New Delhi: Coronavirus, which is now officially a pandemic, is deadly, but not for everyone. Illness due to coronavirus, also called COVID-19, is generally mild, especially for children and young adults, according to the World Health Organization (WHO).
However, the early clinical profile of COVID-19 suggests severe manifestation in people suffering from diabetes, cardiovascular conditions and lung diseases like asthma and chronic pulmonary obstructive disorder (COPD).
These conditions are common among Indians — for example, India ranks second in diabetes incidence, with an estimated 7.7 crore diabetics, according to the International Diabetes Foundation’s Diabetes Atlas.
Similarly, medical journal The Lancet found “heart diseases and strokes” to be one of the top reasons for deaths in India, where the number of cardiovascular disease patients reportedly increased to 5.45 crore in 2016 from 2.57 crore in 1990.
COPD was the second-strongest cause of death in India after heart disease in 2017, killing 9.58 lakh Indians that year, according to the University of Washington’s Global Burden of Disease study 2018.
Patients of these conditions need to exercise additional caution amid the spread of COVID-19, which, according to WHO, had killed over 3,500 people by 8 March.
Such patients are primarily advised to stock drugs for the long-term and take extra precautions, and ensure they’ve received vaccines for influenza and pneumococcal infections, which include severe pneumonia.
If you are diabetic…
While data about COVID-19 in patients with diabetes is limited at present, the condition was present in 42.3 per cent of 26 fatalities in Wuhan, China, the epicentre of the pandemic, according to a Chinese study (which factored in data for December 2019-January 2020) published by the Switzerland-based, peer-reviewed Journal of Clinical Medicine in February.
Individuals with diabetes are at risk of infections, especially influenza and pneumonia. “This risk can be reduced, though not completely eliminated, by good glycaemic control. All people with diabetes (above 2 years of age) are recommended pneumococcal and annual influenza vaccinations,” said Dr Anoop Misra, chairman at Fortis, C-Doc, in a study co-authored by him.
The research, titled “Diabetes & Metabolic Syndrome: Clinical Research & Reviews”, was published in the latest edition (May-June) of ScienceDirect, a portal for peer-reviewed research.
Pneumococcal vaccines prevent infections caused by bacteria spread through person-to-person contact, which could lead to serious infections like pneumonia, blood infections, and bacterial meningitis.
Patients with diabetes generally contract severe infections due to respiratory viruses.
“Diabetes was seen as an important risk factor for mortality in patients infected with Pandemic Influenza A 2009 (H1N1), Severe Acute Respiratory Syndrome (SARS) coronavirus and Middle East Respiratory Syndrome-related coronavirus (MERS-CoV),” the aforementioned study said.
“When people with diabetes develop a viral infection, it is often difficult to treat them due to fluctuations in their blood glucose levels and the presence of diabetes complications. Their immune system is compromised,” Dr Mahesh DM, a consultant for endocrinology at Bengaluru’s Aster CMI Hospital.
Also, patients with Type-1 diabetes should measure blood glucose and urinary ketones frequently if fever occurs while blood glucose levels are high.
“Frequent changes in dosage may be required to maintain normal sugar in the blood,” Misra said.
If you have cardiovascular diseases…
While the specific impact of coronavirus infection on the cardiovascular system remains unclear, according to the American College of Cardiology, “there have been reports of acute cardiac injury, arrhythmias, hypotension, tachycardia, and a high proportion of concomitant cardiovascular disease in infected individuals, particularly those who require more intensive care”.
Arrhythmia means irregular heartbeats while hypotension refers to abnormally low blood pressure and tachycardia to rapid heartbeats.
Patients who have undergone angioplasty or have a stent inside their hearts are believed to be more vulnerable to severe COVID-19 infection. The virus can cause tears in a patient’s blood vessels and then lead to secondary infections.
“Influenza virus is already known as a propellant for heart attacks. The patients who are on blood-thinning medications, their chances of bleeding from lungs become high in case of coughing, such as in the case of coronavirus infection,” said Yugal Kishore Mishra, head of cardiac sciences at Manipal Hospital in Delhi.
Based on an advisory from the US Centres for Disease Control and Prevention (CDC), doctors recommend that cardiac patients should take “flu and bacterial pneumonia vaccinations”.
“When the body is fighting a major pathogen like coronavirus, it becomes vulnerable to other viruses and bacterial infections. The vaccine for flu and pneumonia will reduce the chances of death in case of coronavirus infections,” said Dr K.K. Aggarwal, a cardiologist and former president of the Indian Medical Association (IMA).
Doctors also recommend immunity boosters along with a nutritious diet. “I prescribe regular doses of Vitamin C and B-complex along with vaccination to the susceptible category,” Mishra added.
If you are suffering from lung diseases such as COPD or asthma…
Apart from stocking their routine medicines and inhalers, patients, experts advise, should consult doctors about new dosage requirements, if any.
“With the summer coming, several patients re-adjust and reduce the dosage. In the winter, they generally need higher doses. This time, I recommend all patients to check with their doctors about the required dosage,” said Dr Navneet Sood, pulmonology consultant at Dharamshila Narayana Superspeciality Hospital in Delhi.
“We advise flu vaccines and pneumococcal vaccines apart from… wearing N-95 masks, even if you are feeling healthy.”
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