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Health & Fitness

Elder People

Looking after the Elderly in COVID times

Tips to look after Elderly in COVID times

 

As the world nudges towards normalcy, it is imperative that the elderly continue to practice lockdown norms. The year 2020 has been particularly harsh to them. Not only are they more vulnerable to serious infection due to Covid 19, their lifestyle and social pillars have been disrupted by the newer norms of living , dictated by the virus. Leaders from all over the world have expressed concern about the welfare of the elderly.

 

Why are the seniors more vulnerable?

The elderly account for more than 50 percent of the total COVID deaths. Seniors in UK, USA and Italy have also borne the major brunt of the disease. Let us try and understand why old people are more prone to infection by SARS COV 2. The explanation of the generally heightened risk of the geriatric population lies in a growing understanding of “Immunoscence”. Older people are not as good at reacting to micro-organisms they have not encountered before. When faced with a new virus like SARS COV2 , they are not able to produce virus fighting chemicals due to depletion of naive T cells. Naive T cells are cells which mount a specific response against a ‘never before seen microbe’. The specific response of the body to the virus is thus too little and too late. This allows the initial non-specific response of the body to remain in overdrive producing a cytokine storm. The body immune response is thus ineffective and produces great ancillary damage in the lungs causing Acute respiratory distress syndrome, the commonest cause of death in COVID.

 

Challenges faced by the elderly

The seniors find themselves particularly susceptible during this COVID era. They find almost every aspect of their existence threatened and challenged. Physically, not only are they in greater peril of succumbing to the disease, the structure of house help and care givers that they had put in place for their convenience is shattered. Also, prior to the COVID era, Senior citizens in India led an active social life. They kept in regular touch with extended family and friends. They took active part in satsangs, religious activities, festivals and social programs. Such meetings were frequent and provided recreation and solace to the old-timers. They looked forward to such occasions as they added value and meaning to their life. All these activities stand disrupted in the new era leading to social isolation, frustration and bleakness. Depression, loneliness and anxiety are the new companions. Instances of violence against the aged are also showing a rising trend. The fact that the end appears nowhere in sight is only adding to their dilemma.

 

Practical tips for Seniors to look after themselves

  • Sanitizing, masking and distancing remain the mool mantra for protection.
  • Practise physical distancing not social distancing. Keep in touch with your friends and extended families via telephones and digital platforms. Continue to share and care, but digitally.
  • Group activities which involve talking, singing or eating together are best avoided in person. Such activities can be arranged digitally. Use watts app group chats or zoom meets to organise such meets and remain in touch with your satsang groups or breakfast club.
  • Social activities like group exercises can be promoted as long as you maintain at least six feet distance at all times. Schedule them in open spaces. Yoga or such fitness exercises where people remain restricted to their mats can be organised. Keep group size small. Maintain social distance at all times.
  • Wear mask and face shield when you venture out of the house.
  • If you travel by car, keep the windows open. Wear a mask and face shield during the ride.
  • Avoid travel, hotels and that visit to the market.
  • Avoid talking to unmasked people.
  • Avoid meetings in closed spaces.
  • Eat simple nutritious diet. Immune-boosters like Chywanprash, amla, tulsi, cloves, cinnamon, black pepper and ginger should be a part of your daily diet. Avoid excess salt, sugar and oil.
  • Exercise daily. Practise meditation or yoga daily. Watch your weight.
  • Take your medications regularly. Add supplements of Vitamin D, Vitamin C and zinc.
  • Get your immunity status assessed at regular intervals. Keep in contact with your doctor.

 

Precautions while hiring Care-givers

Restrict the number of care givers. It is better if the care giver is exclusively working for you. It is important that the care giver takes all precautions which are relevant in today’s scenario. SMS is the golden rule. According to a recent study, one in four individuals may have developed immunity to COVID. It is a Good Practice to hire care givers who have developed specific immunity (IgG antibodies to COVID). You could get their immunity profiles checked to see if they are safe for you and your family.

 

What can we do to ease their pain- Tips for family and friends

Just like a herd protects the vulnerable by keeping them well sheltered in the centre, keep your seniors well cocooned. Be a buffer in between the elderly and the outside world for some more time. Teach and encourage the old folks to use chat platforms to remain in touch with friends and family to uplift their spirits. Keep them involved in family discussions and projects. Ask for advice or that recipe you always wanted. Connect with your elderly Aunts, Uncles and well wishers regularly. Just call in to say ‘I care.”

 

Author:
Dr Vibha Tomar
Consultant Pathologist
Tomar Foundation Pathology Lab

 

IgG ELISA antibody against COVID -19

Antibody detection test for COVID 19 and its relevance

As the country goes into unlock mode, it is imperative to point out that “Caution is the need of the hour.”  In cognizance of this the ICMR in its advisory dated 23/06/2020, validated and approved the use of IgG ELISA antibody against COVID -19 for surveillance of state of immunity of individuals and community. The Delhi government too allowed Public sector units, government offices, businesses corporate, agencies, health care workers and organisations planning to reopen business to engage private labs to conduct ELISA (IgG) antibody test to check for immunity against SARS COV2 amongst their employees. They feel this will help in allaying anxiety and fear, both amongst the workers and the consumers. According to some media reports, this is a part of ICMR’s “Immunity Certified Plan” which would allow asymptomatic individuals positive for IgG antibodies to resume usual activities.

At Tomar Foundation Pathology Lab, we are testing Antibody(IgG) to COVID19  to aid in this government endeavour. However, I find that there is a lot of confusion regarding this test and its relevance amongst the general public. In this article, I will attempt to answer the FAQ’s and provide clarity and information on this topic.

 

What is relevance of Antibody (IgG) detection test against COVID 19?

This is an ELISA test for detection of presence of IgG antibodies against SARS COV 2 in the blood. IgG antibodies start appearing after 2 weeks of onset of infection and last for several weeks to months. Many studies have stated that the load of asymptomatic people who have suffered from COVID is at least ten times the official figure. This test is highly useful in identifying people who have suffered from the disease and gained immunity on the quiet.

As IgG antibodies have no role in acute infection, this test has no diagnostic value at the time of acute infection. The presence of IgG antibodies in asymptomatic individual indicates

  • Previous exposure to the Corona virus
  • Development of immunity to SARS COV2
  • IgG positive person can donate plasma.
  • Provides a break in transmission chain in the community

When should the test be done?

  • The test can be done at any time in asymptomatic individuals.
  • In people who have had the disease or had direct exposure to exposure to COVID positive people, it should be done 3 weeks after exposure.

 

Who should get themselves  tested?

According to ICMR, the following populations should get themselves tested

  • Employers and employees at corporate houses, offices and businesses that want to open up
  • Banks, post, couriers, telecom offices: public or private banks, small or large branches of banks and post, telecom offices as well as couriers;
  • Migrant workers
  • Industrial workers / labour force
  • Health Care Workers:
  • Security personnel
  • Police and paramilitary personnel civil defense & volunteers
  • Press corps
  • Immune-compromised patients: diabetics, cirrhosis patients, cancer patients etc.
  • Drivers, personal help and security guards Staff at businesses, homes and offices that want to open up
  • Staff in municipal bodies: Municipal staff working in areas like sanitation, water supply, electricity, etc. where interactions with citizens is expected;
  • Farmers, sellers, brokers, purchasing vendors, distributors and other persons including drivers and labour by virtue of visiting crowded places like main markets
  • Drivers of hospital ambulances, hearse, buses, auto, taxies, etc. Bus conductors, cleaners and helping staff also should be included.
  • Individuals who have been on work front and faced large number of people previously or are going to face in future.
  • Individuals in containment zones
  • Vendors and/ or owners as well as staff working in shops

How reliable is this test?

The reliability of the test depends on the reliability of testing kit used. It is pertinent that the laboratories conducting the test use only ICMR approved kits. ICMR has recommended only IgG (ELISA) test kits for reliable testing. The kit has a sensitivity of 98.3% and specificity of 98.1%.There is low false positive and false negative due to high specificity and high sensitivity.

 

Are Rapid tests for Covid 19 reliable?

ICMR has banned rapid tests for Covid 19 due to their unreliability. These tests have gained a lot of notoriety world over.

 

Is a person with IgG antibody 100% immune to re-infection?

The influenza virus is well known for its propensity to transmutate and change structure. So, a person with IgG antibody may get infected by a new strain of virus. The new strain of virus is still going to be structurally close to the other strains. Thus, he would be better equipped to fight the infection as compared to a person with no antibodies.  Let us not forget,”Small pox was eradicated using a Cow pox vaccine.”

Also the person’s general immunity status and presence or absence of co-morbidities would also play an important role in the scenario.

Getting oneself tested for anaemia, Vitamin d deficiency, Vitamin B12 deficiency, blood sugar levels, kidney function assessment and liver function assessments along with antibody to COVID 9 will go a long way towards preventive care. TFPL offers Basic Immunity profile and Comprehensive Immunity profiles to help allay your anxieties.

 

Author:
Dr Vibha Tomar
Consultant Pathologist
Tomar Foundation Pathology Lab

 

 

How to Keep Corona at Bay

2020 is a watershed year. It will be remembered as a year of lockdown, huge expectations and surmounting frustrations. Country after country bowed down before the Corona virus. Everyone waited for a miracle drug and vaccine with baited breath. Both of them are elusive and attaining them appears distant. Leaders all over the world have declared that we must learn to live with the virus.

How do we learn to live with the enemy and yet keep it at bay? For this, we must first gain insight and knowledge into its mechanism of offence and our body’s defense systems against it. The Novel Corona virus gains entry into our body through the nose eyes or mouth. Breathing carries these particles to the lower respiratory tract. The spike proteins of the corona virus act like a key and lock into the epithelial cells that line the respiratory tracts and air sacs of lungs. A rapid and well coordinated immune response represents the first line of defense against viral infections. Most of the people will kill the virus and develop antibodies and immunity against it. They may remain asymptomatic or suffer from mild, moderate or severe disease depending on the extent of initial viral load and their immunity. Lower initial viral load and higher innate immunity favor the chances of a complete recovery.

However in elderly patients and patients with co-morbidities excessive inflammatory innate response and impaired adaptive host immune defense may lead to ‘Massive release of cytokines and chemokines’ popularly known as “Cytokine storm”. This can cause extensive tissue damage both at site of entry of virus and systematically. An uncontrolled cytokine storm is responsible both for increased morbidity and mortality for the elderly and patients with co morbidities.

The battle against Corona has to be fought on multiple fronts. Only if we fortify ourselves socially, emotionally, tactically, physically and as a herd can we hope to defeat it.

Solidarity not stigma 

There is a palpable stigma surrounding the term’ COVID +’. This leads to a reduction in people seeking medical care/testing and people adhering to interventions (self isolation). Society needs to show solidarity and support to COVID positive individuals and their families. They should be dealt with compassion and empathy. According to WHO, our dogmatic approach towards the disease will lead to under reporting of cases. This will be a major stumbling block in our fight.

Fight the Fear

On a personal level, each person needs to fight the fear of the disease. While we need to keep ourselves safe and break the chain of transmission, we must not be afraid of the disease. Total number of COVID positive cases in India has been 1.2 Million and around 31 thousand have succumbed to it. The mortality rate is around 2.3%. Since we are testing only the symptomatic population, the actual projection of COVID positive population could be at least ten times. This would bring the mortality rate down to 0.2%. “Caution not Fear” is the call of the hour.

Reduce the exposure to virus   

As the prevalence of the disease increases, the war has shifted from the hospitals to the community. Each person is now responsible for protecting himself, his family, his community and his country. Reducing the exposure to virus and viral load is the crux of the issue. Breathing, talking, coughing and singing create virus carrying droplets. These different types of exposure carry different viral loads. Enough virus has to make itself over to you to cause infection.

Successful infection=Virus exposure x duration of exposure

In nut shell, Proximity, type of exposure and duration of exposure are crucial factors deciding the viral load and transmission.

Tactical steps to be taken to reduce virus transmission

  • Sanitization and hand washing
  • Herd Masking
    When the entire community wears a mask, it provides an effective transmission barriers against the spread of disease. Use of mask by both carrier and healthy contact can reduce transmission from 90% to 1.5%.
  • Social distancing
    Maintain at least 6 feet distance in your work and social interactions.
  • Greeting
    Avoid handshakes, touching, kissing and hugging. The Indian ‘Namaste’ is the best form of greeting.
  • Duration of exposure
    Limit duration of interaction with each person. Keep  interactions as brief as possible.
  • Avoid indoor spaces. As far as possible, interact outdoor or in large ventilated spaces.
  • Avoid public bathrooms and restaurants
  • Avoid large gatherings, parties, weddings concerts and cinema halls.

Herd immunity

When a herd moves, it keeps the weakest in the centre to protect them from invasion. We should keep the elderly, diabetics, hypertensive, and people with low immunity protected. While the young and healthy should move out, the vulnerable population should continue to restrict their movements. Look after your elders. Over time the elderly will get exposure to virus in low doses from the younger family members and develop immunity. Also as more and more people get immune the chain of transmission would be broken and the entire herd would be immune and safe.

Healthy and fit

Times are tough. We need to be physically and mentally strong to tackle them. Our immunity is our shield against the disease. Some steps which will help us to improve our health, fitness and immunity are listed below.

  • Drink lots of water.
  • Avoid excess salt and sugar.
  • Eat protein rich food. Eat small portions. Avoid oily and starchy food.
  • Avoid snacking. Eat lots of fruits and salad.
  • Take your daily dose of Vitamin C, Vitamin D, and zinc. They act as immune boosters.
  • Amla, Chyawanprash, Cod liver oil, green tea and masala tea with spices like basil, cinnamon, ginger black pepper, and cardamom are also said to enhance immunity.
  • It is essential to have an exercise regime with cardio and stretch exercises in your daily routine. This helps in maintaining both physical fitness and mental health.
  • Avoid stress. It can cause unprecedented weight gain, hypertension and diabetes. Practice meditation and count your blessings. A stress free positive attitude is a great immune booster.
  • Get your immunity status assessed. TFPL offers Antibody (IgG) to COVID 19 testing and immunity profiles at economical profiles to help you assess your immunity status. Knowing the immunity status of ourselves, our family and our workers can help us to take proactive steps in the right directions in these uncertain times.

All these steps taken in unison will help us in ‘Keeping the Corona virus at bay’ individually and as a community.

 

Author:
Dr Vibha Tomar
Consultant Pathologist
Tomar Foundation Pathology Lab

 

 

How to be healthy fit and energetic during a lockdown

How to be Healthy Fit and Energetic During a Lockdown

The COVID Pandemic of 2020 has heralded a new era of lockdowns and quarantine the world over. It is a watershed event as it will change the way we socialize, interact, do business, and conduct almost every aspect of our life majorly. Our lifestyles, health, fitness and nutrition schedules will also be affected dramatically. In this article We, at Tomar Foundation Pathology Lab aim to provide tips on how we can remain healthy fit and energetic during the troubled times.

The most important aspect of health is preventing the spread of disease. We must maintain social distancing and lockdown norms. Avoid crowded places. It is important not to touch our face and mouth. Use a face mask, whenever we go out of the house. Wash your hands with soap or sanitizer frequently. Do not touch gates, railings or counter surfaces as far as possible. These practices should become part and parcel of our life even when a lockdown is lifted.

We become what we eat. At such time, when our activity level is low, it is better to avoid oily, starchy, fried and carbohydrate-rich food. These foods will not only add to our weight but make us feel sleepy and lethargic. The following points should be kept in mind while planning our meals.

  • Drink lots of fluid.
  • Avoid excess salt and sugar.
  • Eat protein-rich food.
  • Eat small portions.
  • Eat lots of fruits and salads.
  • Avoid snacking. If unavoidable, eat a limited quantity of healthy snacks.

Take your regular source of Vitamin C and Vitamin D daily. They act as immune-boosters. Amla, Lemon, chyawanprash, and cod liver oil are some good immune-modulators. Alternatively, you may take supplements as advised by your doctor. Green tea and Masala tea (with spices like basil, Black pepper, cinnamon, and cardamom) are also said to enhance immunity.

It is extremely important to take out at least an hour for physical exercise. Follow a strict fitness regime. You may go in for your favorite form of Cardio such as treadmill, static running, static cycling, dancing, Zumba, push-ups, and skipping among many others. They help in maintaining weight and enhancing energy levels. Ayush Mantralaya has advised that some form of meditation/ pranayama should also be included in our daily workout as it is a stress buster and mood stabilizer. Yoga /stretches should also be included as they help the body in remaining flexible. One may customize one’s own personal fitness workout or download a good fitness app to help us with this endeavor. Helping with household chores is also a very good way of increasing our physical activity.

These times are a big challenge to our mental and emotional health. There is uncertainty and the fear that it brings, can be nerve-racking. It is important to remain calm and happy as stress hormones are known to reduce our immunity. Also, stress can cause unprecedented weight gain, hypertension, and Diabetes.

  • It is important to maintain cordial and happy atmosphere at homes. Give space to others.
  • Take out time to meditate.
  • Live in the moment.
  • Count your blessings
  • Develop a daily routine.
  • Develop a new skill to get a sense of achievement.

With a positive attitude and a little discipline, we strive to beat COVID and come out of it fitter and healthier.

 

Author:
Dr Vibha Tomar
Consultant
Tomar Foundation Pathology Lab

 

 

2019 Novel Corona Virus Outbreak – A Comprehensive update

2019 Novel Corona Virus Outbreak – A Comprehensive update

2019 Novel Corona Virus Outbreak was first detected in Wuhan , China, and soon spread to other major countries globally including USA, UK, UAE , Hongkong, Australia among other countries. Over sixty thousand cases have been detected up-to-date. India has also reported three confirmed cases.

It is caused by a new strain of Corona Virus called COVID -19 which is a Beta corona virus. Corona virus are a group of zoonotic viruses that cause disease in animals such as camels, cats and bats. Rarely these viruses can infect humans. Early cases of this disease in China had some link to a large seafood and live animal market suggestive of animal to human spread. Person to person spread has been reported in countries outside China.

Transmission of this virus from person to person is via respiratory droplets produced when an infected person coughs or sneezes and the droplets land on the mouth or nasal mucosa of people who are nearby. It is currently unclear whether a person can get COVID -19 by touching a surface or object that has virus on it .

People who have been in China within past two weeks, caretakers of patients with established COVID-19 infection and health professionals involved in the care of such patients are at serious risk. The incubation period is 2-14 days after exposure. Most patients show symptoms within 5- 6 days.

Patients typically develop mild to severe respiratory illness. Warning symptoms are fever, cough, and shortness of breath and breathing difficulties. In most severe cases, it can lead to pneumonia, kidney failure and even death.

WHO analysis shows that while 82 percent of cases are mild, about 15 percent progress to severe and 3 percent are critical. Most of the fatal cases were in senior citizens and people with underlying conditions like Diabetes and Hypertension. Lab diagnosis is based on Serological tests and Viral culture. Treatment is largely symptomatic.

As there is currently no vaccine to prevent 2019-nCoV infection,the best way to prevent infection is to avoid being exposed to the virus. General public has been issued a list of recommendation by CDC to prevent the spread of infection. Here is the list of do’s and don’ts.

Avoid close contact with people who are sick.

Avoid touching your eyes , nose and mouth with unwashed hands.

Stay Home when you are sick.

Cover your cough or sneeze with a tissue. Discard tissue in trash.

Wash your hands with soap and water frequently.

If soap and water are not available ,you may use alcohol based hand sanitizer with at least 60 percent alcohol.

Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Use of face mask [ CDC guideline ] –

People who are well do not need to wear masks.

People with symptoms of 2019 Novel Corona virus and care takers need to wear mask.

 

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