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Coronavirus doctor's diary: Is lockdown good for your heart?

* 5 May 2020

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* [65]Coronavirus pandemic

Cyclists in Leeds Image copyright Getty Images

Are people having fewer heart attacks? And should hospitals protect
black, Asian and minority ethnic healthcare workers by taking them off
the front line? Dr John Wright of Bradford Royal Infirmary considers
these questions in his latest diary.

4 May 2020

One of the intriguing observations during the pandemic has been the
marked reduction in patients coming to hospital with acute heart
attacks or strokes.

Our initial worry was that people were frightened to come in when they
needed to - suffering their symptoms at home rather than risking
getting infected in hospital. This may still turn out to be the case,
but heart attacks and strokes are the sort of episodes in which you
would expect patients to seek help. You would expect them to be picked
up by health services.

Perhaps the slowing down of our frantic lives from our enforced
lockdown, and even the cleaner air we are breathing from the reductions
in traffic, are helping to keep us in finer fettle? Our slow living
might be nurturing new healthier habits and lifestyles.

One clue has emerged from people using the Fitbit health and fitness
tracker in the US.

Heart rate is a good indicator for heart health - the lower your
resting heart rate the better - and Fitbit has found that during
lockdown [66]average resting heart rates have fallen.

Also, while step counts have also fallen, the number of active minutes
has actually gone up - people have swapped desk-based routines for more
mobile routines at home.

Sleep duration has also increased with people going to bed earlier than
normal and sleeping longer. It seems as though the lockdown has had the
health-promoting effect of a good holiday.
__________________________________________________________________

Front line diary

Image copyright Tom Lawton

Prof John Wright, a medical doctor and epidemiologist, is head of the
Bradford Institute for Health Research, and a veteran of cholera, HIV
and Ebola epidemics in sub-Saharan Africa. He is writing this diary for
BBC News and recording from the hospital wards for BBC Radio 4's The
NHS Front Line
* Listen to the next episode at 11:00 on Tuesday 5 May, [67]catch up
with the previous episodes online, or [68]download the podcast
* You can also read the previous online diary entry: [69]Take care
when you clap for carers
__________________________________________________________________

Prof Alistair Hall, a cardiologist and clinical director for Yorkshire
and Humber of the National Institute for Health Research, says he
hasn't seen evidence yet of people just staying at home after having
heart attacks. On the other hand, he has seen people out exercising in
unusually large numbers.

"I have to drive into the hospital, but as I do I see the roads full of
people walking and cycling families. I've never seen anything like it.
It looks as if everyone has the time as a family to exercise, and
they're taking that opportunity to get out of their homes," he says.

He also thinks that people may be more active throughout the day.
Rather than sitting at a desk for hours and hours they're taking more
breaks, walking around, or going up and down stairs, even if they are
taking fewer steps overall.

But there's another possible factor at play. He thinks people are
remembering to take their medicine.

"Cholesterol is the single biggest preventable cause of heart attacks
and strokes in the world," he says. "And I think there's evidence
suggests that during this time people are being much much better at
taking medications that otherwise they might be forgetting or missing."

And that extra bit of sleep? He's also confident it's doing people
good.

"Good quality sleep is very advantageous in terms of health, and I
guess people haven't needed to get up as early," he says. There's a
benefit in terms of heart disease, but also for the immune system,
"which is really important at the time of an infectious pandemic".

Prof Hall does add a note of caution, though: "I'm sure there's some
bad side to this, which might include eating too much chocolate or
drinking too much alcohol."

But if so, the effect doesn't appear to be registering just yet. It may
become more visible later.

There is escalating national concern about the heightened risk to
black, Asian and minority ethnic patients from Covid-19.

There are some possible explanations to do with relative poverty, with
underlying health problems, with overcrowded housing, and with
employment in front-line health and service roles. The suspicion is
that there are also genetic factors at play. Whatever the reasons, it
could have big implications for the future, particularly in the
National Health Service.

There is a real urgency in addressing this concern in a city like
Bradford, where almost a third of our population and NHS staff are
non-white.
Image copyright John Wright Image caption Registrar Rabeia Javid says
her eight-year-old son worried at the start of the epidemic, but now
admires her choice of career

And the fact that 64% of the Covid-positive [70]NHS staff who have died
nationwide are BAME has caused ripples of anxiety to spread to the
hospital.
__________________________________________________________________

Measuring the risk of death from Covid in hospital

People face a number of risks, from exposure and infection, to the risk
of ending up in hospital, and then the ultimate risk of dying.

We have looked at the last of these - the risk of dying in hospital -
among the first 1,276 patients at Bradford Royal Infirmary who were
tested for Covid-19.

Of the 464 patients who tested positive, mortality was 23%, which is
lower than some of the national study results, and crucially we've
found [71]no evidence of differences by ethnicity. This is timely and
reassuring evidence for our communities.
__________________________________________________________________

Dr Sam Khan, consultant in acute medicine, has been ill with Covid-19
since 20 March - more than six weeks - and at one point he needed
hospital treatment. His main symptoms have been a dry hacking cough and
tiredness. He hopes to be well enough to return to work on 15 May.

I asked him what he thought about suggestions that BAME staff should be
kept away from the front line.
Image copyright Sam Khan Image caption Acute medicine consultant Sam
Khan and his wife - neither looking worried in this photograph

He points out that that would be very difficult in Bradford, and in the
NHS generally, because of the large proportion of BAME workers in the
healthcare system - and that it would be odd to tell people who had
trained to be a doctor or nurse that they couldn't see patients because
they were black or Asian, or from a minority ethnic group.

"I don't know how you'd do it, you'd have to start thinking differently
about recruitment policies," he says.

What does it mean for an acute physician like Sam in the longer term,
bearing in mind that he won't know whether the patients he sees are
Covid-positive or not.

"Do we start testing everybody as they come through the door, like
we're doing for HIV now, where we test the majority of people aged
between 18 and 65?" he asks.

I ask him if he is worried.

"We don't know how immune I'm going to be in the future," he replies.
"Yes, it does. It does make me worry. It makes my wife worry more, but
it makes me worried."

Follow [72]@docjohnwright on Twitter

You may also be interested in:

Conspiracy theories have been spreading within parts of the BAME
community that hospital staff want them to die, reports Dr John Wright
- meanwhile, figures suggest an increase in deaths in Bradford outside
hospital.

[73]Fake news makes patients think we want them to die
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* [79]Coronavirus lockdown measures
* [80]Coronavirus pandemic
* [81]Heart attacks
* [82]NHS
* [83]Fitness
* [84]Heart
* [85]Bradford
* [86]Race and ethnicity

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