HOW DOES COVID-19 PRESENT?
Common cold - Colds come on gradually and the most common symptoms are a stuffy nose, sore throat and sneezing. They sometimes also include a cough and fatigue. Fever and headaches are rare.
Seasonal Flu - Symptoms of the flu are abrupt and can include fever or feeling chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, according to Public Health England. Some people may also have vomiting or diarrhoea, though this is more common in children.
COVID-19 - The three hallmark symptoms to keep an eye out for are fever, dry cough,and/or shortness of breath. More recent studies have indicated that at the early stages of the infection, some people experience loss of appetite or sense of smell and diarrhoea. Most patients have a mild or moderate illness, but be very aware of the small possibility of a second phase of illness, needing treatment.
WHAT TO DO IF YOU FEEL SICK
We encourage anyone with signs of a respiratory infection or COVID-19 (fever, dry cough, and/or shortness of breath) to contact Dr Shilpa for guidance through a video consultation or by phone. If you have these symptoms, however mild, stay at home and do not leave your house for 7 days from when your symptoms started (if you live alone), or 14 days (if you live with someone who has symptoms). You do not need to call NHS 111 to go into self-isolation
If your symptoms worsen during home isolation or are no better after 7 days, contact NHS 111 online. If you have no internet access, you should call NHS 111. For a medical emergency dial 999.
The largest study of COVID-19 to date showed that case fatality rate increases with age. Children rarely experience the severe effects of the disease. The two conditions that seem to feature in early analysis are diabetes and hypertension (high blood pressure) so if you have either or both of these you should be taking steps to optimise your health. It is also a fact that our T-cells (a part of our adaptive immune system) function decreases which increases our risk of becoming ill.
Full information - Risk Factors for severe disease and death British Medical Journal March 2020
Immunocompromised means the inability to normally respond to environmental exposures including viruses or bacteria due to a weakened immune system. People who are immunocompromised include those with diabetes, heart disease, hepatitis B, chronic kidney disease, malnutrition, and cancer because those conditions lessen one’s ability to mount an adequate immune response.
Adults with pre-existing conditions like heart disease, diabetes or chronic lung conditions such as asthma, emphysema or COPD have a greater risk of being affected by any virus, including COVID-19 because of decreased ability to fight off infections due to a less robust immune response. In China, COVID-19 patients with heart disease had a 10% case fatality rate, while those with diabetes had around a 7% case fatality rate.
Adults who smoke are at an increased risk for more severe upper respiratory infections overall. Whilst early studies of the novel coronavirus are not conclusive, experts believe one of the reasons that men in China died more often than women from coronavirus was because of increased smoking rates.
Vitamin D Deficiency
THE EFFECTS OF THE LOCKDOWN
Assuming you have a good supply of toilet roll, one of the key aspects of keeping healthy is maintaining social distancing: it sounds simple but it has far-reaching implications. These are some of my patients' experiences of the lockdown in the UK (and most are also mine):
- Isolation and loss of sense of time
- Fear of finances falling off a cliff
- Health anxiety
- Fear that trivial symptoms might be cancer
- Fear of transmitting the virus to elderly relatives
- Fear of not getting food deliveries
- Managing children at home with lack of focus or exams cancelled
- Lack of energy or impetus to complete any tasks
- Putting on weight
- Difficulty in working from home
- Oblivious to the crisis
- Anxious about parental anxiety
- Anxious about society or global issues such as climate change
- Anxious about their future and school term ahead
- Behaviour issues
- Sleep issues
- Snacking and sugar cravings
Helping children and young people to cope:
- Listen and acknowledge
- Provide clear information
- Be honest
- Be aware of your own reactions
- Connect regularly
- Create a new routine
- Be active
- Sleep is really important
- Limit exposure to media and coverage
KEEPING YOURSELF HEALTHY AT HOME
Eating healthy can be stressful right now—your usual restaurants or favorite to-go spots may be closed, you may not be able to find some of your go-to products, and you may even be grocery shopping more than you normally do. Aim to do your best with what you have and allow yourself flexibility in your plan, but keep in mind that nourishing your body with whole foods as much as you can will support a healthy immune system. These are some of our tried and true strategies.
Cut alcohol and refined sugar - While cooped up at home, it can often feel easiest to manage stress by pouring yourself a glass of wine or reaching for a sweet treat. However, the reality is that both refined sugar and alcohol can weaken the body's ability to respond to stress, act as anxiety triggers, and suppress the immune system. Instead of letting your vices get the best of you, shift your mindset toward incorporating foods and beverages that will actually make you feel a greater sense of calm and leave your body in the best place to fight both anxiety and infection. Swap out refined sugar from processed products with whole fruit and starchy vegetables. Replace alcohol with a seltzer and a citrus wedge, a calming chamomile tea, or a kombucha spritzer (try out just half the bottle of a low sugar variety with sparkling water and ice)—you can even put it in a wine glass if you’re feeling fancy.
Stay well-hydrated - Water makes up 75% of our body weight and is required for a number of bodily functions. Even as slight as a 2% or more body water deficiency can impact your cognitive ability. We also know that hydration plays a role in immune function - one study found that dehydration decreased antimicrobial proteins found in saliva that are one of the body’s first defenses against foreign pathogens. Being well hydrated also helps your blood to carry oxygen to cells and lymph to carry white blood cells and other immune cells throughout your body to fight disease. There’s no one-size-fits-all formula for how much water to drink per day, but The Food and Nutrition Board suggests a minimum of 2.7 litres for women and 3.7 litres for men. The exact amount of water you need will vary based on your size, age, activity level, how much you sweat, and medication you take. This water can come from food and beverages combined. Foods with high water content include melons, lettuce, celery, cabbage, and squash.
Superfoods to keep you well - Our philosophy at Shilpa Davé Health is not to promote foods as immune boosting or as treatments of disease, but rather think of optimising your health and well-being, balance and energy by providing the right fuels for cell processes such as mitochondria (the engine room of a cell) and your gut. Here are some superfoods you might want to try. Online deliveries are hard to come by but there are many wholesale food suppliers and smaller companies who normally supply restaurants who are providing great produce. This is the time if possible to cook from scratch.
- Green & Black Tea - The immune-boosting effects of green and black tea are largely attributed to the presence of catechins, which boast impressive health and antioxidant benefits thanks to their polyphenol and flavanol content. Studies suggest epigallocatechin gallate (EGCG), a compound found in tea, offers potentially protective effects against from certain bacterias. As a hydrating, low-calorie beverage, green and black tea can be enjoyed daily, but be mindful of caffeine content—one cup of black tea can contain up to 47 mg of caffeine, so limit consumption if you are particularly sensitive or suffer from a health condition that requires you to limit caffeine intake.
- Avocado - Creamy, fibre-rich avocados also happen to be packed with an impressive amount of glutathione, a compound part of the immune system pathways. Glutathione provides cells with powerful protection against oxidative damage, and half of an avocado offers about 19 mg, making it an incredibly potent source of this molecular powerhouse. In addition to antioxidants, avocados are also an excellent source of potassium, lutein, and vitamins E, C, K, and B6.
- Curcumin - Recognisable for its striking yellow-orange colour, curcumin is a polyphenol extracted from the turmeric root. Research has shown it can have anti-inflammatory effects by inducing the expression and production of interleukin-10, an anti-inflammatory and immunosuppressive chemical. Although turmeric has a low bioavailability on its own - meaning it has a limited ability to be absorbed and utilized in the body - when combined with an active compound found in black pepper, its bioavailability is substantially increased.
- Cruciferous Vegetables - Cruciferous veggies, including broccoli, cauliflower, bok choy, cabbage and Brussels sprouts provide an important source of vitamins and fibre to our diet.
- Almonds - Almonds are usually praised as a nutritionally satisfying snack that may also contribute to weight loss and maintenance but they may also have immune-supportive properties thanks to their abundant vitamin E. Like glutathione, vitamin E is an antioxidant that works in the body by minimising the damaging effect of free radicals. A one ounce serving of almonds provides 35% of your daily recommended of vitamin E.
- Mushrooms - Mushrooms are high in antioxidants and phytonutrients which means that many of them play a function in protecting the body against oxidative stress. While you may be more familiar with the culinary usage of certain mushrooms, like antioxidant-packed Shiitakes, most medicinal mushrooms are intended to be consumed in dried powder form. You can add this powder to a smoothie or bone broth for a powerful immunity-charging beverage.
- Salmon - Thanks to an abundance of essential omega-3 fatty acids and B vitamins, salmon is an almost unbeatable protein source when it comes to health benefits. Omega-3 fatty acids are are an essential dietary fat that are associated with lowering blood pressure, inflammation, and reduced cancer risk. Salmon’s high B vitamin and potassium content also provides benefits for cognitive function and stroke prevention, as well as reducing blood pressure.
It is also a great time to plant some seeds and get your own little vegetable patch underway, there are many online suppliers of seeds and plants still delivering plants and soil and tending to the garden can be very calming and good for your well-being, particularly if you have children who can get involved.
For ideas and inspiration visit www.montydon.com or Monty Don April tips and tricks
RELAXATION AND STRESS REDUCTION
The last thing you want to hear at the moment is to relax because the world is gripped with fear and uncertainty around the NHS capacity, the global economy and your family's immediate concerns. However this is probably the most important aspect of your health as it allows you to function and will allow you to return to travel, work and socialising when the lockdown ends - which it will.
Meditate Today - Just 10 minutes per day of mindfullness or meditation can both set a routine and set your mind free from the constant flow of intrusive thoughts (Useful Apps: Calm, Headspace, YouTube). Calm are offering free soothing meditations, sleep meditations and sleep stories during this difficult time - view the list.
Exercise and Movement - You cannot underestimate the well being benefits of exercise and using your hour per day of exercise is essential. If you don't want to go out or you have a young family, I strongly recommend Jo Wicks' daily PE class (The Body Coach, You Tube channel). Not only is it a great workout, it is funny and laughing is the best form of medicine. Yoga is my personal recommendation (Yoga Studio, Yoga with Adrienne).
Join a Choir - Gareth Malone's Great British Chorus
Visit a Museum online - British Museum; Guggenheim USA; National Gallery of Art Washington; Musee D'Orsay, Paris; National Museum of Modern and Contemporary Art, Seoul; Pergamon Museum Berlin; Rijksmuseum Amsterdam; Van Gogh Museum Amsterdam; Paul Getty Museum LA; Uffizi Gallery Florence; MASP Sao Paulo.
Watch a show online - Visit the What's on Stage website
SHOULD I TAKE SUPPLEMENTS?
Many websites suggest taking supplements to "boost" your immune system, In fact this concept has no scientific merit. The other main property that some supplements are sold as having are "anti-inflammatory". Again, there is little scientific merit in this claim.
Your immune system has 3 main parts to it:
- Barriers such as your skin, mucous membranes and airways
- The "innate" immune response which involves chemicals and cells which can rapidly raise the alert and begin to fight off any intruder.
- The "adapative" immune response. This is the really important one as it involves cells and proteins - antibodies - which take a few days or weeks to emerge. Importantly the adaptive immune response is what is triggered by vaccination.
Many of the symptoms of a cold for example are your body's response to the infection by the innate immune system, not the effects of the virus itself, so "boosting" your immune system would make these symptoms worse.
Inflammation is the sign of a healthy immune response and you would not want this to be over-activated either; it is chronic inflammation that can be damaging, and that is where your gut health can be really important.
There is little evidence to support vitmain C, antioxidants and supplementation of other nutrients in helping prevent or manage COVID-19 with the exception of vitamin D.
VITAMIN D AND COVID-19
Vitamin D deficiency is particularly relevant at the moment as scientists are investigating whether it could be linked to a worse outcome with COVID-19 infection. There is good reason for this as there is good evidence that vitamin D deficiency can be linked to higher rates of upper respiratory tract infections.(1)
Publications are starting to appear discussing the real possibility that vitamin D supplementation could reduce the risk of COVID-19 infections and deaths (2,3). As with most COVID-19 research data, it is too soon to drawn firm conclusions, but there have been data published correlating the highest incidence of cases and more importantly mortality with areas with the highest rates of vitamin D deficiency (Italy and Switzerland). We are starting to see some patterns with patients of ethnic minorities being more severely affected by COVID-19 and research is underway to see if these observations are real. Most of these early communications are not peer reviewed and should be interpreted with caution, but there is no better time to be taking a vitamin D supplement, particularly if you are of Asian, Indian or African origin.
I hope you have found this booklet useful. Please get in touch with any concerns or worries via firstname.lastname@example.org
You can book online 7 days a week at our website www.privategp.org
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We offer Video consultations, Remote Prescribing and Fingerprick Blood testing, Lifestyle Medicine and all aspects of Family General Practice. We will hope to soon be back at base in Kirby Chemist, Teddington High Street, London.
Until then stay safe and keep in touch
Dr Shilpa April 2020
Dr Shilpa Dave - Director Shilpa Dave Health