Wellness During the COVID-19 Pandemic

Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)
Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)

“Yesterday is history, tomorrow is a mystery, today is a gift of God, which is why we call it the present.” -Bil Keane (American cartoonist)

As you know pandemic coronavirus disease (COVID-19) is an infectious disease caused by a new virus. COVID-19 has changed our lives and put our dreams on hold.

People are in quarantine and isolation.

What does quarantine mean? Quarantine sequesters healthy, asymptomatic people exposed to an infectious disease for the duration of the incubation period, to contain the spread of the disease (Canadian Medical Association Journal – CMAJ March 20, 2020). Example: Canadian Prime Minister Justin Trudeau, who was exposed and is asymptomatic, is under voluntary quarantine.

In contrast, isolation refers to separating patients with active infection from healthy, unexposed people, to prevent transmission. Example: Prime Minister’s wife, Sophie Grégoire Trudeau.

Quarantines are enforceable under the Canadian Quarantine Act. This law dates to the 1870s and was updated in 2005 after the SARS outbreak. It allows the federal health minister to enact measures ranging from screenings to mandatory quarantines at Canadian borders.

Quarantines may be necessary but can create hardship for individuals. Quarantine may cause adverse psychological effects. Some people quarantined in Toronto during the SARS outbreak had symptoms of posttraumatic stress disorder and depression, says the CMAJ article.

Quarantine brings financial hardship and stigmatization. To promote compliance, quarantined people need ongoing access to resource materials, open lines of communication and psychosocial support. Is that possible?

In the current environment, I doubt if there is anybody who is not worried or stressed. This can affect your general health.

Stress can make your heart pound, your belly ache, and your palms sweat. Stress increases the level of hormone cortisol. This can lead to increased hunger and binge eating. This can lead to obesity.

Other possibility is depression sets in and you may lose your desire to eat and start losing weight.

There are many ways to stay connected with your friends and family. Thanks to our technological advances we have cell phones, laptops, computers which keep us connected. We can send man to moon but unfortunately cannot prevent common cold or get immediate control of COVID-19. I guess, that is life. We will win this battle as well. Be optimistic.

There are many ways to keep yourself busy during this time of stress. Probably you have already figured it out. Children are not at school. Most of the adults are not at work. How do you stay busy?

I divide the day into three segment of three hours each. Three hours in the morning, three hours in the afternoon and three hours in the evening. About couple of hours are allotted in between each segment for nutrition and family time and some TV.

How do you utilise three-hour segments?

That all depends on your interest. If you are doing your office and business work from home then you have to allow enough time for that. You have to allow time to spend with your family and keep them active and entertained. You have to have time for yourself with yoga (if that is your interest), exercise, and meditation. There are many other options. Too many to mention here. Important thing is to prevent boredom.

Make a list of all the things you always wanted to do but were too busy to do before our lives changed. Stock up on healthy snacks. And let us hope for the best.

We all need good luck. So here it is from me to you! Stay safe.

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Can we prevent sudden death in young athletes?

Owl at Agape Hospice in Calgary, Alberta. (Dr. Noorali Bharwani)
Owl at Agape Hospice in Calgary, Alberta. (Dr. Noorali Bharwani)

Some young athletes die suddenly.

If the athlete is over 35-years of age, sudden death is usually caused by coronary artery disease. If the athlete is below 35-years of age, sudden death is most commonly related to congenital or genetic heart conditions.

Exertional heatstroke can cause sudden death. Exertional heatstroke is caused by an increase in core body temperature brought on by intense physical activity in hot weather. It is most likely to occur if you’re not used to high temperatures.

It is estimated about one in 40,000 to one in 80,000 young athletes suddenly die each year. More than half of sudden deaths are due to underlying heart disease. The most common cause is a genetic condition called hypertrophic cardiomyopathy (HCM). This genetic abnormality causes an area of the heart to become two to three times thicker than usual, making it difficult for blood to pump past the thick point. Complications include heart failure, an irregular heartbeat, and sudden cardiac death.

Unfortunately, up to 50 per cent of those who die never knew they had heart disease.

Review of literature indicates countries such as Italy, teenage athletes are routinely screened with an electrocardiogram (EKG) to detect underlying abnormalities. In the United States, EKG screening is not routinely recommended. It is tempting to order routine EKG to screen young athletes, but there is no strong evidence that indicates screening EKGs can reduce sudden cardiac death among young athletes.

The American Heart Association recommends competitive athletes undergo a 12-item standardized history and physical questionnaire that the organization has developed. EKGs can identify pre-existing heart disease in teens who have a family history of early cardiac death. Genetic testing is used for select individuals with HCM and those who have a family history of heart disease.

A review article in the Canadian Medical Association Journal (CMAJ July 15, 2019) titled,  “The prevention and management of sudden cardiac arrest in athletes,” says exercise may increase the rate of sudden cardiac arrest in athletes with pre-existing cardiac conditions; however, this is difficult to predict or prevent, which means that screening athletes for underlying cardiac pathology is complex, challenging and of uncertain benefit.

A recent Canadian position statement recommends a tiered approach to pre-participation screening, advises against the routine use of EKG as a screening tool, and emphasizes the importance of shared decision-making when considering whether to continue or withdraw from competitive sport.

Establishing effective resuscitation protocols and increasing the availability of automated external defibrillators in settings where competitive sport is undertaken are the most effective strategies in helping reduce the incidence of sudden cardiac death among athletes, says the CMAJ article.

Among young athletes, sudden cardiac arrest is usually the first manifestation of underlying cardiac problem, although one retrospective study found 30 per cent of athletes had symptoms suggestive of cardiac disease before cardiac arrest.

The CMAJ article says, “In the absence of predisposing conditions or symptoms of heart disease, exercise, even at high intensity, poses very little risk to an athlete.”

It is important for young individuals to be involved in regular exercise and sport. The benefits are immense. There is reduced risk of death and disease, and substantial social and psychological gains.

There is no evidence that regular screening of young athletes is beneficial. And sudden cardiac arrest in young athletes is a rare event, the best approach, according to CMAJ article, shared decision-making between athlete and physician is the best approach when athletes who are found to have an underlying cardiac abnormality are considering whether to continue or withdraw from competition.

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Six things to know about coronavirus disease (COVID-19)

Red Rock Coulee (Dr. Noorali Bharwani)
Red Rock Coulee (Dr. Noorali Bharwani)

Coronavirus disease is in the news. It is causing anxiety in the general population.

We know quite a bit about the virus and how it affects us. But there is a lot we do not know. I have gathered some information and summarized it here. Health Canada has lots of information on this subject on their website.

1. What is coronavirus disease?

Coronaviruses are a large family of viruses. They can cause diseases ranging from the common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS-CoV).

COVID-19 is a new disease that has not been previously identified in humans, says Health Canada website.

When there was an outbreak of pneumonia in Wuhan, China determined that a novel coronavirus (referred to as COVID-19) is responsible for the outbreak.

Health Canada says, “Authorities in China and worldwide are conducting further investigations to better understand where the disease came from, how it is spread and the clinical severity of illness in humans.”

WHO recently announced official names for the virus and the illness. The illness has been named as COVID-19 (previously known as “2019 novel coronavirus”). As you can see COVID is an abbreviation of coronavirus disease. The virus which causes this illness is called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

2. Why is it spreading so fast?

The coronavirus is a respiratory virus. It is spread in a similar way to the common cold or to influenza. It has spread from China to at least 40 other countries around the world, affecting stock markets and disrupting travel. Not one person of 117 who have been tested for COVID-19 in Alberta are sick with this virus.

This new virus appears to be spreading from person to person. It may be spread by respiratory droplets when someone infected with the virus coughs or sneezes. But it’s unclear exactly how it spreads or how contagious it is, and research is ongoing.

Currently there is no vaccine to prevent the COVID-19 illness.

3. What are the symptoms of COVID-19?

Signs and symptoms can be mild to severe and include fever, cough and shortness of breath. Symptoms may appear two to 14 days after exposure.

You may not know you have symptoms of COVID-19 because they are similar to a cold or flu.

If you have fever, cough, difficulty breathing and pneumonia then you need to see a doctor. In severe cases, infection can lead to death.

4. What are the risks of getting COVID-19 for Canadians? How can you prevent it?

According to Health Canada the public health risk associated with COVID-19 in Wuhan, China, is low for Canada and for Canadian travellers.

Canada has no direct flights from Wuhan and the volume of travellers arriving indirectly from Wuhan is low. However, at this time, the Government of Canada recommends that Canadians avoid non-essential travel to China.

You try to prevent COVID-19 infection same as you try to prevent common cold and flu: wash your hands frequently; avoid touching your eyes, nose or mouth with unwashed hands; avoiding close contact with people who are sick; coughing or sneezing into your sleeve and not your hands; and staying home if you are sick to avoid spreading illness to others.

5. Is there a vaccine to protect against COVID-19?

No, but it is a work in progress. The flu vaccine does not protect against COVID-19.

6. What is the treatment for COVID-19?

For now, there is no specific treatments for most people with COVID-19. Most people with common coronavirus illness will recover on their own. If you have any symptoms described earlier then contact your doctor.

I hope this information helps. Stay healthy.

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Loneliness in older adults poses mental health risks

Barcelona. (Dr. Noorali Bharwani)
Barcelona. (Dr. Noorali Bharwani)

Let us define loneliness. Loneliness is the state of mind. You can be in a company or relationship and you may feel lonely. You may be alone and feel sorry for yourself. It’s a feeling of sadness or even anxiety that occurs when you want company.

Feeling of loneliness can occur in a crowded place where you are not interacting with others.

Loneliness has a wide range of negative effects on both physical and mental health, including stress, depression and cognitive decline. It can affect your heart. It can lead to stroke.

Come to think of it, we are social animals. Our connection to others enables us to survive and thrive. Especially, seniors are vulnerable to social isolation and loneliness. This leads to physical and mental illness.

Although loneliness is not a classified disease or mental health disorder, it certainly is a mental health issue. According to an article in the Canadian Medical Association Journal (Loneliness in Older Adults, CMAJ April 29, 2019) loneliness affects three major dimensions:

  1. Affect: Feelings of desperation, boredom and self-deprecation.
  2. Cognition: Negative attitudes toward self and others, and a sense of hopelessness and futility.
  3. Behavior: Self-absorbed, socially ineffective and passive.

Loneliness is linked to decline in health. More than 40 per cent of older adults, particularly women, experience loneliness. CMAJ article says there is compelling evidence that loneliness may accelerate physiologic aging. It is associated with elevated blood pressure and atherosclerosis, and increased risk of coronary heart disease, stroke and cardiovascular mortality.

Loneliness is also associated with functional impairment, depression and dementia. It is also a risk factor for death. Several studies have shown loneliness increases all-cause mortality by 26 to 45 per cent. The effect of loneliness is comparable to other known risk factors for death, including obesity and smoking, says CMAJ article.

Lonely individuals use health care service more often than others. It seems lonely individuals seek social contact through health care visits. More than 75 per cent of general practitioners in the United Kingdom reported seeing between one and five patients a day who visited because of loneliness, says the CMAJ article.

There is no medical treatment for loneliness. As loneliness cannot be effectively treated with medications or acute care, health care practitioners may consider social prescribing to connect lonely older adults with sources of support in the community.

Do you want to start a social prescribing network in your area? I believe they have started this in Ontario. The Social Prescribing Network website is a useful resource. Here is some information from their website:

“The Social Prescribing Network consists of health professionals, researchers, academics, social prescribing practitioners, representatives from the community and voluntary sector, commissioners and funders, patients and citizens. We are working together to share knowledge and best practice, to support social prescribing at a local and national levels and to inform good quality research and evaluation. Over the past year we have been setting up regional networks around England, Ireland and Scotland.”

What do you understand by cognitive decline and impairment?

Cognitive decline comes with aging. Cognitive decline means your brain does not work as well as it used to. This isn’t the same as cognitive impairment, which can be the result of damage, disease or an increased level of cognitive decline from another source.

Cognitive impairment is when a person is confused, cannot remember who he or she is, judgement is impaired, has loss of short-term or long-term memory, has trouble learning new things, concentrating, or making decisions that affect everyday life. Cognitive impairment ranges from mild to severe.

The bottom line is, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. Having a sense of purpose is important.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!