Over the last eight months, the world has become familiar with how COVID-19 affects the human body and spreads. COVID-19 is a respiratory disease that enters into the respiratory tract and poses significant harm to a patient’s lungs. It’s safe to say that the pandemic poses greater risks to those already suffering from respiratory issues.
On the heels of Respiratory Care Week, we’re highlighting efforts to further research and reduction methods for respiratory diseases. Respiratory Care Week is devoted to panels, events, and public awareness efforts that show people what they can do to take care of their lungs, breathe well, and enjoy life longer.
We spoke with Marcelo Vaz, MD, PhD, FCCP, Director of Medical Affairs - Therapeutic Expertise and Sushant Sehrawat, MD, Medical Director - Pulmonology and Intensive Care about COVID-19’s relationship to respiratory care and how we can make sure respiratory care patients are kept safe.
This is the second of two blogs devoted to Respiratory Care Week. Read the first one here.
What is the biggest challenge that people with respiratory issues face, in general and during a pandemic like COVID-19?
SS: The respiratory arena involves many different types of diseases. Some are infectious, some are not. Some develop in children and some develop later. The challenges patients face depend on what kind of respiratory disease they have at a particular point in time. For example, infectious diseases tend to resolve over time, but certain respiratory diseases like Chronic Obstructive Pulmonary Disease (COPD), Bronchial Asthma, and Idiopathic Pulmonary Fibrosis (IPF) don’t resolve. As of now, there is no cure for those diseases, but we can control them to a certain extent and extend the patient’s life. That’s the best that we can do at this point.
Chronic respiratory diseases generally cause a deep impact on patients’ personal lives and families. They impact a patient’s mental health, economic status, their life expectancy, and their productivity. On a wider basis, these diseases have an impact on the society—they reduce the social productivity in terms of respiratory indicators of conditions. For example, where I live in the UK, around 4% of respiratory disease patients have COPD. Globally, COPD is a morbid condition but a killer as well.
The COVID-19 pandemic presents a severe challenge for these patients. They are struggling because people with respiratory diseases are more prone to develop severe COVID-19 infections since they get sick easily. That is why we recommend social distancing and self-isolation. Even though taking those measures helps keep these patients safe, their lives are still affected negatively. For one, their social life is diminished, which can take a severe toll on mental health. For another, their treatment options are now limited. These patients are unable to travel to the hospital for treatment as often as they would normally, since hospitals are advising patients to seek in-home care.
MV: There’s a general lack of understanding about respiratory disease itself and different levels of discrimination that come with that lack of understanding. Younger people in high school or universities must overcome not only the little knowledge they and indeed the broader public have of these diseases, but also the discrimination they may face when it comes to healthcare options.
Patients’ self-esteems are already impacted by respiratory disease just by living their lives. Now, these same patients are experiencing additional stress due to this pandemic, which disproportionately effects patients with underlying respiratory illnesses. For example, in the current climate, when anyone coughs or sneezes, it’s easy to stamp them as a non-self-isolating COVID-19-infected subject.
We end up seeing different reaction levels in people’s behavior. This quick-to-judge mentality is something that can impact the mental health and the wellbeing of regular healthy people. It makes sense that patients with underlying respiratory conditions are experiencing this judgement at a heightened level. This is quite complicated and difficult for us as physicians, because of the lack of public information and awareness about respiratory illness. It’s more complicated for patients though.
People are also concerned how the pandemic affects their own medication and supplies. We never know when a shortage may happen, and it’s important to know what to do in case of an exacerbation. Those patients may need to go through an alternative pathway because the access to their normal route may not be available. On top of all this stress with their existing respiratory diseases and the pandemic, patients are expected to anticipate these additional risks.
Are there any respiratory conditions in particular that have been shown to predispose a poorer outcome for those who contract COVID?
MV: Unfortunately, all respiratory diseases are related to a high risk of contracting COVID. There’s no specific data for how individual diseases may be exacerbated. But I believe it’s common sense that the more severe a patient’s respiratory disease is, the higher their risk of contracting COVID will be.
SS: If the patient already has respiratory complications, they are more prone to develop severe reactions to COVID. It all depends on the severity of the patient’s underlying illness and how the lung is compromised.
How have we combatted the respiratory issues people face when contracting COVID-19 so far?
MV: This is difficult to answer because there are so many different scenarios. I believe that generally, the most important measure we’ve taken is early identification of the infection. The sooner you identify and monitor the virus, the better your chances are to combat the respiratory issues.
Keep in mind that respiratory issues are related to how much viral load you have and how much your immune system is able to properly respond to the virus. We cannot control the viral load and we cannot control individual immune responses. We only react to these characteristics.
What we do know is how much the virus has already impacted your respiratory system. From there, appropriate preventative measures can be taken. But if you feel sick, don’t delay looking for medical care. Call the hotline and find out how to get a test in your area. Call your physician for direction on next steps.
SS: Patients are already participating in clinical trials for COVID-19 vaccines. Within PRA, we are trying to develop a more patient-centric approach to clinical trials. That means more mobile-based technology and virtual trials. With these types of trials, patients don't have to go to sites as often and clinical trials can transition to decentralized methods. That’s how we’ll be able to approach participation in clinical trials—both to combat COVID and any other serious disease that could happen in the future.
How can people protect their respiratory system during the pandemic and going into the flu season?
SS: What is most important for people is to protect themselves, especially people who currently have respiratory issues, and to socially distance. Other than that, staying inside as much as possible is effective.
As far as general protection of the respiratory system, I don't think there are many differences between the pre-COVID and the post-COVID eras. For example, if you talk about a prevalent disease like COPD, adopting a healthier lifestyle is something that we always advise.
It is proposed that the COVID infection is even worse if you already have a flu infection. For this flu season, I would advise that if you’re elderly or have an existing respiratory illness, you should get your flu shot.
MV: Both COVID and flu have similar transmission pathways. When you’re preventing the transmission of one, you’re also preventing the transmission of the other. I believe correctly applying the protective measures laid in place for COVID is the only true way right now to stay safe. To practice these measures, everyone can:
Despite the widespread messaging regarding how to reduce COVID spread, people think those precautions don’t apply to them. Those people then become vulnerable to contracting the disease. Social distancing means that if you have to go out, keep two meters (six feet) apart from everyone else. Stay distant enough to be out of range of infectious droplets.
Use face masks.
This was controversial in the beginning, but lately it’s been recognized that using a mask makes a world of difference. It not only prevents you from spreading the virus to other people, but large droplets from others don’t go straight onto your mouth or your nose. You have at least some level of protection between you and the infectious droplets. And if you do choose to wear a mask, you should use it correctly, having it cover your entire nose and mouth. Avoid touching the mask with your fingers, and if it needs to be adjusted, sanitize your hand before and after touching the mask. Replace/wash your masks frequently.
Maintain general personal hygiene.
Both influenza and COVID are not quite difficult to kill. They can be killed by spending 20 seconds washing your hands or using hand sanitizer with alcohol components . So, before you put your hands on your mouth or your face, wash your hands. If you will be in contact with anything that may be touched by anyone else, sanitize your hands. When you wash your hands, make sure to get not only the tips of your fingers, but your whole hand. Everything potentially exposed to contaminants that may come in contact with your face needs to be sanitized. This means your fingernails, the backs of your hands, the spaces between your fingers, and even parts of your wrist or your arm. Washing your hands for 20 seconds allows proper time for soap to kill the virus.
Recognize that disposable gloves don’t prevent virus transmission.
Wearing gloves does not mean that the glove is self-sanitizing everything that it comes in contact with. It just means that the gloves are protecting your hands from contamination and from the caustic effect of soap. The gloves themselves could then be contaminated, therefore frequent replacement or washing hands may also be needed. Never touch your face with a glove.
Avoid touching high-traffic surfaces.
The virus can live on surfaces like plastic and steel for up to three days, so any surface that you touch that could have been touched by other people may be considered contaminated. Either you sanitize it with chloride-based compounds and clean the surface, or you don’t touch it. If you need to touch it, you should sanitize any part of your body that touched it.
Give special consideration to mobile devices.
These are devices we touch constantly, whether we’re at home or out and about. It’s best to try and not use them outside in locations that could be contaminated. You can also use sanitizing wipes to clean the screens and outer surfaces of your devices before you touch them and put them near your face.
Self-isolate when possible.
This is, in my opinion, one thing that shows how far we’ve come as a society. You do it not for yourself, but to protect others. When you self-isolate, you don’t spread the disease. You prevent anyone from contracting the disease. That’s a level of consciousness and consideration that we all should strive to maintain.
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