increased chronic anxiety and panic are likely to lead to significant harm and increased clinical morbidity. 

Initiatives, approaches and debates to protect the public, especially when associated with increased chronic anxiety or in the context of deprivation of liberty, must be considered, weighed and reviewed regularly to prevent harm.

Further to recent liaison with a contact in Asia, we were informed that their approach has remained more or less consistent since January; the public has been educated and asked to be responsible and take steps to protect health for self and others (respecting normalcy, liberty and autonomy), strategies did not include threats or mandatory stay at home, curfews or lockdown initiatives, and a sense of calm and camaraderie continued.  Statistics, research, medical training and experience support this approach.   

#covid19 #calm #protect #children #protectivefactors #FirstDoNoHarm

Transparency is essential during medical and mental health crises.

Transparency is required regarding initiatives and information relating to COVID-19.  The high and ongoing anxiety, panic, hostility and conflict reported within the public in many countries, regarding different debate topics relating to COVID-19, will likely not contribute to reduced risk, it will likely contribute to increased immediate and long term risk and harm; as is supported by longstanding well established evidence-based research. 

The public has to be informed of relevant statistics to reduce panic and chronic anxiety.  Dr Michael Ryan, Executive Director, WHO Health Emergencies Programmes, stated on 5 October 2020, that “our current best estimates tell us about 10% of the global population may have been infected by this virus”.  The WHO reports a global population of 7.6 billion, therefore more or less 760 million have been infected, with 1 034 837 deaths at the time and an infection mortality rate of more or less 0.136%.  These figures have to be published widely and explained in a clinically relevant context to reduce anxiety for the general public. 

Hawaii’s government circulated a fast facts sheet to the public stating that illness due to COVID-19 is usually mild, especially for healthy children and young adults, and that most people recover from COVID-19 without needing special treatment.  We observed that this initiative contributed to significant calm within Hawaii. 

It is essential for good clinical outcomes that individuals believe that it is possible and probable to remain healthy or recover without complications if they follow medical advice, which, considering evidence-based research, has to include risk reducing behaviours (eg washing hands before touching the face) and protective factors for the immune system, general and mental health (eg relating to advocating calm, normalcy, liberty and autonomy to make informed and educated decisions regarding own health).  

Clinical outcome is often affected most by simple measures to prevent harm and to protect.  Simple protective measures cannot be neglected in initiatives to safeguard the public.  

Decisions in the context of the pandemic will have consequences for years to come in many communities and countries, therefore transparency, diligence, clinical responsibility (considering that this is a clinical crisis) and accountability are required.

https://www.bmj.com/content/371/bmj.m4425

#BritishMedicalJournal #BMJ #FirstDoNoHarm #covid19 #transparency

Global Health Plan

Global health plan:

A global health crisis requires a global health plan; a systemic, evidence-based, consistent approach is required with a focus on risk management in the context of respiratory infections (eg hand washing before touching the face or eating) and protective factors that support and strengthen the immune system and contribute to general and mental health (eg calm, normalcy, liberty and autonomy, giving individuals with capacity to make good decisions the responsibility and tools to act responsibly).  

Relevant evidence-based bio-psycho-social risk and protective factors have to be identified, considered and weighed during risk assessments and risk management plans by clinicians with clinical experience in complex and high risk contexts.  Every country is different and biological, psychological, cultural and social contexts vary vastly within many countries.  Culture and social environment must be considered.  Photographs available on our social media links illustrate various living quarters for children; many individuals live 10 per room, do not have plumbing, clean water and do not eat if they do not leave home.  The latter is true for many families in nearly every country including the UK (please see recent reports by The Trussell Trust) and the USA.  Living arrangements and lifestyles are of course different in Hong Kong and Korea or Canada and New Zealand or London, Leicester (in lockdown until recently) and Wales.  

We have to consider the clinical and social outcomes of initiatives put in place to protect the public in every country and context.  

General health, mental health and social risk outcomes secondary to this pandemic and secondary to relevant initiatives put in place to protect in one country, will affect all countries; a global and systemic approach is therefore important.  Consider the relevance of childhood immunisations or vaccines, for example.  Equal, considered and consistent protection in communities and countries should be a treatment goal. 

It is essential that a global health plan prevents harm, protects and is simple, generalisable and evidence-based, not indiscriminate, prescriptive, dictatorial or micro-managing, but rather providing all responsible adults with tools (such as information and education) to make good decisions for themselves, their families and communities in every bio-psycho-social context.  This is the clinically safest approach, considering a systemic and evidence-based view, and is congruent with relevant laws and ethics relating to health, liberty and children. 

Give people the tools, including information and education, and let every adult make responsible decisions for self and others.  This approach has good clinical outcomes in many or most medical fields in all cultural contexts.  Deprivation of liberty has devastating immediate and long term consequences for the immune system, general health and mental health for the general public, as per evidence-based research.   

Let’s work together to protect the most vulnerable in every age group.

#covid19 #lockdown #GlobalHealthPlan #culture #mentalhealth #children #social

A systemic approach is key to affect positive change in most medical domains.

Leadership observed in many countries in Asia during our travels was inspiring; we observed no delays, debates, uncertainty or chaos, we mainly observed clarity, consistency and congruency amongst the public, governmental officials and health professionals.  Messages within recommendations were evidence-based, brief, clear, informative, consistent, helpful to the public and instilled calm.  Governmental officials and health staff appeared clear regarding protocols and policies, and appeared to follow policies diligently; the public appeared to follow their lead.  The public did not present as confused or anxious, but as positive and confident regarding next steps.  The public appeared educated regarding risk and appeared to trust health professionals and government officials, who led by example.  We observed a sense of camaraderie and working together within the public, government and health systems.  These strategies contribute to good clinical outcomes, as per evidence-based research. 

We observed no Police or Military involvement or threats in the context of the pandemic during our travels in Asia. The public was educated in terms of risk and protective factors, and asked to make responsible decisions for themselves and their community. We observed no restriction, severe or otherwise, associated with deprivation of liberty or threat in general towards the public; this, from what we observed, contributed significantly to calm within the community.  Calm, lack of stress or lack of chronic anxiety supports and strengthens the immune system, and contributes to improved general health; resistance to infections, decreased complications, improved recovery times and prognosis, which is supported by longstanding well established evidence-based research.  

Most doctors would agree that ‘forcing’ an adult to do anything, in any context or health discipline, is very seldom, if ever, effective.  A systemic approach is essential.  Quality of communication is key.  Language used is key.  Consider Newton’s third law; a force in one direction promotes a force in the opposite direction of equal strength.  This is relevant in all cultural contexts.  As one doctor reflected “forcing anyone to do anything has never worked if you consider world history, it only serves to create chaos and disaster.”  Most doctors would agree that neglecting a systemic approach, by ‘putting an individual in a corner’, where there is no choice, is a sure measure to increase risk significantly; social, psychological and biological risk.  It is an approach that is seldom effective and often leads to significantly increased risk and harm.  Exceptions do exist, although clear evidence-based clinical indications or legal reasons are required and laws such as the Mental Health Act protect individuals in this context. 

The general systemic approach, quality of communication and language used in much of Asia, as observed, inspired calm, a positive environment and hope within the public, which affect clinical outcome significantly, as per evidence-based research.  These are significant protective factors for general and mental health, and initiatives that protect, support and strengthen the immune system significantly and in more than one way.  These are also evidence-based initiatives for crisis, risk or emergency management in Medicine and Health.  Current statistics also support this approach in these nations.

Let’s work together to protect our most vulnerable. A consistent, evidence-based, systemic approach is essential to achieve good clinical outcomes.

Thank you to the leaders of nations and international organisations who have raised concerns regarding systemic risk and protective factors for children and communities. You are shaping our tomorrow for our children.

#calm #lockdown #leadership #covid19 #systemic #WorldHealthOrganization #risk #ThankYou #education #camaraderie #recovery #complications #prognosis #communication #messaging #evidence #Newton #culture #doctors #laws #language #ImmuneSystem #children #communities #future #ChildProtection

 

A global health crisis requires a global health plan.

A global health crisis requires a global health plan; a consistent, evidence-based and systemic approach with a focus on risk factors and protective factors that support the immune system, general health and mental health, eg calm, normalcy, liberty and autonomy.

It is essential that medical professionals with appropriate and different clinical training, clinical experience and cultural as well as educational backgrounds work together and share expertise to agree on a global health plan without delay. A global health crisis requires a global health approach.

It is essential for a good clinical outcome that clinical recommendations or initiatives include evidence-based protective factors, which include protecting, supporting and strengthening the immune system through initiatives relating to normalcy, liberty, autonomy and avoiding chronic anxiety and high levels of stress.  

First do no harm is an essential focus for good clinical outcomes; this will ensure protection, improved prognosis and decisions in accordance with ethics and human rights laws.  Ensure that all recommendations adhere to this principle.

It is essential that one person or party (with one person responsible) takes the clinical lead and the clinical responsibility in medical crises, this avoids debates and delays.  There is little place in a health crisis for debates or delays, politics or negative emotions; clinical training, experience and research support this approach.  Medical emergencies should be clinically led by a clinician with training in emergency management; with appropriate experience to consider systemic risks and protective factors in high risk and complex contexts and to finalise or amend systemic risk management or action plans without delays.  Medical emergencies require a focus on clinical presentations and relevant systemic bio-psycho-social risk and protective factors, which must be weighed and balanced throughout emergency management by doctors with relevant clinical experience.  

Clinical experience refers to medically trained doctors and specialists who have extensive experience in clinical assessment and treatment, through direct face to face contact with patients, in various high risk and complex settings, including emergencies, ideally in more than one medical domain.  

Leaders with clinical training and clinical experience are essential for good clinical outcomes during clinical assessments, treatment and emergencies. 

Let’s work together to protect our children and communities.

#covid19 #GlobalHealthPlan #ImmuneSystem #Together #evidence #risk #protect #children #communities #doctors #calm, #normalcy, #liberty and #autonomy #outcomes

First Do No Harm

First Do No Harm

“Lockdowns have just one consequence that you must never ever belittle, and that is making poor people an awful lot poorer.”  Dr David Nabarro, World Health Organisation 

“This war, and I think it is reasonable to call it a war, against this virus, which is going to go on for the foreseeable future, is not going to be won by creating tougher and tougher riles that attempt to control people’s behaviour. The only way that we will come out ahead of this virus is if we are all able to do the right thing in the right place at the right time, because we choose to do it.” Dr David Nabarro, World Health Organisation

The UN reports “we are just beginning to fully understand the damage done to children because of their increased exposure to violence during pandemic lockdowns, said Henrietta Fore, UNICEF Executive Director.”

UNICEF, October 2020, reports “Lockdowns and shelter in place measures come with a heightened risk of children witnessing or suffering violence and abuse and can also expose children to new protection risks. When it comes to violence, a number of factors related to confinement measures are likely to result in increased risk for children including heightened tensions in the household, added stressors placed on caregivers, economic uncertainty, job loss or disruption to livelihoods, and social isolation. Children may also increasingly witness intimate partner violence.”

Statistics during lockdown:

Oxfam identified that border closures, curfews and travel restrictions had caused breaks in the food supply that threatened to cause 12 000 deaths a day worldwide, exceeding the 10 000 deaths a day recorded from COVID-19 in April 2020. 

The Trussell Trust, Stop UK Hunger, reported an 89% increase in need for emergency food parcels in April 2020 compared to the same month last year.  At the end of April, 350 000 children were living in a household where someone had been forced to skip a meal in the last week and 249 000 were in families that accessed food-banks.  Only 47% of children who would usually be receiving Free School Meal scheme food were provided either meals or vouchers.

Young Minds, Survey, Summer 2020, reports “80% of respondents agreed that the corona virus pandemic had made their mental health worse; 41% said it had made their mental health ‘much worse’, up from 32% in the previous survey in March. This was often related to increased feelings of anxiety, isolation, a loss of coping mechanisms or a loss of motivation.  87% of respondents agreed that they had felt lonely or isolated during the lockdown period, even though 71% had been able to stay in touch with friends.  31% said they were no longer able to access support but still needed it.  Of those who had not been accessing support immediately before the crisis, 40% said that they had not looked for support but were struggling with their mental health.  11% of respondents said that their mental health had improved during the crisis, an increase from 6% in the previous survey. This was often because they felt it was beneficial to be away from the pressures of their normal life (e.g. bullying or academic pressure at school).” 

MIND, June 2020, reports “Two thirds (65%) of adults and three quarters (75%) of young people with experience of mental health problems said their mental health has gotten worse during lockdown.  Over half of adults (51%) and young people (55%) without experience of mental health problems also said their mental health has got worse during this period.  Young people are more than twice as likely as adults to have used self-harm as a coping strategy (28% of young people vs 11% of adults).  Nearly a third (30%) of under-18s self-harmed to cope, with this rising to over a third (36%) of 16 and 17 year olds.  One in three young people (33%) with experience of mental health problems self-harmed to cope during lockdown.”

Samaritans report “In a survey of over 70,000 adults in the UK just over 1 in 10 reported experiencing suicidal thoughts or thoughts of hurting themselves during the first week of lockdown.  2% reported to have self-harmed or attempted suicide during the first week of lockdown.”

The National Child Mortality Database (NCMD), England, July 2020, reports “In 2020, during the 82 days before lockdown, there were 26 likely child suicides and a further 25 in the first 56 days of lockdown, and the proportion of cases under 15 years of age appeared higher, but these differences did not reach statistical significance.  In 12 (48%) of the 25 post-lockdown deaths, factors related to COVID-19 or lockdown were thought to have contributed to the deaths.”  

MIND, June 2020, reports “A third (32%) of adults and over a quarter (28%) of young people did not seek mental health support during lockdown as they did not think that their issue was serious enough.  More than 1 in 6 (18%) of adults and a quarter (25%) of young people tried to seek help during lockdown, and 1 in 4 (24%) of adults and more than 1 in 4 (28%) of young people were then not able to access the mental health support that they sought.  6% of adults and 9% of young people did not seek mental health support as they were not sure how to do so. This rises slightly to 10% of 18–24 year olds, making them almost twice as likely as over-25s to not have accessed support because they did not know how to.”

Research and analysis, UK GOV, 15 October 2020:  “Of those reporting that they had a worsening health condition during the week leading up to 10 August, around 50% reported that they have not sought advice for their condition.  The most common reason for not doing so was to avoid putting pressure on the NHS.”

 Statistics illustrating significantly increased figures relating to at risk behaviour and child abuse (please know child abuse statistics are likely much higher than reported due to various factors):

Calls to the National Domestic Abuse Helpline increased by 80% in June 2020, while the number of people seeking help from Alcohol Change UK for problem drinking increased nearly 400% from 4089 between 23 March and 30 April last year to 20 067 in the same period this year. 

NSPCC:  Child abuse statistics pre-lockdown 30-day average, 6 Jan-22 March 2020 = 1 325, compared to lockdown 30-day average, 1-31 May 2020 = 1 730 (30% overall increase) 

Physical abuse = 420 vs 559  (33% increase) 

Emotional abuse = 303 vs 500  (65% increase)

Neglect = 30 vs 44  (46% increase)

Sexual abuse = 572 vs 627  (9.6% increase) 

The NSPCC helpline reports a 60% increase in contacts from people with concerns regarding children experiencing online sexual abuse.

Childline reports an 11% increase in the number of counselling sessions regarding online sexual abuse since the stay-at-home guidance was issued.

Between January and June 2020, the US National Center for Missing and Exploited Children (NCMEC) received 12.1 million reports of suspected child sexual exploitation, an increase of 90% from 6.3 million reports during the same time period a year earlier.  

The Internet Watch Foundation and its partners blocked at least 8.8 million attempts by UK internet users to access videos and images of child sexual abuse during lockdown.

Baseline statistics for child abuse before the pandemic (please know child abuse statistics are likely much higher than reported due to various factors): 

Globally, it is estimated that up to 1 billion children aged 2–17 years, have experienced physical, sexual, or emotional violence or neglect in the past year.  WHO

1 in 2 children aged 2-17 years suffered violence in the past year, 12% of children were physically abused in the past year.  WHO

Nearly 3 in 4 children or 300 million children aged 2–4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers.  WHO

Every year, there are an estimated 40 150 homicide deaths in children under 18 years of age, some of which are likely due to child maltreatment.  WHO

Figures relating to the UK:

The WHO reports before the pandemic 2.2 million children in England alone lived with domestic abuse, parental drug or alcohol dependency and/or severe parental mental illness.  Just over 100 000 children in England lived in a household where all three issues were present.  Estimates by CCO show that 379 000 under-fives live with parents suffering from severe mental ill health, and 145 000 are living with parents suffering drug and alcohol problems.  It is estimated that 235 000 under-fives live in houses where domestic violence has taken place in the last year.  

As previously stated, and reported by England’s Children’s Commissioner, risk to children has increased 80-400% during lockdown in this context.  

In the last five years there was an average of 62 child deaths a year by assault or undetermined intent in the UK.  On average, at least one child is killed per week in the UK.  Children under the age of one are the most likely age group to be killed by another person, followed by 16- to 24-year-olds.  Child homicides are most commonly caused by the child’s parent or step-parent; whilst adolescent homicides are most commonly caused by a stranger, friend or acquaintance.  Official measures are likely to be underestimated. NSPCC 

New figures obtained reveal that police recorded more than 200 child sex offences, on average, every day last year.  There were 73,518 recorded offences including rape, online grooming and sexual assault against children in the UK in 2019/20, up 57% in the 5 years since 2014/15. Where gender and age were recorded girls were 4 times as likely to be victims, there were more than 8,000 offences committed against 14-year-olds, making it the most common age group to report offences, there were 12,374 sex crimes recorded against children under 10, and 449 offences were recorded against babies yet to reach their first birthday.  NSPCC, 10 August 2020, England.  

As previously stated, and reported by the NSPCC, child abuse figures in the UK have increased by 30-65% during lockdown in recent reports (90%, as reported by NCMEC).  

Child abuse statistics are likely much higher than reported due to various factors. 

These statistics were unacceptable before the pandemic and lockdown, especially in a world where emphasis is placed on safeguarding a future or a suitable environment or climate for the future.  Many would agree that children are our future, and considering child abuse statistics in every country, including the UK, this might be the most appropriate place to start to aim to ensure a future.

Let us work together to protect our most vulnerable in all age groups. 

#lockdown #covid19 #childabuse #FirstDoNoHarm #schoolmeals #mentalhealth #anxiety #suicide #depression #curfews #deaths #children #future #planet #world #safeguarding #priority #ChildProtection

The Immune System is a system designed to protect the body against risks such as infections including this virus; the immune system learns, adapts and develops, much like some viruses

The immune system is one of the most complex systems in the body and most doctors will agree that this system is not well understood by most, however, it is a system designed to protect the body against risks such as infections including this virus; the immune system learns, adapts and develops, much like some viruses.  

Immunity, considering a biological context, refers to resistance to pathogens and external agents, such as infections.  Tissue (eg spleen, liver, lungs, intestines, bone marrow, lymph nodes, blood and skin), cells (eg lymphocytes) and molecules (eg antibodies) mediate reactions and constitute an immune system.  The coordinated response of these cells and molecules to pathogens and other substances comprises the immune response.

The immune system or response significantly affects susceptibility or resistance to infections and subsequent prognosis in terms of morbidity (degree of illness, associated complications, recovery times and outcome) and mortality, as most medical doctors would agree.

We are concerned that this important system is not considered in the risk management plans or any of the ongoing debates during this health crisis.  We are not referring to herd immunity in any way or immunity in the context of vaccines; we are referring to the immune system in every human’s body that is designed for protection against external agents such as this virus.  

The protective role of the immune system extends to important functions such as relating to recovery, tissue generation, scarring and a defence against tumours, however, the main physiological function is to be a defence against, to prevent or eradicate, infections.  It is therefore essential that the immune system of every person is healthy, supported and protected, particularly in this context of the pandemic.  Initiatives that negatively impact on the immune system, by eg causing stress or chronic anxiety, will therefore likely cause significant immediate and long term harm, as per evidence-based research.  

The immune system is therefore directly related to clinical outcome for every member of the public in the context of the pandemic.  

Initiatives to support the immune system, for low and high risk individuals within the public, are usually simple, although it affects clinical outcome significantly, as most medical doctors would agree.  Many countries in Asia focused on these initiatives, particularly relating to normalcy, liberty and autonomy, as observed firsthand, with good clinical outcomes.  

 Our work with an immunologist on paediatric and neurology wards inspired us to remember the reciprocal interaction between the immune system, the brain and the body; it is one of the most effective tools we have to protect against biological risks and disease.  Most doctors will agree that the brain and body are given powerful messages by context, physical surroundings, social environment, behaviour, thoughts and feelings, and this affects general health and mental health significantly.

Simple protective initiatives often have a significant impact on clinical general health and mental health outcome for high and low risk children and communities.

#immunesystem #covid19 #resistance #prognosis #outcome #recovery #complications #mortality #protective #FirstDoNoHarm #anxiety #normalcy #liberty #autonomy #mentalhealth #health #medicaldoctor #anxiety #calm

Normalcy

Normalcy is a very significant protective factor for mental health and general health, and is often advised and emphasised by medical doctors as part of treatment programmes for children and adults with general medical and/or mental health problems.

We observed in countries in Asia that the public was advised to regularly leave their homes, engage safely within the community with general evidence-based initiatives to protect against respiratory infections (eg wash hands before a meal) and support the immune system (eg maintain a calm and positive mental state and environment, positive in person engagement with loved ones and peers, regular engagement in normative activities, relaxation in fresh air with nature and/or animals, regular exercise, sufficient sleep, adequate hydration and healthy food options such as fresh fruit and vegetables).  These recommendations were advised on large TV screens on a near constant basis within the public; one example was of a grandfather teaching his children how to fish and prepare meals with fresh vegetables, the way he was taught as a child.

Normative activities include engagement in positive face to face social interaction within the community with loved ones, supportive seniors and peers with similar interests, engagement in challenging, enjoyable, meaningful and relaxing activities and hobbies, along with learning and achieving goals, which improve or maintain confidence.  

These normative activities fall under protective factors and contribute significantly to a healthy immune system, general health and mental health for children and adults, along with social, language, emotional, cognitive and physical development, and general well-being in children and young people, preventing impairment and distress for the general public.  We consistently emphasise the importance of these protective factors in all clinical domains with good clinical outcomes.  Treatment resistant cases referred to as ‘hopeless’ are often referred to us, and we almost always attribute positive outcomes to an emphasis on protective factors including normative activities.  Many high risk children associate positive outcomes with “to be busy and to belong” (physical and mental health assessment of 93 unaccompanied minors in #Liverpool in 2005). 

 Normalcy requires a context of liberty and autonomy to maintain a protective function for most adults and young people.  Normalcy, liberty and autonomy were advocated throughout Asia during our travels, as observed firsthand; the public was educated well regarding risk and protective factors, and then asked to make responsible decisions to protect self and others. 

#childpsychiatrist #medicaldoctor #learning #mentalhealth #development #normalcy #normativeactivities #protection #health #interaction #confidence #liberty #autonomy #GlobalHealthPlan #Systemic #covid19 #coronavirus #Health #FirstDoNoHarm #immunesystem #childdevelopment #unaccompaniedminors