Uncontrolled hypertension is a major risk factor for severe illness from COVID-19

Guitar shaped pool in Memphis, Tennessee. (Dr. Noorali Bharwani)
Guitar shaped pool in Memphis, Tennessee. (Dr. Noorali Bharwani)

Hypertension is often called the “silent killer.” Keeping that in mind, when was the last time you had your blood pressure checked?

It is important to have your blood pressure checked on a regular basis. Because of COVID-19 fears, many people are avoiding hospitals and doctors’ offices. Some recent research shows people with uncontrolled high blood pressure are at a high risk of severe illness from COVID-19.

What causes high blood pressure?

Common factors that can lead to high blood pressure include: a diet high in salt, fat, and/or cholesterol. Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol level can lead to high blood pressure. A family history, especially if your parents or other close relatives have high blood pressure. This can affect you.

Blood pressure above 130/80 mm Hg is considered high blood pressure.

Most of the time, high blood pressure has no obvious symptoms. But left untreated, it can damage the blood vessels. This damage can lead to a range of health problems, including: heart attack, stroke, kidney disease and many others.

More than 100 million North Americans have high blood pressure. At least 30 per cent of these people are not aware they have high blood pressure. Uncontrolled hypertension is very dangerous. It’s even more dangerous because when a patient has uncontrolled high blood pressure, COVID-19 is more likely to be fatal or lead to hospitalisation and serious complications.

The Centers for Disease Control and Prevention (CDC) estimates that people with hypertension are three times more likely to be hospitalized if they are infected with the coronavirus, compared to those who don’t have high blood pressure. People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19.

We are learning more about COVID-19 every day.

A recent study published in April in Journal of the American Medical Association (JAMA) found that hypertension was one of the biggest predictors of severe illness and death from COVID-19, along with diabetes and obesity. Controlling hypertension, diabetes and obesity is very important.

We eat too much and we do not exercise enough. Our blood vessels become harder and less compliant with age. When the blood is pumped out of the heart into less compliant blood vessels, the blood pressure goes up. So, the heart has to work harder and eventually it becomes tired, weak and fails. It silently causes damage to our vital organs and eventually results in heart attack, congestive heart failure, stroke, kidney failure and blindness.

Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is no good.

Four steps to lowering your blood pressure:

  1. Exercise most days of the week.
  2. Consume a low-sodium diet.
  3. Limit alcohol intake to no more than one to two drinks per day.
  4. Make stress reduction a priority.

Take care. Be patient. Be safe. Protect yourself and protect others.

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Temperature screening to detect COVID

Mausoleum of Aga Khan III, Sir Sultan Muhammed Shah, located along the Nile of Egypt. (Dr. Noorali Bharwani)
Mausoleum of Aga Khan III, Sir Sultan Muhammed Shah, located along the Nile of Egypt. (Dr. Noorali Bharwani)

Symptoms of COVID-19 can vary from person to person. Symptoms may also vary in different age groups. In severe cases, infection can lead to death.

Symptoms may take up to 14 days to appear after exposure to the virus. One of the primary symptoms with COVID-19 is an elevated body temperature of above 38˚C (100.4˚F). The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather.

Some workplaces have started screening their employees using touchless temperature scanners in order to determine whether they may enter the employer’s workplace.

As Canada continues to reopen, some grocery stores, salons and other businesses have implemented temperature screening in an attempt to prevent the spread of the virus.

The process was made mandatory for all air travellers in Canada in mid-June. Any passenger who shows a fever on two measurements, taken 10 minutes apart, will be asked to rebook after 14 days.

However, some experts wonder whether the step is effective given a person can shed the COVID-19 virus without having a fever or any change in body temperature. The tool often used to measure temperature has also been shown to be unreliable.

A person may have elevated temperature because of certain pre-existing conditions, weather and what the person was doing immediately prior to having temperature checked.

A person may be infected with the virus but may not have symptoms like fever. They are capable of shedding and transmitting the virus. In the pre-symptomatic phase, a temperature check won’t help. If you have fever then we know what we are dealing with.

For those reasons, temperature screening has not been recommended by Canada’s chief public health officer. But temperature checks remain part of COVID-19 detection though not all cases present with fever.

According to World Health Organisation (WHO), temperature screening alone, at exit or entry at the airport, is not an effective way to stop international spread, since infected individuals may be in incubation period, may not express apparent symptoms early on in the course of the disease, or may suppress fever by taking medications.

Temperature screening measures require substantial investments for what may bear little benefits. It is more effective to provide prevention recommendation messages to travellers and to collect health declarations at arrival, with travellers’ contact details, to allow for a proper risk assessment and a possible contact tracing of incoming travellers, says WHO.

Temperature screening should be considered just one layer in a screening process. It is within the rights of a business to deny you service on the grounds of a high temperature. You can be denied service if you refuse to wear a mask or refuse to have your temperature taken. This is because employers and employees have the right to a safe working environment.

Employers are responsible for the safety of their employees.

The most effective way to protect yourself against the new coronavirus is by frequently cleaning your hands with alcohol-based hand rub or washing them with soap and water. Cough into your sleeve. Maintain social distancing. Wear a mask in public places. Maintain adequate ventilation and adequate environmental cleaning.

In situations where you cannot keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.

Take care. Be patient. Be safe. Protect yourself and protect others.

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

How accurate are COVID-19 tests?

Alligators in New Orleans. (Dr. Noorali Bharwani)
Alligators in New Orleans. (Dr. Noorali Bharwani)

By this time everybody knows the basic facts about the COVID-19 pandemic. COVID-19 is a communicable respiratory disease caused by a new strain of coronavirus. It was first reported in China.

Scientists are still puzzled by the origin of this virus. It is possible the virus began in animals. At some point one or more humans picked up the virus and now it has spread all over the world.

The disease spreads from person to person through infected air droplets. This happens during sneezing and coughing. It can also be transmitted when humans have contact with hands or surfaces that contain the virus and touch their eyes, nose, or mouth with the contaminated hands. Frequent hand washing is important.

Since there is no vaccine or treatment for COVID-19, infection can be prevented by observing personal hygiene.

Currently in Canada, there are three ways of testing for COVID-19 (Canada.ca).

Molecular PCR and point-of-care testing (swabs from nose or throat)

Molecular PCR and point-of-care tests detect the virus and diagnose COVID-19. If you are being tested for a possible current case of COVID-19, you will receive one of these tests.

Molecular PCR test – uses swabs to collect samples from the nose or throat which are sent to a laboratory for testing. Results are ready in 1-3 days.

Point-of-care test – involves a rapid test done at the time and place of care, such as a hospital or doctor’s office. This test uses swabs to collect samples from the nose or throat which are then tested on-site. Results are ready in 30-60 minutes.

Antibody testing (blood test – serology)

Health care providers may have access to blood tests, called serological tests, which are used to see who may have already had the virus.

These tests detect the presence of antibodies produced by your immune system in response to an infection. A positive serological test means that someone has been exposed to the virus in the past, but cannot reliably indicate how long ago that exposure occurred. As a result, they are not used to diagnose a case of COVID-19 in early stages of infection, since they don’t detect the virus itself.

This kind of test help us estimate how many people have had COVID-19, determine which public health measures need to be in place and better understand how much the virus has been circulating in the community. Positive serology does not equate with lifelong immunity.

How accurate are these tests?

Accuracy of the test depends on the timing of the test.

A positive test means that you have COVID-19 and must follow public health measures. False positive results are also possible. Health care professionals make their diagnosis based on a number of factors, including test results and symptoms.

If the test is negative but you have symptoms then you have to ignore the test results and follow quarantine guidelines. A negative test can indicate that a person is not infected, but it doesn’t always mean you’re COVID-19-free.

If you’re tested too soon after exposure, the virus may not be detected because the person is still incubating the virus and it is not detectable at the time of the test and will ultimately become infectious.

Test accuracy can vary during the course of your illness. Timing of the sample collected is important. Test positivity does not always entail infectivity. Results of RT-PCR test may remain positive for many weeks after the clinical disease has resolved. It is believed this is unlikely to be associated with replicating virus on cell culture and are unlikely to be infectious.

Stay safe, wash your hands frequently, wear a mask and maintain social distancing.

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

The importance of controlling your weight during the COVID-19 pandemic.

The Westin, Antigua. (Dr. Noorali Bharwani)
The Westin, Antigua. (Dr. Noorali Bharwani)

Are obese individuals at a higher risk of contracting and dying from COVID-19?

Yes. We know cardiac, respiratory and metabolic diseases (such as diabetes and hypertension) are more common among patients with obesity. These have been identified as risk factors for more severe disease or death from COVID-19. It is critical that people living with obesity, and especially people with a body mass index (BMI) over 40, take all possible precautions to avoid infection.

A BMI of 30 or higher is considered obesity. Your BMI should be checked at least once a year because it can help determine your overall health risks.

Your aim should be to keep your waist measurement less than half that of your height. That should be easy to measure compared to calculating BMI.

It is important to remember, although BMI is generally a good way to estimate how much body fat a person has, it does not measure body fat directly and therefore is not reliable in all cases.

For example, a person may weigh extra because he or she is athletic and has a lot of muscle, and not because he or she has excess body fat.

Your risk of diabetes increases as you build more fat around your waist line.

Women with a waist measurement of more than 90 centimeters, and men with a waist measurement of more than 100 centimeters may have more health risks than do people with smaller waist line. Your waist circumference should be checked at least once a year.

Abdominal fat or obesity has more severe health effects than fat in other parts of the body. Obesity is a chronic and often progressive disease, similar to diabetes or high blood pressure.

Many organizations including Obesity Canada, the Canadian Medical Association, the American Medical Association, and the World Health Organization now consider obesity to be a chronic disease.

COVID-19 has imposed restrictions on people’s movements and their capacity to be mobile and active. More people feel depressed and lonely. Outdoor activities are restricted. Gyms are closed. Many people find eating a source of pleasure.

How can you take control of your weight and your life?

First thing would be to categories your weight status. Are you of normal weight, overweight, obese or extremely obese? You can do this by choosing one of the methods described earlier.

Second, remember obesity is generally caused by eating too much and moving too little. Cut back on sweet and greasy food. Make healthy diet choices. Mediterranean diet is a good choice.

Third, increase your physical activity. The four main types of physical activities are aerobic, muscle-strengthening, bone-strengthening, and stretching. Aerobic activity is the type that benefits your heart and lungs the most.

Fourth, remember achieving a healthy weight through diet and physical activity is the best way most people can improve their health.

Fifth, it is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid of. Habits that have been ingrained in your system since childhood. Be patient and persevere. You can do it!

Sixth, experts agree there is no single solution to the problem of obesity. We should help people make better choices. Avoid your enemies – sugar, fat, salt, overeating and lack of physical activity.

Take care.

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