On Preventive Strategies

Care of High-Risk Individuals in COVID 19 Era, here are some important tips
On Preventive Strategies

It is a well-known finding from all the major studies on COVID-19 from several countries including India that the highest risk of mortality is in populations more than 60 years of age (3.6%) and is incremental with age.14.8% for population more than 80 years of age. This is basically not because of ageing but due to associated medical problems with increasing age. Patients with high blood pressure (6.5%), diabetes (8%) and previous cardiovascular diseases (like old heart attacks, previous bypass surgery or angioplasty, angina etc) 10.5%.

Is the Risk of getting infection higher in these patients?

Patients with these problems are not at a high risk ofgetting infected as compared to general population but if they get infected bythe virus the disease can take a more serious form. This is because of lowerimmunity related to more virulent viral entry into the cells. Lower viralclearance, diminished T cell function and more chances of severe inflammationleading to a Cytokine storm.

The key therefore is to be very vigilant. Maintain physicaldistancing, washing of hands with soap and water for more than 20 seconds,staying inside home as far as possible and use simple surgical or cloth masksif going out if necessary.

Preventive Steps for patients with high blood pressure:

To continue all the prescribed medicines including ACEinhibitors (Ramipril, Lisinopril, Enalapril etc) and ARB's (Telmisartan,Losartan, Olmesartan etc). All other classes of drugs for reducing the BP areequally safe.

To keep BP under control by measuring it regularly. Theusual recommended cut off as per our Indian guidelines is less than 140/90 mmsHg. Home BP measurement has been shown to be superior to an isolated BPrecording in a clinic or doctor's chamber. For this a calibrated and certifiedinstrument available with chemists or on line is the best. In case the BPreadings are concerning, it is good to communicate with your health careprovider. Self-treatment is not recommended except for minor adjustments.Mercury manometers for BP monitoring have been phased out internationally.Oscilloscopic instruments rather than the dial type of aneroid instruments arepreferred. They are easier to use and do not need a stethoscope etc.

The measures like regular physical activities need to continuefor at least 30 minutes a day. It can be in the form of walking on the terraceor in the room, treadmill or stationary bicycle. It should come to about 8000steps on your mobile or watch app. This also brings in a state of wellbeing.

Salt restriction, and eating low calorie diet with plenty offresh fruits and vegetables is important to prevent weight gain.

Care for a Diabetic Patient

Besides observing all the general precautions as forpatients with high BP, these individuals should control their diabetes wellunder supervision of their doctor. Blood sugar monitoring periodically by homedevices which all diabetics should have. The sugar levels should be maintainedbetween 70 to 180mgs, HbA1c below 7 %. Avoid hypo-glycemia.

Patients who get COVID +ve even without any symptoms likefever and cough need to get in touch with your doctor. Some drugs may have tobe stopped. In general metformin and sulfonyl-ureas (Glimiperide,glibenclamide, Gliclazide etc are reasonably safe. However drugs like DPP4inhibitors (gliptin group of drugs: linagliptin, sitagliptin etc ),Thiazolidinediones ( pioglitazone, rosiglitazone etc), GLPi analogues(Liraglutide etc) are avoided as far as possible because of the theoreticalpossibility of increasing viral loads. SGLT2 inhibitors (empagliflozin,dapagliflozin, canagliflozin) are reasonably safe unless there is high fever,vomiting etc. Insulin is very safe and all diabetics who need hospitalizationwith COVID are usually shifted to it. Any changes are to be made in consultationwith your doctor.

Life style measures like exercise, low fat diet rich infresh vegetables and seasonal fruits which are not very high sugar containingare recommended. Meditation like Prana yams and Yoga are good accompaniments.

Care of a patient with heart disease

Besides the routine preventive steps since this group is atthe highest risk of serious events in case of infection extreme caution isneeded.

All the drugs including aspirin, cholesterol loweringmedicines and drugs to improve heart function like ACE inhibitors (Ramipril etc)and ARB's (Losartan , valsartan etc), ARNI ( Sacubitril , valsartancombination etc), Beta blockers (metoprolol, bisoprolol etc) diuretics(Furosemide etc) must continue. The vaccination for flu (every year) andpneumonia (every 4 years) must be taken periodically.

If these patients become COVID +ve without symptoms none ofthe drugs should be stopped on their own but a consultation with the treatingcardiologist should be sought. Since there is an overlap of some of thesymptoms of cardiac illness with COVID like cough, shortness of breath andchest discomfort an expert opinion and early investigations are necessary whichmay require hospitalization in an appropriate hospital which will manage andalso repeat a COVID test if needed.

Acute symptoms of chest pain, shortness of breath orfainting need attention at the earliest. The management of a heart attack andrelated life-threatening problems is an acute emergency and needs an urgentattention at the closest hospital with facility for treating heart patients.Don't waste time and go early.

It is important to remember that the mortalities oftreatable diseases should not increase while trying to contain COVIDinfections. There is a general impression that a smaller number of patientswith acute heart emergencies are presenting to hospitals since the beginning ofthe lock down. This defies science and may lead to a sudden up rise with majorcomplications due to delayed treatment after curbs are eased out.

Author is a Cardiologist, Past President of Cardiological Society of India and SAARC Cardiac Society, Editor in Chief of ASIAINTERVENTIONS, a recipient of Padmashiri and Dr B C Roy Award.

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