The Science of COVID-19: Staying on track during the COVID-19 Pandemic: A Focus on chronic health conditions

Dr. Indira Bhoj
Coordinator- Chronic Disease Unit
Ministry of Health

Life has changed. In less than a year so much has happened around us. The very process of interacting with other human beings has been changed. We adapted to the changes without even realizing some of the fundamental implications.
Routines are different. Persons are now working from home, working online or have lost jobs. Even the family members who were used to being at home before the pandemic find themselves having to change their routines to accommodate other relatives who are now in the home. Without realizing it, these changes have significant impact on stress levels, activity levels, sleep schedules and relaxation opportunities.
Relationships have changed. The fundamental way we interact as human beings has been reshaped. Family gatherings, outdoor trips, eating out, going to movies etc. have been curtailed. Hugging, high-fives and other basic human methods of communication and socialization now have to be thought out. How we support each other in times of sadness, distress and need has been impacted in a way never before experienced.
Dealing with a medical condition or simply staying healthy during these times can seem overwhelming. But, as they say, “How do you eat an elephant?” There is only one answer: One bite at a time.
A good starting point is self-evaluation. This would include making a list of all the activities/routines/goals etc. that you were working on before the pandemic hit. Also make a list of what you are doing currently. As you evaluate, you may realize that you have lost focus of important priorities, gone off track with certain goals, lost opportunities for meaningful activities. You may also need to evaluate how you were feeling before the pandemic (e.g. happy, hopeful, ambitious, positive, excited, stable, peaceful, fulfilled, optimistic) and how you are now feeling ( e.g. bored, exhausted, sad, tired, frustrated, angry, worried, hopeless, hurt).
Next, you can decide to move forward. It’s important first of all to have a positive/productive mindset. We often focus on difficulties. It is a good idea to talk about the problems in our lives with persons who are in a good position to provide solutions. We should also ask our very own selves, “What can I do? How do I solve this problem? What are opportunities I have now with my new routine that I didn’t have before?”. You will have to set new goals and find ways of achieving them.
Challenge yourself to stay active. Staying active and exercising are major components of preventing as well as treating Diabetes, Hypertension, Obesity, Arthritis, Stroke, Heart Disease and may other medical conditions. You can try exercising at home, doing bodyweight exercises, stretching exercises, threadmill walking, stationary bike or weights. You can make weights by filling small plastic water bottles with stones or sand. A fun exercise is dancing. There are many Youtube exercise videos that you can choose based on your activity level. There are even routines for bedridden and wheelchair bound patients. Just set the time every day and stick to it! Household DIY (do it yourself) projects are sometimes physically exhausting. Gardening, repainting, reorganizing etc. are good ways of getting in physical activity. Outdoor activities and exercises are a great option if possible. The change of environment also improves mood and a sense of wellbeing. Above all, set realistic goals for exercise and be safe.
Eat well. Being at home provides more opportunities for snacking and breaking mealtime schedules. It is important to stick to the basics – use lots of vegetables, fruits and high quality proteins. If you are less active during the pandemic, you have to consider that you will not need as much energy. The main foods that we use to provide energy are starches (rice, flour, whole grains and ground provisions), fats (butter, cheese, avocado, oils) and proteins (peas, beans, meat and fish). You can cut back your portion sizes of starches and fatty foods if your activity level is lower, and especially if you notice an increase in body weight (clothes are fitting tighter, waist measurement is increasing). Don’t skip meals.
Support and encourage others in similar situations. Partner with someone you know who has similar goals and issues. Talk with them frequently, set common targets and keep each other on track. Celebrate each other as you make progress. This will keep you focused and maintain a mindset.
Document your progress and keep monitoring. Use a notebook and keep track of your blood pressure levels, blood sugar levels, body weight and waist measurements. This will allow you to detect when something new or unusual happens. It will also help the medical team to understand how you have been coping between visits to clinic.
Follow your treatment plan. Skipping days and doses of medications can be dangerous. If you feel you are having drug side effects or wish to make changes to your treatment, contact your doctor about it.
Minimize unhealthy habits such as alcohol and tobacco use, long periods sitting and extended screen time.
Keep Learning. If you have a question about your condition, write it down in your notebook or seek answers right away. Often, we let the question go and never bother to find out the answers. By writing things down, we can later ask someone e.g. community health worker or find the answers from books, pamphlets or internet. Most of us have friends or family members who can help us to find information online or otherwise. Use trusted patient care sites online (e.g. WebMD, Mayo clinic) if you must use the internet.
Stay encouraged and establish balance. Find new and creative ways to break your routine if you are becoming tired or bored. Try to spend some time outdoors every day. Connect with family and friends online or by phone. Try looking at a new type of show, listen to a new type of radio program. Include comedy and inspirational shows in your day.
Learn how to interact with the health system in this new situation. Establish some way of always being in contact with your clinic. Try your best to keep your appointments. Prepare for your visits by taking along all information that might be useful-e.g. notes you are making at home. Get their phone number. Call the clinic and seek advice if something happens. Avoid turning up unannounced if you can. Health centers and clinics usually have schedules for different services. Find out what are the different services/clinics offered at the health center as well as the schedules. Persons with chronic diseases have regularly scheduled appointments for the CHRONIC DISEASE CLINIC but can also be seen on an OUTPATIENT visit for new or urgent matters that cannot wait until the next clinic appointment. If you are going to the clinic as an OUTPATIENT, I would suggest that you find out which are the days and times set aside for OUTPATIENT visits. The exception to these tips would be an emergency situation, in which case, you should seek attention as soon as possible.
For those who have not been diagnosed with a chronic health condition, it is still important for you to get your health checks, especially if you have not had a check-up for over 2 to 3 years or if you have a risk factor that requires follow up. Consider contacting your nearest health center or primary care doctor to discuss when you should get you next check.

Article submitted as part of the Ministry of Health’s COVID-19 public information and education programme