Care of Cancer patients during COVID-19 pandemic

 What is the need?

Cancer patients have compromised immune status, hence they are a more vulnerable group in the COVID-19 pandemic. People with a weakened immune system are more at risk of being seriously ill if they get infected with COVID-19. So, cancer patients may be at a higher risk of acquiring COVID-19 infection. They need to be extra careful with precautions to avoid contracting infection. 

Who are at high risk?

Cancer patients who are currently undergoing treatment. They include

• Patients undergoing active chemotherapy
• Patients undergoing immunotherapy or other ongoing antibody-based treatment
• Patients undergoing other targeted therapies

General precautions for cancer patients:

• Wash your hands with soap & water or sanitize them with alcohol-based hand rub thoroughly & regularly.
• Maintain at least 1 meter (3 feet) distance from others.
• Regularly sanitize the frequently touched surfaces.
• Avoid going to crowded places & stay at home.
• Avoid touching eyes, nose & mouth.
• Make sure people around you follow good respiratory hygiene.
• If you develop any symptoms like fever, cough, difficulty in breathing, chest pain, throat pain, diarrhea, abdominal pain, call your doctor, report to the nearest health center & follow the instructions given.
• Take care of your diet & nutrition as directed by your doctor.
• Continue doing moderate exercises as directed by your doctor.
•  To minimize hospital visits, keep an adequate stock of medicine & consumables at home.
• Keep the numbers of people who can help you in the time of need.

References:

1. Guidelines for cancer patients during COVID-19 pandemic, National health mission, Tamil Nadu.
2. https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic#:~:text=For%20all%20patients%20(A%20and,and%20relatives%20with%20COVID%
3. https://www.asterbangalore.com/blog/cancer-care-during-covid-best-cancer-hospital-aster-cmi-442D19
4. http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2020;volume=57;issue=2;spage=218;epage=220;aulast=Adhikari
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256336/
6. https://www.alimentarium.org/en/magazine/nutrition/what-exactly-balanced-meal photo credit
7. https://www.cleveland.com/open/2020/08/ohio-coronavirus-cases-up-1296-friday-update.html photo credit

Care of Cardiac patients during COVID-19 pandemic

 What is the need?

Till now it is very clear that COVID-19 disease behaves differently among different subsets of patients. The disease tends to be relatively mild and self-limiting in younger individuals but  it tends to take on a rather sinister course in the elderly and several others with risk factors like  pre-existing cardiovascular disease, hypertension in addition to age and diabetes have emerged as fairly strong associates of a poor outcome in patients with this disease. Presence of CVD is associated with increased mortality in COVID-19 infections, hence they need to take extra care to prevent infection. 

Instructions to patients with specific heart disease:

Patients with heart failure-

• Should maintain their salt & water restrictions as before.
• Should periodically monitor their health by watching weight, urine output, effort tolerance etc. to identify early decompensation as advised by the cardiologist.

Patients who have coronary stents in situ-

• Should continue anti-platelet drugs as advised as before since stopping them can result in recurrent MI & sudden death.

Patients on anti-coagulant therapy-

• Should have their RT-PCR done & get their dose titrated by cardiologist over phone.

General instructions:

• Always be in positive outlook.
• Follow healthy habits & lifestyle as advised.
• Continue the already advised dietary modifications & restrictions by cardiologist.
• Keep active inside home with simple exercises like short walk.
• They are advised to strictly continue the prescribed medications as before by cardiologist.
• They should avoid routine consultations but call or consult to the doctor whenever needed.
• They should stay at home, maintain social distancing, wash the hands with soap & water.
• Sanitization of frequently touched surfaces should be done regularly. 
• They should take adequate rest.
• Stop alcohol & smoking.

When to seek emergency care?

• If they develop any COVID-19 symptoms like fever, throat pain, breathlessness, Generalized body ache, new loss of taste or smell, chest pain, diarrhea, abdominal pain etc.
• Any cardiac symptoms like chest pain/pressure, especially during exercise, facial dropping, arm weakness/numbness, speech changes, loss of vision, severe headache, breathing difficulty at night associated with leg swelling, dizziness, fainting etc.

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References:

1. Covid-19 pandemic: focused recommendations for management of cardiac patients, National health mission, Tamil Nadu.
2. https://www.world-heart-federation.org/covid-19-and-cvd/
3. https://www.heartandstroke.ca/articles/coronavirus-heart-disease-and-stroke
4. https://journals.sagepub.com/doi/full/10.1177/2047487320925632
5. https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2020/june/keeping-your-heart-healthy-during-covid
6. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance
7. https://www.ohsu.edu/knight-cardiovascular-institute/my-heart-healthy-plate photo credit
8. https://www.vectorstock.com/royalty-free-vector/incoming-call-on-mobile-phone-vector-23305059 photo credit
9. https://depositphotos.com/23893445/stock-photo-cute-woman-sleeps-on-the.html photo credit

 

Care of Diabetic people during Covid-19 pandemic

 What is the need?

Diabetes mellitus is a chronic metabolic disease which can lead to acute or chronic complications, if left untreated. The morbidity & mortality due to COVID-19 infection is significantly more among people who are immunocompromised, elderly, hypertensive, diabetic, with CAD & respiratory illness. Hence, people with diabetes needs to be taken care to prevent infection & complications due to COVID-19.

Guidelines for management of Type 2 Diabetes mellitus:

• All patients with diabetes should ensure to achieve & maintain a good glycemic control.
• Target fasting blood sugar (FBS) should be <120 mg % & postprandial blood sugar (PPBS) should be <180 mg %
• They should continue medications (OHAs/Insulin) in same dosage if blood sugar levels are under control.
• If blood sugar levels are uncontrolled their medications have to be increased or should be switched over to insulin as per protocol.
• They should take balanced & nutritious diet as it helps to boost immunity.
• Take adequate water to avoid dehydration especially in hot weather.
• They should do moderate physical exercises as well as yoga & meditation for relaxation.
• They should avoid alcohol & smoking.
• They should take care of co-morbidities like hypertension, hyperlipidemia, CAD etc. & should continue medications without fail.
• They should call to their physician if co-morbidities are not under control or need consultation for any new symptoms.
• Elderly diabetics (particularly >65 years) should take extra care to avoid outside movement.
• If they develop any symptoms like cough, fever, running nose, throat pain, vomiting, abdominal pain, chest pain, breathlessness, diarrhoea etc. (COVID-19 symptoms), they should immediately report to nearest health center.
• They should have adequate stock of medications like insulin, oral antidiabetic drugs, drugs for co-morbidities, blood glucose monitoring strips, glucose power for use in case of unexpected hypoglycemia.
• They should look after their feet daily for any injury or decrease in sensation & use soft footwear especially made for diabetics.
• They should follow all precautions to prevent COVID-19 infection like staying at home, wearing mask, maintaining social distancing & washing hands frequently with soap & water.
• Keep number of people you can take help if needed if you are staying alone.
• Keep a regular schedule, avoiding overwork and have a good night's sleep.

Guidelines for management of Type 1 Diabetes mellitus:

• People with type 1 diabetes should continue insulin without fail & increase the dose if diabetes is uncontrolled by taking consultation of the physician. 
• They should take plenty of fluids to avoid dehydration & take nutritious diet.
• They should check for ketone bodies if they develop symptoms like vomiting, abdominal pain or fever & report to the nearest health center.

Guidelines for management of Gestational Diabetes mellitus:

• Pregnant ladies with diabetes should check their blood sugars routinely & follow the proper diet plan.
• They should report to the physician if blood sugar is uncontrolled & should be shifted on insulin as per standard guideline.
• Report to the doctor for any unusual symptom & follow the instructions given.

References:

1. Guidelines for management of diabetes mellitus during covid-19 pandemic, National health mission, Tamilnadu.
2. https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html
3. https://www.diabetes.ca/resources/tools---resources/faq-about-covid-19-and-diabetes
4. https://www.diabetes.org/coronavirus-covid-19
5. https://www.diabetes.org.uk/about_us/news/coronavirus
6. https://www.novonordisk.co.in/patients/diabetes-care/Diabetes-care-in-special-situations/Diabetes-and-COVID-19.html photo credit
7. https://www.medicalnewstoday.com/articles/317466 photo credit
8. https://in.pinterest.com/pin/515521488567629350/ photo credit

Care of Hypertensive people during Covid-19 pandemic

 What is the need?

As we all know till now, the presence of co-morbidities like Hypertension and Diabetes is a strong predictor of the disease related morbidity and mortality in COVID-19 infected people. In our country there is high prevalence of hypertension & COVID-19 cases are still increasing, hence its very important to know about the care & management of hypertensive people.

How COVID-19 is affecting hypertension management?

Angiotensin Converting Enzyme 2 (ACE 2) is present in the Heart, Lungs and Kidneys & it has a protective role on the Cardio-vascular system as it converts Angiotensin II to Angiotensin (1-7). Now it is known that SARS CoV-2 spike protein binds to ACE 2 & reduces the Cardio-protective effect of this enzyme. Now concern is being raised about treating patients with ACEIs (eg. Lisinopril, captopril etc.) which increases the level of ACE 2 thereby facilitating the penetration of SARS CoV-2 (as its spikes binds to ACE 2)  into the Cardiac cell.

Guidelines for management of hypertension:

Pharmacological:

• The target Blood Pressure should be less than 140/90 mm Hg & frequent monitoring of Blood pressure should be done 
• If a person is COVID-19 positive & is already taking anti-hypertensive other than ACEIs or ARBs, they may continue the same 
• If a person is COVID-19 positive & has newly diagnosed hypertension, the choice of drug varies upon the clinical scenario.
• Calcium Channel Blockers are the preferred drug of choice in this situation.
• Both Beta blockers and ACEIs can cause respiratory symptoms (like Bronchospasm and cough), hence not preferred as the first line drugs for initiating treatment of hypertension.
• Hypertensive patients who are already on CCB and not getting controlled, ARBs instead of ACEI may be added as the Second line of drug.
• ACEI is avoided in this situation due to its facilitation of penetration of the COVID-19 virus into the cardiac cell.

Non-pharmacological:

• Low salt diet (reducing salt intake to less than 5 g of salt per day)
• Avoidance of Alcohol and smoking
• High consumption of vegetables and fruits
• Low fat diet (Dietary Advice to Stop Hypertension-DASH) 
• Any warning symptom like palpitation, swelling of legs, chest pain, headache, giddiness, etc. should be addressed.
• Self medication should be strictly prohibited as drugs especially NSAIDs and Steroids increase BP or may contain Sodium which may further increase the BP.
• Reducing weight and maintaining it.
• Regular physical exercise - at least 30 min of moderate-intensity exercise (walking, jogging) on 5 -7 days a week.
• Do yoga & meditation for relaxation. 
• Hypertensive people should stay at home & should not go outside unnecessarily.
• They should wear mask, maintain social distancing & practice hand hygiene to prevent infection.
• Call your physician whenever needed to consult & follow the instructions given.

References:

1. Guidelines for management of hypertension during COVID-19 pandemic, NHM-Tamil nadu
2. https://www.nhp.gov.in/disease/cardio-vascular/hypertension-high-blood-pressure
3. Ernesto L Schiffrin, John M Flack, Sadayoshi Ito, Paul Muntner, R Clinton Webb, Hypertension and COVID-19, American Journal of Hypertension, Volume 33, Issue 5, May 2020, Pages 373–374, https://doi.org/10.1093/ajh/hpaa057
4. https://onlinelibrary.wiley.com/doi/10.1111/jch.13917
5. https://journals.sagepub.com/doi/full/10.1177/1470320320927851
6. https://www.nature.com/articles/s41371-020-0356-y
7. https://ish-world.com/news/a/A-statement-from-the-International-Society-of-Hypertension-on-COVID-19/
8. https://www.whleague.org/index.php/2014-07-09-22-47-11/covid-19-hypertension-guidance
9. https://bloodpressuremeasurementblog.wordpress.com/2015/06/19/how-to-take-blood-pressure-in-easiest-possible-manner/ photo credit
10. https://www.goodreads.com/book/show/51018305-dash-diet photo credit
11. https://www.ptproductsonline.com/industry-news/research-development/antihypertensive-medicines-may-increase-fall-risk-older-adults/ photo credit
12. https://www.yogajournal.com/practice/yjs-40-frequently-answered-questions-yoga photo credit
13. https://www.owensborohealth.org/news-events/news-media/2020/covid-19-signage/ photo credit

Take additional care of Elderly during Corona Pandemic

 Who are Elderly?

As per WHO, Geriatric people or Elderly are the people who are of age 60 years & above.

What is the need?

Elderly people are one of the most vulnerable categories for COVID-19 infection. They are at high risk of death due to decreased immunity, many co-morbid conditions & different treatment regimes. Therefore Elderly should be protected from getting COVID-19 infection by taking extra care. 

How to reduce risk of infection?

• Elderly should stay at home & should avoid meeting visitors at home.
• Should maintain social distancing of minimum one meter & avoid physical contacts.
• Their hands should be washed with soap and water for minimum of 20 seconds.
• Frequently touched surfaces should be cleaned with disinfectants regularly.
• Sneeze and cough either into tissue paper / handkerchief which has to be disposed into a closed bin.
• Proper nutrition of Elderly should be ensured through home cooked fresh hot meals.
• They should maintain adequate hydration with frequent intake of warm water.
• They should do regular moderate exercise (like walking) and meditation.
• They should have exposure to sunlight for a minimum of 30 minutes as it helps to increase the Vitamin D levels.
• They should avoid alcohol and tobacco related products.
• They should have adequate sleep for 8 hours.
• Family members should talk to them and they should also talk to friends via phone call or video call. 
• Family members should always be ready to help the elderly whenever needed.
• Talk to your doctor & postpone the elective surgeries (if any) like cataract surgery or total knee replacement till situation becomes normal.
• Health of the elderly should be monitored regularly. Monitor their blood pressure & blood sugar level daily.
• If they develop fever, cough and/or breathing difficulty immediately contact nearest health care facility and follow the medical advice given.
• Do not do self-medication.
• Do not go to hospital for routine checkup or follow up. 
• As far as possible make tele-consultation with your healthcare provider using online platforms.
• They should continue the regular medications for the chronic diseases without fail to avoid complications.
• They should not go to crowded places like parks, markets and religious places.
• Should not go out unless it is absolutely essential.
• Should engage in physical activities (walking in the balcony or terrace) and practice the forgotten hobbies.
• Always think positively.
• Keep the windows of room open for cross ventilation.
• Care givers should wash hands before & after giving physical assistance to the older persons.
• Work- from- home option for the youngsters in the family can limit the risk of exposure.
• If possible, a separate house/room may be arranged for elderly persons in the family. 
• Their medication should be arranged beforehand by younger members of the family.
• Make frequent communication to elderly staying far from your home by phone calls or video calls or whats app massages to prevent loneliness, anxiety and depression.
• Set up emergency contacts & speed dials for the time of need.

References:

1. https://www.who.int/news-room/q-a-detail/q-a-on-on-covid-19-for-older-people
2. https://www.unicef.org/india/stories/caring-elderly-during-covid-19-pandemic
3. https://www.who.int/news-room/q-a-detail/q-a-on-on-covid-19-for-older-people
4. https://healthlibrary.askapollo.com/taking-care-of-elderly-at-home-during-covid-19/
5. https://www.dreamstime.com/illustration/home-safety-senior.html photo credit
6. https://www.123rf.com/photo_128161284_stock-vector-elderly-people-professional-social-help-service-workers-volunteers-family-support-flat-cartoon-eleme.html photo credit
7. http://professionals.site.apic.org/infection-prevention-basics/clean-your-hands-often/ photo credit
8. https://www.alimentarium.org/en/magazine/nutrition/what-exactly-balanced-meal photo credit
9. https://goxomed.en.made-in-china.com/product/tCaJuMRbHdVg/China-LCD-Display-Arm-Digital-Blood-Pressure-Monitor-for-Elderly.html photo credit
10. https://www.spine-health.com/treatment/pain-management/medications-neuropathic-pain photo credit