Floored! Why was I KO’d by Covid in 2020?

 


 Now and again, I’ll have a patient in my A&E who is suffering from a respiratory disease of some kind, and they are experiencing “air hunger.” This means that their breathing efforts, while laboured and strained, are not resulting in enough oxygen entering their body. It appears exhausting, but it also looks frightening. I often see fear, sometimes terror, in their eyes as I do what I can to help their breathing.

While I have always empathised, I had never experienced such breathlessness myself. Until March 2020. Along with fever, aching muscles and profound lethargy, that Spring morning introduced me to the feeling of air hunger. I sensed a rising fear within that I couldn’t “get enough air” despite working hard. I needed to send a text message about an appointment I was not going to make, but I couldn’t focus on the screen, and the phone fell from my hand. I spent the rest of the day barely moving in bed, trying to suppress a black fear that felt close by. I had, after all, just the day before been watching the news about several doctors in China dying from pneumonia caused by a mysterious new coronavirus.


This was before widespread testing for Covid-19, but I had all the features of a viral pneumonia over the following few weeks. I lost 6Kg (1 stone) in weight, which might sound lovely, but it was mostly muscle loss, including from my face. A friend remarked that I resembled an old man. Thankfully, I made a more or less full recovery, apart from a lingering loss of smell and taste. My baseline fitness had evaporated though, and it took 6 months before I could manage to run any distance again.

Plenty of folk my age contracted Covid that Spring, most of whom had mild symptoms. So why was I affected so badly, but not them? Research has since shown that the people who were most affected or died from Covid were frail, obese or had significant underlying medical conditions. Thankfully, I fall into none of these categories. Something else must have been going on…

I have thought about this a lot in recent years. It wasn’t just bad luck. I’ve come to the realisation that it must have been to do with my immune system. My body just didn’t fight off the virus effectively - so it gave me a really good kicking. In 2020, in my mid-forties, I was in pretty good shape. Reasonably fit, a regular gym attendee who could run 10K. Why then, was my immunity to infection in such a feeble condition?

A significant part of the answer has a single and consistent component. My job. My work as an A&E doctor, with all the associated stress, overnight duties and related poor dietary habits, bears the blame I’m afraid. Let’s dig a little deeper.


Chronic stress can be the result of working in a high-pressure, high-risk environment where the demands of the role frequently exceed a capacity to safely manage them. This type of stress, over time, can impair regulation of important chemical mediators in the immune system, and suppress the function of T-cells which have a vital role in fighting infection.

When we have a restful night’s sleep, the components of our immune system undergo a degree of re-organisation and re-balancing – a kind of ‘housekeeping’ which helps maintain robust function. Studies have also shown that sleep enhances the immune response to a vaccine, suggesting it has a crucial role in combating any new invasion of viruses. Shift work, with its attendant sleep disturbance, has consistently resulted in an increased risk of cardio-vascular disease, diabetes, and some cancers. The likelihood is that immune dysfunction is playing a role here too.

A balanced diet containing all the key vitamins and minerals is essential to provide our body with the component parts that it needs to assemble immune function cells. For example, Vitamin D contributes to the production of Neutrophil cells, whose job is to destroy invading bacteria. Our gut health is an often-neglected area here too. Around 70% of overall immune activity happens in our digestive system. Diets which are high in ultra-processed foodstuffs (e.g. fast-food, ready meals, crisps, chocolate bars) contribute to poor gut health and subsequent impaired immune function.

So, let’s take an average overnight duty in A&E. I will most certainly have been stressed for much of it, slept poorly either side of it and I will have eaten copious amounts of ultra-processed food, craving the energy fix it provided. Rinse and repeat, time and again – perhaps it’s not hard to see how the sabotage of my immune system happened so insidiously. An illness or infection of some kind was surely in the post…

Since 2020, I have been fortunate enough to be able to reduce my working hours and I no longer have overnight duties. I appreciate that this is not possible for everyone. Being aware of the hazards though I believe can only help – if we then seek to modify those things that are in our control.


How about you? What are the factors at work, or in your life, that are sabotaging your immune system? It is probably best to look at these things now, rather than waiting for some nasty virus to knock you to the floor too…

 

 

 

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