COVID-19 – effect on persons living with other health conditions/chronic diseases

Dr Tariq Jagnarine
BSc, MD, MMed FamMed, CCFP

Amid the stress and confusion of coronavirus shutdowns and social distancing orders, it can seem as though everything is on pause, especially to those who are most vulnerable such as older persons, pregnant mothers, diabetics, asthmatics, persons with hypertension, heart problems, and other illnesses.
Patients have expressed worry about going to crowded pharmacies and even grocery stores in fear of contracting COVID-19. There is even recent research that shows evidence that people with serious issues such as chest pain, appendicitis, ectopic pregnancy are avoiding emergency rooms.
One important fact which should not be overlooked during this pandemic is – acute and chronic health conditions can still occur at any given time and requires attention and care while most clinics have postponed regular visits until further notice. Therefore, taking care of one’s health is even more critical right now, as the new coronavirus increases the risk for people with underlying medical problems.
Despite COVID-19 being a new disease and limited information regarding risk factors for severe disease, the Centers for Disease Control (CDC) indicates that the following groups are most vulnerable and may experience severe illness from COVID-19:
* Persons 65 years and older
* Persons who live in a nursing home or long-term care facility
* People of all ages with underlying medical conditions, particularly if not well controlled, including:
* Chronic lung disease or moderate to severe asthma, chronic smokers
* Heart conditions that are unstable – recent heart attacks, heart failure, etc.
* Immunocompromised – diabetics, cancer, organ transplant, HIV/AIDS
* Obesity (body mass index [BMI] of 40 or higher)
* Diabetics
* Chronic kidney disease undergoing dialysis
* Liver disease
COVID-19 primarily affects the lungs, so people with lung diseases, such as asthma, chronic obstructive lung disease (COPD), and lung cancer have less “pulmonary reserve,” which is like having a backup generator waiting to kick in if the power goes out. Therefore, what might have been a mild infection for someone else can develop into a severe infection for someone with these underlying lung problems.
Beyond the lungs, research indicates that COVID-19 may have devastating effects on the kidneys and heart. An extreme immune system response known as a cytokine storm – (too much cytokine produced as part of an immune response) can damage organs. In addition, mini blood clots have developed in some patients resulting in strokes, heart attacks and even pulmonary embolisms.
High blood pressure, congestive heart failure or diabetes can also increase the risk of developing severe symptoms from COVID-19. In the CDC sample, 73 per cent of older patients hospitalised with COVID-19 also had hypertension, about a third had diabetes and just over half had cardiovascular disease.

Managing chronic conditions amid a pandemic is not easy. It requires adjusting daily routines and dealing with new obstacles.

One of the challenges is meeting medical appointments and clinic visits. During the pandemic, most clinics have postponed in-person visits for routine check-ups to avoid exposing patients or staff to the coronavirus. Nevertheless, that does not mean your doctor is not there for you.

What can patients do?
* Call the nearest health facility and explain the underlining health conditions or symptoms to a nurse or doctor.
* Video conferencing with the health facility
* Health facilities can provide online waiting rooms and services to stable and non-urgent patients.
* Have all medications refilled at the nearest health facility and avoid not taking medications regularly.
* Use medications as prescribed by the doctors.
* Continue to monitor blood sugars often.
* Monitor blood pressure often
* Avoid stress and try various relaxation methods such as – yoga, meditation, and mindfulness.
* Avoid excessive alcohol consumption or drug use.
* Avoid overeating and maintain a proper diet, as advised by health care workers – less salt, low fat, less starchy food. Lots of fruits, vegetables and protein.
* Do indoor exercises
* Once stable, avoid health facilities.
* If you experience unexplained, severe, sudden symptoms, contact a health care provider immediately.
Chronic disease management is taking a backseat during the coronavirus outbreak, with patients avoiding doctor’s visits to prevent disease spread. As the virus continues to loom large over the nation, patients are fearful of engaging with the healthcare system, even for needs unrelated to COVID-19.
Strong patient engagement in care plans has long been the bedrock of chronic disease management, with frequent check-ins with primary care providers and specialists being a key component of that care. But now with the social distancing protocol and concerns about coronavirus spread in healthcare facilities, those management strategies may be at risk
However, as the coronavirus outbreak stretches on, questions linger about how to treat these patients and individuals with chronic illnesses while avoiding disastrous health episodes among individuals who do not have COVID-19.