COVID-19 in the Context of Weight Loss Surgery
What are the symptoms?
Unless you’ve been living under a rock (which you might be now thanks to recent Government mandates), you would be all too familiar with the Coronavirus pandemic. With it comes an ‘infodemic’ that is creating a lot of confusion and overwhelm, not to mention some really clever internet memes.
Few, if any, however have spoken about the virus in the context of people who have undergone weight loss surgery – is there any information out there yet on this specific group, and what could it mean for you?
A summary of what we know so far….
Coronavirus, scientifically known as SARs-CoV-2, and now colloquially referred to as “the Rona”, is spreading rapidly for a couple of key reasons:
- It is easily transmissible (that is, it gets around easily). It is passed on through human-to-human contact, and it can travel in infected droplets1 and has an ability to survive on inanimate surfaces for extended periods of time, the exact duration of which, depends on the type of material said surface is made from.2
- Our bodies have not yet been exposed to this virus. Just like you look different to your original ancestor, this virus looks quite different to its original ancestor (the virus it originally mutated from) – so much so that it appears as a completely new invader to our immune system. Consequently, our bodies are not yet primed with the appropriate arsenal to mount a rapid response and fight it, which is what is required to ultimately stop or slow its spread.
But I get a cold every May! How will I tell if it’s “Rona”?
Depending on the person, symptom severity varies with it thought that many are asymptomatic (meaning they show no signs and symptoms at all) and others experiencing more severe symptoms to a point which, in a small percentage of the population (<1%) can sadly be fatal (see updates on how Australia is tracking daily here). For most confirmed cases, it is thought roughly 80% will have mild symptoms that present in a similar fashion to other upper respiratory tract infections such as the common cold which is caused by rhinoviruses and the flu, which is caused by influenza viruses.3,4 “But I get a cold every year in April/May? How do I tell if it’s Coronavirus?” you might be asking. Thus far the pattern has shown that there may be some slight nuances in the symptoms caused by these different viral infections which is nicely summarised in an infographic provided by the Australian government. 5Of course, if you suspect you have the symptoms it is important to work with your local doctor, to get tested.
Identifying the Symptoms of Coronavirus by the Australian Government.
Fortunately, for the majority of people the COVID-19 illness, is relatively mild. However, social distancing is recommended to protect the smaller percentage of the population who are more vulnerable – like our beloved Nan.
So who is at greater risk (other than Nan)?
To date it we understand that everyone is at risk of catching the virus if exposed, however the concern lies in how your body responds to ‘Rona’. Thanks to regular news updates, you can probably cite verbatim, who is at more risk of having a negative experience upon contracting the virus – but why is that the case, and is there any link with bariatric surgery?
A lot of the information is still largely theoretical, but thoughts are:
- The elderly (i.e. Nan and her friends) and immuno-compromised individuals such as those taking immunosuppressive medications or undergoing chemotherapy or suffering blood cancers – put simply, they don’t have the resources to build a robust immune response and fight the infection.
- Those with hypertension, type II diabetes or cardiovascular disease – this is because the way this virus enters into our cells, is via a receptor (think of it like a gateway into the cell) known as the ACE2 receptor. These individuals have been shown to have more of these receptors, therefore more ‘gates’ to let the virus into their cells.
- People with a lot of inflammation – the symptoms caused by the virus are actually the result of an intense immune and inflammatory response – people who are already in a heightened state of inflammation
So, what about bariatric surgery patients?
Well to date, there is no evident pattern emerging that suggests that having undergone weight loss surgery alters your risk outside of the factors listed above! In fact, for those who have now experienced the benefits of weight loss surgery and dropped some kilos, you could now be faring better!
Obesity is one such condition that can be linked to a heightened state of inflammation and some specialists are hypothesising that overweight individuals are at greater risk of more severe response to infection
(disclaimer – there is yet no data available to support this). However theory suggests, if you are on a downward weight loss trajectory – that is a positive thing for more reasons that one!
What else can I do?
Follow the best practice advice from health authorities on slowing the spread through simple hygiene and sanitation practices. These aren’t just useful for preventing spread of the COVID-19 virus, but really are good habits to maintain for preventing the spread of any infection including cold and flu. Make sure you are a carer not a sharer - following the authorities’ guidelines on social distancing to protect others. Finally, try to protect yourself as best you can by making sure your immune defences are strong!
How do I ensure my immune defences are strong?!
Eat Well: What does that mean? Lots of fresh fruit and veggies. Fortunately, if the shelves at the local supermarket are deprived of pasta– then the panic buyers have done you a favour. Refined carbohydrates are no friend to your immune system, instead you need nutrient-dense foods. Think about how you can incorporate veggies into every meal (veggie scrambled eggs for breakky or a Green Smoothie for breakfast (see suggested recipe), salad for lunch, fish and veggies for dinner), and try to eat 1-2 pieces of fruit daily. Oranges, Kiwi fruits, berries are particularly high in vitamin C.
Top up your nutrients: Post-surgery, bariatric patients are at greater risk of nutritional deficiencies and lifelong supplementation is required to stay nutrient replete. As it is more difficult for you to get everything you need from food alone, make sure you are keeping on top of your key nutrients to keep on top of any lurgy that could arise this coming winter.
Manage your stress: Easier said than done with some of the complex issues we are currently faced with, but one thing we know is that in the case of psychological stress one of the body systems that suffers in our immune system. Stress is well known to suppress immune system function, and is linked to reduced ability of the immune system to control viral infections, as well as increasing inflammation which can make symptoms feel worse.6 Now more than ever, find time to give yourself regular time-out, meditation and time in nature and enjoy the benefits.
Prioritise sleep: Over the last 15 years, strong evidence has accumulated to show that sleep enhances immune defence, validating the popular wisdom that ‘sleep helps healing.7 Aim for 7 to 8 hours of sleep each night to restore energy and allow your immune system to regain its strength.
Keep physically fit: Outside of the obvious weight loss and muscle health benefits which are so critical for your journey post- weight loss surgery, staying physically fit also helps keep your immune system fighting fit as well.
While there is yet so specific analysis done to investigate the effect of weight loss surgery on the body’s response to infection with ‘the Rona’, we know weight loss has multiple benefits for health. In light of the recent pandemic the best this you can do for your health is to follow the advice of our domestic health authorities and practice the general habits that help support weight loss, but simultaneously keep your immune system strong,
- Xiao F, et al. Gastroenterology. Marc 3. Pii:S0016-5085(20)30282-1.
- van Doremelon N, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020 Mar 17.
- Rodriguez-Morales AJ, et al. Travel Med Infect Dis. 2020 Mar 13; doi: 10.1016/j.tmaid.2020.101623.
- Wang, D. JAMA 2020. doi: 10.1001/jama.2020.1585
- Morey JN, et al. Current directions in stress and human immune function. Curr Opin Psychol. 2015 Oct 1; 5: 13 – 17.
- esedovsky L, et al. Sleep and immune function. Pflugers Arch. 2012 Jan; 463(1): 121-37.