The Chronic Disease Pandemic Wave. The role of wellness.

Dr. James Aw

The Chronic Disease Pandemic Wave. The role of wellness.
In the pre-COVID era, the World Health Organization (WHO) declared that the rise of Non-Communicable Chronic Diseases (NCCD) like diabetes, heart disease, chronic respiratory diseases and cancer was a “slow motion” disaster contributing to approximately 70% of deaths globally (1).

COVID-19 has accelerated the importance of chronic diseases. Interrupted care of chronic diseases may well be another type of pandemic “wave”. Several global studies have now confirmed that advancing age (over 50) and individuals with high blood pressure, diabetes, coronary artery disease, chronic obstructive lung disease (COPD) and cancer are at increased risk of death and complications of COVID-19 (2). These chronic conditions all share four preventable risk factors – tobacco use, excessive alcohol, unhealthy diets and physical inactivity. Obesity is also a risk factor for complications from COVID-19 infection. The CDC recently updated its list of chronic conditions that may increase risk of complications from COVID (3).

There are concerns that the pandemic will cause multiple waves of strain on the health care system. As resources and focus has had to shift to dealing with COVID, this graphic shows some of the challenges that the system will have to manage, including post COVID recovery, and the impacts of resource restrictions on non-COVID conditions, delayed care of chronic conditions because of COVID and mental health.

Source –
https://justanoldcountrydoctor.com/2020/04/14/will-health-care-infrastructure-survive-the-covid-19-pandemic/ Opens new window

Many individuals may not even know that they are in the risk group if they are not getting screened. When was the last time you had your blood pressure checked? There is concern that the focus on COVID-19 has led to patients avoiding seeking medical care or going to emergency departments. This has led to a delay in cancer screening and routine check ins with their physicians to refill prescriptions and testing (i.e. lab work, BP checks, etc.). During the 2002-2004 SARS outbreak – chronic care hospitalizations for diabetes initially dropped but then skyrocketed afterwards (4).

Working from home has also had a negative impact on some individuals regarding weight gain, increased alcohol consumption, stress and inactivity. Studies from past pandemics suggest that suboptimal management of chronic diseases occur due to restrictions, uncertain economic situations and change in normal healthy behaviours. A recent study found that the average daily step count measured by a wellness smartphone app in 190 countries decreased by 27% or 1432 steps within 30 days of the pandemic (5).

Mental health is also a concern during this pandemic. Resiliency during a crisis has been linked to individuals who cultivate meaning from stressful situations (what good can come out of this tragic situation?) and embrace gratitude and positivity mindsets (what are you grateful for?).

Health care systems have also had to adapt and pivot to a digital health service model. In the future – you will likely hear more about remote biosensor testing, smart medical homes, virtual health teams and wellness technology (coaching, data collection, triage, etc.). Doctor patient in-person visits may be triaged differently (i.e. virtual, data-driven vs in-person examination, testing, etc.).

Personally – I have been managing my patients in my primary care practice both virtually and in-person during the pandemic. We have strict infectious control protocols in the clinic and need to treat all patient encounters as possible COVID – but most of the in-person conversations lately have been focused on managing chronic disease management and prevention during a pandemic.

Wellness Tips for Chronic Diseases and COVID:

1. Increase home monitoring. Changes in blood pressure, heart rate, temperature, frequency of medication usage and glucose levels are all “flags” to check in with your physician. Identifying new trends are important.
   

2. Take a medication inventory. Never run out of your medications and always take them as prescribed. If you are developing new symptoms (side effects or poor control of your chronic condition) – then check in with your doctor.
   

3. Stay up to date with cancer screening protocols and immunizations. Check with your doctor. https://www.cancer.gov/about-cancer/screening/screening-tests Opens new window

4. Practice good COVID hygiene. Wear a mask in public (particularly if prolonged indoors in closed crowded spaces) and wash your hands frequently. If you have any infectious symptoms or unusual symptoms then get tested for COVID. https://www.who.int/health-topics/coronavirus#tab=tab_3. Opens new window

5. Have a plan in case you get COVID. Who will help you if you are quarantined or hospitalized? Make a list of your medications, key contacts and physicians. Keep a summary of your medical conditions and important reports/investigations. Bring any home monitoring data. Being organized will only help the doctors in the ER department.
   

6. Don’t smoke or drink too much alcohol. Eat a healthy diet (plant based, nutrient rich from natural sources, fish, etc.) and avoid processed foods.
   

7. Create daily healthy habits. Move often. Stretch. Eat healthily and not too much. Relax and recharge. Have fun. Sleep.
   

8. Make yourself accountable. Create a checklist. Set goals. NIH has some nice templates. https://www.nih.gov/health-information/your-healthiest-lf-wellness-toolkits Opens new window

9. Stay positive. Lead with gratitude. Live your meaningful life. Stay curious. Have fun!
   

10. Stay connected. Nurture a strong and supportive social network. Check in with loved ones – often. Live well. Laugh often. Love much.
    
    Improving your wellness and wellbeing have now become a COVID prevention strategy! The investments you make in your personal wellness will have long lasting benefits – even after this pandemic.
    
    Stay safe and well!
    
    References
    1. https://www.who.int/publications/10-year-review/ncd/en/index2.html Opens new window2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31067-9/fulltext Opens new window3. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medicalconditions.htmlCDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html Opens new window4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7135451/ Opens new window5. https://www.acpjournals.org/doi/10.7326/M20-2665 Opens new window
    Resources
    COVID and Diabetes
    https://idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html Opens new windowCOVID and Heart Disease
    https://www.heartandstroke.ca/articles/coronavirus-heart-disease-and-stroke Opens new windowCOVID and COPD
    https://www.ab.lung.ca/covid-19-copd Opens new windowCOVID and Cancer
    https://www.cancer.gov/about-cancer/coronavirus/coronavirus-cancer-patient-information Opens new windowhttps://www.cancerresearchuk.org/about-cancer/cancer-in-general/coronavirus-and-cancerOpens new window