Home Health Glenn Ellis Ellis: Managing chronic disease while sheltering in place

Ellis: Managing chronic disease while sheltering in place

By Glenn Ellis

As cities, states and the federal government takes increasingly aggressive moves to stop the spread of the COVID-19 virus, a significant number of us have to deal with more than sheltering in place. For many, particularly African Americans, the diabetes, high blood pressure, and obesity-related conditions will become even more difficult to manage.

Heart disease, cancer, diabetes and stroke are among the most common causes of illness, disability and death in the United States, according to the Centers for Disease Control and Prevention (CDC). These chronic conditions can be more common or severe in minorities, including African Americans.

The stress of dealing with these new restrictions will take its’ toll on everyone for some time to come; and will lead the type of chronic stress that puts people at risk of numerous health problems, including anxiety, depression, digestive issues, headaches, heart disease, weight gain and memory and concentration.

This is important because with new guidelines for “staying in place”, many African Americans who have struggled long before the COVID 19 pandemic with managing chronic conditions are in for a real challenge.

African Americans suffer from higher percentages of chronic diseases such as heart disease, kidney disease and diabetes which are perpetuated by a lack of access to quality care.  Currently, 48 percent of African American adults suffer from a chronic disease.

Here are a few facts about the health of blacks from WebMD: Diabetes is 60 percent more common in black Americans than in white Americans; African Americans are three times more likely to die of asthma; and nearly 42 percent of black men and more than 45 percent of black women over age 20 have high blood pressure. Even obesity, which is a risk factor for being infected with coronavirus, hits black folks disproportionately. Seven out of 10 African Americans ages 18 to 64 are obese or overweight.

Just by using a very simple mathematical analysis, it is not a stretch of the imagination to think that as many as 50 percent of all African Americans are a vulnerable population.

So, the point of this column is to make sure we are paying attention to the impact that sheltering in place can have on some of the health challenges that many of us were dealing with long before we heard of the COVID 19 pandemic. Think about it – preventing, managing, and treating chronic conditions requires a tremendous amount of effort around eating right, getting some physical activity, taking your medication, and managing your stress. All of these will be disrupted in varying degrees as we move through this coronavirus pandemic.

Diabetes requires consistent management to prevent progression of the disease. If you have diabetes, you need to know how foods affect your blood sugar levels. While sheltering in place, not only are you dealing with changes in what’s available for you to eat, how often you are eating, and how much you are eating.  Too much food may cause your blood sugar level to climb too high (hyperglycemia). Ignoring your dietary patterns and behaviors during this period can make what was a difficult job keeping your “sugar” down could bring on heart disease, kidney disease and/or foot amputations as consequences.

During the best of times, folks with high blood pressure consume far more sodium than they should. The American Heart Association says if you already have hypertension, have diabetes or kidney disease or are African American the recommendation is that you eat 1,500 milligrams of salt a day. One fried chicken breast contains nearly 1,000 milligrams of sodium! So, you have to be really careful with your sodium consumption during these times.

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently. Conditions such as cardiovascular disease, type 2 diabetes, obesity, and cancer are drastically improved when physical activity and exercise are part of your medical management plan.

Being restricted only adds to the sedentary lifestyles that many of us already had before all of this. Now, we need to understand that we are at even greater risk, so it is important to make sure you develop some sort of physical activity that you can carry out and maintain.

Stress is not equitably distributed, and neither are stress-related health outcomes. As we have known for quite some time, the American Psychological Association’s report captured the impact of stress: “On a psychological level, stress affects the way people think, feel and act both towards themselves and others. They may be less trusting and more concerned about being rejected, undermining relationships with family members, educators, and health care providers.”

People tend to experience stress when they do not have sufficient resources. For African Americans, what has been a way of life is about to become more difficult than even imagined. Money; jobs; childcare; health, all are going to take its toll. Be proactive and work on developing a positive outlook and stay as active as possible.

Just pointing out a few things that we should be mindful of when looking at the disproportionate ways the African American community will be impacted by the COVID 19 pandemic. And please don’t forget to take your meds.

Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. For more good health information visit: www.glennellis.com.