LIVING WITH THE ENEMY

How to protect yourself from Covid-19

As temperatures cool and days shorten, the start of autumn is accompanied by a new apprehension of what lies ahead in our battle with Covid-19. Yes, we’re washing our hands, trying to distance and covering our faces, but the stark fact that most of us have not yet had the virus makes it seem inevitable that there will be more cases and, for some, serious complications.

However, much as it may feel out of our hands, there are tactics we can use to help ourselves and loved ones who may be vulnerable, says leading respiratory expert, Professor Claire Shovlin of Imperial College London.

Preparing for illness might sound like a rather gloomy message, but ‘prehabilitation’, as opposed to rehabilitation, is a word that medics are using to describe what will give us a chance of faring better should we contract Covid-19 – or any other illness. It’s an idea that has already been shown to make a real difference for cancer patients facing major abdominal surgery, in whom a programme of fitness and breathing exercises has led to a quicker recovery, with fewer complications.

‘Covid comes in different phases and people experience different elements, but if you develop pneumonia and have to breathe faster or harder, your respiratory muscles will be better at managing this if they have been trained a little through exercise,’ says Professor Shovlin, who thinks that exercise would be a helpful addition to Government recommendations. She adds, ‘It’s not going to help with everything that Covid can cause, but there are some complications where this should help, based on what we know in other settings.’

Common sense can go a long way while we wait for the evidence to guide us

What really makes a difference?

Evidence for the value of pre-conditioning the body comes from programmes such as PREPARE for Surgery at Hammersmith Hospital, London. Venetia Wynter-blyth, the specialist gastrointestinal nurse consultant who set up and oversees the programme, says even two weeks of exercise has been shown to improve heart and lung fitness. And yes, that improvement will disappear if you give up and do nothing after two weeks!

Government recommended amounts of exercise for all ages can be found at nhs.uk/live-well/exercise. This explains more about moderate-intensity activity (which raises your heart rate so you can still talk but not sing; brisk walking, for example) and vigorous activity (which makes you too breathless to speak in full sentences).

What if you don’t enjoy exercise? ‘Think of that old jazz song by Ella Fitzgerald, ’Tain’t What You Do (It’s The Way That You Do It),’ says Venetia. ‘Any activity is better than none, and dog walking, gardening, housework and even going up and down stairs, if performed at an intensity that makes you feel a little breathless, is exercise. Dancing around the kitchen is better than sitting on the sofa.’

Consistency along with intensity is key, adds Venetia. Short, five- to 10-minute bursts throughout the day can be just as effective as an hour of exercise. In fact, it is more beneficial to be active throughout the day than to do a short, sharp burst of exercise and then slump for the rest of the time.

There are no age limits, and those in their 80s have benefited just as much from the PREPARE programme. For anyone who is chair-bound or has limited mobility, any movement at all, rather than sitting or lying all day, will be of huge benefit, advises Venetia. Taking extra steps around the room or using stairs several times a day (even just one step up and down) will help. Simplest of all is a set of breathing exercises (see box overleaf).

Need to know While scientists race for answers, there’s another powerful weapon we possess that can also help us.

‘Common sense can go a long way while we wait for the evidence to guide us,’ says Professor Shovlin. ‘Covid-19 is caused by a virus, and people have had experience of catching viruses before, particularly common colds. Covid is not the same, but many people notice that their immunity to viruses varies. If you know you are more likely to catch a cold if you do certain things, such as missing out on sleep, then these are areas you can address.

‘The same approach applies to thinking what we can do about blood clots, which are a significant complication for some people with Covid-19. We think about prevention of blood clots every time we fly, so you could adapt aeroplane guidance. This advice includes leg exercises that you can do if you start feeling unwell and are in bed, or otherwise limited in mobility. Airline advice also includes keeping your fluid intake up. Staying hydrated is important for people with a fever, as it can be easy to become dehydrated.’

One message Professor Shovlin is keen to get across is that if someone with Covid symptoms is not getting better after a few days, then it is worth going to hospital as there are treatments that can help. ‘The virus has different stages and getting expert help before you become very ill is important,’ she cautions.

Lifestyle clues One of the unsolved puzzles is why some people are at greater risk of Covid-19 than others.

In terms of how we can better help ourselves, Adrian Martineau, professor of respiratory infection and immunity at Queen Mary University of London, is leading a national study called COVIDENCE UK, to discover if lifestyle factors play a part. He would love GH readers to take part by completing an online questionnaire: qmul.ac.uk/covidence. UK residents aged 16 or over are eligible, whether or not you have already had Covid-19.

So far, there are a few tantalising clues, including levels of vitamin D. Made by the action of sunlight on the skin, it is best known for its role in forming strong bones but it also has a function in the immune response.

With regard to Covid-19, Professor Martineau explains: ‘Vitamin D helps cells in the lungs make natural antibiotic-like substances called antimicrobial peptides, which can help to ward off viruses as well as bacteria. Vitamin D is also known to dampen harmful inflammation. We know that people who get very sick with Covid have damaging inflammatory responses.’

He cautions though: ‘Clinical trials with people (not just in test tubes) are needed to know whether supplements might have a beneficial role. It is hoped trials will start in September and people from the COVIDENCE UK study will be invited to take part. We also hope to test levels of antibodies to work out how protective they are.’

Meanwhile, as winter approaches, taking a daily supplement of vitamin D3 is a good idea, as is getting outside each day – current UK guidance recommends everyone considers taking a 400iu (10 microgram) daily supplement all winter.

Experts are debating about

Any activity is better than none; gardening, dog walking and housework all count as exercise

higher amounts of vitamin D3, but too much can be harmful as it can cause excess calcium to build up in the body, which can weaken bones and damage the kidneys and heart.

A second preliminary finding from the COVIDENCE UK study suggests exercise can act as a possible preventative, as well as helping us fare better should we become ill with the virus. ‘It seems people who take regular exercise of sufficient intensity to quicken the pulse and make them out of breath have a lower risk of contracting Covid-19,’ says Professor Martineau. ‘This is not explained by the fact that people with less good physical health may also be less likely to exercise – the analysis adjusts for underlying physical health, so the effect of exercise seems to be independent of that.’

Clean air tactics Opening windows and using extractor fans reduces indoor air pollution and also has relevance to Covid-19.

Jonathan Grigg, professor of respiratory and environmental medicine at Queen Mary University of London and a member of the Committee on Medical Effects of Air Pollutants, says it is increasingly likely that air pollution increases vulnerability to Covid-19 infection. His research has proved that high levels of air pollution lead to increased bacterial infections, such as pneumonia. Now his laboratory research indicates pollution particles from traffic may also increase vulnerability to Covid-19. For this reason, he believes preventing the most polluting traffic from re-emerging on to our roads should be part of Government Covid-19 policy. We can all play a part here, too, by holding on to those lockdown habits of walking or cycling, instead of using the car for short trips. When it comes to cleaner air indoors, some air purifier manufacturers are claiming they may trap the virus, but this has not been scientifically proven. More effectively, for cleaner air at home, avoid using aerosol products that release Volatile Organic Compounds (VOCS). These are chemicals found in a range of household, decorating and personal care products that have been shown to be harmful for lung health. Formaldehyde is also a VOC commonly used in furniture, carpets, flooring and shelving, but must be listed under EU regulations, so check the labels. Finally, try to avoid HBM. No, not another virus, but Hearsay Based Medicine. Yes, it can be confusing as rules change and new findings emerge but, as Professor Shovlin points out, while science still seeks certainties, common sense can stand us in good stead.

Getting outside for a daily dose of vitamin D is vital