Managing Daily Life During the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic has fundamentally changed our lives and the way society functions, likely having lasting effects. Without a doubt, trying to maintain a normal routine is difficult. It’s even more challenging for individuals with chronic diseases and disorders, as the very support systems they need – that is, the healthcare system – are focusing resources and efforts toward looking after patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

What is the coronavirus?

COVID-19 results from SARS-CoV-2, which belongs to a broad group of viruses known as coronaviruses.¹ A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. They can infect humans and animals, depending on the type of virus. Coronaviruses in humans are common and usually cause symptoms similar to those of the common cold. However, SARS-CoV-2 is a new virus originating in China from an animal coronavirus that spread to humans as announced on December 31, 2019. Only two other specific coronaviruses have a similar infection pattern (animal to human): severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The SARS-CoV-2 virus is highly contagious and COVID-19 can lead to severe disease and death. There is great variance in the percentage of population with the virus worldwide and there are great variances in death rate. This is why most countries are imposing strict physical distancing rules. Only time will show the true impact of this novel virus.

Tracking the Virus and the Race to a Vaccine

Several factors make this disease extremely challenging to address. For starters, there is currently no approved vaccine to prevent COVID-19, therapy to treat it, or way to stop its spread other than physical distancing and personal protective equipment. Pharmaceutical companies and governments across the globe are racing to develop effective treatments for the disease. Check out Canadian research efforts at Innovative Medicines Canada.

There are many unverified stories in conventional and social media that might lead you to changing your treatment routine; however, we strongly recommend that you do not stop any of your medications without the advice of your physician. Please do not respond to any current advertisement or marketed product alleged to prevent or treat COVID-19, unless you hear that Health Canada has approved it and your physician recommends in it your individual case. Opportunistic charlatans might be trying to make money from our fear of the disease and products they are selling might result in side effects – or worse – hospitalization or death.

Symptoms of COVID-19 typically take 5-8 days to appear in an infected individual, but can take up to 14 days, and might initially display similarly to the common cold or flu but then become more severe. They can be vague and non-specific, but can include:

• fever
• tiredness
• dry cough
• difficulty breathing
• pneumonia in both lungs

Some may experience:

• aches and pains
• nasal congestion
• runny nose
• sore throat
• gastrointestinal symptoms, such as diarrhea^2,3
• diminished sense of smell or taste
• purplish sores on the feet and sometimes on the hands, in children

Individuals with mild symptoms who are otherwise healthy should self-isolate. Seek medical attention if you have a fever, a cough, and difficulty breathing. Call ahead, if possible.

Risk Factors and Disease Trends

Populations who are at an increased risk for severe outcomes of COVID-19 include individuals who:

• are aged 65 and older
• have compromised immune systems
• have underlying medical conditions, such as lung infections/diseases, diabetes, hypertension, heart disease, pulmonary disorders, and obesity⁴
  • with regard to obesity, individuals with a body mass index (BMI) of 40 and above should take extra caution in protecting themselves from infection⁵

According to Health Canada, individuals 60 years of age and older represented the highest rates of hospitalizations (66%) and intensive care unit admissions (63%), showing that older populations tend to experience worse cases of the disease whereas most of the younger populations undergo mild cases with recovery at home (91-98%). By contrast, only 5% of total known cases are individuals 19 years of age or younger, however, since this group tends to be asymptomatic or have mild disease, this information might be skewed. This is only a snapshot in time. As this pandemic continues, the figures will likely change.⁶

Despite slightly more females (55%) infected with COVID-19, men appear to be at higher risk for severe outcomes than do women. This seems to support disease trends in other parts of the globe. In Italy and China, both incidence and mortality rates are higher in men than in women.⁷ However, sex bias in disease outcomes is common. Women live about six years longer than men do on average and chronic diseases are more common in men than they are in women. These might be due to genetic differences between men and women, such as the existence of two X chromosomes in women compared to only one in men and the immune system being stronger in women than in men.

Lastly, there is no known immunity to the disease and evidence is still lacking on whether those who have already been infected can relapse or contract the disease again.⁸

Do medications increase a person’s risk for COVID-19?

Various medications may present an increased risk for contracting the virus or increased risk of severe COVID-19 symptoms.⁹ However, some of these findings are unconfirmed observational trends, not using gold standard research methods. Therefore, unless your healthcare provider recommends that you discontinue a particular treatment regimen, please do not stop taking your medications, especially if they are keeping your condition inactive and/or in remission. This is because doing so might cause a flare-up, increase your risk of complications, and result in hospitalization.

Should You Wear a Mask?

Proper hand washing (at least 20 seconds) and physical distancing are the best ways to prevent the spread of this novel coronavirus. These practices are crucial since infected individuals can also spread the disease by touching materials and leaving droplets containing the virus behind for others to acquire. A study found that the lifespan of the virus on plastic and stainless steel could be up to 72 hours, cardboard for up to 24 hours, and copper for up to 4 hours.¹⁰ Make sure you do not touch the portion of the mask that faces outward as you remove it, and only touch the ear loops or ties.

However, emerging research and Canada’s Chief Public Health Officer support the additional use of non-medical masks for those showing no symptoms.¹¹ Transport Canada has also issued a public notice requiring all individuals travelling by air to wear a non-medical mask or face covering that covers their mouth and nose while on the aircraft and at airport screening checkpoints. Individuals travelling by marine modes of transportation and by rail or bus are strongly encouraged to wear non-medical masks as well.¹²

Health Canada published a page on how to create a non-medical mask or face covering to reduce the spread of disease.

It is very important to follow the advice of the Public Health Officer in your community, as each region has variances in prevalence of the virus and their capacity to handle the more severe side of COVID-19. While it is challenging for all of us to change our routines and go through hardship and worry, we must maintain the rules to keep others and ourselves safe. There are still so many unknowns about SARS-CoV-2. It has the capacity to mutate and this changes how it reacts in humans.

Mental Health and Wellness

Read our new article on Mental Health and GI Conditions for more information.

Experts predict that the COVID-19 pandemic will result in significant consequences to our mental health and wellbeing. You, a friend, colleague, or family member might have already experience COVID-19 and lived through the effects of serious illness and death. We empathize with the tragedy facing these individuals.

Researchers have learned that depression and post-traumatic stress disorder (PTSD) are among the highest reported consequences from past epidemics.¹³ We have seen this occur during the SARS epidemic, during which 35% of individuals who survived infections experienced moderate to severe depression.¹⁴ A recent Angus Reid survey found that half of Canadians have felt their mental health worsen during the COVID-19 pandemic.¹⁵ Many Canadians are experiencing financial hardship, perhaps with a loss or reduction in income, and pressures in their families, such as taking care of children or an elderly parent. These all add burdens, especially if you are already battling a chronic disease. Most gastroenterologists have had to postpone gastrointestinal and liver diagnostic tests and surgeries indefinitely while hospitals keep space clear for potential COVID-19 patients, which can add uncertainty to your continuum of care. All these things can play heavily on your mental health. We hope that by searching our website, you might find some answers to your gastrointestinal and liver questions.

Based on a recent survey in China, more than 50% of the population had moderate to severe psychological distress during the COVID-19 pandemic, with many experiencing PTSD and depression due to self-isolation and quarantine. Individuals reported increased levels of binge eating correlated with higher stress levels. Weight gain from emotional eating can negatively influence patients recovering from bariatric surgery and those who recently lost weight from treatment.

As shown above, you should know that feelings of helplessness, distraught, concern, depression, isolation, and boredom are a normal reaction to the pandemic and others are going through the same experiences. Among many other organizations, we are here to help. There are also some techniques you can use to cope during this crisis.

Take breaks from social media, especially the news. It’s difficult to not come across something related to COVID-19 online and it makes up the majority of content in the news. However, the constant barrage of information can be too much. Schedule a short time in your day where you go without an electronic device, such as your phone, computer, TV, or radio.¹⁶

Think of ways you can make use of your spare time. Are there projects or things you’ve always wanted to do but felt like you never had the time for? Journaling can also help by reflecting on the positive things in your life right now. Take the time to relax and practice mindfulness by taking deep breaths and meditating. Try to eat healthily, get seven or more hours of sleep per night, and exercise daily. Enjoy fresh air and a change of scenery from the confines of your home by taking a short walk outside, while still practicing physical distancing. Finally, if you can’t do something productive because you are too overwhelmed, then forgive yourself and accept the current reality.

Physical distancing and staying home does not mean we no longer have means of staying connected. It isn’t actually social distancing, the phrase initially used. Check in on your friends and loved ones virtually, by phone or video call. Now, more than ever, we need each other.

For additional tools and resources, visit Wellness Together Canada. Further supports are also available in your province. Please go to your provincial or territorial government website to learn more.

Medical Appointments

If you have upcoming appointments with your physician and/or healthcare specialist and the meeting is in-person, ask if they can do a virtual meeting instead via video conferencing or a phone call.¹⁷ This best ensures the safety of both parties and practices physical distancing, lowering your risk of infection. Make sure you have all of the important information with you so that the meeting goes as smoothly and efficiently as possible. It may be beneficial to write down all of the symptoms and health issues you would like to discuss as well as a list of medications (including over-the-counter and natural health products) that you are currently taking. If anything worsens with your disorder or disease, please do not hesitate to contact your physician, as you might need treatment now to stop the condition worsening.

If things are serious, do not avoid going to hospital but, if you can, it is best to call and advise that you are arriving so they can prepare for you. Don’t hesitate to call 911 if you have difficulty breathing. There is concern that people who are seriously ill are avoiding the hospital when they shouldn’t be.¹⁸ If you are in the hospital for your appointment, make sure you have a mobile device and its charging cable in case the staff needs to set up a virtual meeting with you at the last minute.

Patient support programs are exploring how they can expand virtual delivery of their services, such as patients who may be able to move to self-administered treatments.¹⁹ This may affect patients with Crohn’s disease and ulcerative colitis who use Humira® (adalimumab). Some clinics are providing virtual training sessions for patients to self-inject at home. Please speak with your care coordinator and/or healthcare provider for more information.

Medications

Please do not stockpile medications and do not buy more supplements or over-the-counter drugs than you usually need. This is crucial since doing so might hurt the healthcare system and lessen supply to those who need it, such as individuals who require it in their daily regimen and those affected with COVID-19. Health Canada and many pharmaceutical companies have issued assurances that drug supplies are not currently in jeopardy. They are in constant communication with partners in production and distribution warehouses to track inventory levels. This will stay stable as long as the demand remains consistent and does not spike due to stockpiling.^20,21

However, to ensure the availability of supply, some government (public) plans have mandated that pharmacies only provide a 30-day supply for prescriptions.²² As a result, you will need to make sure you will have your next month’s supply ready for refill before your current medications run out. Some pharmacies have mobile and/or online tools to help you access your medications on time. Check with your local pharmacy to see if this is an available option for you.

Outlook

Unfortunately, there are no definitive answers on how much longer we will all have to practice physical distancing. The development of a vaccine requires mass production and wide distribution, adding to our timeline. Additionally, the pandemic is teaching us many lessons about the fragility of various aspects of our social support systems and the necessity of a strong healthcare system, especially support for our seniors. On the other hand, we are witnessing the rapid transformation of our healthcare system in adopting technology and virtual programs. Communities have come together during these difficult times to help one another. Many companies, organizations, and individuals have stepped up to donate medical supplies, relieve customers of monthly bills, and provide food and shelter to those in need. Despite our circumstances, we have shown an incredible amount of strength and care for one another.

We wish you all the best as you endure this pandemic. Stay safe and stay well.