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Published on: May 15, 2020
4 minute read
By: Dr Rajan Choudhary

Living With COVID And Returning To BAU!

Hurdles to Business As Usual – Hurdles to Life as Usual – Living with COVID!

Obstacles to re-open the country

As we come to the 2-month mark of lockdown, its effect on the populous is becoming apparent. The extreme restrictions have had a significant impact on people’s physical health, mental health, and general livelihood, and many people are itching for life to get back to normal. Many countries including New Zealand, Germany, Italy, and Spain have seen the first peak of COVID infections pass, and some have already begun reopening parts of their economy. This has led to concerns from public health officials that relaxing the lockdown too early and too liberally will lead to a rapid increase in infection rates. Indeed, Germany has already seen an increase in R0 above 1 (one infected person will infect more than one person, causing the disease to propagate).

Trying to work out how to reopen a country without causing another spike in COVID deaths is probably the biggest issue faced by public health officials across the world. And trying to convey clear instructions to the public is an issue some countries are currently struggling with. In the next few blogs we will look at the issues faced, what has worked and what needs improvement, and what we as the public can do to keep ourselves safe.

THE MASKS WE WEAR

We have discussed masks at the start of the pandemic, and we have discussed masks as the pandemic has progressed. Why are we bringing it up again?

Masks have been a heated point of contention, but their role in public health has matured over the past few weeks. At the beginning of the pandemic, masks were a rare commodity, with DIY stores running dry of masks, stories of people stealing masks from clinical environments, and very confusing advice on whether the public should wear masks in public.

At that time the WHO had recommended only infected patients and those working with infected people wear masks, to save on the precious PPE for medical professionals. N95 respirators are seen as the gold standard in protective equipment, and hospitals are still struggling to provide staff with enough respirators, let alone the public. Concerns have also been raised on whether using masks will provide a false sense of security, especially if they stop washing hands or touch the infected parts of the masks.

But now we are past the first COVID peak, and advice on masks has changed. People should wear a mask if they are in public. Germany has implemented this advice, as has Austria for its public markets. In the US many stores are requesting public wear masks before entry. Rather than surgical masks or respirators, the use of homemade or purchased cotton masks has been encouraged.

LET’S LOOK AT WHY

Surgical masks and respirators aim to protect the user from inhaling microscopic aerosolized COVID particles. Cotton masks do not function this way. Instead, they prevent the wearer from spreading COVID by catching much larger droplets that is coughed/sneezed or generally breathed out.

The majority of people with COVID-19 are able to spread the infection to others up to 3 days before they show symptoms. Indeed as many as 50% of infections seem to occur from pre-symptomatic individuals. During this time they produce the greatest amount of viral particles, and these particles can stay in the air for several hours. Someone with asymptomatic COVID walking around in public or in a shop could infect lots of people.

So wearing a mask, even if you are not symptomatic or around infected patients helps prevent the spread of the infection. We know already just how infective COVID-19 is, so any measures that reduces infection even a little will end up reducing spread drastically on a population level. It has been compared to seatbelts – one person might not feel the benefits, but they save thousands of lives across the country on a yearly basis.

IS THERE ANY EVIDENCE?

In our blogs, we often talk about the importance of evidence. We look at the quality of evidence, how different types of research gives good and bad evidence, and why we should always give evidence-based advice.

So is there any evidence supporting masks? We have evidence that cloth masks can stop 99% of droplets that are coughed up, and whilst it doesn’t block aerosols or actual viral particles it still has a significant impact on transmission. We also have strong evidence from high infectivity in choir groups and at call centers that the majority of transmission is via the air, rather than from surfaces.

But what about the highest level of evidence? Comparing people who do or don’t wear masks is not a study that can be easily performed or one that has been performed adequately. But why should you wait? There is minimal to no risk associated with wearing a cloth mask, it offers some protection to you and a lot of protection to the public. In these cases, we should take a precautionary approach.

We don’t have any high-quality evidence looking at hand washing or physical distancing. But precautionary measures enforced have helped reduce infectivity. The same applies to masks. The best we can offer is an Australian study looking at mask use during influenza. They found observational data suggest that transmission of viral respiratory infection was significantly reduced during the SARS epidemic with the use of face masks as well as other infection control measures” and “in an adjusted analysis of compliant subjects, masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.”. In compliant users, masks were highly efficacious.

So that’s our advice. If you're going to go out in public, wear a mask.

If you don’t have a mask, you can order one online. Or be adventurous. Make one out of an old T-shirt or sock. Here are some ways to make one without needing to sew.

https://www.theguardian.com/us-news/2020/may/11/make-non-medical-coronavirus-face-mask-no-sewing-required masks

https://www.youtube.com/watch?v=r51YroAFPds DIY Face Mask

MORE INFORMATION

https://www.fast.ai/2020/04/20/skeptics-masks/#mightnt-people-handle-their-masks-wrong-and-make-things-worse Masks - FAQ

https://www.bmj.com/content/369/bmj.m1435 face masks for the public

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30918-1/fulltext wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity

https://twitter.com/trishgreenhalgh/status/1253244613927874560 twitter trisha

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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World Heart Day: Top 10 Heart-Healthy Foods to Include in Your Daily Diet

As we celebrate World Heart Day, it’s essential to reflect on the health of our most vital organ—our heart. Cardiovascular diseases (CVDs) remain a leading cause of death worldwide, and while genetics do play a role, our diet has an enormous influence on heart health. Fortunately, small changes in what we eat can have a big impact on reducing the risk of heart disease and improving overall wellness. In this blog, we’ll explore the top 10 heart-healthy foods to include in your daily diet. These foods not only contribute to maintaining a healthy heart but also help in preventing heart disease and managing cholesterol levels.

1. Why Your Diet Matters for Heart Health

Our food choices directly affect our hearts. A poor diet can lead to high cholesterol, high blood pressure, and even diabetes—key risk factors for heart disease. Adopting a diet rich in heart-healthy foods can make a substantial difference in heart disease prevention.

In fact, the World Heart Federation emphasizes diet as a critical factor in reducing the burden of cardiovascular disease. But what foods should we focus on? Here’s a list of foods known for promoting heart health.

2. Top 10 Heart-Healthy Foods to Include in Your Daily Diet

1. Oats

A daily bowl of oatmeal is one of the simplest steps you can take to reduce your risk of heart disease. Oats are rich in soluble fiber, which helps lower LDL (bad) cholesterol. Studies show that consuming oats regularly can have a significant effect on cholesterol reduction within just a few weeks.

2. Fatty Fish (Salmon, Mackerel)

Fatty fish like salmon and mackerel are high in omega-3 fatty acids, which reduce inflammation and lower triglycerides. Including fish in your diet at least twice a week is one of the most recommended strategies for improving heart health. Omega-3s help maintain a steady heartbeat and keep your arteries free from blockages.

3. Almonds

Almonds are packed with heart-healthy fats, fiber, and plant sterols that help manage cholesterol levels. A handful of almonds a day can reduce LDL cholesterol and protect your arteries from inflammation. They also contain magnesium, which helps prevent the development of high blood pressure.

4. Avocados

Rich in monounsaturated fats, avocados are known to improve heart health by lowering bad cholesterol levels while boosting good cholesterol (HDL). This fruit is also high in potassium, an essential mineral for controlling blood pressure.

5. Leafy Greens (Spinach, Kale)

Leafy greens are loaded with vitamins, minerals, and antioxidants. The nitrates found in greens like spinach and kale help reduce arterial stiffness and improve blood flow, which in turn lowers blood pressure and promotes better heart health.

6. Berries (Blueberries, Strawberries)

Berries, particularly blueberries and strawberries, are loaded with antioxidants, which help reduce oxidative stress and inflammation. Several studies have linked berry consumption to lower blood pressure and a reduced risk of heart disease.

7. Olive Oil

A staple in the Mediterranean diet, olive oil is rich in monounsaturated fats that reduce inflammation and lower cholesterol levels. Replacing butter or margarine with olive oil can help reduce your risk of heart disease significantly.

8. Legumes (Beans, Lentils)

Beans and lentils are excellent sources of plant-based protein, fiber, and various minerals that help lower blood pressure and cholesterol. Studies show that consuming legumes at least four times a week can lower the risk of heart disease.

9. Tomatoes

Tomatoes are rich in lycopene, an antioxidant linked to a reduced risk of heart disease. Lycopene helps prevent LDL cholesterol from becoming oxidized, a process that contributes to plaque buildup in the arteries.

10. Dark Chocolate (70%+ Cocoa)

Surprise! Dark chocolate, when consumed in moderation, is beneficial for heart health. It contains flavanols, which help improve blood vessel function, lower blood pressure, and increase circulation. Just make sure it’s at least 70% cocoa to maximize the heart benefits.

3. Benefits of Including These Foods in Your Diet

Each of the above foods contributes to heart health in different ways. Whether it’s lowering cholesterol levels, reducing blood pressure, or improving overall cardiovascular function, incorporating these foods into your daily routine can make a significant difference.

For example:

Oats and almonds help lower bad cholesterol.
Fatty fish and olive oil reduce inflammation.
Leafy greens and berries boost antioxidant levels.

4. How to Easily Incorporate These Heart-Healthy Foods into Your Diet

Wondering how to get started? Here are a few simple ideas:

Breakfast: Swap sugary cereals for a bowl of oatmeal topped with fresh berries.
Lunch: Add avocado slices to your salad or sandwich, and drizzle with olive oil.
Snacks: Reach for a handful of almonds instead of chips or processed snacks.
Dinner: Grill some salmon or mackerel, and serve it alongside a fresh spinach salad.
Dessert: Enjoy a small piece of dark chocolate (just a square or two!) after dinner.

5. The Link Between Diet and Heart Disease Prevention

A healthy diet is essential for heart disease prevention. The Mediterranean diet, which emphasizes whole grains, fruits, vegetables, and healthy fats like olive oil, has been shown to reduce the risk of cardiovascular diseases significantly. Moreover, reducing processed foods, sugary drinks, and saturated fats can prevent plaque buildup in arteries, lowering the risk of heart attacks and strokes.

6. Final Thoughts on Eating for a Healthy Heart

Eating for your heart doesn’t have to be complicated. Start small by incorporating one or two of these heart-healthy foods into your diet each week. Over time, these small changes will add up to major improvements in your cardiovascular health. On World Heart Day, take the pledge to care for your heart through mindful food choices.

Remember, what you eat today impacts your heart tomorrow. So, make it a point to prioritize foods good for heart health and build a strong foundation for a healthier future.

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