Keeping healthy Amidst a Pandemic

Sri Lankans will have to continue to take precautions in the year 2021. 
Pic by Waruna Wanniarachchi 

• Delayed presentation can lead to life threatening complications
• It is best to be careful about what you eat and protect yourself, avoiding risky activities and hospital visits as well
• Risk factors for CVDs include Diabetes, hypertension, high cholesterol, smoking and a family history of heart disease
• Chronic diseases that are immunocompromising in nature, such as diabetes and arthritis are to be watched out for
• With the pandemic, people had more time to spend with their loved ones

The year that passed was a challenging one with a killer virus that took away millions of lives apart from those who fell victim to it and recovered later on. Even at this passing minute, many are in ICU wards, battling life and death. However, life has to go on amidst the pandemic and the best way to brave it is to be aware of your health more than before. 

With that, the Daily Mirror Health Capsule sheds light on a few key medical disciplines and what patients with respective illnesses should keep in mind during the new year. 

Staying safe with respiratory illnesses
 Though vaccines to prevent COVID-19 would roll out to most countries in the upcoming months, mitigating the pandemic is still very crucial. According to the Centre for Disease Control and Prevention (CDC), people with pre-existing respiratory problems are at an increased risk of contracting COVID-19. “Therefore, it is important that such people take the necessary precautions,” warned Dr. Chandimani Undugodage, Consultant Respiratory Physician and Senior Lecturer at Faculty of Medical Sciences, University of Sri Jayewardenepura.

 Therefore, for example, when adjusting the mask, hand hygiene should be practised.  “Also, they should ensure that the inner surface of the mask, which comes in contact with the nose and mouth, doesn’t get contaminated,” said Dr, Undugodage adding that it was advisable to have a box to keep the mask, when removed.  She also pointed out that masks with valves should not be used.  “What you are breathing, goes out from the valves unfiltered and this increases the risk of transmission of COVID- 19,” she revealed.  

Dr. Undugodage pointed out that if there is an exacerbation of symptoms (which can happen due to not taking the medication regularly or due to an infection), it is important to seek medical help immediately. “Delayed presentation can lead to life threatening complications,” she said, urging people to not fear visiting hospitals.

The risk of transmission to family members is high if patients who use CPAP machines and nebulizer devices at home are infected with COVID- 19, as these devices generate aerosols. Therefore, when symptoms exacerbate they should seek help immediately.

While it does sound scary that one is at a high risk of contracting COVID- 19, preventing and mitigating it is quite simple. All one has to do is to follow the basic health guidelines and doctor’s advice!

Be extra protective of your ‘ENT’ this year!
It is time to start the new year with a positive mind and a healthy body! Despite the COVID-19 pandemic which is still present, people are bound to celebrate the New Year, even in the smallest way possible. However, we must not forget to stay healthy and follow the rules of social distancing. Engaging in New Year festivities unprotected may burden your health and can also cause complications of the ears, nose and throat (ENT).

According to Dr. Chandra Jayasuriya, ENT Surgeon of the National Hospital, Colombo, ENT issues involve injuries/ infections to the ears, injuries to the nose and infections /foreign body obstruction in the throat.

People are prone to acquiring such complications during new year festivities, especially when they are around firecrackers.

“Firecrackers can cause noise injury because the ear is a sensitive organ. Extremely intense sounds can rupture the eardrum and also destroy the inner year,” Dr. Jayasuriya explained.

She further stated that attending careless ‘meet and greets’ these days can make you prone to getting infected by foreign bodies. Dr. Jayasuriya advised to be careful when consuming meat and fish as well and to be careful especially when feeding children.

“Also, leaving children unattended, giving them the opportunity to put various objects into the mouth can cause foreign bodies to enter the body, and even get into the airway and the lungs which is a life threatening condition,” she said.

Dr. Jayasuriya stated that when people get together during the festive season, most tend to get involved in fights which can cause nasal bone fractures or ear lacerations.

Unlike earlier times, patients are required to do a PCR test before a procedure nowadays and according to Dr. Jayasuriya it usually takes about two days to obtain the results; thus subjecting the procedure to delay.

Therefore, it is best to be careful about what you eat and protect yourself, avoiding risky activities and hospital visits as well.

Maintaining an optimal cardiovascular wellbeing 
Let’s all begin this year committing ourselves to the most important New Year’s resolution, being healthier. A key aspect of being healthier is maintaining an optimal cardiovascular wellbeing, especially as the COVID-19 global pandemic is now slowly reshaping the world.

Consultant Cardiologist Dr. Chandrike Ponnamperuma emphasised that the pandemic has created a high risk environment for all cardiovascular diseases (CVD). COVID-19 patients seem to be at a higher risk of facing cardiovascular complications. “In COVID-19 infected individuals, there is a certain tendency for the formation of blood clots and sometimes we have seen them presenting as heart attacks or strokes,” he explained.

According to Dr. Ponnamperuma, to reduce this risk, people should get their risk factors under control. Risk factors for CVDs include Diabetes, hypertension, high cholesterol, smoking and a family history of heart disease. Controlling these factors is very important as the current pandemic situation demands you to keep cardiovascular health risks as low as possible.

“Moreover, as people with CVDs are especially vulnerable, they should be extra cautious as to avoiding crowded places to minimise the risk of being exposed to COVID-19. They should take care to adhere to the health regulations proposed by the health authorities such as wearing masks and guidelines in relation to social distancing,” he commented.

In addition, if they experience any symptoms such as chest pain they should seek treatment promptly and should inform the authorities if they had any exposure to COVID-19. “People who are at a higher risk should get themselves screened for heart diseases without waiting for the symptoms to worsen,” Dr. Ponnamperuma said.

Closely watch chronic conditions 
Patients who are battling chronic diseases are vulnerable during pandemics and need to be ever vigilant of their lifestyles, signs and symptoms. Chronic diseases that are immunocompromising in nature, such as diabetes and arthritis are to be watched out for. While we hope 2021 restores normalcy and brings about better changes, it is important that we remain cautious.

 Diabetes
 General advice for diabetes patients during a pandemic, as given by Dr. Manilka Sumanatilleke, Consultant Endocrinologist: Continue taking your diabetes medication/Insulin as usual, as well as your cholesterol and blood pressure medicines including Enalapril, Losartan etc.
Moreover, recent studies have suggested, that being Vitamin D deficient is associated with poor outcomes following COVID-19 infection, especially in people with diabetes. Taking 2000 IU (International Units) of oral vitamin D daily on a regular basis, along with sun exposure will yield desirable results in terms of improving immunity against COVID-19 infection. Those who are diagnosed as vitamin D deficient would need higher doses to begin with, and should continue with the above-mentioned maintenance dose.

Proper glycemic control is a must. The standard of care includes maintaining HbA1c < 7%, blood pressure <130/80 mmHg, and control of cholesterol levels.

It must be kept in mind that diabetics are not at an increased risk of contracting the infection if they follow the general measures. If you have been diagnosed with the COVID-19 virus, do not panic; even amongst diabetic patients, only a few get complications.

Chronic Arthritis:
 Consultant Rheumatologist Dr. Himantha Athukorala advises patients with chronic arthritis to maximise COVID-specific precautions and adhere to social and physical distancing measures, as drugs that are prescribed for arthritis have the potential to affect immunity.

Most arthritis drugs are steroids or disease modifying drugs, which are both capable of suppressing the immunity of patients who consume these medicines long-term. Hence, a patient with chronic arthritis becomes more susceptible to infections by default. In patients with severe COVID infection, whose lungs have been inflamed, drugs such as Dexamethasone (steroid) and Biologics are used. Interestingly, both these drugs are rheumatology drugs, and are prescribed by specialists to combat lung damage.

When considering the numbers, most patients with arthritis are elderly patients, and as age is also a risk factor for COVID-19, elderly arthritic patients need to take extra care regarding their daily habits. Patients may continue with their routine medications.

No need to panic 
 With COVID-19, anxiety levels struck a new high with the unpredictable nature of the virus. “People get to read about it from various sources and sometimes they may not be credible,” opined Dr. Ramani Ratnaweera, Consultant Psychiatrist at Karapitiya Teaching Hospital. “There’s no need to harbour unnecessary fear because we now know that there’s a cure. Apart from that we know that if we take the necessary precautions that we could stay safe,” assured Dr. Ratnaweera. 

But she pointed out that those who contracted the illness had to face much stigma and that they were cornered from society. “With the pandemic, people had more time to spend with their loved ones. They started to communicate more, get more attached and subsequently strengthen relationships with people who are close to them. However it’s important to be vigilant about our children and their education since many of them don’t have the resources to study online. As a result they may feel anxious about their studies. Children who’re slow learners could be affected and the adults need to be more responsible in this case.” said Dr.Ratnaweera.

Revising guidelines and practical solutions paramount 
A brand new year, with revitalizing hopes amidst the inevitable chaos of COVID-19, is all what we are trying to bag-up in days to come, as we step-in to 2021.

In terms of facing both acute and chronic conditions related to nervous system which comprises brain, spinal cord and neurons, what matters the most is to to identify the exact pathology, accessible treatment modalities and prognosis in order to focus on a ‘reliable’ and ‘achievable’, optimal quality of life.

“Recently we came across many patients on whom, the socio-economical pressure created by the pandemic with restricted movements and drastic changes to life style have resulted in neuro-psychological issues like headache disorders and anxiety. Also it has created a significant impact on patients with chornic neurological conditions like stroke, dementia, parkinson’s disease and Alzheimer’s” said Dr Dilum Palliyeguruge, Consultant Neurologist, THK. 

“Disrupted accessibility to health care system all over the island has resulted in a delay in obtaining treatment especially in programmes like thrombolysis for strokes. 

“Revising the guidelines and finding practical solutions in terms of poor drug compliance due to restricted clinics, disruption of rehabilitation programs and compromised care-giving services should be addressed in the national level as the Covid out-break doesn’t seem to be carrying a green-light towards an end, any soon,” said Dr. Palliyeguruge. 
We wish our readers a safe and healthy 2021!

By Kamanthi Wickramasinghe, Ashani Gunasekara, 
Dr. Yashodhara Embogama, Muqadassa Wahid, Thisari Andria Walawege and Amritha Sridharan.