heart care foundation was established on the world heart

Heart Care Foundation was established on the World Heart Day of 2005. In a span of over 15years the Foundation was able to launch and run successfully the following projects in thefield of heart care in the State of Kerala.

Save 1000 hearts,1000 lives,1000 families

Save a life,Save a lifetime

Installation of AED’s(Automated ExternalDefibrillator)

Caring hearts’a quarterlyMagazine

Heart BandsLife time achievement award’for eminent doctors in thefield of Cardiology.

World heart day(September 29)Celebration

Hrudayasangamam Socialexcellence award

‘Hridayapoorvam,Alangad’

Dear Friends in Heart Care Foundation

I am writing to you during a time when the entire world is goingthrough an unprecedented pandemic which has adversely affectedeveryone and every organization, one way or another. COVID19pandemic, which first appeared in the world at the end of 2019, hasravaged us for more than 9 months. Despite the best efforts by theGovernments the spread of virus is unabated and it’s projected thatby end of September 2020, India will have more than 50 lakh cases

and the world would have approximately 3 Crore cases with over 10 lakh deaths. On thepositive side, various vaccines are in phase 3 trials in different countries and if everything goeswell it is assumed that a vaccine would be ready for commercial use by the first quarter of2021. Until then all of us will have to take precautions by using mask, washing hands usingsoap/sanitizer and maintaining social distance. I am confident that the world will get over thiscrisis too.

Before I dwell further, let me congratulate all the front line warriors that include doctors,nurses, administrators, health workers, sanitary workers and all paramedical staff who havebeen in the forefront fighting the deadly virus with their untiring work and sacrifice. From theperspective of Heart Care, I would like to inform you that long before the COVID19 pandemicaffected us, we have been going through a ‘Silent Pandemic’ in Cardio Vascular Disease.Infact heart disease is still the leading cause of death world over. The pandemic has brought intwo major issues 1) the genuinely sick people with serious heart condition are not able to availtreatment on time due to the restrictions in travel and the fear of contracting the virus. 2) Thelong lockdown has forced people to stay indoors thus denying them any physical activity.These two developments may see a surge in heart related issues in the coming days. I wouldtherefore urge you to take care of your health and resume moderate physical activities and becareful in your food consumption.

As stated earlier, we will come out of this a lot stronger with many lessons learned during thepandemic. Until I write to you next, take care of your health which is the Number 1 priority atthe moment.

Stay Home Stay Safe

Dr. Jose Chacko PeriappuramChairman HCF

JANUARY-SEPTEMBER, 2020|CARING HEARTS|03

Advisory Board Members• Mr. C.J. George• Mr. Alex Muthoot• Dr. V.P.Kuriyipe• Mr. Johnson Mathew K • Fr. Johnson Vazhappilly• Fr.Jose Alex Oruthayapilly• Dr. Junaid Rehman• Dr. V.P.Gangadharan• Mr.Justice(Rtd) Cyriac Joseph• Mr.Justice (Rtd)Kurian Joseph• Mr. Bipin Andrews• Dr. Philip Augustine• Mr. Shibu Philips• Dr. M.R.Rajagopal• Fr. (Dr)Paul Karedan• Mr. E K Premachandran• Adv. Bijoy Cheriyan• Mr. Bindu Madhav• Mr. M.I.George• Mr. John Poomkudy• Mr. Nelson Pavunny• Adv. Peeyus A. Kottam• Mr. M.K.Babu• Mr. K.N.Marzook• Mr. Mathew Tharakan• Mr.Justice (Rtd) K. Narayana Kurup• Mr. Stanley Kunjipalu• Mr. T.A.Varkey• Mr. T.P.Tomy• Dr. Gregor Williams

Trust Members• Dr. Jose Chacko Periappuram (Chairman)• Mr. Raju Kannampuzha (Secretary)• Adv. K.K.Chacko Anathanam• Mr. George E.P.• Dr. Jacob Abraham• Dr. Jo Joseph

Medical Panel• Dr. Rony Mathew Kadavil (Chairman)• Dr. Jayakumar T. K• Dr. Alexander Thomas• Dr. Ali Faizal• Dr. Anand Sreenivasan• Dr. G.Babu Vasudevan• Dr. C.G.Bahuleyan• Dr. Binu Ramesh• Dr. Geevar Zachariah• Dr. George Jacob• Dr. Govindan Unni• Dr. Jaideep C Menon• Dr. V. L. Jayaprakash• Dr. Johny Joseph• Dr. Mathew Abraham• Dr. P.P.Mohanan• Dr. Rajan Joseph Manjooran• Dr. Saji Kuruttukulam• Dr. Edwin Francis• Dr. Thomas Mathew

Editorial Panel• Mr.P.Krishna Kumar (Chief Editor)• Dr. Jo Joseph• Mr. Dinesh P. Thampi• Dr. Nisha Vikraman• Mr. Dominic J. Mechery

Programme Co-Ordinator • Mr.Stephan Pascal

Executive Director• Mr. Dominic J. Mechery

Conceived, Edited & Designed by• [email protected]

C O N T E N T S

03 Chairman’s Message

05 ED’s Message

06 Editor’s Message

07 Covid and children : Dr. Abraham K Paul

10 What is Covid-19?: Dr. Jo Joseph

14 Covid 19: Facts and FAQs: Dr. Rajesh V

18 Corona curbs and the elderly: Dr. C.Nair

21 HCF Statistics

22 Covid and Endocrine: Dr. Jayaprakash P

25 Hridayapoorvam - Alangad

26 Covid 19 and Heart Disease: Dr. Abhilash T.G.

28 HCF Archives

30 Impact of Covid19 on Cardiovascular Disease

31 Zoom Meeting with TCS employees

32 We need your help...

35 HCF Trustees

04|CARING HEARTS|JANUARY-SEPTEMBER, 2020

COVID 19 pandemic has brought regular activities of allorganizations to a standstill; an N G O is no different. In fact NGO’shave suffered the most since almost all the activities of an N G Oinvolved close interaction with people. However, we cannot sit idleeither in these trying times. While programs involving people directlyhas to be kept pending we can think of innovative methods to capturethe attention of general public and our well-wishers. We understandfrom media that during these periods’ even genuine people who fellsick could not avail of medical help fearing the virus and this is goingto be a major challenge once the virus disappears. Even though medicalexperts speak about a balanced medical care this is not happening,since all the resources is currently concentrating on COVID 19.

The COVID 19 pandemic has brought in unprecedented restrictionsand lock downs world over including India. Pandemic also exposed thepreparedness in terms of infrastructure, availability of equipment’s andmedical teams to face a pandemic of this scale, a big learning to allcountries even to the developed countries. In India while we went in fora total lockdown in the initial stages, once the same was relaxed thenumber of persons affected of the virus rose exponentially. Whilewriting this message its projected that number would touch 50 lakh inIndia by September end.

Our Governments must put their heads together in revitalizing primarycare and resuscitating a failing public health system, which was put toextreme tests during the pandemic and is of critical importance in thelong run. It is high time the Government make a provision of 5% of itsG D P for Public health from its current position of less than 2%.Please note most of the developed/developing countries spend 10% ofits GDP on public health. Further, we should have systems in place toface similar pandemics which is for sure will come back. Also thereshould be a proper system in place to analyze the data, for example thedata on the cause of death in some states is as low as 21%.

We have to learn from the positives of pandemic like this and put inplace concrete steps otherwise all what we have learned will be of nouse and we may not have many chances.

Dominic J MecheryExecutive Director


Strange times indeed! Entire world is topsyturvy thanks to the pandemic pandemonium. COVID 19 has unified the world like nothing ever has.

The virus has become so omnipresent that Caring Hearts also is dedicatingan entire issue to understanding COVID and how to live with it.

The last 6 months or so has wreaked unprecedented havoc in our lives,financial and health-wise and for the first time, we witnessed the wholeworld sit and wring their hands without a clue about something. Andeveryone became desperate for some good news, any good news.

Like it happens every time when a disaster strikes, we do get a lot of lessons to take home and Ithink those are the positives that we all should ponder. Containment of the pandemic is definitelybeing done tirelessly by professionals and let them work in peace, Godspeed. Let us reflect onwhat has been happening with and within us, on the positive side.

Doctors have been imploring us to change our habits of food and life-style and we used to ignorethem blissfully. Now, everyone is overly conscious about their hygiene, food, exercise and socialbehavior. Have we ever thought of cleaning our hands so much even though we were taught to doso right from our pre-school? Did we ever give any thought to the junk we were hogging fromevery outlet that we chance upon? Have we ever acknowledged that being a couch potato wasreally not healthy even though it was drilled into us by all that matter? Have we ever had time forour loved ones even though the means of communication exponentially exploded? Now, thanks tothe “new normal” since this March, everything has found a new balance. This definitely is apositive that we should inculcate in future. A lot of values have been re-discovered. Let us not losethem and go back to our old ways please.

Caring Hearts is releasing a special issue this time, obviously on COVID. Apart from Caring justfor the Heart, we have requested the best in the Healthcare field to talk to us, on how COVID isaffecting their area of expertise and they have been kind enough to contribute articles making thisedition of Caring Hearts, another collector’s item.

2020 started with so much hope and promises setting a milestone of sorts and we will foreverdefine our lives as before COVID or after COVID. Generations will talk about the pandemic thathappened in 2020 and we, the survivors will remember 2020 as the year that changed our lives andour life-styles.

We will remember 2020 for the truly heroic and selfless acts of the health-care workers all over theworld who stood tall to take up the challenge of the unknown pandemic, disregarding their ownsafety.

We will also remember 2020 with a pang for all the lives lost and promise ourselves that we willnot let their deaths be just a sad statistic.

Krishna Kumar


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We are in the midst of apandemic caused by novelcoronavirus SARS-CoV-2.

Fortunately, children have been lessaffected in terms of both complicationsand death. Although signs and symptomsare similar to adults, a smaller numberof children tend to be asymptomatic.

Dr. Abraham K Paul,Senior Consultant Paediatrician,Indira Gandhi Co-operative hospital,Kadavantara.

I will highlight some salient featuresconcerning Covid and children.

The prevalence of paediatric cases is2% in US and 2.2% in China.Most ofthe children had exposure to householdmembers with confirmed Covid-19.

Signs and Symptoms

Among children with availableinformation, 73% only had symptomsof fever, cough or shortness of breath,compared with 93% of adults aged 18-64 years. Body pain, sorethroat,headache and diarrhoea where commonsymptoms in adults. These were lesscommonly reported in paediatricpatients. Information on hospitalization,status was available for 29% cases inchildren aged <18 years and 31% casesin adults.

It is observed that children do not alwayshave fever of cough as reported signsand symptoms. They are likely playinga role in transmission and spread ofCovid-19 in the community, thus

emphasising the need for strategies likesocial distancing and everydaypreventive behaviours to curtail spreadof virus.

Preparedness for reopening andconduct of schools during Covid andpost Covid period

It is absolutely important to give correctinformation to children regarding thepandemic, which is essential to preventanxiety and fear among children, anddecreasing stigmatisation of teachersand children infected. WHO andUNICEF have released a joineddocument addressing the issues relatedto prevention of spread of Covid-19 inschools.

Impact of COVID-19 on schools

The resultant impact on the studentsare:

1. Interrupted learning

2. Poor nutrition - mid day noonmeal scheme providing

(Contd... next page)

The prevalence of paediatric cases is 2%in US and 2.2% in China.Most of thechildren had exposure to householdmembers with confirmed Covid-19


significant proteins andcalories is unavailable

3. Confusion and stress forparents and teachers

4. Challenges of e-learning andhome schooling

5. Gaps in child care and higheconomic burden for parents

6. Rising exposure to childpornography, sexual

exploitation and domesticviolence

7. Social isolation

Measures to be adopted by theschool administration

When schools are fully or partiallyopen, COVID-19 prevention andcontrol strategies should bemaintained. The recommended actionsand requirements outlined in thefollowing section are simple and canbe adopted in all schools irrespectiveof the economic discrepancies.

1. Hygiene and environmentalcleaning to limit exposure

2. Physical distancing at school

3. Regular screening and

management ofsymptomatic students,teachers and other schoolstaff

4. Communication withparents and students

5. Additional school-relatedmeasures

6. Regulations to be followedin Residential schools

Physical distancing at school –some tips

Measures given here also addressesthe issues of spacing in schoolsespecially staggering the openinghours and modification of timetable.

a. Maintain a distance of atleast 1 metre betweeneveryone present at school.

b. Increase desk spacing (atleast 1 metre betweendesks), putting dividers inbetween desks, altering thearrangements like a circularclass room, staggeringrecesses/breaks and lunchbreaks (if difficult, analternative is to have lunchat the desk).

c. Modify the timetable, withsome students and teachersattending in the morningsession and others in theafternoon session. Anotheralternative is to have halfthe students attending on 3days of a week and theother half on the other 3days {odd-even plan}.

d. Consider increasing the

number of teachers, ifpossible, to allow for fewerstudents per classroom (ifspace is available).

e. Advise against crowdingduring school pick-up or daycare and if possible, avoidpick up by older family orcommunity members (e.g.grandparents) and staggerarrival and/or dismissaltimes.

f. Move lessons outdoors orventilate rooms as much aspossible (and try to avoiduse of air conditioners,especially central type).

g. Create awareness to ensure

When schools are fully or partiallyopen, COVID-19 prevention andcontrol strategies should bemaintained. The recommendedactions and requirements outlined inthe following section are simple andcan be adopted in all schoolsirrespective of the economicdiscrepancies


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the students do not gatherand socialize when leavingthe school and in their freetime.

h. Cancel field trips, assembliesand other large gatherings.

i. Limit nonessential visitorsand reduce congestion in theoffice.

j. Limit bringing in studentsfrom other schools forspecial programs (e.g.,music, robotics, academicclubs)

k. Parent teacher meetings canbe restructured via phonerather than face-to-face,enabling easiercommunication both ways.

l. Discourage staff, studentsand their families fromgathering or socializinganywhere at places like afriend’s house, a favouriterestaurant, a birthday partyor the local shopping mall.

New systems of learning

We need content and deliverysystems that harness and utilizetechnology to its fullest. Looking atthese challenges of colleges andschools, various initiatives have comeup from the Ministry of HumanResources, Department of TechnicalEducation, National council ofeducational research and training(NCERT) and NGOs.

Some of the new initiatives areSwayam - online courses for teachers,UG/PG teachers for non-technologycourses, e-modules on varioussubjects. National digital library,google classroom and e-Yantra are

other resources. Swayam portalintegrates NCERT textbooks,engineering and non-engineeringcourses and e-books for students. It isa viable alternative and easy learningto grasp the course. The portal wasset up by Government of India nearlytwo and a half years ago and itdefinitely endorses the fact that e-learning may not be a distant dream.

Government has created NationalKnowledge Network, NationalProject on Technology EnhancedLearning (NPTEL), National Missionon Education Through Informationand Communication Technology(NMEICT). These connect easilywith institutions and provide the high-speed band network for educationinstitutes.

Efforts need to be made by all of usto make sure PC/ Desktop/ Mobilefor end delivery are available to everystudent irrespective of the strata ofsociety. Giving away laptops to allstudents studying in 11th standardand above in Tamil Nadu is anexample which shows us that this isfeasible. Future of education is goingto be global teachers, globaluniversity, degrees obtainable fromreputed universities offeringinteresting distant learning contentand a global outlook. Faculty willalso need to stand up to this challengeof integrating technology in theirteaching. Accreditation criteria needreconsideration.

Routine vaccination in

COVID-19 pandemic

Immunisation has been recognised asa core essential healthcare service,and needs to be continued in a safemanner even during the pandemic. A

healthy child undergoingimmunisation does not have anyadditional risk due to the pandemic.On the other hand, immunisation isgoing to protect the child againstvaccine preventable communicablediseases. Immunisation should bedone in separate or segregated OPDsat all levels, be it a private clinic,nursing home or a multi-specialityhospital. The birth dose of vaccinesneeds to be given before dischargefrom the hospital. All the vaccines inthe first year of life are a priorityand should not be postponed.Influenza and varicella vaccines alsoneed to be given. Other vaccines andboosters may be postponed only iflogistics do not permit. All massimmunisation activities should bepostponed to maintain socialdistancing measures.

Effects of the pandemic on childand adolescent psyche

Children are being exposed to aninformation overload and oftenhorrifying news of the effects of thepandemic. They are witnessing highlevels of stress and anxiety amongthe adults around them. Experiencesof the new routine of staying coopedup at home; unable to frequentplaces they have enjoyed, meetfriends, play and engage in activitiesthat they enjoyed, have created asense of insecurity in children evenas young as 2 years of age.Therefore, listening to what childrenbelieve about COVID-19 isessential; providing children with anaccurate explanation that ismeaningful to them will ensure thatthey do not feel unnecessarilyfrightened, overanxious or guilty.



virus that causes COVID-19 is a novel(new) coronavirus. It is not the sameas other types of coronaviruses thatcommonly circulate among peopleand cause mild illness, like thecommon cold. The risk for severeillness from COVID-19 increases withage, with older adults at highest risk.

HOW DOES COVID-19 SPREAD?

The virus that causes COVID-19 isthought to spread mainly from personto person, between people who are inclose contact with one another (withinabout 6 feet for 15 minutes or longer)through respiratory droplets when aninfected person coughs or sneezes. Itmay be possible that a person can getCOVID-19 by touching a surface orobject that has the virus on it and thentouching their own mouth, nose orpossibly their eyes, but this is notthought to be the main way the virusspreads. The best way to protectyourself and to help reduce the spreadof the virus that causes COVID-19 isto limit your interactions with otherpeople as much as possible and takeprecautions to prevent gettingCOVID-19 when you do interact withothers. Those steps include wearing aface covering, maintaining socialdistance of 6 feet and washing yourhands frequently. If you start feelingsick and think you may have COVID-19, get in touch with your healthcareprovider within 24 hours.

What evidence do we have thatwearing a mask is effective inpreventing COVID-19?

There are several strands ofevidence supporting the efficacy ofmasks.

One category of evidence comesfrom laboratory studies of

Dr. Jo JosephMD, DM (AIIMS)Cardiologist,Lisie Hospital,Ernakulam

Coronavirus disease 2019(COVID-19) is a respiratoryillness that can spread from

person to person. Patients withCOVID-19 have experienced mild tosevere respiratory illness, includingfever, cough, shortness of breath,fatigue, muscle or body aches,headache, new loss of taste or smell,sore throat, congestion or runny nose,nausea or vomiting, and diarrhea. The

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The virus thatcauses COVID-19

is a novel (new)coronavirus. It is

not the same asother types of

coronaviruses thatcommonly circulate

among people andcause mild illness,

like the commoncold. The risk for

severe illness fromCOVID-19

increases with age,with older adults at

highest risk


Two compelling case reports alsosuggest that masks can preventtransmission in high-risk scenarios.In one case, a man flew from Chinato Toronto and subsequently testedpositive for COVID-19. He had adry cough and wore a mask on theflight, and all 25 people closest tohim on the flight tested negative forCOVID-19. In another case, in lateMay, two hair stylists inMissouri had close contact with 140clients while sick with COVID-19.

respiratory droplets and the abilityof various masks to block them. Anexperiment using high-speed videofound that hundreds of dropletsranging from 20 to 500 micrometerswere generated when saying asimple phrase, but that nearly allthese droplets were blocked whenthe mouth was covered by a dampwashcloth. Another study of peoplewho had influenza or the commoncold found that wearing a surgicalmask significantly reduced theamount of these respiratory virusesemitted in droplets and aerosols.

But the strongest evidence in favorof masks come from studies of real-world scenarios. Because it wouldbe unethical to assign people to notwear a mask during a pandemic, theepidemiological evidence has comefrom so-called “experiments ofnature.”

A recent study published in HealthAffairs, for example, compared theCOVID-19 growth rate before andafter mask mandates in 15 statesand the District of Columbia. Itfound that mask mandates led to aslowdown in daily COVID-19growth rate, which became moreapparent over time. The first fivedays after a mandate, the dailygrowth rate slowed by 0.9percentage-points compared to thefive days prior to the mandate; atthree weeks, the daily growth ratehad slowed by 2 percentage-points.

Another study looked at coronavirusdeaths across 198 countries andfound that those with cultural normsor government policies favoringmask-wearing had lower deathrates.

Everyone wore a mask and none ofthe clients tested positive.

Do masks protect the peoplewearing them or the peoplearound them?

There’s enough evidence to saythat the best benefit is for peoplewho have COVID-19 to protectthem from giving COVID-19 toother people, but you’re still goingto get a benefit from wearing amask if you don’t have COVID-19.

>>>

>>>


consideration may be comfort. Thebest mask is one you can wearcomfortably and consistently. N95respirators are only necessary inmedical situations such asintubation. Surgical masks aregenerally more protective than clothmasks, and some people find themlighter and more comfortable towear.

The bottom line is that any maskthat covers the nose and mouth willbe of benefit.

The concept is risk reduction ratherthan absolute prevention. Nobody’staking a cholesterol medicinebecause they’re going to prevent aheart attack 100 percent of the time,but you’re reducing your risksubstantially.

If we’re practicing socialdistancing, do we still need to wearmasks?

A mnemonic that is representative ofthe policies during this pandemic the“Three W’s to ward off COVID19:”wearing a mask, washing your

Masks may be more effective as a“source control” because they canprevent larger expelled dropletsfrom evaporating into smallerdroplets that can travel farther.

Another factor to remember, is thatyou could still catch the virusthrough the membranes in youreyes, a risk that masking does noteliminate.

How many people need to wearmasks to reduce communitytransmission?

What the community really want is100 percent of people to wearmasks, but at least 80 percentisneeded to get reasonableprotection. In one simulation,researchers predicted that 80percent of the population wearingmasks would do more to reduceCOVID-19 spread than a strictlockdown.

Even if you live in a communitywhere few people wear masks, youwould still reduce your ownchances of catching the virus bywearing one.

What are the different typesof masks?Professional Respirators

Called N95 respirators, thesemedical devices are made to preventexposure to tiny droplets that canremain suspended in the air. Healthcare workers who wear themundergo a fit-test to find the rightmake, model and size to ensure atight seal. The N95 respirators arecurrently in very short supply andshould be reserved for health careproviders and first responders.

Procedural and Surgical Masks

These are loose-fitting masksdesigned to cover the mouth and nose.

Do surgical masks protect againstcoronavirus?

Although they are not close fitting,blue, disposable masks are fluidresistant and provide some protectionagainst larger respiratory dropletsfrom coughs and sneezes. Primarily,they prevent the wearer fromspreading infectious droplets toothers. Like N95 respirators, thesemasks are used by health care workerswhose safety depends on an adequatesupply. They cannot be washed.

Cloth Masks

According to the CDC, these masksmay help slow the spread of COVID-19, and help keep people who mayunknowingly have the virus fromtransmitting it to others.

Does the type of mask matter?

Studies have compared variousmask materials, but for the generalpublic, the most important

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Used mask should be considered as potentiallyinfected. Masks used by patients / care givers/close contacts during home care should bedisinfected using ordinary bleach solution (5%)or sodium hypochlorite solution (1%) and thendisposed of either by burning or deep burial


hands, and watching your distance.

But of the three, the most importantthing is wearing a mask. There’slittle evidence that fomites(contaminated surfaces) are a majorsource of transmission, whereasthere is a lot of evidence oftransmission through inhaleddroplets.

What is the correct procedure ofwearing triple layer mask?

While wearing a medical mask, thesteps given below needs to befollowed. If you do not follow them,you may get infected from the maskitself.

These steps are:

Unfold the pleats; make surethat they are facing down.

Place over nose, mouth andchin.

Fit flexible nose piece (ametallic strip that can easilybe located) over nosebridge.

Secure with tie strings(upper string to be tied ontop of head above the ears –lower string at the back ofthe neck.)

Ensure there are no gaps oneither side of the mask,adjust to fit.

While in use, avoid touchingthe mask.

Do not let the mask hangingfrom the neck.

Change the mask after sixhours or as soon as theybecome wet.

Disposable masks are never

to be reused and should bedisposed off.

While removing the maskgreat care must be taken notto touch the potentiallycontaminated outer surfaceof the mask

To remove mask first untiethe string below and then thestring above and handle themask using the upper strings.

How to dispose used masks?

Used mask should be considered aspotentially infected. Masks used bypatients / care givers/ close contactsduring home care should bedisinfected using ordinary bleachsolution (5%) or sodium hypochloritesolution (1%) and then disposed ofeither by burning or deep burial.

Introduction

Corona viruses are important humanand animal pathogens. By the end of2019, a novel coronavirus wasidentified as the cause of a cluster ofpneumonia cases in Wuhan, a city inthe Hubei Province of China. Itrapidly spread, resulting in anepidemic throughout China,followed by an increasing number ofcases in other countries throughoutthe world. In February 2020, theWorld Health Organizationdesignated the disease COVID-19,which stands for coronavirus disease2019. The disease was subsequentlydeclared as a global pandemic. Thevirus that causes COVID-19 is

designated severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2). Being a disease known to medicalscience for less than a year, it has tobe admitted that understanding onCOVID-19 is still evolving.

Magnitude of the problem

Since the first reports of cases fromWuhan, cases have been reported inall continents, except for Antarctica.At the time of preparing thismanuscript, global case tally hascrossed 30 million with reporteddeaths nearing 10 lakhs. The reportedcase counts underestimate the overallburden of COVID-19, as only afraction of acute infections arediagnosed and reported.

Dr. Rajesh V,Chief Consultant inPulmonary Medicine,Rajagiri HospitalChunangamvelyAluva – 682 112


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the air over time and distance), butthe extent to which this mode oftransmission has contributed to thepandemic is controversial. Scatteredreports of SARS-CoV-2 outbreaks(eg, in a restaurant, on a bus) havehighlighted the potential for airbornetransmission in enclosed, poorlyventilated spaces.

Period of infectivity

The precise interval during whichan individual with SARS-CoV-2infection can transmit infection toothers is uncertain. The potential totransmit SARS-CoV-2 begins priorto the development of symptoms andis highest early in the course ofillness; the risk of transmissiondecreases thereafter. Transmissionafter 7 to 10 days of illness isunlikely, particularly for otherwiseimmunocompetent patients with non-severe infection. Infected individualsare more likely to be contagious inthe earlier stages of illness. Onemodeling study suggested that

Seroprevalence surveys in the UnitedStates and Europe have suggestedthat actual values exceed theincidence of reported cases byapproximately 10-fold or more. Indiahas more than 50 lakh reported caseswith above 80000 deaths.

Source of The Virus

The closest similarity of SARS-CoV-2 is to bat coronaviruses, and itappears likely that bats are theprimary source; whether COVID-19virus is transmitted directly from batsor through some other mechanism(eg, through an intermediate host) isunknown. Understanding on the modeof transmission is incomplete. InWuhan, at the beginning of theoutbreak, association with a seafoodmarket that sold live animals wasnoted, where most patients hadworked or visited. However, as theoutbreak progressed, person-to-person spread became the main modeof transmission.

Person-to-person spread is thoughtto occur through close-range contact,mainly via respiratory droplets. Virusis released in the respiratorysecretions when a person withinfection coughs, sneezes, or talksand can infect another person if itmakes direct contact with the mucousmembranes (nose, eyes, mouth,respiratory tract etc). Infection mightalso occur if a person’s hands arecontaminated by droplets or bytouching contaminated surfaces andthen they touch their eyes, nose, ormouth. Droplets typically do nottravel more than six feet (about twometers). SARS-CoV-2 can also betransmitted through the airborne route(through inhalation of particlessmaller than droplets that remain in

infectiousness started 2-3 days priorto symptom onset, peaked 1 daybefore symptom onset, and declinedwithin seven days of symptoms.Infectivity of asymptomatic personsis less known.

The risk of transmission varies bythe type and duration of exposure,use of preventive measures, and theamount of virus in respiratorysecretions. The risk of transmissionafter contact with an individual withCOVID-19 increases with thecloseness and duration of contactand appears highest with prolongedcontact in indoor settings.

Personal protective measures

Considering the global pandemicscenario and communitytransmission, personal protectionadvices have been issued by theWorld Health Organisation.

1. Practice social distancing byavoiding crowds, gatherings andmaintaining a distance of six feet(two meters) from others when inpublic

2. Wear masks when out in public.Most individuals in thecommunity can wear a non-medical mask (eg, a cloth orfabric mask). Individuals who are>60 years old or have underlyingmedical comorbidities shouldwear a medical mask, as shouldthose who have symptomsconsistent with COVID-19

3. Diligent hand washing,particularly after touchingsurfaces in public. Use of handsanitizer that contains at least 60percent alcohol is a reasonablealternative if the hands are notvisibly dirty (Contd... next page)

The risk oftransmission aftercontact with anindividual withCOVID-19 increaseswith the closenessand duration ofcontact and appearshighest withprolonged contact inindoor settings


4. Respiratory hygiene (eg,covering the cough orsneeze)

5. Avoiding touching the face(in particular eyes, nose,and mouth)

6. Cleaning and disinfectingobjects and surfaces thatare frequently touched.

7. Ensure adequate ventilationof indoor spaces.

Symptoms

A substantial proportion ofpatients infected with SARS-CoV-2do not exhibit any symptoms or verysubtle symptoms indistinguishablefrom a common viral flu. There areno symptoms that are diagnostic ofCOVID-19. The incubation periodfor COVID-19 may be as long as 14days, with most cases occurring fourto five days after exposure. Fever,cough, cold, muscle pain, body pain,headache, diarrhea, and loss ofsenses of smell or taste, are some ofthe common reported symptoms.Pneumonia is the most frequentserious manifestation of infection,with approximately 15 percent ofpatients developing severe infectionwith shortness of breath and lowoxygen levels. Many othercomplications have been reported,blood clots resulting in heart attack,stroke, kidney failure etc. Mortalityrate has varied between 1-5% ingeneral.

The Lung and Covid-19

Pneumonia appears to be the mostfrequent serious manifestation ofinfection, characterized primarily byfever, cough, dyspnea, and bilateralinfiltrates on chest Xray or CT scan

Diagnostic tests

Diagnostic testing is advised inpersons with consistent symptomswho reside in or have traveled to areaswith community transmission or whohave had recent close contact with aconfirmed or suspected case ofCOVID-19. If possible, allsymptomatic patients with suspectedCOVID-19 should undergo testing.However, limitations in testingcapacity may preclude testing allpatients with suspected infection;suggested priorities includehospitalized patients and symptomaticindividuals who are health careworkers, work or reside in congregateliving settings, or have risk factors forsevere disease. Nucleic acidamplification testing (NAAT), mostcommonly with a reverse-transcriptionpolymerase chain reaction (RT-PCR)assay, to detect SARS-CoV-2 RNAfrom the upper respiratory tract is thepreferred initial diagnostic test. Apositive NAAT for SARS-CoV-2confirms the diagnosis of COVID-19.However, in many symptomaticindividuals, a single negative NAATresult is sufficient to exclude thediagnosis of COVID-19. However, ifinitial testing is negative but the

of the chest. However, other features,including upper respiratory tractsymptoms, myalgias, diarrhea, andsmell or taste disorders, are alsocommon. Although some clinicalfeatures (in particular smell or tastedisorders) are more common withCOVID-19 than with other viralrespiratory infections, there are nospecific symptoms or signs that canreliably distinguish COVID-19.However, development of shortnessof breath approximately one weekafter the onset of initial symptomsmay be suggestive of COVID-19.

Respiratory failure and acuterespiratory distress syndrome(ARDS) are the most dreadedcomplication in patients with severedisease and can manifest shortly afterthe onset of breathlessness. In a studyof 138 patients with extensivepneumonia, ARDS developed in 20percent after a median of eight daysafter the onset of symptoms;mechanical ventilation wasimplemented in 12.3 percent.Although not noted in the majority ofpatients, gastrointestinal symptoms(eg, nausea and diarrhea) may be thepresenting complaint in somepatients.


“W

hat y

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on’t

do

dete

rmin

es w

hat y

ou c

an d

o.”-

Tim

Fer

riss

COVID-19 has been associated withthromboembolic complications.Fever should be treated withtemperature lowering medicines likeparacetamol. Supplemental oxygenshould be given for subjects with lowoxygen levels. Low dose steroidsbenefit patients with hypoxia (lowoxygen). Oxygen delivery via a highflow nasal cannula device has provedto be beneficial in COVID-19. Lyingon the front aspect of the chest(prone position) improvesoxygenation in severely hypoxicpatients. Non invasive or ventilatorysupport may be needed in non-responding hypoxia. Nutrition andgeneral nursing care is of paramountimportance.

There is a healthy degree ofuncertainty on drugs that areeffective for COVID-19. Agents thathave been tried includehydroxychloroquine andchloroquine, azithromycin,

suspicion for COVID-19 remainshigh and confirming the presence ofinfection is important formanagement or infection control, wesuggest repeating the test. Estimatedfalse-negative rates have ranged fromless than 5 to 30 percent. Rapidantigen testing can provide fasterresults although the detection rate ismuch lower than RT-PCR. Serologictests detect antibodies to SARS-CoV-2 in the blood and can help identifypatients who previously had COVID-19. Detectable antibodies generallytake several days to weeks to developand hence serologic tests have lessutility for diagnosis in the acutesetting.

Treatment of COVID-19

The optimal approach to treatmentof COVID-19 is uncertain. Thesuggestions made here are based onlimited data and might evolve rapidlyas clinical data emerges. Manypatients with known or suspectedCOVID-19 have mild disease thatdoes not warrant hospital-level care.Having such patients recover at homeis preferred, as it prevents additionalpotential exposures in the health caresetting and reduces burden on thehealth care system. The evaluation ofhospitalized patients withdocumented or suspected COVID-19should assess for features associatedwith severe illness (severe shortnessof breath, low oxygen, extensivepneumonia) and identify organdysfunction or other comorbiditiesthat could complicate potentialtherapy.

Patients hospitalized with COVID-19 should receive pharmacologicprophylaxis for venousthromboembolism (blood clotting).

ivermectin, Favipiravir, remdesivir,tocilizumab, convalescent plasmaetc. Institutional protocols aredeveloped by many hospitals takinginto account the local prevailingscenario. Growing experience mighthelp us to form evidence basedguidelines and universal protocols.

Vaccines

The global crisis created byCovid-19 pandemic has resulted inan unprecedented research effort andglobal coordination has resulted in arapid development of vaccinecandidates and initiation of trials.There have been difficulties in thedevelopment of coronavirus vaccineshistorically. Coronavirus vaccines inanimal models that mimic humandisease have been immunogenic butgenerally not shown to effectivelyprevent acquisition of disease.Further, there is a concern thatvaccination, as with naturalcoronaviral infection, may notinduce long lived immunity and re-infection may be possible. In someways more concerning has beenvaccine associated diseaseenhancement. Development of newvaccines is a time consumingprocess and 3-5 years is considered ashort time for a new vaccine to becommercially available afterinitiation of research. In keepingwith the primary medical doctrine of“cause no harm”, a candidatevaccine has to go through stringenttests in various phases before it getsapproval nod from regulatorybodies. Even with acceleratedapproval pathways awaiting Covid19 vaccines, the author is pessimisticwith regard to launch of a vaccine inthe next year.

In keeping with theprimary medicaldoctrine of “causeno harm”, acandidate vaccinehas to go throughstringent tests invarious phasesbefore it getsapproval nod fromregulatory bodies


Covid 19 pandemic hascaused heighteneduncertainty and anxiety,

more so among the elderlypopulation.

Scary, frightening, uncertain, no endin sight, no treatment, vaccine/ no

increases anxiety often to a levelbeyond one’s control. Notoriouslyknown as one of man’s worst enemies,anxiety wrecks one’s life.Copingmechanism has to do extra work tocontain anxiety and we end up losinglots of mental energybattlinganxiety.The energy stock gets drainedgradually. Brain networks involved incoping anxiety become weaker andineffective to handle themountingtask.Anxiety which serves positiverole in normal stress reactionoverwhelms the individual, makinghim inactive and inefficient, like anautoimmune disorder where our ownimmune mechanisms work againstourbody parts.

Manifestations of anxiety, from mildto moderate to severe, appeardepending on the efficacy orotherwise of the coping mechanisms.

Dr. M.C. NairDirector – Head of PsychiatryNair’s HospitalKannadikkaduNH – 66, MaraduErnakulum – 682304

vaccine, when, how safe, those above65 and below10 not to venture out,SMS (Social distancing, face Mask,frequent wash with Soap),learn to livewith corona, socialisolation,emotional distancing fromdear ones, job loss, pay cuts or no payare the talk of the ‘new normal’world.It is no wonder that theseuncertainties definitely causeemotional distress in the form ofanxiety. This is a perfectly normalresponse to stressin order to prepareus for fight or flight.

The outpouring information by theoverzealous mediasows the seed ofpanic among the vulnerable,especially the ‘senior- most’ citizensadding insult to injury. However themiddle aged and even young ones areno exception.

Covid 19, replete with uncertainties,


“Be

open

to a

djus

tmen

ts. T

here

’s n

othi

ng a

bout

this

cur

rent

mom

ent i

n hi

stor

y th

at a

llow

s for

stub

born

ness

.” ~

Unk

now

n

help tide over the monotony andimprove emotional immunityrequiredin these days of pandemic.Worryingover the uncertainties related to covid19 will only exacerbate stresswhich isnotorious to reduce immunity.

The older generation has every reasonto be proud.They are a treasure houseof unlimited knowledge andexperience.The fact that they haveexperienced the best and worst ofboth worlds should boost theirconfidence, decision making, helpdevelop positive attitude and enablethem to handle stress with ease.

‘Stay connected’andempower thebrain network.

Remain connected with society:socialise well, communicate withfriends and relatives, organise groupsof likeminded individuals, getinvolved in socially useful activitiesand make an enriched environmentaround them, all the whilemaintaining Covid protocol.Thisstrengthens the fastest network on

It has been observed that the quantumof anxiety and its physical andpsychological symptoms in affectedindividuals are directly proportionalto the duration and impact of socialisolation and fear of virus. Longstanding anxiety on its own isdisturbing to the sufferer and it canalso lead to development of the moredebilitating depressive symptoms,ifnot attended to in time. Very oftenuncontrolled anxiety can be a silentkiller by worsening already existingphysical and psychiatric diseases, afactoften neglected to be emphasized.

How to promote wellness andimprove emotional immunity?

Be Positive.

Do all that one can to improve thecoping mechanisms or in other wordsemotional immunity.Primarily itshould be aimed at reduction of stressand replenishing the energy stock.

Self-esteem, confidence, enthusiasm,energy, and optimism have to bemaintained at an adequate level to

earth,the neural network in the brainwhich isrequired for coping withstress of life.

Mend your mind throughMindfulness activities• Reschedule activities of daily

living to suit the ‘New Normal’world.

• Be Busy• Displace bad thoughts and refill

with new / healthy ones.(readingand indoor games can be goodtools)

• Concentrate in what you do.Remember the saying “ Workwhile you work and play whileyou play” This can help ward offdisturbing thoughts.

• Engage in house hold chores,from cleaning to cooking

• Distract oneself through music,humour, TV and Radio

• Limit exposure to disturbing newsand videos related to thepandemic.

• Engage in Agri- Horticulturalactivities, best among the manyrelaxing exercises. A‘five inone’beneficial activity, it ensuresphysical exercise, emotionalsatisfaction, poison freevegetables for consumption,mindfulness and improvement ofphysical and emotional immunity.(Even if you do not have spacefor a prayer room, find space fora kitchen garden).

• Promote one’s hobbies ordevelop new ones.

• Make humour an integral part oflife, like salt for curry.

• Moderate exercise every day.

• Ensure adequate sleep.


Self-esteem, confidence, enthusiasm, energy,and optimism have to be maintained at anadequate level to help tide over the monotonyand improve emotional immunityrequired inthese days of pandemic


>>>>>>>>>>>>>>>

link http://www.facebook.com/Heart-Care-Foundation-109454360750328

HCFfacebookPage

HCFONAM KitDistributedTaking into consideration the

difficulties faced by the people inview of the COVID 19 pandemic, theFoundation distributed 50 Onam kitswhich included a variety of provisionsfor celebrating the Onam festival to theneedy people of KarumaloorPanchayath. The Onam kits werehanded over to Mr Shiju PresidentKarumaloor Grama Panchayath onAugust 28,2020.

Whether our life will be taken away by corona or other illnessesalready contracted through our life style,we need to take adispassionate approach to life for a peaceful exit.

The following is a poem on Corona and Covid 19 written by a tenyear old child. He has a message to the adults as well.

The Coronavirus is terrible.Covid-19 is danger.But think of what we have done to the Earth.Isn’t that terrible?The lockdown is a chance to think back.To what we did to a defenseless planet.

One virus changed the world.It stopped the outrageous act of humans.The virus made them feel like the Earth being dirtied.The humans felt ashamed and promised that they would stop.Littering, take the earth for granted, and buying unnecessary things.

Covid is not goodBut until we stop hurting the EarthThe virus will not stop hurting the humans

We took everything for granted and we wanted more than what theEarth provided so it decided to punish us with a deadly virus tomake us realize our actions, says the ten year old.


“Not

hing

in li

fe is

to b

e fe

ared

, it i

s onl

y to

be

unde

rsto

od. N

ow is

the

time

to u

nder

stan

d m

ore,

so th

at w

e m

ay fe

ar le

ss.”

- Mar

ie C

urie

(Figures in lakh)

Ischemic Heart Diseases 15.4Chronic Obstructive Pulmonary Disease(COPD) 9.6Cancer 7.8Stroke 7.3Diarrheal Diseases 7.2Lower Respiratory Infections 5.1Tuberculosis 4.5Neonatal Disorders 4.3Asthma 2.5Diabetes 2.5COVID – 19 (as on October 12, 2020) 1.09

Note: All figures except cancer are from WHO’s Global Burden of Diseases.All figures are in annual numbers.Source: Times of India

Interstate comparison of average Per Capita Spending in19 Major States: 2004-5 and 2011-12 (in 2004-5 Prices)

State

OdishaWest BengalGoaGujaratMaharashtraBiharChhattisgarhHaryanaHimachal PradeshJharkhandMadhya PradeshPunjabRajasthanUttar PradeshUttarakhandAndhra PradeshKarnatakaKeralaTamil NaduAverage for 19 States

Total population incrores as per census 20114.109.100.156.0011.2010.302.502.500.683.207.202.706.8019.901.008.406.103.307.20112.33

Per capita healthexpenditure2004-5179205798187348124-189486-164326198150-216231319230230 (All India 304)

Per capita health expenditure2011-12 in 2004-5 prices2382971,790439397183364353970307328438304224528408469282465465 (All India 312)

Source: Column 1: Census 2011, Column 2: NCMH, Column 3: Expenditures incurred by 19 states under the statebudget, the NRHM, the NACP, and the RSBY totallingRs. 60.4 billion. Note: 1 crore equals to 10 million.

TOP 10 CAUSES OF DEATH IN INDIA


The coronavirus (COVID-19) pandemic has impactedhuman life in many ways.

Though caused by a respiratoryvirus, its infection involvesvirtually every organ-system in the

symptoms, enter intensive care units,as well as have an increased risk ofdeath.

COVID AND DIABETES

Diabetes seems to be a risk factor foracquiring COVID and it definitelyincreases the risk for complicationsand death from COVID. Obesity,hypertension, and cardiovasculardiseases are common in people withdiabetes and are all linked withadverse outcomes. Diabetes is presentin 1 out of 3 patients that enterintensive healthcare units, requireventilators, or patients that are non-survivors. On the positive side,patients with good control of diabeteshad significantly lower death rates dueto COVID-19.

We will try to answer some commonquestions regarding COVID andDiabetes

Dr. Jayaprakash PConsultant EndocrinologistMedical Trust HospitalM G Road, Pallimukku,Kochi, Kerala 682016

body. COVID-19 pandemic hasresulted in the biggest disruption tohealthcare delivery in livingmemory. The pandemic has broughtthe entire world’s focus onto healthand perhaps as never before,humankind is collectively worriedabout its health.

There is evidence that peoplesuffering from hormone conditions,such as diabetes, obesity, thyroiddisease and adrenal diseases, face anincreased risk of complicationsofCOVID infection. Studies show that26% of COVID- 19 patients with asymptomatic disease were obese and15% had diabetes, and theseindividuals had worse outcomes andpoorer survival compared to non-obese and non-diabetic individuals.COVID-19 patients with obesity,diabetes, and other chronic diseasesare more likely to suffer with severe

Studies show that 26% ofCOVID- 19 patients with asymptomatic disease were

obese and 15% had diabetes,and these individuals had

worse outcomes and poorersurvival compared to non-

obese and non-diabeticindividuals


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oura

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not

the

abse

nce

of fe

ar, b

ut r

athe

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t som

ethi

ng e

lse

is m

ore

impo

rtan

t tha

n fe

ar.”

- Fra

nklin

D. R

oose

velt

The symptoms of COVID-19 aresimilar to that of the seasonal flu thatmost of us develop. However, since itis highly contagious, you must isolateyourself and practice measures toavoid spreading it to your family andfriends. Please contact the publichealth authorities, who will give youinstructions on how to proceedfurther. Do not travel to the hospitalin your vehicle.

Q4: What should I do with mymedicines if I develop COVID-19?

Continue to manage diabetes, just likeyou were handling it earlier. Do notdiscontinue or modify anymedications without consulting withyour doctor. Strictly do not take any

Q1: Are people with diabetesmellitus at a higher risk ofdeveloping COVID-19 infection?

People with type 1 and type 2diabetes with poor glucose controlmay be at higher risk of developingCOVID-19, similar to any otherinfections. If you contract COVID-19, the risk of severe disease can bereduced by keeping glucose andblood pressure under tight control.

Target Blood glucose levels

Fasting/ premeal - 80- 130mg/dl

2 hours after food - less than180 mg/dl

Avoid hypoglycemia - lessthan 70 mg/dl

Q2: What should I do to avoidgetting COVID -19 infection?

All people with diabetes shouldstrictly follow the public healthguidelines advocated by thegovernment from time to time. Thesemeasures include quarantine/lockdown advice, social distancing,hand washing recommendations, safepractices while coughing or sneezing,and universal use of the mask.

Q3: What should I do if I developCOVID-19 infection?

over the counter medications fordiabetes or COVID-19, includinghydroxychloroquine (HCQS), unlessadvised by your doctor. Since youmay require isolation for suspectedCOVID-19 infection, make sure thatyou have enough supplies of yourmedications (tablets and injections)and glucometer strips for at least amonth. Your targets for bloodglucose control should be as strict asbefore.

Q5: I am a person with type 2diabetes on oral glucose-loweringdrugs? How should I manage mydiabetes if I get COVID-19?

Please monitor capillary glucose(using glucometer) twice daily andsee if you can maintain targets. Ifyou have not made any recentchanges in medicines and yourHbA1c is less than 7%, you canconsider reducing the frequency ofglucose monitoring. See where youfit in and decide on the furthercourse of action.If you are a personwith type 2 diabetes on insulin, youwill need to take all precautions


All people with diabetes should strictly followthe public health guidelines advocated by thegovernment from time to time. Thesemeasures include quarantine/lockdownadvice, social distancing, hand washingrecommendations, safe practices whilecoughing or sneezing, and universal use of themask


similar to people with type 1diabetes.

Q6: I am a person living with type1 diabetes on insulin. What shouldI do if I get COVID 19 infection?

People with type 1 diabetes are atincreased risk of wide fluctuations ofblood glucose and diabeticketoacidosis during infections. Keepyourself well hydrated with water ornon-sugary drinks. Continue tomonitor blood glucose more closelyand urine ketones if glucose is morethan 250 mg/dl it is advisable to getadmitted.

Q 7: Will my treatment of bloodpressure, cholesterol, or heartdisease change during COVID -19?

It is advisable to use home bloodpressure monitoring and aim for ablood pressure below 140/80 mmHg. Based on current scientificevidence, all BP medicines are safe,and you should not discontinue anyblood pressure medication withoutdiscussing it with your doctor.Continuation of drugs that you areusing for high cholesterol or heartdisease are essential

Q8: What should I take care of myfood and exercise during theCOVID season?

People with diabetes should followthe healthy diet patterns advised bytheir doctors and dieticians.Nonspecific unproven remedies thatcirculate in social media with claimsto improve immunity like honey,lemon, and baking soda may bedetrimental for some people withdiabetes. Please discuss this withyour doctor before using these.Exercise has to be continued,

it is possible that patients withuncontrolled thyroid disease(especially thyrotoxicosis) may be athigher risk of complications (forexample thyroid storm) from anyinfection. So it is strongly recommendthat patients with thyroid diseasecontinue taking their thyroidmedications to reduce this risk.

OTHER ENDOCRINECONDITIONS

People with other endocrineconditions like adrenal diseases,pituitary diseases and gonadaldiseases are thought to have a higherrisk of developing severe COVIDinfection if the underlying condition isnot treated adequately. So optimalmanagement of these conditions byare essential to prevent morbidity andmortality due to COVID.

Adapted from the Expert guidanceon COVID from the ProfessionalAssociation of ClinicalEndocrinologists (PACE), Kerala

preferably indoor. For outdoorexercises, strictly follow the socialdistancing protocols.

In brief, people with diabetes shouldensure a healthy lifestyle, regularglucose monitoring, and adherence tolifestyle measures and medicationsduring this pandemic.

OBESITY

Obese people have a bad outcomewhen they contract COVID. Reportshave found a strong link betweenobesity and admission to critical careas well as the use of invasivemechanical ventilation. The highimpact of COVID-19 in patients withobesity and severe obesity is probablyrelated to the deleterious effects ofobesity on lung function. Obesity isassociated with decreased expiratoryreserve volume, functional capacityand respiratory system compliance.Severe obesity causes sleep apneasyndrome and in those with increasedabdominal obesity, pulmonaryfunction is further impaired bydecreased movement ofdiaphragmatic muscles. So keepingyourself healthy by shedding excessbody weight is all the more essentialin these COVID times

THYROID DISEASE

Viral infections are known to triggerautoimmune thyroid disease andsubacute thyroiditis- a conditioncausing inflammation and pain in thethyroid along with increased thyroidhormone levels in the body. There arereports of increased cases ofthyroiditis in areas were COVIDspread was severe. There is noevidence that those with poorlycontrolled thyroid disease are morelikely to contract COVID. However,


“Whe

re y

our

trea

sure

is, t

here

will

you

r he

art b

e al

so.”

- A

nony

mou

s, H

oly

Bib

le

The third screening camp –Hrudayathoduopam-for the benefit ofWards 5, 6, 7, & 8 of the AlangadGrama Panchayath were held onSaturday, February 15, 2020 atGoverment L P School, Kottapuram.The camp started at 2.00pm with Mr.P S Jagadeeshan (Ward Member 5)of Alangad Grama Panchayathwelcoming all the participants andthe dignitaries to the Third screeningcamp. Ms. Radhamani JaisingPresident of Alangad GramaPanchayath Mr. M.K Babu,Ms.Geetha Thankappan (WardMember 6) and Ms. Mini Babu(Ward Member 7) and Ms. ElsaJacob (Ward Member 8) felicitated.Mr. V A Shamzudeen(ChirangaraResidential Association President)proposed the vote of thanks.

After the formal meeting theparticipants were guided to thecounters set up in the hall were theCoronary Risk Analysis Report washanded over. This was followed by adetailed presentation in Malayalamby Dr Jo Joseph on various aspects of

heart condition and the relevance ofthe report given to the participantsand modifications required in theirlife style. After the detailedpresentation the floor was open forqueries which were answered by Dr Jo.

The school auditorium was packedwith 376 participants who heard thepresentation of Dr Jo in raptattention.

The Camp concluded at 5.00 pm.

Hrudayathoduopam-forthe benefit of theAlangad GramaPanchayath were heldat Goverment L PSchool, Kottapuram


The coronavirus diseasepandemic has causedunprecedented stress on

individuals, Governments, and thehealth system. In this article, we willbe discussing Covid-19 and heartdisease.

COVID-19 is caused by severe acuterespiratory syndrome coronavirus 2(SARS-CoV-2) and was identified insome pneumonia patients in Wuhancity in China. The disease spreadsprimarily from person to personthrough small droplets from the noseor mouth, which are expelled when aperson with COVID-19 coughs,sneezes or speaks. The mostcommon symptoms of COVID-19are fever, dry cough, andtiredness.Most people (about 80%)recover from the disease withoutneeding hospital treatment

Important points regardingCoronavirus disease and Heartpatients

• Heart disease patients have noincreased risk of contractingCOVID-19.

• But patients with Heart diseaseare at increased risk of

and low BP. COVID -19 cancause life-threatening arrhythmias(irregular heartbeats). Newerreports say that thereis anincreased chance of blood clottingin COVID-19. Blood clotting inthe arteries causes heart attacks,stroke, and limb ischemia. Bloodclotting in the veins causes deepvein thrombosis of the leg veinsand blood clot in the lungs (pulmonary embolism). In a fewcases,the virus may directly affectthe heart (myocarditis). Finally,mental stress is a riskfactor forheart disease.

• So it is very important to practiceSMS ( Social distancing, Mask,Sanitizer) both by patients andfamily members.

Dr Abhilash T G MD DMConsultant InterventionalCardiologistTravancore Medical College,Kollam

developing severe disease if theyget infected with the virus and thechance of death is high.

• Other high-risk groups are theelderly, patients with diabetes,hypertension, lung disease,patients undergoing cancerchemotherapy, and pregnantladies.

• COVID 19 can affect the heart indifferent ways. Decreased oxygenin blood caused by lung infectioncan cause increased stress on theheart and worsen the existingcondition. The body’s excessiveimmune reaction against the virusmay affect major organ systemsincluding the heart and causedecreased pumping of the heart

Heart disease patients have noincreased risk of contracting

COVID-19


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etim

es y

our

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t is t

he o

nly

thin

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orth

list

enin

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.” -

Mar

issa

Mey

er

(Enalapril, Ramipril), ARB (Losartan, Telmisartan) areassociated with severe COVID-19 disease. This is not proven andthere is no need to stop thesemedications.

• Drugs like Hydroxychloquine andAzithromycin used in thetreatment of COVID-19 cancause some ECG abnormalitiesand irregular heartbeats. It isimportant to seek advice fromyour doctor and take an ECGbefore and after taking thesedrugs.

• There is a chance of reinfectionwith coronavirus as the immunityacquired by disease is reported tobe short-lasting. So it is importantto continue preventive measureseven if you had a COVID-19infection.

• It is not advisable to take vitaminand herbal formulations for theprevention of Coronavirusinfection.

• Eat well, regularly, and healthily.A diet rich in fresh vegetables

• Practicing ‘Reverse Quarantine’by patients with severe heartdisease will greatly decrease thechance of contracting the disease.

• Cardiac patients must continueall prescribed medications.

• Routine follow-ups may be doneby virtual methods liketelemedicine.

• If you develop any symptoms,don’t hesitate to visit the hospitaland get evaluated. Sometimesyour regular physician may notbe available due to workingarrangements in the hospitalduring this pandemic season. Itshould not prevent you fromgetting evaluated if you have anysymptoms.

• Patients who are taking bloodthinners like Warfarin needs tocheck INR every 4-6 weeks andinform the results to your doctorand make necessary dosageadjustments.

• Some reports were saying certainmedicines used for hypertensionbelonging to ACE inhibitors

and fruit isrecommended. Limitcalorie intake. Avoid refinedsugars and sweetened beverages.

• Avoid smoking and alcoholconsumption. Smokingincreases the risk of severeCOVID disease and heartdiseases. Drinking alcohol doesnot protect against coronavirusand can be dangerous.

• Drink plenty of water unless youare advised fluid restriction.

• Exercise regularly for 30-45minutes. If you are unable to gooutside, aerobic exercises maybe performed inside the house.

• Keep a check on your bodyweight.

• Avoid sitting or lying down forprolonged periods. Thisincreases the chance of bloodclotting in leg veins and clotmay migrate to the lungs.

• Use virtual methods ofsocializing.

• Reduce anxiety and involve in arecreational activity likelistening to music, readingbooks, watching movies,painting, etc.

• Try to learn new things viaonline courses and keep yourselfengaged and avoid negativethoughts.

• Avoid negative social mediamessaging.

• Don’thesitate to get tested if youhave any symptoms suggestiveof COVID-19 like fever, sorethroat, cough, tiredness, etc asearly initiation of treatment isvery important.


The idea that drinking eightglasses of water a day is goodfor your health has been dismissed as a myth.

Scientists say there is no evidence drinking large amounts ofwater is beneficial for average healthy person, and do noteven know how this widely held belief came about. A youngwoman drinks a glass of water: No benefit in drinking eightglass of water a day, scientists say. Myth: Healthy people donot need eight 8oz glasses of water a day.

Specialist in kidney conditions in America reviewed researchon claims eight 8oz glasses of water help flush toxins fromthe body, preventing weight gain and improving skin tone.

Dr Dan Negoianu and Dr Stanley Goldfarb, of the renal,Electrolyte and Hypertension division of the University ofPennsylvania, said no single study indicate average healthy

people needed to drink this amount ofwater- a total of 3.3 pints- each day.”Indeed, it is unclear where thisrecommendation came from”. Theysay in a review in the journal of theAmerican Society of Nephrology. Theresearchers did find some evidencethat individuals in hot, dry climates, as

well as athletes, need to increase the amount of waterthey drink. Studies have also shown that drinking lotsof water helps the body to clear salt and urea.

But no studies have found any benefit to the organs ofincreased water intake. DrNegoianu and Dr Goldfarbalso investigated the theory that drinking more watermakes you feel full and curbs appetite. Peoponents saythis may help maintain a healthy weight and fightobesity, but the evidence for this claim remainsinconclusive, state the review. No carefully designedclinical trials have measured the effect of water intakeon weight maintenance.

Headache also are often attributed of waterdeprivation, but there is little data to back this up,claim the scientists. Only one small trail has addressedthe question, and while trail participants who increasedtheir water intake experienced fewer headaches thanthose who did not, the result were not statisticallysignificant.

In addition water has been touted as an elixir forimproved skin tone. The authors said that dehydrationcan decreased skin stiffness, no studies have shownany clinical benefit to skin tone as a result increasedwater intake.

The literature review by Negoianu and Goldfarbreveals there is no clear evidence of benefit fromincreasing water intake. On the other hand, no clearevidence exists of a lack if benefit. “There is simply alack of evidence in general.” They explain. Onaverage, the body uses between 1.7 and 2.6 pints (one-1.5 liters) of water daily and more in high temperatureor when exercising. This is replaced through drinks buta large amount is also contained in food, so it is notnecessary to drink and equivalent amount to replacewater level. Too much water can affect the balance ofsalt in the body causing “water intoxication,” whichcan be fatal.


“The

hea

rt o

f a fo

ol is

in h

is m

outh

, but

the

mou

th o

f a w

ise

man

is in

his

hea

rt.”

- Ben

fran

klin

In connection with the WorldHeart Day the Foundation inassociation with Lions Club

District 318 C organised a Webinaron zoom platform on the subject‘Impact of COVID 19 onCardiovascular Disease’. Ln DistrictGovernor invited everyone to theseminar and Ln Sajiv introduced theSpeakers Dr Jose ChackoPeriappuram, Chairman Heart CareFoundation and Dr Jo JosephTrustee, Heart Care Foundation. DrJose set the stage with his imitableintroductory remarks. He stated theplace Lions club had in theFoundations programs in the initial

days and went on to speak about theCOVID which in his words was adisaster.He was of the opinion that alockdown is imminent for s shortperiod to tide over the exponentialgrowth in the last few days in ourState.

Dr Jo then took over and had adetailed presentation with a powerpoint presentation. The presentationwas supported by latest data from

across the World on COVID and itsadverse affect on heart. COVID had


“Ulti

mat

ely,

the

grea

test

less

on th

at C

OV

ID-1

9 ca

n te

ach

hum

anity

is th

at w

e ar

e al

l in

this

toge

ther

.”- K

iran

Maz

umda

r-Sh

aw

brought down the number ofprocedures and genuine patients aretherefore denied timely help/assistance. This will have a surge inpatients with serious heart conditions.According to him smart phones & AIwill have a big role to play in thefuture of medicine, and tele medicinewill take the place for routine checkup. He also sees care will migrate tohomes. In the changed circumstancesthe health workers and Doctors aregoing through tough times bothphysically and psychologically. Over7000 health workers have died worldover and in India over 600 have died,this puts the health workers at greaterrisk. The only positive side he statedwas that death due to pollution hascome down.

He earnestly requested everyone tohave a check on the food intake andhave moderate workout since, thelockdown and consequent time athome without any physical activityhave enabled people to gain weight.Another point he stressed wasdifficulty in getting treatment of somecritical illness like kidney ailment andTB in view of the COVID rush at thehospitals, According to him in shorttime from now there may not be aspecialization but only Covidologistamong Doctors.

After the presentation the floor wasopen for Q & A session. Participantsasked several questions on COVIDand Cardiology, which was explainedin detail by Dr Jo. The Webinarwhich started at 7,00 pm came to aclose at 8.40 pm. In all 230participants took part in the Webinar.After the official Vote of Thanks, LnDistrict Governor concluded theproceedings.

Dr Jo Joseph, Consultant Cardiologist & Trustee,Heart CareFoundation addressed the employees of Tata Consultancy Services(TCS) on July 06,2020 on the topic, ‘Silent Pandemic’. The meetingwas attended by over 150 participants. The topic which was veryrelevant in the current scenario was well appreciated by all theparticipants. The Q & A session was also very lively with activeparticipation of the employees from TCS.

The Awareness class and about Basic Life Support-CPR conducted for the staff of TCS Info park wasled by Dr. Jacob Abraham (Trustee HCF). Mr. Dominic J

MecheryExecutiveDirector, Heart Care Foundation and Mr. StephanPascal Program Coordinator H C F assisted Dr Jacob.

Dr. Jacob Abraham gave a brief on Heart Care Foundation and itsprojects before making a detailed presentation on CPR. The sessionwas well attended by over 150 participants from various Departmentsof T C S. During the class Doctor narrated real life incidents on theuse of CPR and thereby conveyed the need of knowing these skills tothe participants.

Doctor took time to answer all the queries of the participants andallowed some participants to have a feel of the real time operation byusing the mannequins for demonstration. The session was very livelywith participants actively asking questions on various aspects ofCPR.Mr. Antony Jose of TCS proposed the vote of thanks.


Dear Friend, since you are reading this Ipresume that you either are a Heart CareFoundation member or a member friend has

given this to you. Either way, you are very important tothis humble movement called Heart Care Foundationand we all are thankful for whatever help yourvaluable association can bring to the Foundation.

Let me briefly explain to you the activities of theFoundation. Founded on the World Heart Day,September 29, 2005 and inaugurated by the thenGovernor Sri. R.L Bhatia, HCF was able tosuccessfully complete several projects related to heartcare in Kerala. Our first project ‘Save 1000 hearts,1000 lives, 1000 families’ provided financialassistance to over 1500 needy patients from all overthe state, without any discrimination in cast or creed.The next program ‘Save a Life, Save a Lifetime’launched in 2007 has been a big hit among thecorporate houses, schools and colleges and we haveconducted over 200 training sessions on Basic LifeSupport–CPR and was instrumental in the installationof AED’s (Automated External Defibrillator) at manyprominent public centers.

Every World Heart Day is celebrated as the inceptionday of Heart Care Foundation and during the veryelegant official function each year, an eminent doctor,

selected by an expert panel, is awarded the HeartCare Foundation’s Lifetime Achievement Award.Another very important activity,‘Hrudayasangamam’ happens twice a year and itsprimary objective is the rehabilitation of patientswho underwent heart surgery during the period.Through general Q&A with senior doctors,physiotherapists and dietitians, the patients areencouraged back in to normal life stream. Familymembers of the patients form an integral part of thisget-together and the experience sharing as well asthe general Q&A with the experts helps them realizethat their loved one is no longer an invalid. Addingcharm to this social gathering is our ‘SocialExcellence Award’ constituted in memory of ourfounder member Mr. C V Shanmugam. Selected byanother expert panel, the awardeeis an eminentpersonality that exceled in their respective field ofactivity.

Yet another project is ongoing and is unique as wellas ambitious and will help a much larger populace,hopefully covering the entire state. Recentlylaunched by Sri P.Sreeramakrishnan,HonorableSpeaker, Kerala Legislative Assembly,‘Hridayapoorvam’, is aimed at making the generalpublic ‘Heart care literate’, panchayath by

“Oft

en w

hen

you

thin

k yo

u’re

at t

he e

nd o

f som

ethi

ng, y

ou’r

e at

the

begi

nnin

g of

som

ethi

ng e

lse.

”- F

red

Rog

ers


panchayath. In a three phasedprogram, people of age group 30 to60 will be given tests at the local labsand the results will be fed in to asoftware program developed underthe guidance of the HCF. Theprogram will analyze the cardiac riskfactor of each result and anawareness session conducted by aneminent cardiologist will make surethat everyone understands theircardiac health. Those with risks willbe advised to consult their localphysician and others will be givengeneral tips to keep up a healthy,heart friendly life style. We haveselected Alangad GramaPanchayath as the first locality forthe project and response from thepeople as well as the governmentagencies has been very heartening.Hopefully, entire Kerala will soon beHeart Care literate in a short while.

There are many ways to activelyassociate with Heart CareFoundation. Being a member is thefirst step. Please get in touch withany member or directly with the HCFoffice and they will guide you.

We need your help. Let us help thosein need together.

Looking forward to yourassociation,

Dr. Jose Chacko PeriappuramChairman, Heart Care Foundation

There are many ways to actively associatewith Heart Care Foundation. Being amember is the first step. Please get intouch with any member or directly withthe HCF office and they will guide you


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cut h

ere

cut h

ere

GOVERNING COUNCILMEMBERS

Rev Fr.Austin Mulerikal

Mr. O.T Alexander

Mr. George Dominic

Mr. Abdul Azeez

Mr. B.Binoay

Mr. Kochouseph

Chittilapally

Mr. Thomas George

Muthoot

Mr. George Thomas

Mr. Vinoo Devassy

Mr. Dinesh P. Thampi

Dr. Nisha Vikraman

Mr. Zachariah Poomkkudy

Mr. Raja Sethunath

Mr. Mathew Thayyil

Mr. T.V.Lukose

Dr. P.Sreekumar

Mr Prasad K. Panicker

Mr. S.Sivakumar

Mr. K.Venugopal

Dr. Praveen Pai

CARING HEARTS - January-September 2020. Regd. No: KERENG/2009/29265 - Price - Rs. 125.00

heart care foundation was established on the world heart

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