Coronavirus FAQ: Answering the most frequently asked Covid-19 questions of 2020 - The Daily Guardian
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Answering the most frequently asked Covid-19 questions of 2020

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How serious is Covid-19?

Covid-19 is a highly infectious disease. However, a large proportion of those infected or tested positive either do not develop any symptom or have mild or moderate symptoms. Nearly all people with mild to moderate symptoms recover with supportive care. It can be serious or severe for high-risk populations such as the elderly and those with pre-existing health conditions. However, it is difficult to predict who can develop severe disease. Therefore, everyone should follow preventive measures.

Who is at risk of developing severe illness?

This is not possible to assess with certainty. However, the elderly and anyone with pre-existing health conditions (such as high blood pressure, heart disease, lung disease, cancer or diabetes) appear to develop serious illness more often than others. There is emerging scientific evidence that people with comorbidities are up to twelve times at higher risk of death due to Covid-19 and up to six times more likely to be hospitalised. Men in all age groups are at higher risk than women. Clearly, reducing comorbidities and improving one’s health is key to battling Covid-19. The experience of clinical settings in India indicates that people with two or more comorbidities in any combination, such as diabetes and kidney disease or hypertension and chronic lung disease, are at higher risk of serious diseases. In India, there are an estimated 55 million people with heart diseases and 70 million people with diabetes, which makes all of them high-risk.

Are men at higher risk in comparison to women and if yes, why?

The epidemiological data on Covid-19 cases from different parts of the world as well as India has shown that proportionately more men have tested positive for Covid-19 than women. Of all the Covid-19 deaths in India, 70 per cent of the deaths have been in men. This indicates that men are at a higher risk of suffering from moderate to severe disease. The reasons are not fully understood, and knowledge is evolving. Most likely, it is due to the way in which the immune system of men and women reacts. Researchers have found that in Covid-19, the immune response of men is mostly through cytokines and chemokine (the protective chemicals released by the immune system). The cytokine-based response, while being protective, can be harmful in excess, and results in severe disease, a phenomenon more commonly seen in men. In women, the immune response against Covid-19 is predominantly driven by T-cells. The T-cell-dependent response is more balanced and nuanced. There is more evidence emerging that oestrogen (a hormone in women) may have some protective role against the moderate to severe disease.

There is recent evidence that there could be a post-Covid-19 syndrome in children. How serious is this?

This is still being evaluated. It has been reported from multiple places in the US and is seen in individuals who sort of recovered and then they have a fever, hyper-inflammatory syndrome which affects the skin, intestines, and also results in cardiac dysfunction. Many of these patients require ICU care to support blood pressure. This is a syndrome that has been called multisystem inflammatory syndrome in children (MIS-C) and a case definition has been developed. This is a new disease and knowledge is still evolving. It mimics another similar childhood disease known as the Kawasaki disease.

Can a person be reinfected with Covid-19?

There are not many reports that we can classically categorize under reinfection as of now. To classify any case as reinfection, the genomic sequence of the virus from both episodes should be conducted. There have been only a few such cases of reinfections verified based on genomic sequence out of the 45 million cases reported till the end of October 2020. Based on this information, it is too early to make any conclusive reference. As the pandemic progresses and more and more people recover we may come to know how much of a problem reinfection is.

Does air pollution increase the chance of Covid-19 infection?

There have been studies which have indicated that increased air pollution or PM2.5 level is associated with increase in the morbidity and mortality by 10–17 per cent.2 Pollution causes airway inflammation and predisposes one to infection. More specifically, increase in air pollution results in higher number of cases of chronic respiratory and cardiac diseases such as asthma and chronic bronchitis. These conditions already burden the respiratory and cardiac system of an individual. Thereafter, if a person get Covid-19 infection, it is likely that the already burdened immune system and the inflammation caused by pollution in the system of that individual may not be able to fully handle the disease. Therefore, air pollution is likely to affect the moderate to severe cases of the disease. Studies have reported that the mitigation of air pollution can reduce Covid-19 mortality but can also help in reducing the future mortality.

I keep hearing about mutation in SARS-CoV-2. What does it mean for the severity of disease?

The mutation is a minor change in viral genomic sequence. All viruses mutate which helps them to adapt to continue to infect the human host. SARS-CoV-2 is fairly stable, yet there have been around 15,000 mutations which have been reported till September 2020. But most of these mutations have been in non-significant section of the viruses. There is no evidence that mutations in the various parts of SARS-CoV-2 would alter its ability to cause disease. Current evidence also does not suggest that any significant mutation has occurred to make the vaccines being developed ineffective.

What do we know about the risk of transmission from a confined space?

The study in the journal Science had found that people using long-distance or long-duration shared transport had a high risk of transmission. In fact, this risk was found to be higher than the risk of transmission to those living in the same household. These findings have implications on the use of long-distance mode of travel such as buses and trains.

Are there things I should not do to protect myself from Covid-19?

The key is to follow CABs at all times. A few harmful behaviours like the following should ideally be avoided:

• Smoking (it is the best time to quit smoking).

• Wearing multiple masks (handling of these masks can be challenging and put you at additional risk).

• Taking antibiotics (this is a viral infection, antibiotics do not work).

Is there any special protocol to follow for washing fruits and vegetables?

Wash them thoroughly as you would do otherwise, with clean water. Do not use detergent or other harmful materials on fruits and vegetables. Wash your hands properly after washing fruits and vegetables and avoid touching your face while washing fruits and vegetables.

Can I catch Covid-19 from my pet?

It is a disease transmitted from human-to-human through droplet infection as well as through surface contact. Though there have been a few cases of transmission reported from domestic animals to humans, the details on additional factors are not available for those settings. Studies have found that cats and dogs can get the virus from human beings. Researchers have cautioned against the over-interpretation of these findings. As of now, limited evidence suggests that animals do not contribute to wider spread of infection.

Can Covid-19 be transmitted by houseflies and mosquitoes?

There is no evidence that Covid-19 can be transmitted through houseflies and mosquitoes.

Can Covid-19 spread from shoes?

Evidence available till now indicates that the likelihood of Covid-19 being spread through shoes and then infecting others is low. As a precautionary measure, families with infants and young children should store shoes where children cannot reach them.

Can Covid-19 spread from food? How safe is food ordered from outside?

There is currently no confirmed case of Covid-19 transmitted through food or food packaging. Packaged food and food items are unlikely to transmit the virus. There is no evidence to suggest that Covid-19 is transmitted through food and water. However, considering that the containers we use may hold and transmit the virus to others, it is essential that we remain cautious. Anyone with suspected symptoms like cough and cold should avoid cooking food for others. One should properly clean the surface of the packaged food as a precaution.

Is it safe to receive a courier package?

Yes. Evidence says that the likelihood of an infected person contaminating commercial goods is low. The risk of catching Covid-19 from a package that has moved through, travelled and been exposed to different conditions and temperatures is low. The outer surface of the package should be properly cleaned.

Should one shower after returning from every public place, mall or a hospital?

It is not necessary to shower every time after returning from public places. However, this should be looked at on a case-to-case basis and the risk one poses to family members. If there are high-risk members, it may help to change clothes and take a shower. Every visit to the hospital does not mandate a shower on return but it can be done as a precautionary measure. However, healthcare workers who spend long hours in hospital and potential cases may consider changing clothes and taking a shower on return.

Excerpts from the book, ‘Till We Win’ (Penguin). Dr Chandrakant Lahariya is a medical doctor and leading public policy and health systems expert. Dr Gagandeep Kang is a noted infectious-disease researcher. Dr Randeep Guleria is director of the All India Institute of Medical Sciences, New Delhi. The authors have made an attempt to cite the most updated and reliable sources including peer-reviewed medical journals.

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WARNING SIGNS OF A BRAIN TUMOUR ONE MUST NOT IGNORE

Brain tumour is an abnormal growth of the brain cells. The extra growth inside the brain can exert pressure on the skull, causing life-threatening complications.

Dr Ravi Gopal Varma

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Brain tumour is an abnormal growth of the brain cells. The extra growth inside the brain can exert pressure on the skull, causing life-threatening complications. However, not all brain tumours are malignant. Some can be non-cancerous, benign or harmless masses of cancerous cells that mainly target the structural tissue of the brain. It can start either in the brain, or cancer elsewhere in the body can spread to the brain.

According to WHO guidelines brain tumours are categorized into four grades based on the intensity and abnormality of the cells.

·         GRADE 1: Cells look benign and grow slowly; survival of the patient is likely.

· GRADE 2: Cells look slightly abnormal. The tumor grows slowly and may spread to other tissues.

· GRADE 3: Cells look abnormal. The tumor grows aggressively and tends to recur.

· GRADE 4: The cells look abnormal and spread quickly. Tumour could be life-threatening.

WARNING SIGNS AND SYMPTOMS OF BRAIN TUMOUR

Depending on the type, location, and stage of the tumor, it can cause both physical and mental symptoms. Some of the commonly observed signs and symptoms of brain tumors are

Unusual headache: Headache can be a common symptom. If someone is experiencing an unusual headache, especially a new one that feels localized to a specific part of the head it could be an early indication of a brain tumor. The headache tends to be more severe in the morning. A brain tumor increases the pressure inside the skull, which can lead to inflammation and tissue damage. Hence, severe, persistent headaches can occur. If there are changes in the frequency or intensity of the headaches, one must consult a doctor.

Seizures: They are one of the most common symptoms of brain tumors. The seizures occur when the brain’s normal patterns of electrical impulses are disrupted. It is reported that brain tumor-related epilepsy (BTE) is common in low- and high-grade gliomas. The risk of seizures varies between 60% and 100% among low-grade gliomas and between 40% and 60% in glioblastomas.

Memory loss, Speech difficulties and hearing loss: Brain tumors can affect the stages of creating, storing and recalling of memory. Retrograde amnesia, a state where one can’t recall memories that were formed before the event that caused the amnesia and anterograde amnesia, where one can’t form new memories after the event that caused the amnesia can occur in people with brain tumor. A brain tumor can affect the communication capabilities of a person and can cause difficulties in uttering or producing sounds, finding the correct word, and understanding what others are saying. It can also have an impact on reading and writing. Also, the pressure exerted by a tumor on surrounding nerves may cause hearing loss and imbalance.

Weakness in the hands and legs: Weakness or numbness in the face, arms or legs is a common occurrence in brain tumors. It is caused by brain tumors located in the frontal lobes or the brainstem. Weakness in one foot/leg or both feet/legs can cause difficulty in walking. Hence, one may experience loss of balance while walking.

Sudden shifts in mood or personality: Mood changes are commonly associated with brain tumors located in the frontal lobe. This part of the brain is highly involved in regulating personality and behaviour and it also helps controls a person’s behavior and emotions. Sudden mood change can be seen in persons whose pituitary gland has been affected by tumors. It can cause the gland to under-or overproduce hormones, leading to a hormonal imbalance. Getting to know about one’s diagnosis of brain tumor can greatly affect the mental and emotional state.

WHEN TO SEE A DOCTOR

The above symptoms are a clear indication that one must immediately seek medical help. Upon diagnosis and conducting a range of neurological tests, your doctor will be able to identify and tell you what’s causing the symptoms.

If diagnosed with a tumor, one can identify the types and follow the doctor’s advice. Always remember that early diagnosis and treatment are important to help prevent the tumour from growing.

The writer is the Lead Consultant Neurosurgery & Program Director – Global Centre of Excellence in Neurosciences, Aster Hospitals Bengaluru.

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SHOULD YOU PRACTISE YOGA ON AN EMPTY STOMACH?

If practising yoga on an empty stomach works for you, do that. On the other hand, if you feel like eating something to get a better start to your day, consider something light.

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In this fast-paced world, where we are all trying to cope with the hectic lifestyle, Yoga has become a preferred choice of exercise for many, not only to stay fit, active and agile but also to reduce stress and promote relaxation of the body and mind. With physical exercise, it becomes important to focus on the right nutrition and right diet as well.

So can you or should you practice Yoga on an empty stomach?

Well, there are many claims doing the rounds, with some saying it’s necessary to do yoga on an empty stomach and other’s saying it’s not. Some also consider eating the right breakfast is necessary. However, remember you and only you will know and understand your body, so make sure you listen to it, protect it and celebrate it.

While it is believed, working out in the morning on an empty stomach is the best approach, as you can get the best of your breath work and your yoga practice, nourishing your body allows a deeper yoga practice. It is necessary to have something light before you exercise in the morning to help jumpstart your metabolism. However, remember to avoid eating anything heavy for at least 4 hours before performing any asanas.

If you are looking for a great way to lose more weight, try practising Yoga while on intermittent fasting. It is one of the best morning workouts as it allows the body to use the stored fat as energy and is easy on the body. If you first eat something and then workout, your body will focus more on burning the food you just put into your body instead of your stored fat. Also doing high impact or cardio workouts while on fasts, requires you to burn a lot of energy because of the high intensity workouts. 

In the end, remember everyone’s body is different and reacts differently. What may work for us, will not work for others. It really comes down to observing and understanding your body, listening to what it likes and what it dislikes and what deems fit for you. If practising yoga on an empty stomach works for you, do that. On the other hand, if you feel like eating something to get a better start to your day, consider something light.

The writer is a fitness expert.

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HIGH OPTIMISM LEVELS ARE LINKED WITH LONGER LIFESPAN

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A new study led by researchers at Harvard T.H. Chan School of Public Health has found that higher levels of optimism were associated with longer lifespan and living beyond age 90 in women across racial and ethnic groups.

The study was published in the Journal, ‘American Geriatrics Society’. “Although optimism itself may be affected by social structural factors, such as race and ethnicity, our research suggests that the benefits of optimism may hold across diverse groups,” said Hayami Koga, a PhD candidate in the Department of Social and Behavioral Sciences at Harvard Chan School and lead author of the study. “A lot of previous work has focused on deficits or risk factors that increase the risks for diseases and premature death. Our findings suggest that there’s value to focusing on positive psychological factors, like optimism, as possible new ways of promoting longevity and healthy ageing across diverse groups.”

In a previous study, the research group determined that optimism was linked to a longer lifespan and exceptional longevity, which was defined as living beyond 85 years of age. Because they had looked at mostly white populations in that previous study, Koga and her colleagues broadened the participant pool in the current study to include women from across racial and ethnic groups. According to Koga, including diverse populations in research is important to public health because these groups have higher mortality rates than white populations, and there is limited research about them to help inform health policy decisions.

For this study, the researchers analyzed data and survey responses from 159,255 participants in the Women’s Health Initiative, which included postmenopausal women in the U.S. The women enrolled at ages 50-79 from 1993 to 1998 and were followed for up to 26 years.

Of the participants, the 25 per cent who were the most optimistic were likely to have a 5.4 per cent longer lifespan and a 10 per cent greater likelihood of living beyond 90 years than the 25 per cent who were the least optimistic. The researchers also found no interaction between optimism and any categories of race and ethnicity, and these trends held true after taking into account demographics, chronic conditions, and depression. Lifestyle factors, such as regular exercise and healthy eating, accounted for less than a quarter of the optimism-lifespan association, indicating that other factors may be at play.

Koga said that the study’s results could reframe how people view the decisions that affect their health.

“We tend to focus on the negative risk factors that affect our health,” said Koga. “It is also important to think about the positive resources such as optimism that may be beneficial to our health, especially if we see that these benefits are seen across racial and ethnic groups.”

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Social isolation is a key reason for dementia

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Scientists have found that a major reason for dementia is social isolation, which causes changes in the brain structures associated with memory, according to a study by the University of Warwick.

Setting out to investigate how social isolation and loneliness were related to later dementia, researchers at the University of Warwick, University of Cambridge and Fudan University used neuroimaging data from more than 30,000 participants in the UK Biobank data set. Socially isolated individuals were found to have lower gray matter volumes of brain regions involved in memory and learning.

The results of the study are published online today (June 8, 2022) in Neurology, the medical journal of the American Academy of Neurology, in a paper entitled “Associations of social isolation and loneliness with later dementia” by Shen, Rolls, Cheng, Kang, Dong, Xie, Zhao, Sahakian and Feng.

Based on data from the UK Biobank, an extremely large longitudinal cohort, the researchers used modelling techniques to investigate the relative associations of social isolation and loneliness with incident all-cause dementia. After adjusting for various risk factors (including socio-economic factors, chronic illness, lifestyle, depression and APOE genotype), socially isolated individuals were shown to have a 26% increased likelihood of developing dementia.

Loneliness was also associated with later dementia, but that association was not significant after adjusting for depression, which explained 75% of the relationship between loneliness and dementia. Therefore, relative to the subjective feeling of loneliness, objective social isolation is an independent risk factor for later dementia. Further subgroup analysis showed that the effect was prominent in those over 60 years old.

Professor Edmund Rolls, the neuroscientist from the University of Warwick Department of Computer Science, said: “There is a difference between social isolation, which is an objective state of low social connections, and loneliness, which is subjectively perceived social isolation.

“Both have risks to health but, using the extensive multi-modal data set from the UK Biocomputational scbank, and working in a multidisciplinary way linking sciences and neuroscience, we have been able to show that it is social isolation, rather than the feeling of loneliness, which is an independent risk factor for later dementia. This means it can be used as a predictor or biomarker for dementia in the UK.

“With the growing prevalence of social isolation and loneliness over the past decades, this has been a serious yet underappreciated public health problem. Now, in the shadow of the COVID-19 pandemic, there are implications for social relationship interventions and care — particularly in the older population.”

Professor Jianfeng Feng, from the University of Warwick Department of Computer Science, said: “We highlight the importance of an environmental method of reducing the risk of dementia in older adults through ensuring that they are not socially isolated. During any future pandemic lockdowns, it is important that individuals, especially older adults, do not experience social isolation.”

Professor Barbara J. Sahakian, of the University of Cambridge Department of Psychiatry, said: “Now that we know the risk to brain health and dementia of social isolation, it is important that the government and communities take action to ensure that older individuals have communication and interactions with others on a regular basis.”

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Controlling body weight in early life can prevent male infertility later

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Controlling body weight more carefully during childhood and adolescence can be helpful in preventing male infertility later in life, suggests the findings of a recent study.

The researchers will be presented at the Endocrine Society’s annual meeting in Atlanta, Ga. The study finds that children and adolescents with overweight or obesity, or those who have high levels of insulin or insulin resistance tend to have smaller testicles compared with their peers with normal weight and insulin levels.

“More careful control of body weight in childhood and adolescence may help to maintain testicular function later in life,” said lead researcher Rossella Cannarella, M.D., of the University of Catania in Italy.

The prevalence of male infertility is increasing, and the average sperm count has been reduced by half in the past 40 years worldwide for no apparent reason, she said.

Testicular volume (a measure of testicle size) is directly related to sperm count. This means smaller testicles tend to produce less sperm. Up to one-quarter of young men aged 18-19 have low testicular volume or smaller-than-normal testicles. This puts their future fertility at risk, Cannarella said. At the same time, the prevalence of childhood obesity has increased.

“This evidence suggests a possible link between childhood obesity and the high prevalence of low testicular volume in youngsters,” she said.

To look for a possible link between low testicular volume and obesity, the researchers assessed testicular volume in 53 children and teens with overweight and 150 with obesity. Their results were compared to 61 age-matched healthy peers. The boys and teens with normal weight had a significantly higher testicular volume compared to their peers with obesity or overweight.

The study also looked at the relationship between obesity-related metabolic abnormalities, such as insulin resistance and hyperinsulinemia, on testicular volume. Insulin resistance is an impaired response of the body to insulin, resulting in elevated levels of glucose in the blood.

Hyperinsulinemia is abnormally high levels of insulin in the body. Children and teens with normal insulin levels had significantly higher testicular volume compared to those with hyperinsulinemia. Post-puberty teens with insulin resistance had lower testicular volume compared to those without insulin resistance.

“These findings help to explain the reason for the high prevalence of decreased testicular size in young men,” Cannarella said. 

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‘Inadequate nutrition puts male runners at risk of stress fractures’

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Male runners who do not receive enough energy from their diet can be at risk for stress fractures, according to a new study.

The findings of the study will be presented at the Endocrine Society’s annual meeting in Atlanta, Ga. “Our findings indicate that male runners, including recreational runners, should be counselled on the importance of adequate nutrition and caloric intake to optimize hormones, body composition, and bone health and to prevent stress fractures,” said lead researcher Melanie S. Haines, M.D., of Massachusetts General Hospital in Boston, Mass.

Female athletes with undernutrition are at risk for low bone density and stress fractures, Haines noted. “However, it is unclear whether a similar process occurs in male athletes,” she added.

The researchers enrolled 15 male runners and 16 male non-athlete controls, aged 16-30 years. They assessed their bone density, body composition and blood hormone levels. They found that bone density of the tibial cortex, or outer shell of bone of the lower leg, was lower in athletes than controls. This may increase the risk for stress fractures in male runners, which occur in this outer shell of bone. Lower weight and muscle mass, and lower levels of hormone associated with fat mass (such as leptin and estrogen) were associated with lower bone strength in the lower leg.

“We suspect that a subset of male runners may not be fueling their bodies with enough nutrition and calories for their high level of physical activity. The undernutrition that results negatively affects hormones and bone. Just getting enough calcium and vitamin D is not enough to overcome other macronutrient and micronutrient deficiencies,” Haines notes. Hormones are very important for bone health and strength. Abnormal hormone levels in the body can contribute to low bone density and increased fracture risk. The Endocrine Society recognizes that there are a number of risk factors for poor bone strength in young men, including low body weight or losing too much weight, diets low in calcium, low vitamin D and testosterone levels, and eating disorders.

Male runners, including recreational runners, should be counselled on the importance of adequate nutrition and caloric intake.

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