Introducing Fit for Covid
As the Cayman Islands approaches re-opening and the level of community cases rises, obviously vaccination remains the first line of medical defence against a highly infectious disease that tends to be mild in those vaccinated but far more serious in those who are not.
However, vaccination status is not the only factor influencing how patients experience Covid-19. Some of these factors, like being 80 years of age, are things we can do nothing about except protect those individuals more carefully.
However, there are many factors affecting Covid disease severity that, if identified, can be address or treated, and that carries health benefits and security well beyond Covid itself. Fit for Covid is about understanding the very best defence against severe disease is to combine vaccination with tackling the health issues known to lead to more severe Covid disease.
It’s an approach to wellness that just happens to be very timely.
NOT A VACCINATION SUBSTITUTE!
We wish to be explicitly clear that the Fit for Covid programme is NOT a substitute for vaccination. We encourage anyone thinking that fitness is enough to read the very say story of unvaccinated 42-year-old fitness enthusiast John Eyers, who sadly lost his life thinking good health was all he needed. Fit for Covid is vaccinated AND in good health.
Fit for Covid Approach
Our approach is a sensible, evidence-based one that focuses on putting you in optimal health so that should you find yourself with Covid, you are minimising the risks of suffering more severe disease. What’s more, addressing these risk factors is good news for health, vitality and longevity regardless of Covid. The approach is simple, based either around a well-person medical, or a sickness approach if you have symptoms suggestive of an underlying disease. We’re focused on addressing two sets of factors:
- Identification and treatment of conditions and health status known to affect disease severity e.g. diabetes, blood pressure etc
- Reconciliation of lifestyle-factors known to affect disease severity, with advice and appropriate support to address them
We do this through a medical, with blood tests, and follow up treatment, guidance and support. If you have medical insurance, the matters we are addressing tend to be covered (policies may have deductibles or co-pay of course) and we can check this for you.
Risk Factors for Severe Disease
The following are known or suspected to affect disease severity if you catch Covid. It is important to understand this is not a complete list and the understanding and evidence is still evolving. The list here focuses on the ones that we can address i.e. the ones worth identifying and doing something about to ensure you are ‘Fit for Covid’, alongside being vaccinated against Covid.
A study from the UK involving a massive 48,400 adult patients with Covid-19 examined the impact of physical activity status on hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19. Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. Moreover, although the effect was statistically significant for all three degrees of disease severity, the effect was most beneficial in preventing death, where patients who were consistently inactive had a 2.49x greater likelihood of dying than infected patients who were consistently active (OR 2.49; 95% CI 1.33 to 4.67).
We’ll discuss your activity levels and how best to achieve the right levels regardless of your current activity status.
Heart Disease & Blood Pressure
Many types of heart disease can affect whether you are likely to develop severe COVID-19 symptoms and patients with uncontrolled heart and cardiovascular problems have some of the most severe Covid disease, resulting in increasing hospitalisation, ventilation and death. Conditions can include:
- Pulmonary hypertension
- Congenital heart disease
- Heart failure
- Coronary artery disease
Many of these were silent killers even before Covid-19 but the importance of identifying them, given their impact on mortality, has grown significantly. One of the reasons heart disease is the World’s greatest killer is that many people with it don’t know it, until it hits them with a cardiac event, many of which carry a high mortality rate (even before Covid). Raised blood pressure is a risk factor for or clue towards them that we can look directly at. If you have high blood pressure, your risk may be higher regardless of the severity of any underlying additional illness and this is an area we will pay particular attention to.
Besides blood pressure, other symptoms of heart problems can include:
- Shortness of breath
- Palpitations (irregular heart beats, or a “flip-flop” feeling in your chest)
- A faster heartbeat
- Weakness or dizziness
- Fatigue (feeling tired)
- Swelling in ankles, legs, feet or abdomen
- Chest discomfort or pains
- Low exercise tolerance
We want to know about these and if you have a number of these or specific ones we’d also want to ensure you are seen urgently.
Diabetes and Obesity
Type 1 and type 2 diabetes can increase your risk of serious COVID-19 symptoms and effects. Having a higher body mass index that’s considered overweight, obese or severely obese also increases this risk. Obviously diabetes and obesity are strongly associated with each other, but not all diabetes comes with obesity and vice versa. Both diabetes and obesity reduce the efficiency and effectiveness of an individual’s immune system and diabetes can increase the risk of infections in general too. Again, the challenge with diabetes is that many individuals have it but don’t know it. In the US, according to the Centers for Disease Control and Prevention, the 2020 National Diabetes Statistics Report, some 7.3 million adults met the criteria for diabetes but did not know they had it. Typical symptoms of diabetes can include:
- Urinate (pee) a lot, often at night
- Are very thirsty
- Lose weight without trying
- Are very hungry
- Have blurry vision
- Have numb or tingling hands or feet
- Feel very tired
- Have very dry skin
- Have sores that heal slowly
- Have more infections than usual
We’ll look at your diabetes status metabolically and should you be found to be diabetic or pre-diabetic, we’ll help you address this through both lifestyle and medication approaches, many of which also help address obesity too.
Vitamin D Status
Vitamin D status and Covid-19 appear related but more research is needed. What is most definitely known is that patients with severe Covid disease tend to also have low vitamin D status. What is less clear, given that vitamin D is so important for general health, is whether deficiency is a cause of more severe disease or whether it is a marker for poorer health and immune system, and thus associated with poorer outcomes from Covid-19. What’s indisputable is that vitamin D is important for health and good health generally is associated with better outcomes and less severe disease (many diseases in fact). Vitmin D is known to play important roles in heart disease, blood pressure, diabetes, the immune system and some types of cancers. Common symptoms of vitamin D deficiency are:
- Bone pain
- Muscle weakness, muscle aches, or muscle cramps
- Mood changes, like depression
Many people are completely unaware they have vitamin D deficiency. Surprisingly, given the degree of sunshine we have (sunshine leads to vitamin D production by the body), the Cayman Islands has a significant amount of vitamin D deficiency and it is more common in darker skin too. However, it is our well-founded attempts to avoid the hazards of sun damage and skin cancer, through staying indoors, use of high factor sun screens that leads to a deficiency. A word of caution too. Too much vitamin D can cause toxicity leading to other problems. You are unlikely to produce too much naturally but if you think you might be deficient, it’s best to have a simple test done and be advised on an ideal dose to restore optimal vitamin D levels. That’s something we will do as part of Fit for Covid.
Lung Problems, including Asthma
COVID-19 targets the lungs, so you’re more likely to develop severe symptoms if you already have lung problems. However, it is also likely that you already know you have them, given that they tend to be more obvious in symptoms. Conditions known to affect Covid severity include:
- Chronic obstructive pulmonary disease (COPD)
- Lung cancer
- Cystic fibrosis
- Pulmonary fibrosis
- Moderate to severe asthma
If you have known lung issues, it is important these are properly managed by your doctor anyway. We’ll examine chest health as part of our approach and help explain any medications you may be one, as well as refer you if we feel that you need additional attention.
Chronic Kidney or Liver Disease
One of the effects of both chronic kidney and liver disease is that they can weaken your immune system. This may increase your risk of being seriously ill if you were to catch Covid-19. Additionally, if you have more serious COVID-19 symptoms, some of the medications to treat these may have further negative effects on the liver, so it is important to establish whether you have any kidney or liver disease. Fortunately, their functional status are likely to show up on the series of tests we will run as part of the well-person approach.
Other Severe Conditions
There are, of course, many other conditions that can pre-dispose an individual to a more severe disease or outcome. As part of a well-person and optimal health approach, we will obviously address any concerns and look for obvious signs, if these are things you do not already know about. Like all diseases, milder Covid occurs in those with a healthy immune system that fights the germs, viruses and various pathogens that cause disease. Many of these more severe conditions and some of their treatments weaken your immune system. The types of things we’re talking about include:
- Sickle Cell Disease
- Organ transplants
- Cancer treatments
- Bone marrow transplant
- Long-term use of prednisone or similar drugs that weaken your immune system
If you have a weakened immune system, you may need to take extra precautions to avoid the virus that causes COVID-19. As mentioned, our Fit for Covid approach will obviously include picking up any signs of untoward illness but it sits alongside the many means of identifying them anyway, such as pap smears, mammograms, general physical examinations, and specific symptom monitoring.
How to Proceed
The Fit for Covid Optimal Health process is simply a form of well-person (or sickness care if you have symptoms) and can be booked online with our lead for Covid Optimal Health, Dr Francisco Martinez. You may book this online below. Additionally, if you would prefer to have this under the Women’s Health Team, you may also book this with Dr Madhavi Manoharan or Dr Lisa Joels. In each case, please select one of:
- Fit for Covid with Symptoms (symptoms listed above, not Covid symptoms)
- Fit for Covid Well-Person
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