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Home / Analysis / A few tips for high-risk individuals to keep away Covid-19

A few tips for high-risk individuals to keep away Covid-19

People with heart conditions, high blood pressure and diabetes are at a higher risk. Vigilance and a bit of lifestyle change can make a lot of difference

analysis Updated: May 21, 2020 07:15 IST
Dr Upendra Kaul
Dr Upendra Kaul
The asymptomatic Covid-19+ve patients should consult their doctors before altering the dosage or stop using their regular medication
The asymptomatic Covid-19+ve patients should consult their doctors before altering the dosage or stop using their regular medication(Getty Images/iStockphoto)

It is now well established that the coronavirus disease (Covid-19) affects the elderly the most. The highest rate of mortality due to the virus is among the people older than 60 – only incremental with age. More than the age, the unusual death rate is due to the medical conditions associated with age. According to a report by China’s Centre of Disease Control and Prevention, out of a sample of 504 deaths, 31% had high BP, 16% diabetes and 18% underlying cardiovascular diseases. Similar numbers of a high percentage of co-morbidities have also been experienced in India and the United States.

Not that such patients are at a high risk of getting infected, just that, with advancing age, they have a weaker immunity. Once they are infected, it has the potential to take on a more serious form. A weak immunity means a lower viral clearance, diminished T-cell function, and higher chances of severe inflammation leading to a cytokine storm, a form of heightened auto-immunity which, instead of killing the virus, ends up harming your own cells.

The key, therefore, is to be vigilant – with proper physical distancing, cleaning of hands, and the use of masks.

But among those who are at a higher risk are patients with high blood pressure (BP). They should continue using their prescribed medicines such as angiotensin-converting enzyme (ACE) inhibitors (ramipril, lisinopril and enalapril) and angiostensin-receptor blockers (ARBs) (telmisartan, losartan and olmesartan). All other classes of drugs for reducing BP are safe.

Among the simple measures to keep BP under control is measuring it regularly. Home BP measurements are superior to an isolated BP recording in a clinic or a doctor’s chamber. A calibrated and certified instrument available with chemists or online works. There are newer instruments that record the BP three times within a duration, and give out an average reading, a more accurate measurement than the old, one reading system.

In case the BP readings are unusually high or low, speak with your health care provider. Except for minor adjustments, self-treatment is not recommended in this case.

Involve yourself for regular physical activities for at least 30 minutes a day – averaging about 8,000 steps. Use moderate salt, avoid alcohol, and eat a low-calorie diet, with plenty of fresh fruits and vegetables.

All the general precautions meant for a BP patient applies equally to diabetic patients. The patient should monitor the blood sugar periodically using easily-available home devices. The sugar levels should be maintained between 70 and 180 mgs and HbA1c below 7%.

Those who are Covid+ve without symptoms must get in touch with their doctor, who might advise the patient to stop taking certain medicines. Generally, medicines such as metformin and sulfonyl-ureas (glimiperide, glibenclamide and gliclazide) are safe. However, drugs such as dipeptidyl peptidase-4 (DPP4) inhibitors (gliptin group of drugs like linagliptin and sitagliptin), thiazolidinediones (pioglitazone and rosiglitazone), and glucose stimulated insulin secretion (GLPi) analogues (liraglutide) are stopped because of a theoretical possibility of increasing the viral load. Sodium glucose transport protein 2 (SGLT2) inhibitors (empagliflozin, dapagliflozin and canagliflozin) are reasonably safe unless the patient has high fever and vomiting. Insulin is safe – diabetics who need Covid-19-related hospitalisation shift to it.

Much as with BP, this also requires lifestyle measures such as moderate exercise, use of low-fat and low sugar diet. Fresh vegetables and seasonal fruits work better. Meditation like pranayams and yoga are good accompaniments.

Cardiac patients, on the other hand, need extreme care to avoid a high-risk event like a heart attack. All preventive steps for BP and diabetes apply here as well. But aspirin, cholesterol-lowering medicines and the ones administered to improve heart function – such as ACE inhibitors (ramipril) and ARB’s (losartan and valsartan), angiotensin receptor-neprilysin inhibitors (ARNI) (sacubitril and valsartan combination), beta blockers (metoprolol and bisoprolol) diuretics (furosemide) – must continue. The yearly flu and the four-yearly pneumonia vaccination must be administered.

The asymptomatic Covid-19+ve patients should consult their doctor before altering the dosage or stopping the usage of regular medication. Since there is an overlap of symptoms in cardiac conditions and Covid-19 – cough, shortness of breath, and chest discomfort – patients must seek an expert opinion without any delay. They may require investigation and immediate hospitalisation to avoid complicating the situation.

It is important that Covid-19 infection should not increase the mortality rate of treatable diseases. You just need to be a bit more vigilant.

Dr Upendra Kaul is a cardiologist, former president, Cardiological Society of India and SAARC Cardiac Society, editor-in-chief, Asia Interventions, and recipient of Padma Shiri and Dr BC Roy Awards

The views expressed are personal

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