Dr. Shyam P Lohani

Nutrition plays a vital role in healthy living. It has proven function in boosting immune system and maintaining proper immune function. Nutrients help people develop a strong immune system and remain healthy. People with malnutrition show delayed responses to many infectious diseases. Vitamin A fights against multiple infectious diseases. Along with Vitamin D, it regulates the immune system and helps to prevent its over-activation. An antioxidant such as Vitamin C protects us from the injury caused by free radicals.
A healthy immune system is our best defense against many infectious diseases including COVID-19 along with preventive measures such as social distancing, use of mask, avoidance of crowded and confined places. To maintain a healthy immune system, good nutrition is an absolutely necessity. However, not a replacement for good hygiene and vaccine, good nutrition can work synergistically with medicines to improve vaccines’ effectiveness, reduce the prevalence of chronic diseases, and lower the burden on the healthcare system.

Issues
The role of nutrition is vital for the prevention as well as the treatment of infectious diseases. To maintain adequate nutrition, people in many parts of the world are struggling immensely. The COVID-19 patients with serious symptoms, which account for about 2-3 per cent of cases and need intensive care unit (ICU) support, nutrition becomes more important. To maintain skeletal muscle and avoid metabolic disturbances, nutrition plays an important part, more so when the patient is spending 2-3 weeks in ICU.
The management and care of critically ill COVID-19 patients require a similar intensity of care to that required for patients admitted with viral pneumonia-induced respiratory failure. It is known for many decades that challenges exist in integrating nutrition requirements for patients to treatment and recovery plans.
The COVID-19 patients who develop serious effects of viral insult may require immediate respiratory support. People in need of respiratory assistance may stop eating as soon as they are admitted to hospital and also unable to tolerate and maintain oral nutrition.
Feeding tubes are often utilised for most patients admitted in ICU to deliver nutrition, hydration, and medications as most of them will be sedated and ventilated. The proteins and calories required for the body are met through feeding tubes. Oftentimes, nutrition and hydration are delivered directly into the vein. The demands of each individual patient in terms of nutrition should take into account the age, gender, and other underlying medical conditions.
Patients at ICU requiring intubation often have difficulties in maintaining adequate nutrition even after extubation. The demand for meeting nutritional requirements is difficult for people who may not be able to eat enough food during the recovery phase. The loss of lean mass that occurs with the rate up to 1 kg per day in ICU is further exacerbated when patients are not able to eat required nutrition.
The most common complication of critical condition that occurs up to 50 per cent of patients is muscle wasting. The loss of lean mass or muscle wasting may lead to an increase in recovery times, impair immunity, increase infection risk, and result in wounds and pressure ulcers. In many cases, the complication may lead to an increase in mortality.
Patients suffering from serious effects of COVID-19 and been hospitalised at ICU will be at increased risk of malnutrition and will likely have suffered the loss of muscle during their stay. Therefore, nutrient-rich, fortified, healthy fresh foods, or specialise nutrition supplements are required to help people regain the weight and muscle that may have been lost.
COVID-19 takes its toll on the elderly as well as people suffering from underlying health conditions such as cardiovascular disease, diabetes, obesity, respiratory illnesses, and cancers. The issue of nutrition in those patients is complex and it is often difficult for health professionals to keep these patients in stable condition at ICU.

Challenges
Respiratory difficulties prevent patients from eating effectively and those who need assisted ventilation are more prone to suffer further from nutritional insufficiency. Therefore, the challenges of maintaining optimum nutrition become vital for early extubation and speedy recovery afterward.
Insufficient dietary intake of key nutrients, excessive energy intake or a poor overall diet quality not only compromise immune function but also increases the risk of infection and delay in recovery of infected patients. The fear of contracting disease has greatly reduced people’s ability to access and/or maintain a healthy diet and getting sufficient exercise during the pandemic has been more difficult and pieces of evidence indicate people of all ages are eating less healthily. The lockdown has caused the disruption in the food supply system that may add great challenges for people getting sufficient nutrition not only due to shortages of fresh vegetables but also artificial price hike.
There is no trade-off between the health of people and the nation’s economy. Both require aggressive and appropriate balance in getting control of the virus. The testing and tracing capacity of the country, improvement of isolation care, and treatment to those with severe symptoms at ICU, and availability of ventilators will support faster economic recovery, moving people from unemployment to work and our children go to school safely.
The COVID-19 pandemic won’t be the last infectious disease we face. Therefore, it is up to us to use preventive measures to counter the challenge. Although good nutrition does not guarantee that we do not get sick, it helps for the best outcomes.

(A Professor, Lohani is the founder and academic director of Nobel College. lohanis@gmail.com)