• The second COVID19 wave is dwarfing the first.
  • The lockdown will last for many more months and experts are advising yet stricter measures as high dependency beds and ITU beds are overloaded.
  • It is important to do everything we can to avoid infection and to get as ready as possible in case we do.
  • Pre-habilitation is worth exploring – how to get as fit as possible to improve our resilience and outcome. This post explains how.


Well, the daily figures available here continue to make for unhappy reading. The news and media are full of heart-aching stories from the front line critical care services which are slowly becoming overwhelmed in some areas. The new variant B117 seems to be spreading more rapidly, although at least some of the increase would have happened anyway. Thankfully, experiments suggest it, and the 5012y.V2 variant from South Africa, remains susceptible to at least Pfizers vaccine, and by implication the others too.There are good grounds for optimism. 

However, vaccines won’t have much impact for a while on Intensive Care beds occupancy, the driver of policy. This is because vaccines have been targeted initially at the over 80’s to save lives, while the majority of ITU beds are occupied by those under 70.

So what can we do to both get ready for COVID19 and get through another and potentially longer lockdown? 

As I wrote at the beginning of the pandemic getting ready for COVID can be thought of as similar to preparing for other health challenges such as an operation, or any physical or mental challenge, but has some unique features. 

Rehabilitation is what you do to recover. 

Pre-habilitation means doing everything to ensure we are as physically and mentally ready as we can be for infection. Bit like training for any sport, or just trying to get as healthy as possible. 

This carries the message of hope than many of us can improve our chances of not only doing well, but also ending up immune, either with a manageable infection from which we have recovered, or vaccination. (Or both)

While I dislike those “10 things you didn’t know about your health” sort of titles, but I cant help but encapsulate Pre-hab in the same sort of way. The basis of what I said a year ago hasn’t changed much, but is worth looking at once again. Ii shall be as brief as I can, the highlighted text takes you to more detail if you wish. 

So what can we do to help ourselves, stay healthy and stay out of hospital……

1. Avoid the virus

I can only echo calls from the front line to do what we can to avoid the virus at all – that means less human contact. The 2m rule makes sense, so does isolation to whatever extend we can manage it. Washing hands with warm soapy water kills the virus and wearing masks is a sensible, effective way of preventing spread to or from other people.

Reading recently that cases in Cornwall are increasing, and that there are 15, yes, fifteen ITU beds in the county is a cause for reflection. More can be created, but it’s harder to create staff and support from nowhere. Services, pared down for years, mean available beds can soon be filled.

In Devon we are very lucky to have a dispersed population and like everywhere, cases are concentrated in cities and towns. But when it comes to damping down viral spread, infections and hospital admissions, it’s one for all and all for one. It seems inevitable that rates of infection are going up, and Intensive care beds are being occupied with patients from other regions whose beds are full. So simple hygiene matters for ourselves and everyone around us.

2. Avoid accidents or going to hospital where possible

This is a pretty bad time to be going to hospital for any reason, and avoiding accidents is more important than usual. I considered this when using a hedge-cutter or walking on a frozen Dartmoor – I really would feel most embarrassed if I ended up in A+E with any preventable injury or accident. 

Now is not the time for risky sports or hobbies or any other activity involving postponable risk. Driving and cycling needs extra care too. Perhaps leave mending that gutter till later in the year?

3. Take Vitamin D and get sunshine when you can.

I have posted on this quite a few times and pending the definitive Randomised Controlled Trial, not only does it makes perfect sense to take Vitamin D3, 5000iu daily, I would say its essential! This is a fraction of the dose we receive on a sunny summers day and many times more that is needed to avoid rickets, the most alarming consequence of Vitamin D deficiency. 

While the Government seems scandalously behind the curve on this one, the science is simple. We are designed to be outdoors pretty much all the time, all the year. That not being the case, levels of Vitamin D are very low in all modern populations. Vitamin D has important immune functions and the optimum function of our immune system is essential for defending ourselves against COVID19. If your diet is poor, magnesium and Vitamin K2, may needed to get the best out of Vitamin D, click here for more info on that.

More and more evidence is accumulating that Vitamin D can make a difference in how our immune system is functioning and this has even been highlighted in an article in the Observer as I write. I hope everyone is taking this, though I’ll bet millions are not. Yet, COVID19 patients have lower Vitamin D levels and those with low levels do worse. A trial of a fast acting Vitamin D in Spain showed improvements in outcome for those given Vitamin D. 

I just can’t emphasise enough how important it is to have normal levels of Vitamin D in your blood when you encounter Sars-Cov2. This applies even more if you has a dark skin. Please pass this information on to others. For more information, click here.

4. Exercise and look after your lungs.

There has never been a better time to stop smoking. Vaping can be a half way house for many but has its consequences too. Smokers lungs are chronically inflamed and this is a bad baseline when facing infection and inflammatory overload from viral pneumonia. 

Guess which lungs
are the smokers!

It can be tough to quit, more so when we are stressed and anxious, but it can be helped by the thought of COVID targeting our lungs – which it does. It can be done. As an ex-smoker I remember well how quickly my lungs cleared and my fitness increased – goodbye to the morning cough and rattles in the chest – symptoms of smoking you really don’t want to be a part of your normal life and Im sure would make any respiratory illness worse.  

Quitting is the best health decision any smoker can make.Click here for more information and encouragement.

Beyond ending the poisonous effects of smoking, exercise to increase fitness and general as well as lung health brings its own benefits. It might be tough for some with restrictions, but take the opportunity to build whatever activity you can build into the daily routine. The ability to tolerate being short of breath helps and the benefits of exercise go beyond clearing COVID19. For the elderly and those at particular risk, even a short walk is a lot better than nothing. 

A little exercise can reduce the risk of respiratory infections and regular exercise, which thankfully does not have to be that strenuous, can increase the level of white blood cells in the blood. Doubling the amount of light activity brings big benefits too. This is a positive message, you don’t have to put on the lycra, or go to the gym, or run a marathon, just build in as much movement and activity into the daily routine as you can. 

5. Eat well

Food should make us feel good, maintain our health and keep our weight in the normal range. Sadly, this is far from the case in the western world. The first thing to do is to look at our diet and get rid of the poisons, sugar, low quality vegetable oils (especially if heated) and processed flour. 

A recent PHE paper summarised the evidence of the impact of overweight on outomce from COIVD19:

“This evidence suggests excess weight is associated with an increased risk of the following for COVID-19: a positive test, hospitalisation, advanced levels of treatment (including mechanical ventilation or admission to intensive or critical care) and death. The risks seem to increase progressively with increasing BMI above the healthy weight range, even after adjustment for potential confounding factors, including demographic and socio-economic factors.”

So, outcome with COVID19 is improved by losing weight, so let’s have a quick look at that. One of the best ways to lost weight is to reduce the amount of sugar in your diet. Consider it to be rather like quitting smoking. 

We start from a high baseline too, the food industry sell us about 35Kg of sugar a year per person, which equates to an astonishing 24 spoons of sugar a day. For everyone like me, having virtually none, there will be someone having 48 spoons day, or more!

The record in my clinic was a young lady eating her way through 600 spoons of sugar a week, mainly in the form of Lucozade. Her health was terrible until she addressed the issue. Despite her huge calorie intake, she felt perpetually hungry, this graphic briefly explains why.  

The Sugar Trap!

The main targets are added sugar in hot drinks, then soft drinks and sugar rich fruit products like yoghurts, which in my opinion are expensive slow acting metabolic poisons. Then the sugar hidden in our food. This is clear for biscuits buns confectionary and chocolate, but there is lots hidden in most ultra-processed food, which sadly, makes up 60% of the calories consumed in the UK. If you avoid added sugar, your consumption of junk food will drop too.

My experience of helping patients to reduce sugar intake was wonderful –  simple changes led to significant weight loss, and perhaps more importantly, people having more energy, sleeping better and just feeling better, sharper too. 

Further to this is the big chunk of the population with diabetes, pre-diabetes and the metabolic syndrome who fare badly in hospital – a good diet can avoid this – put another way – stop poisoning ourselves with sugar. For more information, click here.
Eating food that improves wellbeing is the next step. Fresh quality vegetables, nuts and pulses, meat and dairy from grass fed livestock quality, and organic eggs from healthy chickens.  When cooking avoiding using cheap vegetable oils which are increasingly regarded as toxic. It seems saturated fat might not be so bad after all, but the quality varies according to the way it is produced and the farms from which it comes. 

Remember, we are what we eat – soil quality, the plants that grow on it and the animals that graze on it have a big part to play in our health. 

Zinc deficiency is common and can be corrected with supplements for those of us who need them – a good diet means this in not likely to be needed, but the link between poor soil is very evident when it comes to zinc – to find out more, click here. 

Food is a big social, environmental and political issue as well. Our post war food policy has been directed to providing low quality low priced food, which plays both in terms of the origin of the whole pandemic, and how it impacts our resilience to infection. We need better farming, better food and a better environment – that means us buying better food from farmers committed to restorative farming.

6. Fasting – how we eat.

I have warmed to this healthier way of eating by simply having a late breakfast coupled with no eating after an early evening meal. This is called 16:8 (ish) time restricted eating. Only having a breakfast on one or two days a week is another way too.

There are significant benefits to fasting, whatever way you choose to do it. In terms of weight loss if you need this, but also simply feeling better as the metabolism starts to use stored fat as an energy source. This helps anyone who tends to put on weight easily keep weight off

Not eating late into the evening helps with sleep and fasting also helps gets rid of that terrible phenomenon of craving for food. For more information click here. 

7. Take care with alcohol

I have it in mind to write a detailed post on alcohol, particularly as sales have increased during lockdown. A nurse at Derriford recently told me of her colleagues increasingly turning to a glass or two of wine to wind down after the stress of a day on the wards – a common habit easily acquired in these difficult times –  and really worth avoiding.

Why? Because alcohol has some pretty terrible effects on the immune system, on mood, and on our ability to think. Im partial to an occasional glass of wine myself, but have to note that it is followed by poor sleep, reduced ability to concentrate and think the next morning, and is a direct cause of low mood and depression. Any hint of a hangover means you have had too much, but also lower mood, poor thinking ability and a foggy mind is something we can soon assume is normal for us – we can get used to it – it isn’t normal. Drinking very intermittently, I know this.  

With alcohol, all the alleged benefits are associated with the fun and socialising which comes along with it – there are ZERO health benefits from alcohol itself and lots of harms. When we drink alone, without all the health enhancing fun and socialising, the impact is entirely negative.

An unhappy relationship

The biggest impact of alcohol in terms of brain damage occurs in the late teen years (Damn!) and the over 60’s (Damn again!!) So for anyone enjoying their Autumn years, shall we say, the best level of alcohol intake is somewhere far less that current recommended limits for intake and ideally none at all. For anyone drinking daily, or even a few times a week, it is an issue worth addressing.

Having good sleep, a clear mind and better mood it definitely a prize worth having. If you’re in a vulnerable group then take serious care with alcohol, and if you drink every day, you both have a problem and a simple way to feel better and be healthier.  More on this later….

8. Look after your mind

Looking after the body is one thing; good information and motivation leads to good decisions. The mind is another thing. It’s more of a challenge for many of us to maintain good mental health in these trouble, lonely, isolated months, indeed, times. Taking care with or avoiding alcohol makes a big difference but beyond that what can we do?

We are all different, and find our own sources of inspiration, but some things common to us all come to mind. Get whatever exercise you can – even with the restictions we can get out and move. The benefits of even very small amounts of exercise are impressive, but it needs doing. Good food helps, junk food directly lowers mood. 

Connection is really helpful, both in terms of the world around us, and the people and living things in our lives. For me a simple magnifying glass helps open up the beauty of simple things around us, but whatever inspires need reaching out for. 

Care with the online world too. The proven links between screen time and mental health in the young applies to adults too. This is tough in the modern world and now worse with lockdown when our screen time is expanding and in some ways a social lifeline. If you feel OK, then perhaps this is not such a problem, but screen time needs to be used very carefully when feeling low or anxious. Quality of screen time matters. 

If you’re coping that is fine. If not then I am reminded of my approach to patients with depression as well as my own experiences with it. It hard to ‘fight back’ when motivation is low, but all the more important to do so. When depressed it really is important to look after yourself –  just at a time when we are least likely to be bothered.

Take care with sleep, eat health enriching food and drink, breathe fresh air, notice things around you, communication with loved ones and friends; all need to be worked at when when it seems so easy not to. Get help if you feel you need it. Click here to find out more about NHS services – they are pretty good

Sometimes just sharing what you are feeling is a positive move in itself. Connect even though you don’t feel you want to. Opening up about feeling low is not easy, but worthwhile – you need to be understood.
Mindfulness and meditation really helps prevent depression and is a wonderful tool to use when feeling low. A break from rumination, unpleasant recurrent thoughts and a moment away from the anxiety and dark feelings that can plague the depressed mind can be a blessing. 

It takes some time to develop the ability to enjoy meditation, but it has been shown to have many positive effects, even on the structure of the brain. Click here for a free on-line course

Bear in mind that the pandemic will be over, and vaccination will help it along – we will look back on all this some time soon. There are early signs already that the recent surge in cases has peaked. Fingers crossed that this will soon lead to reduced pressure on hospitals. 

More and more people are immune to the virus, and the antibody response seems to last at least 6 months and potentially for many years. There is good news. The days are getting longer, spring and summer will come, and then we can make a better world for ourselves and our children once all this is over. This pandemic will make us collectively wiser. 

9. Sleep well.

The first thing to say is that if you are not sleeping well, it really is something worth thinking about and trying to improve. It’s amazing how resilient we are and how we can get used to poor sleep and the consequent below-par days.

The shorter lives of night shift workers testifies to the toll of unnatural sleep patterns. Poor sleep is terrible for the brain and is a hallmark of mental health problems.

Sleep is also important for the immune system, for mental health and to be ready for COVID. I shall write more on this later, but suffice it to say there are traps to avoid. Alcohol can help us drift off, but causes waking and lower quality of sleep. Eating late in the evening means we lie in bed with a full stomach with our internal systems confused, bloated. Regular habits help our internal body clocks and a decent circadian rhythm is important where possible. 
Our new online world needs care too – not using screens in the evening helps with sleep and those long hours in front of a screen need to be used efficiently. This is difficult with lockdown, but like any other activity, too much late artificial light is definitely a bad thing for sleep and mental health.

Getting up at the same time is key, sleeping in to ‘catch up’ means poorer sleep the following night and disrupts that rhythm.  For more information, click here, or here

10. Hope for the best, plan for the worst. 

It is important to remember that the vast majority of us will not be too troubled by COVID19.  Risks increase with age, with weight and for those with certain pre-existing illnesses, if you have dark skin, possibly with a bigger viral load and of course, just plain old fashioned bad luck. 

Reducing risk can be easier than this!

If you have chest problems or feel vulnerable, a pulse oximeter, a simple and cheap device which measures oxygen in the blood, can be useful in terms of when to know to get help. Click here for more information.

For most of us this means a quick thought about arrangements for looking after children and pets if admission is ever contemplated. Its always good to have a Plan B. For some it might mean making harder decisions about what sort of treatment you want. For everyone, taking a mobile phone and charger to hospital is a must.

For those who have no choice…..

Many healthy choices are limited for many people. Living in polluted areas, poor housing, crowded households, low pay, and stressful lives are not a matter of choice for many. The isolation needed to avoid spreading the virus is not possible for many people with no savings and lies behing some of the failure of our pandemic management. We live in a sick society and our leader have not been able to rise to the challenge, here or abroad

Poverty is defined by the constant worry about how to make ends meet and is ever more common. We need a fundamental re-boot of society to address this and I cannot help by think the undeserved, accumulating wealth has got to be tackled. 

Habits of smoking and drinking are easily ingrained. Cheap, poisonous food is all many people can afford and in some areas all you can get. Millions of people are struggling financially and emotionally, and the young are particularly hit by all the impacts of reductions in the human contact so essential for their lives. 

Nevertheless, everyone can do something to get through this. Stopping smoking and cutting down alcohol saves money. Eating well can be done on a budget and money can be saved by avoiding food that makes us sick. (For example, two cans of Coke a day = £250/year) Exercise and healthy activity can be free and built into day to day life. Walking is and excellent exercise and costs nothing. Mediation and mindfulness too are free. 

We all have some choices, and for those in the vulnerable groups in particular, it has never made more sense to choose the healthy options.

I hope this post helps make you think about doing anything that can be done. Sitting back and waiting can be such a difficult experience. My experiences of the considerable benefits of taking a positive, active approach to lifestyle with MS makes me realise how important this can be for us to get through COVID19, for our families, the NHS, the wider environment and our future.

Good Health!

3 thoughts on “Defending yourself against COVID19 – Pre-habilitation revisited….

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