Getting ready for COVID – pre-habilitation

The old saying “ Hope for the best, plan for the worst” is pertinent in this age of COVID. Optimism springs eternal. We could have hoped for the pandemic to have played out the way it has in South Korea and even China, but it’s a bit too late for that.  Or that it might just fizzle out in the summer like flu; that a safe vaccine might be on its way, or there might be treatment around the corner, or, as is the case for the majority, the infection will come and go with various degrees of severity and leave us with prolonged immunity. 

However, in this phase before the vast majority of us are infected, hope is something entertained in only the mind; planning requires a bit more action.

Why plan? As things are right now, we might be getting the notorious ‘herd immunity ‘by the back door. The idea behind this is that 80% or more of us will get the infection slowly enough for the NHS to cope. Then the most vulnerable 20% will then in a way be ring-fenced by the immunity of others, who will, in effect have hoovered up the virus with their collective antibodies. This assumes that immunity to COVID is persistent in those infected. At the point of writing, this in not certain. Even if it is, that means 80% of us will have to deal with the infection. How can we get ready?

Rehabilitation is what you do after the infection, it varies from putting your tissues away, to learning to walk and talk again.

Pre-habilitation is what you do before. It is an investment in your future with dividends that are potentially massive.

I’m interested in this as I used to give similar advice to patients of mine awaiting surgery, or chemo, or the other many and varied physical or mental challenges of life of which we might be lucky enough to have some warning. Some time to prepare. The self-evident suffering of those coming ill-prepared for surgery when I was a junior doctor lurks in my mind too and motivates me to share this with you. 

Already data from Intensive Care Units are revealing the influence of lifestyle on how this virus impacts. This means positive steps now can potentially save a lot of trouble down the line. 20% of people don’t have symptoms at all, 60% have a nasty illness of varying severity, but can manage at home, and the other 20% need help of various descriptions. 

I hope this advice will mean you are more likely to find yourself in one of the first two groups.

Let’s get “COVID ready”!

I will summarise what to do here pending more detailed posts on each recommendation;

There has never been a better time to stop smoking, and if you get your head around its current dangers, perhaps never an easier time either. Smokers are 14 times more likely to get COVID infection, and if you smoke, you are more likely to end up on ITU and die. Giving up is a great gift to yourself, your family, friends to the NHS and to society. Vaping is less damaging than smoking, but still leaves inflammation in the lungs which will disadvantage you if the infection comes your way. There really is no argument. Be kind to your lungs and they will be kind to you.

Try to do something that makes you short of breath every day. Anything! If this is not possible then breathing exercise can help too. COVID infection makes breathing harder work and healthy lungs handle its impact better. This particularly applies to anyone with asthma or other lung disorder.

Air pollution plays a significant part in the the risk of COVID infections. Try to avoid exercise in polluted areas if you can, and wearing a mask outdoors in our hazy cities might makes sense.

There is a preponderance of overweight and obese patients with severe COVID – so it is best not to be overweight or obese. The two best ways to lose weight rapidly are to get sugar out of the diet (20Kcals per spoonful!!) and to fast by whatever way you choose. The simplest way is to stretch out the non-eating time is simply by not eating in the evening, and having a late breakfast. More later on other options. There are other advantages too in making the body use up its fat sores for energy.

Exercise is helpful to get in trim for any challenge ahead. A little exercise is massively better than nothing, with the benefits increasing more slowly the more you do. Don’t go too far and end the day exhausted. Ideally doing something you enjoy, outdoors if you can.

Vitamin D is a big issue! Especially so if you have dark skin, can’t get out much or cover your skin. In this situation it is reasonable to assume you are deficient and his is likely to worsen any infection. Despite the recent sunny weather, Vitamin D deficiently remains very common and right now it’s reasonable to get Vitamin D levels up to normal by taking 5000iu (125mcg) daily. I do this and have done for years, admittedly prompted by my MS.

Getting out in the sun, without burning will allow the body to make its own, but the sun, as of April is still low in the sky. So getting as much skin in the sun as possible for as long as possible without burning makes sense. Watch out for this as the year goes on, but now is the chance to get a protective tan which will help avoid sunburn if the sunny weather intensifies.

There are two strands to healthy diet. The first is not eating highly processed sugary food containing low quality fats and the other is to increase fresh fruit and vegetables, healthy omega 3 rich oils and nuts. Meat eaters are well advised to buy organic grass fed meat and dairy if you can get it. A diet rich in high quality organic (in other words normal) food is likely to really help

A nutritious diet by definition doesn’t need much by way of supplements, but vegetarians might and vegans really should be taking VitaminB12.  Zinc and Magnesium supplements might make sense for some if you are unable to source or afford fresh healthy vegetables, but take care if you are on any medications. The science is uncertain, yet the reason behind deficiency in these minerals is likely to be the declining mineral content of our soils which means that may vegetable are not the quality they used to be. 

It seems that Vitamin C, according to early reports in China is making a difference to outcome of patients with severe COVID on ITU’s. They are giving big doses, equivalent to about 60 oranges, many times a day. While hard evidence on its use for prevention outside ITU is awaited, (indeed it might never come) it seems to me that it might be reasonable to take 1g twice daily at the first hint of an infection and then 1 gram an hour until improving. I note that above 3g a day some people will get diarrhoea, so if you do, tail back the dose. Of course, this might mean that when you try to order some, they are sold out. This is seen as controversial, the science is seen as arguable, but again, while we wait for more research, it seems reasonable not to miss the potential benefits of Vitamin C seen in China. The fall-back position is a healthy diet. I will update this post as more evidence comes in.

The most sensible drinking, from the biological point of view, is none at all. Alcohol is not in any way good for any cell in the body. There may be components of wine or beer that have benefits in isolation, but booze is simlpy bad for physical and mental health. If makes sleep worse and most of its many calories are stored in you abdomen and around the organs – just where you don’t want them.

I don’t want to enter the COVID experience with a hangover!

The reported benefits of alcohol come from their association with having fun and happy  socialisation. Seeing friends, conversing, sharing experiences and having a laugh is good for the mind and body. Alcohol is taken associated with this, hence the ‘science;’ showing that moderate alcohol intake is good for health.

Better still is doing all of those things, when possible, without alcohol at all, but it’s not an ideal world. 

So, if you do drink, then have as many alcohol free days as you can manage don’t binge and really make the most of the experience. 

If you have asthma, diabetes or hypertension, then tighten up the control as much as you can. Specifically, look at how you are managing your condition and doing all you can in to strengthen your body and mind. The most common conditions are all improved by the other measures here, including in some cases, the ‘undiagnosing’ (this wonderful word is not in my spellchecker!!) of hypertension and diabetes by vigorous lifestyle improvements. Make sure your asthma inhalers are up to date and in good supply. 

These are anxious times for so many reasons, yet here are ways to control the mind. I am so glad I have got used to meditating –  it is simply wonderful to be able to switch off and experience calmness when I choose to.

Mindfulness helps too, yoga or any of these techniques are weapons to be able to manage the anxiety before during and after COVID and indeed any illness or challenge. There is of course more to a healthy mind. Keeping the mind active and challenged, doing things you enjoy, improving relationships with those around you and with the world around you will help you get through this, and beyond. 

If you are thinking the worst and feeling like the anxiety is getting on top of you, then consider the best case scenario. Treatment around the corner; safe vaccines, or a mild disease with prolonged immunity. A rapid economic realignment leading to a better world? These things might happen too!

Sound sleep is good for the immune system, the mind and the body. It doesn’t take hard science for any of to know how awful it is to be sleep deprived and it’s good to enter the COVID experience shall we say, sleep replete.

In this time of lockdown, regular hours might be easier to keep; early to bed, early to rise and a regular sleep routine helps too. It would be bad luck, or perhaps bad planning, to develop symptoms after a bout of lost or poor sleep that was avoidable. 

Stock up with everything you need to get by for two weeks of the illness and some rehabilitation beyond. Who is around to help? Who would you be able to help if they needed supplies and encouragement?

Make a list of the things you will need if you need to go to hospital. Take a  phone and its charger – they are essential.  

Who will look after the children is you go to hospital? Or the pets you are responsible for? These day to day realities need to be sorted to ensure any problems with COVID are not worsened by the anxieties of feeling poorly or leaving home.

For those with assets, have you a will in place? For those who might not want the full range of hospital treatment, do you want to consider a living will, or advanced directive? This would let those around you know what your wishes are. Let your GP know too. It might help those who will care for you, now it is time. Many of you won’t. It’s a matter of good planning. 

Rather like experiences of illnesses such as MS, it really helps to be doing what we can, to feel a bit more in control of your fate. Being a good patient with a good outcome starts now.

Getting more healthy has never been more important. Get COVID-ready!