Intended for healthcare professionals

Rapid Response:

Re: Coronavirus disease 2019 (covid-19): a guide for UK GPs

Dear Editor

The article highlights that up to 5% of patients may need critical care support during the course of an infection. [1] As clinicians we may begin to ask ourselves apart from distance (isolation) and hygiene measures, what other practical advice can we give patients to prepare themselves prior to and in case of infection?

Covid-19 and cardiovascular risk factors

A case series of 138 hospitalised patients from Wuhan has identified, hypertension, diabetes, and previous Cardiovascular Disease (CVD) as risk factors for Intensive Care Admission. [2] In addition to this Covid-19 patients admitted to hospital had a median age of 51. [3] As specialist in chronic disease, GPs may have an opportunistic and important role in helping patients to improve their baseline cardiorespiratory fitness over the coming months.

What can we learn from Peri-operative care?

Many NHS trust already screen patients for maximal oxygen uptake (VO2 - mL/kg/min) as a routine part of pre-operative assessment for some high-risk surgical patients. Disease specific VO2 cuts offs have been shown to predict risk of 90-day mortality and risk of post op admission to high dependency unit. [4]

There are number of simple field tests including the 6-minute walk test5, or resting heart rate method that can be used to approximate patient’s maximal oxygen uptake. Some smartphones and wearable activity trackers also give patients accurate estimates of this6 and could be used to prescribe and track progress to a graded exercise programme.

“Exercise is medicine”

As patients are increasingly asked to self-isolate and stay at home, they may inadvertently reduce physical activity levels over the coming months. Any intervention to safely prescribe physical activity, even to those with low baseline fitness is unlikely to cause harm and will have other benefits to their overall physical and mental health.

On a population level prescribing home-based exercises, might help patients to make up for any exercise lost from commutes, normal activities of daily living and communal sports activities. It may also help the NHS on a population level as a screening tool, to identify high risk patients and precondition them to hopefully reduce the burden on high dependency care.

Reference

1. Razai M, Doerholt K, Ladhani S, Oakeshott P. Coronavirus disease 2019 (covid-19): a guide for UK GPs. BMJ. 2020;:m800.
2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;.
3. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Internal Medicine. 2020;.
4. West M, Asher R, Browning M, Minto G, Swart M, Richardson K et al. Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery. British Journal of Surgery. 2016;103(6):744-752.
5. Mänttäri A, Suni J, Sievänen H, Husu P, Vähä-Ypyä H, Valkeinen H et al. Six-minute walk test: a tool for predicting maximal aerobic power (VO2 max) in healthy adults. Clinical Physiology and Functional Imaging. 2018;38(6):1038-1045.
6. Kwon S, Ahn J, Lee S, Lee J, Lee D, Hong J et al. Estimating Maximal Oxygen Uptake From Daily Activity Data Measured by a Watch-Type Fitness Tracker: Cross-Sectional Study. JMIR mHealth and uHealth. 2019;7(6):e13327.

Competing interests: No competing interests

14 March 2020
Irfan Ahmed
Sport & Exercise Medicine Registrar / GP
Barts Health (Public health department)
Barts Health NHS trust