The COVID-19 pandemic has unleashed devastation and disruption to lives and livelihoods the likes that, we have not seen on our shores since World War II. * The suffering has been abundant and varied. From our senior citizens who are the most vulnerable and beloved members of our communities and families, of which some have either been hospitalised or have sadly passed having succumbed to COVID-19, to those who have been furloughed and are awaiting a verdict on their future with a sense of trepidation, or to those who have lost their job, business and sense of identity that came with the role, position or industry they held or represented prior to the pandemic. This is to say nothing of those suffering from mental health issues; that have been exacerbated due to an enhanced feeling of displacement, isolation and abandonment as a result of this induced lockdown.
This virus has torpedoed the optimism and anticipation that heralded a new year and decade, and in the process has demonstrated itself as nothing short of a pernicious and opportunistic disease.
COVID-19 is a type of severe respiratory syndrome (SAR) caused by a specific strain known as SAR-coronavirus-2 (SAR-COV-2), which is highly infectious. COVID-19 patients present with symptoms almost identical to those of the flu such as; a fever, fatigue and a cough but can also present with a shortness of breath, or anosmia (a loss of smell).
What makes COVID-19 that more menacing and difficult to control, is the fact that 78% of people present as asymptomatic (showing no symptoms) thereby making it impossible to know whether a person is contagious or not. 1
According to the latest figures, as of the time of writing (26th May 2020), the number of UK fatalities from reported cases of patients that have contracted COVID-19 stands at 14%. 2
Those patients with pre-existing conditions are more likely to succumb to COVID-19. Out of the main pre-existing conditions two conditions stand out, diabetes and ischaemic heart disease (IHD), as depicted by the chart created by the Office for National Statistics (ONS) in Figure 1.
Figure 1: Proportion of deaths involving COVID-19 by age, sex and main pre-existing condition in England and Wales, March 2020.
Before the arrival of the COVID-19 pandemic, there was and still is an ongoing diabetes epidemic within the UK that is on course to becoming a crisis in the future. From a report compiled by Diabetes UK, 4.7 million people in the UK have diabetes, equating to one in 15 of the population, with a further one million people within the population living with undiagnosed type II diabetes. 3
According, to this report by Diabetes UK, it is projected that five million people within the UK will have diabetes by 2025. Alarmingly, 90% of those diagnosed with diabetes globally, have the type II variety.
Type II diabetes develops when the insulin response levels are not sufficient in effectively regulating (specifically by clearance) an individual’s blood glucose (sugar) level. This is due to the elevation of insulin levels over an extensive period of time, which subsequently results in cells becoming resistant to the effects of insulin (meaning glucose is not absorbed into the muscle and fat cells within the body). Eventually, insulin production decreases over a sustained period of time, causing the level of sugar in the blood to remain and become too high. This is clinically referred to as hyperglycaemia an (excessive amount of glucose in the bloodstream). The significance of diabetes, in particularly type II diabetes, is that it is a multifactorial disease with a cluster of common pathologies such as; obesity, insulin resistance, dyslipidemia (an abnormal level of fats in the blood) and hypertension, which are collectively referred to as metabolic syndrome.
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Returning to the ONS study, at least one diabetes-associated pathologies; appeared in the top three most common main pre-existing conditions in deaths involving COVID-19 across multiple age groups for both genders. In the male category, a constituent of metabolic syndrome appears as one of the top three causes of COVID-19 related deaths in 10 age groups out of 11 (aged 0 to 90+). Whilst in the female category, one of the common diabetes-associated pathologies was found within the top three of common main pre-existing conditions responsible for COVID-19 related deaths in four out of 11 age groups.
Amongst male category, the leading most common main pre-existing conditions was IHD which accounted for almost 20% (18%) of COVID related deaths in England & Wales in March of this year. Interestingly, the highest incidences of deaths attributed to metabolic syndrome as the common main pre-existing condition in COVID-19 in the female category was seen in middle-aged women aged 50-54, 55-59 and 60-64. 5
Across both genders and all ages groups, diabetes and constituents of metabolic syndrome, accounted for, on average, approximately 16% (15.75%) of deaths in female patients and 20% of deaths in male patients in the month of March in 2020 for England and Wales.
The COVID-19 pandemic coupled with UK’s diabetes epidemic has culminated in a perfect storm. What’s more, both diseases share a common risk factor and affect the same demographics, consequently wreaking synergetic havoc upon specific areas and communities within the country. Both COVID-19 and diabetes share the risk factors of affecting those of advancing age and those from an African-Caribbean and South Asian ethnicity or Black, Asian and Minority Ethnics (BAME); hence making both demographics highly susceptible to both diseases. 6 7
Furthermore, a recent study makes for ominous reading and further compounds the synergistic consequences upon the aforementioned demographics, as it proposes COVID-19 may in fact be a vascular disease given its disproportionate affect on individuals with cardiovascular comorbidities. 8
Diabetes is also a macrovascular disease, responsible for complications such as coronary heart disease (CHD) and strokes; both of which, again, affects an older demographic and BAME groups more.
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In light of these findings and trends, there is a palpable sense of concern regarding a second wave of COVID-19 come the winter season.≠ Nevertheless, as we gradually move towards easing and exiting the lockdown, and enter into the summer, we are afforded a window of opportunity upon which to reflect and assume a renewed sense of responsibility over our lives. There are three key reasons why this opportunity must be proactively utilised.
Firstly, this opportunity must be used for the adoption and maintenance of daily physical exercise or activities. This lockdown has placed a great emphasis on mobility and staying active. It has spurred people to improvise and adapt their lockdown lifestyle in order to incorporate exercise as well as some physical activity that provides some resemblance to the activities they engaged in prior to the lockdown. These efforts should be applauded, encouraged and maintained during and post-lockdown.
Any form of physical activity you undertake makes a considerable difference towards staving off a sedentary lifestyle that plays a major role in the development and worsening of type II diabetes. These forms of exercise needn’t be grand or done by you alone. They can be done socially either with members of your household or with close friends (observing government guidelines). They can range from simple to challenging; whichever is a comfortable pace for you to begin with. So far as you start, it is never too late.
Secondly, we should use this opportunity to review our diet. Our cooking and consumption habits may have, to a degree, undergone a form of change during the lockdown. Our temptation to opt for a convenience meal or takeaway, particularly at the start of the lockdown, may have been curtailed. By doing so, we have reduced the amount of meals, condiments and accompanying beverages that are high in free sugars and salt. Be it out of love, necessity or experimentation, continuing the practice of making home cooked meals allows for you to consciously participate in your meals and account for its nutritional value and conducive effects on your body and well-being.
This is especially important in BAME individuals with or susceptible to type II diabetes or who fall into the at risk category for COVID-19 (those of advancing age, 65+ years). By opting to grill as opposed to fry, or replacing seasoning low in sodium as opposed to using salt or seasoning high in sodium, or by selecting a beverage free from sugars as opposed to established full sugar beverages, you are ensuring that you eat a healthy and well-balanced diet that is very much in alignment with a low to medium glycaemic diet.
This does not only allow you to achieve better control of your blood sugar levels, but it has the strong probability of sending type II diabetes into remission in the long-run. 10
For now, you’d be making a difference, in the short-run, in mitigating the dual effects of COVID-19 and diabetes.
Thirdly, by making a concerted and conscious effort to undertake and maintain physical activity, along with a healthy and balanced diet, you would be taking measures that would pay dividends for our NHS both in the short-run and in the long-run. In the short run, it would improve your chances of recovery, thereby reducing the demand on immediate resources such: as beds, clinical apparatus (ventilation equipment, if necessary) and healthcare staff, in both primary and secondary setting.
Whilst in the long-run it would liberate a sizeable amount of capital§, used to treat complications from a preventable and even curable chronic condition in type II diabetes. This newfound and available capital could then be reallocated towards allowing another patient elsewhere within the NHS access to a novel life-saving medicine. Your actions, unquestionably, would achieve a net benefit of a more robust, fair and economically sustainable NHS.
In closing, COVID-19 and diabetes make for a sinister combination. The effects of both diseases are clinically significant given the susceptibility of an aging and BAME demographic, of which the latter is also susceptible to macrovascular disorders such as cardiovascular disease (CVD), a leading complication of diabetes. However, through assuming responsibility of starting and maintaining physical activity and appropriate dieting, the full effects of both COVID-19 and diabetes can be mitigated somewhat.
The incorporations of these changes to your lifestyle needn’t be sudden or introduced in a manner that causes inconvenience. By starting small, incremental changes develop into habits, those habits become daily routine and hence, those daily routines shape and form our lifestyle. Overall, the desired outcome from this is to preserve and improve one’s chances of surviving COVID-19, whilst also supporting and saving the NHS in the short run and long run respectively.
As lockdown measures are eased and we begin to return to some semblance of normalcy it is vital that during this period we do not become reckless or complacent towards starting and maintaining our sense of assumed responsibility. It is crucial, that we do not allow the synergetic impact of both COVID-19 and diabetes to sweep across this country leaving behind a path of sorrow and devastation in its wake. Finally, it is imperative that we, Nnadi’s Healthcare & Pharmaceuticals, not only help to combat diabetes during this pandemic but continue to offer our efforts after it too. We along with you will assume our responsibility of remaining consistent in our contribution to supporting the NHS now and via its Diabetes Prevention Program as part of its Long Term Strategy Plan, in everyway we can.
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Footnotes:
* To apply context to that statement, we do not mean, nor are we comparing the 75 million recorded fatalities from that campaign against those of COVID-19 in any way. This comparison is made in terms of daily routines and the impact upon the economy.
≠ Despite there being legitimate concerns over the outbreak of a second wave of COVID-19 among the medical community; in depth research analysing epidemic waves argues that it would be unwise to make such claims based on substantial uncertainties and novelty of evidence. Our understanding of COVID-19 is still in its infancy and surveillance is recommended to guide preparedness planning. For more information on this see: CEBM: COVID-19 Epidemic ‘Waves’:
https://www.cebm.net/covid-19/covid-19-epidemic-waves/
§ According to Diabetes.co.uk, it approximately costs the NHS £14 billion a year to treat diabetes and its complications. Breaking this cost down further; it costs the NHS over £1.5m an hour, which equates to 10% of the NHS budget for England and Wales. The NHS currently spends £25,000 a minute on diabetes.
References:
4.
Basciano H, Federico L, Adeli. K. Fructose, insulin resistance and metabolic dyslipidemia. Nutrition & Metabolism.2005; 2:5:1-14.
5.
Office of National Statistics (ONS): Analysis of deaths involving COVID-19: deaths occurring in March 2020 England and Wales; Reference table for trackers.
8.
Varga Z, Flammer AJ, Steiger P, Haberecker, Andermatt R, Zinkernagel AS. Endothelial cell infection and endotheliitis in COVID-19. The Lancet.2020; 395:10234:1417-1418.
10.
Hallerg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reserving Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients.2019; 11:766:1-17