Yes, the COVID-19 vaccine is here. And there's only one holiday left before 2020 finally comes to an end.

But mental health experts say it's normal to feel stressed out right now. And there are many things that people can do, short- and long-term, to address how they're feeling and make a change.

There's evidence that mental health is worsening during the pandemic, especially in the most vulnerable populations — younger adults, isolated seniors, members of Black and Hispanic communities, and care providers, whether paid or unpaid. But anyone can be vulnerable.

A survey of more than 5,400 U.S. adults published in August by the Centers for Disease Control and Prevention found "markedly elevated" self-reported symptoms of depression and anxiety in the United States at 31%.

Suicidal thoughts in the prior month affected 11% of respondents and 26% of adults 25 or younger. In addition, 31% of adults providing unpaid care to other adults, such as in multigenerational households, reported suicidal thinking.

Dr. Ken Duckworth, chief medical officer at Virginia-based National Alliance on Mental Illness (NAMI), said the effects of widespread mental health issues of all kinds may become the "next wave" of the pandemic.

"We had a mental health crisis before the pandemic," Duckworth said. "And the pandemic has just accelerated uncertainty, economic distress. … Nobody knows when they are going to get [COVID], or if they are going to get it. Human beings don't like that kind of uncertainty. Some do struggle more than others."

A key trigger of prolonged grief is the lack of traditional funerals and wakes, mental health experts say. Thousands of funerals have been canceled or downsized in Minnesota since the start of the pandemic.

"That's just a really important ritual and many people have not been able to have that. And the grief process is going to take a lot longer," said Sue Abderholden, executive director at NAMI Minnesota.

Latest statistics

Minnesota crossed the grim threshold of 5,000 COVID-related deaths Thursday, 278 days after the first death in the state was attributed to the viral respiratory illness on March 21.

State officials reported 40 new deaths on Sunday, including 27 residents of long-term care or assisted living. All who died were over age 50.

More than 2,500 new cases of COVID were announced Sunday, bringing the state's total to more than 409,000. Sunday's statistics included new deaths and cases from Friday and Saturday.

The average number of deaths per day peaked at 67 in mid-December, and stands in the mid-40s today, still higher than in prior months.

Nationally, the U.S. has been averaging at least 2,400 deaths per day from COVID since Dec. 13. At least 18.7 million Americans have been infected.

Dealing with grim news

Mental health experts say it's OK to tune out the news at times for the sake of mental health — they do so in their own lives. But stress triggers abound in a year of a global pandemic, racial justice reckoning and economic devastation.

If added holiday stress is pushing problems to new levels, options exist to create short-term and more lasting change.

• Recognize signs of problems: Sustained profound sadness and big changes in sleep or appetite are important to watch, as are recurrence of substance abuse, loss of energy, a fast-beating heart, urges to cry, panic attacks and suicidal thoughts. Some reactions are normal, but major depression symptoms last at least two weeks.

"Is it a short-lived reaction or is it going on and on?" said Dr. Michael Trangle, psychiatrist and senior fellow with the HealthPartners Institute. "If you're having symptoms of whatever ilk, whether from depression, anxiety, and it feels like you are unable to function normally socially, in school or occupationally, then it's a problem."

• Telehealth appointments are available: Talk therapy can be well-suited to video or audio-only sessions, and a smartphone may allow more privacy than a home computer. An initial appointment will likely be a screening, potentially followed by a recommendation to start a course of therapy.

"Telehealth is available. Would I say it's pervasive? I think it's working to become pervasive," said Daniel H. Gillison Jr., CEO of NAMI.

• Exercise to release endorphins: Research suggests physical activity, including walking, has beneficial effects on depression symptoms. So get creative.

"We encourage families of kids to dance in the kitchen. Because you are moving, you are getting those endorphins going, playing happy music which can help you smile," Abderholden said.

• Connect with others: "Connection is a kind of antidepressant," Duckworth said. Phone calls and video chats are good, but it doesn't have to be with family — book clubs, Alcoholics Anonymous and grief support groups are all active online now. Don't be afraid to break the ice for someone else who might benefit from more connection.

• Use a helpline: Phone-based helplines include the National Suicide Prevention Lifeline, the Minnesota Warmline (651-288-0400) and the state Crisis Text Line (Text MN to 741741). The Minnesota Farmer and Rural Helpline is available at 1-833-600-2670 or by texting FARMSTRESS to 898211.

Many Minnesota counties have mental health crisis lines for emergencies. NAMI MN maintains a detailed list of resources at namimn.org.

Joe Carlson • 612-673-4779