Q: Is there anything I can do to prepare for having COVID-19?

Is there anything I can do to prepare for having COVID-19?

If you live in the UK you will have realised by now that the government plans to extend the tail of the SARS-CoV-2 epidemic to allow herd immunity to develop and at the same time protecting the most vulnerable people from getting COVID-19 by shielding.

What this means is that most of us (~80%) will become infected with SARS-CoV-2 at some point in the next 6-18 months and a significant proportion of us who are infected with the virus will get symptomatic disease or COVID-19. Therefore you should prepare yourself for getting COVID-19 and potentially severe COVID-19.

If you did get severe COVID-19 is there anything you can do to maximise your chances of surviving the infection and its immune complications? Preparing for a physiological stressor like COVID-19 is called prehabilitation. Prehabilitation is usually used for patients about to have major elective surgery with the objective of reducing the chances of operative and post-operative complications.

So if you have multiple sclerosis a COVID-19 prehabilitation programme makes sense. The following is a list of things I recommend you do:

1. Smoker? If you are a smoker stop smoking. Smokers are 14 times more likely to die from COVID-19 than non-smokers. If this figure doesn’t scare you into stopping smoking nothing will.
2. If you have comorbidities make sure their management is optimised.
3. Hypertension: Check your blood pressure yourself. If it is high see your GP. If you have established hypertension make sure your medications have been adjusted to render you normotensive.
4. Diabetic? Make sure you adhere to your diabetic medication and be extra-vigilant with your glucose monitoring. You may need to check in with your diabetic nurse or diabetologist for advice if your blood glucose levels are all over the place.
5. Obese? Maybe it is time to get back on that diet and lose some weight?
6. Alcohol misuse: If you drink more than the national guidelines is COVID-19 lockdown not time to try and cut back on your excessive drinking? If you have a drinking problem and need help please speak to your GP.
7. Asthmatic? How is your asthma control? If you have bronchospasm you may need to get your meds/inhalers changed. You don’t want to have poorly controlled asthma when you get COVID-19.
8. Sleep-deprived or sleep disorders? It is important you optimise the amount of sleep you are getting. Sleep deprivation is associated with multiple poor health outcomes. PwMS are more likely than the general population to have a sleep disorder. If you use sedatives to sleep you may want to try and wean these as they can affect respiratory function if and when you get COVID-19.
9. Diet? This is a good time to review your diet to see if you can improve it. A healthy balanced diet with as little processed and ultra-processed food is what you should be aiming for.
10. Dietary supplements? It may be a good time to make sure you are vitamin replete. I recommend adults take 5,000U of vitamin D3 per day. In general, if you eat a balanced diet you do not need dietary supplements. However, if you have an unbalanced diet, for example a vegan diet you may need to take extra zinc, iron and selenium. There are theoretical reasons why zinc may help your immune system in COVID-19.
11. Exercise? There is no doubt that being deconditioned or unfit is a risk factor for a poor outcome from many serious diseases. If you are unfit and in lockdown, this would be an opportune time to start exercising with the aim of increasing your fitness. For those of you who are mobile, I have suggested the couch-to-5 programme in the past. If you are not mobile there are upper body exercises that you can do. Ideally, an exercise programme should be personalised with a physiotherapist, but if this is not possible there are pragmatic ways of getting going on your own.
12. Breathing exercises? A lot of HCPs are instructing the general population to start doing deep breathing exercises to increase the ventilation of the little-used parts of the lung. This can be done before or more importantly after you develop COVID-19. The following breathing exercises have been kindly provided by Sally Roberts, a physiotherapist:
    • Start by sitting in a comfortable position- back supported, knees slightly bent.
    • You are going to localise your breathing to the three areas of the chest/lungs in turn.
    • Start by placing your hands on your upper chest with fingers touching your collar bones (clavicle) take two to three deep breaths, breath in through your nose and out through your mouth. Feel your upper chest (apical region) rise and fall as you breath in and out.
    • Next place your hands onto your lower ribs at the sides. If you find it difficult to use the palm of your hand, place the back of your hand against your ribs. Two – three more deep breaths – in through the nose, out through the mouth.
    • As you breath in feel your ribs expand outwards. If you apply a bit of pressure onto your ribs with your hands it will help you to expand this part of your chest.
    • Now place one hand into the soft area between the bottom of your ribs – as you breath in feel the soft part rise and descend on breathing out – again 2-3 breaths in through the nose and out through the mouth. This is using your diaphragm efficiently.
    • If you begin to feel dizzy – take a rest in between each exercise and breath normally.
    • All of these exercises are designed to increase your lung capacity and use areas of the lung you may not use regularly except on physical exercise.
    • If you feel breathless it may help to stand and lean against a support onto your forearms – not gripping – a banister or work surface may be the right height and breath slowly and as deeply as you can.
    • If you have an underlying chronic chest disease e.g. COPD or asthma, you need to consult your respiratory physiotherapist for more detailed or specific advice.
13. Mental health: Anxiety and depression are stressors in themselves and will affect how your body responds to infection. It is important that if you are anxious and/or depressed you get this treated. Exercise, mindfulness (meditation) and cognitive behavioural therapy have all been shown to reduce anxiety and improve depression. These are things you can do yourself. I am aware that it may be hard to address depression and anxiety during the lockdown, but there are things you can do to help yourself; but, if you think you need help can please reach out to your general practitioner and/or MS team.
14. Advanced directives / Living wills: It is important to prepare for things in advance. If you did get severe COVID-19 and needed to go to ITU, possibly be ventilated and receive advanced life support. Is that what you would want? If it is not, make sure this is documented formally with your general practitioner and is included in your medical records. Also, let your family know what your wishes are. It may be a good time to update your will and instructions for your family in the event of you getting severe COVID-19 and passing away. You may want to prepare a folder summarising your medical condition, including your advanced directive, with all the necessary contact details of your next of kin. If you do get COVID-19 and are admitted to the hospital. Also, make a list of things you will need to take to hospital in the event of you getting COVID-19; please don’t forget your mobile charger. Please remember visitors are not allowed for COVID-19 patients so having a functioning mobile phone is an important way of keeping in contact with your family and friends.

Date & Disclaimer: 17-April-2020; please note this information will be time limited and will change as new data emerges.