Around 10% of people have a slow recovery from COVID-19 infection that lasts longer than 3 weeks (UK COVID symptom study). Most people will recover within 12 weeks. People who do not recover within this time-frame may have Long COVID if their symptoms are not explained by another illness.
The likelihood of developing long COVID is not linked to any particular symptoms, the severity of the initial illness or if hospital admission was needed. The symptoms of long COVID can affect any part of your body and can change over time.
What causes long COVID?
The short answer is that we do not know what causes long COVID to occur. We do know that similar symptoms have been found in patients suffering from other coronaviruses such as SARS and MERS.
There are likely to be a number of causes of long COVID rather than just one in particular. These include a persistently high viral load, inflammatory or immune reactions, physical weakness and psychological factors such as PTSD.
For people who continue to suffer symptoms, the NHS has a great website to advise on symptom management.
What are the symptoms of long COVID?
General non-specific symptoms
Tiredness
Fever
Pain
Fatigue
Tiredness can occur after any severe infection as the body recovers. For example post-viral fatigue is fairly common.
The tiredness in long COVID can be severe and be similar to that in Chronic Fatigue Syndrome and ME (Myalgic Encephalitis).
Psychological symptoms
Anxiety
Low mood
Depression
Poor sleep
PTSD occurs in a minority of people, often healthcare workers.
Persistent chest symptoms
Persistent cough
Breathlessness
Blood clots
Having a COVID-19 infection increases the risk of blood clots. This might present with breathing difficulties, chest pain, or palpitations.
Heart symptoms
20% of people admitted with COVID-19 have obvious heart involvement, but probably a greater proportion have undetected heart involvement. Symptoms include:
ENT: tinnitus, earache, sore throat, dizziness, loss of taste/smell
Skin rashes
Which symptoms need urgent attention?
You should seek urgent medical attention if they have the following symptoms:
shortness of breath
chest pain
severe psychological distress or ideas of self-harm
severely ill child
What should you do if you suspect you have long COVID?
You should seek medical advice and discuss the nature of your symptoms with the doctor. The first thing of course is that you should have a history of having COVID-19 infection, or have had symptoms that were suspicious of a COVID-19 infection.
Long COVID is a diagnosis of exclusion. That means that other serious medical problems should be excluded before assuming that the cause is long COVID.
A relevant examination should be done according to the symptoms and may include the pulse, blood pressure and oxygen levels. Tests may also be useful to make a diagnosis and can include blood and urine tests, chest x-ray and ECG.
Take home message
Symptoms of long COVID can affect virtually any part of the body or more than one body part at a time. The condition my fluctuate and last for long periods of time.
We are just beginning to see these cases for the first time and therefore have limited experience of what treatments might work. Most of the evidence currently comes from consensus of medical professionals or individual cases that they have seen.
Long COVID is a diagnosis of exclusion so other medical problems need to searched for. You should not automatically assume that your symptoms are due to long COVID as they may be due to another problem. That is why it is important to discuss the problem with an experienced medical professional and why a number of tests may have to be done to arrive at a diagnosis.
Social media currently abounds with ‘useful’ information about medication and supplements that will protect you against COVID-19. Much of this is hearsay and downright wishful thinking. Prime example is President Trump taking hydroxychloroquine as preventative medicine. I hope he does not come into any mischief as have so many in recent studies.
How about vitamin D?
Interest in vitamin D is has been sparked via two main channels. First of all, people are now looking with interest at a meta-analysis (good quality evidence) published in the British Medical Journal in 2017. This included 25 studies with a total of over 11,000 participants. It showed that vitamin D supplements were safe and that they protected against respiratory infections. COVID-19 causes respiratory symptoms and hence the increased interest in this study nowadays.
The second observation is that people from black, Asian, and minority ethnic (BAME) backgrounds have a greater rate of COVID-19 infection and death rate compared to white Caucasians. People from ethnic backgrounds represent 14% of the UK population but 34% of COVID-19 patients. Death rate in British Black Africans and British Pakistanis is 2.5 times that of the white population. If we look at NHS staff, then those from BAME backgrounds represent 64% of deaths despite only making up 20% of the NHS workforce. Among doctors, the death rate in Blacks and Asians is an astounding 94% of the total number.
These inequalities in COVID-19 infection and death rate have been thought to be due to greater health problems in ethnic minorities. There is also an increased incidence of poverty, and they tend to live in larger, extended families. However, that does not entirely explain the disparity in rates of death among doctors. This is why vitamin D levels have become so interesting.
Researchers from the United States have found that patients from countries with high death rates such as Italy, Spain and the UK, had lower vitamin D levels than those not so severely affected. Another study also showed that average vitamin D levels in countries were strongly related to COVID-19 cases and death rate.
What does NICE say?
As always the National Institute of Health and Clinical Excellence prefers to side with hard evidence. In December 2020 they came out with rapid guidance advising people in the UK to continue to supplement with vitamin D in the Autumn and Winter months. However, they also said that there was not currently enough evidence to support taking vitamin D solely for the prevention and treatment of COVID-19.
The problem with this guidance is that we do not have the luxury of waiting until all the evidence is collected. People continue to suffer severe COVID-19 infections, become hospitalised, die or have prolonged suffering from long-COVID. We should be acting on the evidence we have so far even if it is not the gold standard randomised controlled trials. Vitamin D is cheap, has no adverse effects in standard doses and is good for bone health. There is little or no harm from taking it and potentially great benefit.
What’s the verdict?
My opinion is that we should all be taking vitamin D supplements based on the evidence we have so far. This is especially important for high risk groups such as those with BAME backgrounds and key workers. Standard doses for adults of 1000 IU are available over the counter, and higher doses of 4000 IU are available online. Since I have multiple risk factors for severe COVID-19 including being a doctor with an Asian background, I am taking the higher dose of 4000 IU per day.
Taking vitamin D supplements does NOT mean that we should avoid taking the COVID-19 vaccine. We should also continue to follow standard advice regarding hand hygiene, face coverings and social distancing,
The results of further studies on COVID-19 and the role of vitamin D should be released later this year. These should make matters clearer once and for all. Until then, I would err on the side of caution and take supplements.
Among the failures of the UK government in handling the COVID-19 pandemic is the lack of testing. Successful countries starting testing right at the beginning of the crisis in combination with contact tracing. We might have been able to lessen the mountain of deaths had we done the same.
Until now, there does not seem to be a sensible policy on COVID-19 testing. The government seems more concerned with showing they have tested a lot of people than actually saving lives. There does not seem to be a plan to use testing as a way of combating the virus.
Types of coronavirus test
There are 2 main types of coronavirus test. The first is the PCR test in which nose and throat swabs are taken. This test is used in people who have symptoms to find out if they currently have the infection. PCR tests are being done at NHS testing centres and community “Hot clinics”. Anyone who has symptoms suspicious of coronavirus should call 111 or their own GP, both of whom can refer to these testing centres.
The second type of test is the IgG antibody test. It tells you if you have had coronavirus infection sometime in the past. The IgG antibody test should be done a minimum of 3 weeks following the start of symptoms or after being in contact with someone suspected of being infected. Antibody levels have been found in one study to start decreasing after 2-3 months.
Most people will have had mild symptoms of coronavirus or no symptoms at all. Testing people with the IgG antibody test can tell people for sure if they have had the infection or not. This may be important for some as a form of reassurance. Past experience shows that having a virus infection does give that person some protection against future infection. However, we do not know for certain if having a coronavirus infection gives people any immunity. If it does provide immunity, then we do not know what level of antibodies is needed to provide protection or how long that will last.
A more important use of COVID-19 IgG antibody test may be to facilitate getting people back to work after self-isolation ends. Employers will therefore be particularly interested in getting their workforce checked.
Reliable coronoavirus tests now available
Fortunately, reliable COVID-19 tests are now available to the public. The most reliable tests are processed in the laboratory after the samples are taken.
You can now order UK MRHA approved and CE marked home coronavirus (COVID-19) antibody test kits online that use a sample of your blood taken through pinprick. The sample is then posted back to the laboratory and results received by email.
Alternatively, you can get a blood sample taken at a private clinic. Two antibody tests are currently approved by the UK government. These are the Abbott and the Roche COVID-19 antibody tests. I am pleased to say that we now offer the Abbott test at Prime Health.
The accuracy of the a test is determined by its specificity and sensitivity. The specificity of the Abbott test is 100%. That means that if you get a positive test, there is little or no chance of it being incorrect. The sensitivity of the Abbott test is 97.5% which means that there is a false negative rate of 2.5%. That is very reasonable for such a test.
Update 15/04/2021
We also now have the Roche COVID-19 antibody test for the ‘s’ or spike antibody which can measure antibodies from people having vaccinations to see if they have been effective.
You can book a test by calling 01932 50499 for an appointment.
How about a vaccine?
I personally had the antibody test a few weeks ago. I thought that I might possibly have been exposed to coronavirus because of the numerous patients I see with coughs and colds. Unfortunately, my test was negative. I guess I will have to wait for the vaccine to come out like everyone else. Preliminary indications are that it will give immunity for at least a few years and gives better protection than having had the infection. In this new and rapidly changing landscape, we shall have to wait and see.
I would also recommend that everyone should have the influenza vaccine this year. The reason for this is to protect people from influenza that has very similar symptoms to COVID-19 infection. New vaccines come out at the beginning of October. Most people with influenza usually manage it by themselves at home. However, any such symptoms may now trigger contact with with the healthcare system. The ideal scenario would be to get vaccinated for influenza and COVID-19 in the same appointment.
I hope that a new COVID-19 vaccination will be available by the Autumn when there is a risk of another wave of infection.
Imagine this. You develop a cough and a fever and worry that you have COVID-19 infection. So you call your GP who asks you how high your temperature is. You do not have a thermometer in the house and cannot give a definite answer. You feel hot but do you actually have a fever?
Your GP asks you if you feel short of breath. Your chest does feel a little tight but is that due to the infection or is it because you are feeling a little anxious about having COVID-19?
It has been estimated that 40-70% of us are going to get a COVID-19 infection. All UK GPs have now moved to telephone and video consultations. If you have a cough, fever, runny nose or sore throat, they will not be asking you to attend the clinic for assessment. That means that they cannot make the same accuracy of diagnosis that they are used to when they were able to see patients face to face.
If your symptoms are severe, your GP will ask you to call 111 or go to the Accident and Emergency department of the local hospital. You do not really want to go to the hospital unless you really need to. You will be putting yourself at greater risk of infection and further burdening the health service.
In this situation, having some basic medical devices at home can allow you and your doctor to get a more confident assessment of your condition.
Every house should have a thermometer
A body temperature over 37.5 C (99.5 F) is a fever.
There are a number of thermometers that you can purchase which are inexpensive and will do the job perfectly well.
Ear thermometers
The ear thermometer that you are used to seeing in your GP surgery is used because it has disposable covers. That avoids cross-infection from one patient to another. This type of thermometer can be purchased for home use and can be used for different family members. However, in this crisis it is becoming increasingly difficult to find.
Digital thermometers
A more practical solution may be to use a standard digital thermometer. It is widely available and much more cost-effective for an item that you are going to use only occasionally.
The way to use this thermometer is to place the tip beneath the tongue until it beeps. However, you will need one thermometer for each household member because of the risk of spreading infection.
The other, less reliable method, is to place the tip of the thermometer in the closed armpit. Remember you will need to add 1 C to the reading if you are going to do it this way to get the correct reading.
Forehead thermometers
The infrared forehead thermometers are newcomers to the market and are accurate if used properly. These are the ones that you may have seen used in airports. The are used by scanning people’s foreheads from a distance of a few centimetres.
Advantages are that they can be used for more than one person and can be used in babies
The other type of forehead thermometer is the strip that is used for babies. It works by direct application to the baby’s forehead. The colour change of crystals in the strip tells you the temperature.
Consider getting a pulse oximeter
People who have severe COVID-19 infection get a severe type of chest infection that worsens their breathing. A pulse oximeter is vital to check oxygen levels in the body to assess the severity of that infection. This is more important for people who already have longstanding chest problems such as asthma.
A pulse oximeter is a device that measures the percentage of oxygen in your blood. It also shows your pulse or heart rate.
Everyone should have an oxygen saturation of 100%. However, the standard pulse oximeters only have 2-digits so they will give a maximum reading of 99%.
Normal heart rate is between 60 to 100 per minute.
Adult patients with severe COVID-19 infection will have an oxygen saturation of 93% or less. Their breathing rate (number of breaths per minute) will also be 30 or more per minute. Please note that these figures are different for children and a doctor should be notified more urgently in their case.
Of course, you should not wait until your oxygen saturation reaches such a low level of 93%. You should seek medical attention for any level of 95% or less, or if you feel that your breathing is getting worse.
The price of these devices has also gone up in recent weeks from an average of £35 to ridiculous prices of £90 or more from profiteering. Waiting time for delivery has also gone up.
Most asthma sufferers are already familiar with using peak flow meters to assess their breathing ability. These simple devices can give an indication from day to day if your asthma is deteriorating.
The best way to use a peak flow meter is to check your level when you are feeling well and note it somewhere. Then when your breathing feels worse, you can compare it your normal levels. Click here to read how you can use a peak flow meter effectively.
Paracetamol or ibuprofen?
I was in a supermarket a couple of weeks ago when I came across the over-the-counter medication section. It was completely empty, except for shelves of ibuprofen!
This is another sign of the times and the power of social media. It was after the French health minister made the claim that ibuprofen worsens the condition of COVID-19 patients.
Thankfully, we now have real evidence to the contrary rather than one person’s opinion. King’ College London have conducted research showing that ibuprofen is perfectly safe to use. So you can now go and get some medicine which is in good supply!
Should you be wearing a mask?
At the current time, there is no government advice for everyone to wear a protective mask. Such advice is only for those at high risk such as health and social care workers.
For everyone else, the standard advice remains:
Stay at home
– Only go outside for food, health reasons or work (but only if you cannot work from home)
– If you go out, stay 2 metres (6ft) away from other people at all times
– Wash your hands as soon as you get home
– Do not meet others, even friends or family.
– You can spread the virus even if you don’t have symptoms.
Summary
Many of us are likely to get COVID-19 infection. For most of us, we will get mild to moderate symptoms. Only a minority will get severe infections needing hospital admission. There also a proportion of us who will have infection without any symptoms at all.
Primary care doctors are working remotely so they are not in the best position to assess your symptoms as they used to be. It is, therefore, important that we all take more responsibility for our health. By taking sensible measures we can put ourselves in a better situation to take care of our health in this new environment.
As far as technology is concerned, medical practice is very much behind. In UK general practice, we have been using electronic medical records for more than 25 years. Comparatively, UK hospitals are yet to catch up and their medical records are still handwritten.
Still, we can still do much to bring ourselves up to date in general practice. We have been doing telephone consultations for some time, but video consultations are far from the norm. This is about to change with the COVID-19 pandemic as all UK general practices have been asked to make this a reality as soon as possible.
What this means for doctors
All UK general practices have been forced to have mostly telephone and video consultations in order to limit the spread of the COVID-19 virus. For doctors that means dealing with more uncertainty and risk as we are unable to examine patients. However, you might be surprised to learn that for many conditions an examination is not absolutely necessary. The most important part of the consultation is the history itself. This is what the great Professor William Osler meant when he said:
Listen to the patient, he is telling you the diagnosis.
William Osler
An experienced doctor can therefore make a good diagnosis over the telephone. Video consultations can give the added benefit of seeing the patient when needed and reduces uncertainty and risk further. Prescriptions can also be sent electronically to the most convenient pharmacy and further reduce the need for direct contact.
Disadvantages include diagnostic error, unnecessary or wrong medication or over-prescribing. This is most detrimental in the case of antibiotics as increasing antibiotic use can lead to greater antibiotic resistance. It could also cause the appearance of ‘superbugs’, something we really do not need right now!
What this means for patients
Research has shown that remote consulting is acceptable to most patients. Only around 25% actually want to have a face-to-face consultation. It offers great convenience especially for routine tasks for stable patients. Just think of the time and effort in having to make a trip to the clinic and then finding parking!
The COVID-19 crisis is likely to last about a year. As patients get used to the convenience of remote consulting, this genie is unlikely to go back into the lamp! This means that telephone and video consultations are likely to be the future norm, with face to face consultations only when absolutely necessary.
It also means that patients will need to take greater responsibility for their health. For example, a patient with high blood pressure is unlikely to be invited to the clinic just to have his blood pressure checked during the COVID-19 crisis. It would be ideal if the patient purchases his own blood pressure machine so that he can check this at home. If he needs to have his medication adjusted, then he can let his doctor know his home blood pressure readings. The doctor can then adjust the medication on the basis of these readings.
Over the coming months, self-care is going to be a necessity for many patients. Appointments in hospital are already being cancelled for outpatient visits and surgery. Clinical staff are being diverted from their own specialties to aid in the care of COVID-19 patients. In essence, routine medical care is being taken away and patients themselves will have to fill part of that gap with self-care.
The future
Over the coming year, I foresee a number of innovations in the delivery of healthcare. An increasing number of patients will be taking more responsibility for their own health. They will also be dealing with their own medical problems in partnership with their doctors like never before.
This can only be a good thing. It is the silver lining to the current cloud hanging over us all.
Nowadays, we’re all on lockdown. Maybe this will last another 2 weeks if we’re lucky.
Howver, if you have possible COVID-19 symptoms, your stay at home has to be even more restricted.
What does this mean in practice?
Ideally, you should:
– sleep alone
– don’t share a bed, toothbrush, crockery, towels or food
– stay in one room – this should be one that others do not go as much as possible. If you need to use other rooms, then used them when others are not there.
– if possible, use a separate bathroom. If this is not possible, then the ill person should clean the bathroom after each use.
– if possible, have meals brought to your room rather than preparing it yourself in a shared space.
– all people in the household should be regularly washing their hands.
Returning to normal activity after COVID-19
– people with symptoms should self-isolate for 7 days. They can return to normal activities if they are well after this period.
– everyone else in the household should isolate for 14 days to stop virus spread.
– any member of the household who does NOT develop symptoms can return to normal activities again after 14 days isolation. This is 14 days from the first day of the ill person’s symptoms. You do not have to keep restarting the 14 day clock each time a person gets sick.
Remember that ill people are likely to cough for some weeks: they can return to normal even if they are still coughing.
For those people who have tested positive for COVID-19 or been admitted, they will be given specific advice on discharge.
Through talking to patients all day, I have realised that many just do not realise the possible ways that COVID-19 can present.
Their reactions to my advice are also highly variable from surprise to being advised to self-isolate to feeling insulted that they might actually have it!
There seems to be a fundamental misunderstanding by many people about what they should do.
Official guidance
The current official guidance is that you should suspect COVID-19 if you have:
– high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
– a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
Does that mean that if you don’t have these particular symptoms, then you shouldn’t worry? Essentially, the answer is no!
The reality
As COVID-19 spreads we are learning that it can also present in other ways:
– sore throat
– blocked or runny nose
– loss of sense of smell
– diarrhoea and vomiting
– shortness of breath
In other words, any sign of a respiratory infection affecting nose, throat and chest. When symptoms are severe, then diarrhoea and vomiting may also result.
Symptom severity varies
Between 40-70% of us are going to get COVID-19 infection.
Most of us are going to get mild to moderate symptoms. Small children and teenagers in particular seem to have a mild disease. Only a very small proportion of us are actually going to get symptoms severe enough to need hospital care. This is likely to be mostly the elderly and those with chronic diseases.
The bottom line
Of course, there are the usual viral and bacterial infections that are still going around. Someone’s symptoms could be due to any of these infections other than COVID-19.
But, someone currently with any symptoms of a respiratory infection should behave as if they do have COVID-19 in order to prevent possible spread. That’s because a test is not yet widely available to tell us the difference.
What does this mean in practice?
It means that people with respiratory symptoms should do the usual self-care during the first week of illness as they would do for any viral infection:
– take paracetamol for pain and fever
– drink plenty of fluids
– try honey for a sore throat and maybe some throat pastilles
– try honey and lemon in hot water for a cough (don’t bother with cough mixtures)
– rest
AND take precautions to prevent spread as if they have COVID-19:
– self-isolate for 7 days if they have symptoms
– the home occupants should self-isolate for 14 days if they don’t have symptoms because they can become symptomatic during this time
Most people will improve during the first week from self-limiting conditions including common viral infections. They will also get better from some bacterial infections such as tonsillitis without the use of antibiotics because our immune system is pretty efficient.
After the first 1 week of illness, if people are not improving then they should get in touch with their doctor. They should get in touch sooner is they worsen in any way.
If symptoms are similar to those of COVID-19 and are severe, people should contact 111 directly.
I spoke to a lady this morning who had classical symptoms of COVID-19 with fever, shivers, cough and was becoming more short of breath over the past 1 week. She was a non-smoker and had no history of asthma. She sounded very short of breath on the phone. I advised her to contact 111 without delay. She told me that she didn’t want to go into hospital because she was a single mother with 3 small children and there was no-one to look after them…….
I’ve lost count of how many times I’ve washed my hands today. COVID-19 has got the World at their basins scrubbing away several times throughout the day. It’s the first thing that I taught my family when I learned about the seriousness of the pandemic.
But are you handwashing well enough for it to be effective?
Since there is no current protection against the COVID-19 virus, handwashing is one of the few ways of protecting ourselves.
Why is it important?
We don’t know exactly how COVID-19 is spread, but we are beginning to learn some important facts. Although, direct touch is unlikely to be the main way of spreading the virus, it remains an important risk.
One study showed that we each touch our face23 times per hour! Almost half of the time it is to our mucus membranes like our eyes, nose and mouth. From these areas we can catch the infection that’s on our hands. So if you have been touching an infected surface at the supermarket or on the train…….
The virus is present in droplets in the air so it can spread by someone coughing or sneezing nearby.
Copper: up to 4 hours
Cardboard: up to 24 hours
Beware your Amazon delivery!
Plastic and stainless steel: up to 2-3 days
The supermarket trolley!
Faecal matter
There is some evidence that the virus is shed in faecal matter so a person not washing their hands after visiting the toilet can spread it onto surfaces.
Soap and water or sanitising gel?
Soap and water is best but if you don’t have any handy, then use a hand sanitiser that contains at least 60% alcohol.
How long do you wash for?
20 seconds.
That’s the time to sing Happy Birthday twice! I can just picture you at the basin singing as you wash!
Watch this video and see if you have a black-belt in handwashing.
The escalating problem of COVID-19 cases and deaths has focused our attention on how we can protect ourselves by improving our immunity.
Of course, we should practice social-distancing and hand-washing as preventative measures. We should also self-isolate: the current guidance is for 7 days if you suspect you have the virus and 14 days for household members who are not ill.
What is your immune system?
I am regularly asked how you can change your lifestyle to boost your immune system. Mostly, the questions are about different foods and supplements.
The key to understanding this lies in the word ‘system’. The immune system is not just a single thing that you can increase or decrease. It is made up of a complicated interaction between different cells and processes in your body. A better way of thinking of it might be to think of how you can improve your overall health. The healthier you are, the better you will be at defending yourself against infection and recovering from it.
Eat more plant-based foods
We have known for a long time that eating a diet rich in vegetables, fruits, whole grains, legumes (beans and pulses), nuts and seeds is great for our health. For example, it’s the basis for the Mediterranean diet and the 5 ‘Blue Zones’ in the World where people have the longest lives.
Plant-based foods are packed full of vitamins, minerals and fibre. These help to reduce inflammation in the body and improve our gut health. Since 80% of our immune system is in our gut, this can only be a good thing. We can improve gut health further by eating fermented foods such as yogurt, sauerkraut, kimchi, miso and kefir.
It’s a good idea to limit the amount of meats that we eat and instead try oily fish such as salmon, trout, mackerel, herring, and sardines. In the UK, we have a tradition of ‘meat and two veg’. Most patients I see rarely have a day where they don’t eat meat, chicken or fish. Why not try a meatless-Monday, one vegetarian day per week. You can then try to increase the number of vegetarian days each week. You’ll find that getting your 5 or 7-a-day is not so difficult after all.
Walking through the supermarkets these days and looking at the empty shelves make me wonder what people are trying to achieve. I can understand them buying staples such as rice, pasta, milk and eggs. More puzzling is the buying of highly processed foods such as pizza. Perhaps it’s the stress of the current crisis which is making people crave comfort food. Whatever the reason, processed foods and sugar are more likely to worsen health and ability to fight infection.
Exercise regularly
We all know that exercise is good for us but most of us still don’t get enough of it. Exercise is known to boost our ability to fight infection including viral infections such as the common cold. Using our muscles during exercise has an anti-inflammatory effect. It also helps get our infection-fighting cells called ‘neutrophils’ to the infection site faster and function better. Exercise improves the function of another group of immune cells called ‘macrophage’ which patrol the body guarding against infection. Our thymus gland produces yet another type of cell called a T-cell. The thymus gland starts to shrink from the age of 20 and so does our supply of T-cells. However, exercising can increase your number of your T-cells to the same level as that of younger people.
Exercise also helps us to recover better once we have an infection. Now, I don’t mean that we should exercise whilst we are ill as we are going to need our rest. I mean that we are more likely to make a better recovery if we have been previously exercising regularly.
There is a ‘Goldilocks’ level of exercise though, so you should exercise in moderation. A good guide is the recommended half-an-hour of brisk walking done 5 times per week. Too much exercise can be bad for us and weaken our ability to fight infection. However, I would hazard a guess that most of us probably don’t fall into that athletic category!
Don’t let self-isolation stop you. You can still go for a walk or run, or exercise at home using the countless home exercise programs on YouTube and other internet sites. Personally, I like ‘Beachbody On Demand’ as they cater for virtually every type of exercise. You might also take some inspiration from a Frenchman who ran a marathon on his balcony during the lockdown!
Get some decent sleep
We live in a sleep-deprived society which is causing our health to suffer in numerous ways. These range from tiredness and poor concentration and memory, to low mood and anxiety.
Sleeping is healing. We now know that sleeping less than 6 hours per day reduces our immunity. Experiments haven’t been done in humans, but rats who were stopped from sleeping all died from sepsis (overwhelming infection). We should all be trying to get a minimum of 7-8 hours of sleep at night. There’s some great information of how to improve your sleep from the Sleep Foundation.
Since Boris Johnson introduced the pub and bar ban, the booze shelves in supermarkets are now also empty! Alcohol is one of the most potent disruptors of REM sleep. It can result in the same duration of sleep but it will be more disturbed and less restful. Excessive alcohol intake can also reduce the ability of our bone marrow to produce immune cells. If you want to improve your sleep and boost your immune system, then drink less, and less often!
Caffeine is also a strong disruptor of sleep. It’s in coffee, tea (including green tea), soft drinks, and dark chocolate. Your cuppa or two in the morning may not a big problem, but caffeine has a long half-life of around 6 hours. So any caffeine after 2pm is likely to reduce the quality of your sleep. Beware decaf as it contains around 15-30% of the usual caffeine amount. Try camomile tea instead in the evenings which will help to you to relax and improve your sleep.
Actively reduce your stress
Stress plays havoc with our immune system. It increases our levels of the hormone cortisol in the body and increases inflammation. This makes it more likely for us to get sick and hamper our recovery when we do.
Most of us don’t do anything actively to reduce our stress levels. Watching the TV and reading a book may be relaxing but these activities are not enough to heal our body and mind. Regular exercise and good sleep will help. Studies have shown that mindfulness and meditation reduce our chances of getting sick and reduce the duration of illness. There are numerous apps that can help you get into this including Headspace and Calm. And how about mindful movement exercises such as yoga and tai chi. There are free-to-use YouTube sites such as ‘Yoga with Adriene’.
As with all lifestyle hacks, mindfulness, meditation, yoga and tai chi are only going to be useful for our health if we practise them on a regular basis. So make a plan which includes set days and times when you are going to practise them. Start small, just a few minutes a day is enough to begin with and then increase the time.
Get enough vitamin D
Supplements are another topic that comes up often when we talk about improving health. They are a big money-spinner and you’ll find numerous supplements in the shops that will make fantastic claims. Although it’s nice to think that simply taking a pill or potion will do us wonders, it’s unlikely that they will do us any good, and may actually do us harm. That’s because taking a concentrated ingredient which has been extracted out of a food will promote certain biochemical pathways in the body in an unbalanced way. That doesn’t happen in nature when we eat a whole food.
To date, no single supplement has been found to have a benefit on improving our immunity. That includes the most common one used, vitamin C. However, there is some evidence for the benefits of vitamin D supplements in protecting against respiratory infections.
It’s now March and we’ve just come out of a dark UK Winter so our vitamin D levels will have dropped. We all know that we can make vitamin D from sun exposure, but for dark-skinned individuals such as myself, it’s advisable to take supplements as we absorb less sunlight. I would recommend a minimum of 2000 units per day. Vitamin D can also be found in certain foods such the eggs, mushrooms and oily fish, and is added to cereals and milk.
Lay off the salt
Our body is really good at maintaining normal salt levels in our bodies. But it has to work harder if we eat too much salt. It does this by producing hormones called ‘glucocorticoids’ (steroids). The problem is that these hormones also weaken our immune system.
So, certainly have salt in your food but it might better to avoid extra at the table. Also, processed and junk food are well known to contain high levels of salt and are best avoided.
Maintain a healthy weight
You probably already know that being elderly and having a chronic disease are risk factors for developing severe complications of COVID-19 infection.
Obesity (BMI > 30) is a risk factor for various illnesses including type 2 diabetes mellitus and high blood pressure. Unfortunately, it is also a significant risk factor for developing infections.
To maintain a healthy weight, you first need to achieve a healthy weight! Fortunately, following a healthy whole-foods diet, sleeping well, keeping active and reducing stress are all ways we can do this.
Stop smoking
Stopping smoking may seem obvious but it’s surprising that many people continue to do so. Smokers are more likely to suffer from infections of every sort and from respiratory infections in particular. COVID-19 is a respiratory infection and smokers have a higher risk of developing a severe illness and become hospitalised if they do so.
Stay well
The current COVID-19 crisis will be with us for some time to come, perhaps up to a year or more. It’s natural that we turn our attention to our health at times like these. It also gives us a good opportunity for us to change to healthier habits that will improve our general health for the future.
It’s the fifth day of doing mostly telephone consultations. Thankfully, almost all patients are completely okay with it. It’s amazing what an experienced GP can do over the phone especially with the convenience of being able to issue electronic prescriptions directly to the pharmacy. However, some patients always need to be seen and we are still seeing a few patients daily.
Those with infection-type symptoms are told to self-isolate for 7 days and those living with them for 14 days if they are not symptomatic. If severe symptoms, then they should contact 111.
Being a GP has sometimes felt like a thankless task over the past few years with increasing workload and even more scrutiny and pressure. It’s not difficult to feel that your work gets taken for granted. Refreshingly, this week I have found patients to be amazingly understanding and thankful for continuing to have access to medical services. People are much more resilient than we think they are; perhaps even more than they themselves think they are. It’s at times like these that brings out the best in people. I have never lived through a war but I wonder if this is how people behaved; supporting each other in adverse circumstances. It has brought people together, perhaps because we are all in the same boat; united against a common enemy.
This is a stark contrast to the scenes in supermarkets nowadays where it seems as if it’s every man for himself! And what’s this fascination for toilet roll?! It has given rise to a whole genre of social media jokes and another meaning to toilet humour!
But joking aside, I spoke today to an elderly lady who has been unable to find any paracetamol to treat her osteoarthritis knee pain. She wondered if I could please prescribe some until the situation dies down and she can buy them herself again. A sign of any civilised society is that we look after our vulnerable people. They need our serious attention right now.
I spoke to another gentleman suffering from palpitations. He would not be able to attend the surgery so he had bought himself a blood pressure machine. I advised him to check his blood pressure and pulse daily for the next one week and let us know the readings. We would then be able to adjust his medication in line with his readings. Just last week, this would have needed a clinic visit to add to our already hard-pressed appointments. Now, on his own initiative under the current circumstances, he will become a partner with us in taking care of his own health.
I think that this pandemic will change people’s behaviour in how they seek healthcare for a generation. I believe that we will become more knowledgeable and self-reliant, and that technology will help. I am sure that this necessity will be the mother of a number of inventions over the coming year. People will take more responsibility for their health and this can only be a good thing.
