The pandemic body: How we have changed physically and what to do about it

From the so-called “Covid stone” to “mascne”, the past two years have had an impact on our general health in more ways than one. While we stayed at home to protect ourselves, and the wider community, what impacts have the necessary public health restrictions had on our bodies, and what steps can we take to reverse the damage?

More than half or 51 per cent of people surveyed for the Healthy Ireland Survey 2021 revealed that they drink more, smoke more, have gained weight or reported a worsening of their mental health in the past 12 months, showing the worrying impact the Covid-19 pandemic has had on the health of the nation.

The survey, which was published in December, represents a detailed insight of a time interval during which Covid-19 restrictions had a significant impact on the health and wellbeing of the people of Ireland.

Weight

According to the findings of the 2021 Healthy Ireland survey almost three out of 10 people (29 per cent) reported that their weight had increased during the pandemic, with weight increases reported most often by women aged over 30 and mothers.

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The survey also revealed that 36 per cent of people reported consuming two or more unhealthy snack foods daily, with 24 per cent consuming one unhealthy snack on a daily basis.

Working from home meant that for most people the daily commute by foot from the train station or bus stop to the office was cut so our activity levels fell while at the same time we had 24/7 access to the fridge.

The pandemic also meant that some people were perhaps getting take-aways more often in a bid to support their local restaurants and, according to social media posts, a lot of banana bread and sour dough bread was baked.

Louise Reynolds is a registered dietitian and communications manager with the Irish Nutrition and Dietetic Institute. She says that while our eating habits have changed as a result of the pandemic, as a dietitian the most important thing for her is that people have a healthy relationship with food.

'Your best weight is the weight you can live your happiest, healthiest and best life at. Let's step away from the scales. Let's not be too hard on ourselves'

“The whole cycle of beating ourselves up if we put on a little bit of weight and then going on a really strict crash diet and maybe losing a few pounds but then going back to you know, overeating. That’s not sustainable and it doesn’t make you feel good,” she says.

Reynolds says the pandemic has been “a huge challenge” for everybody, and it is best not to add another challenge in the mix by pressurising ourselves to be a particular weight.

Instead, she suggests that for the new year to try to be “your best weight”.

“Your best weight is the weight you can live your happiest, healthiest and best life at. Let’s step away from the scales. Let’s not be too hard on ourselves... the conversations around weight, let’s not have those in front of our children. Ideally, let’s not have those conversations at all. You know, because we all know what we should do. But it’s putting pressure on people.”

For the new year, Reynolds suggests making some simple positive changes. For example, looking at things we could eat more of, such as fruit and vegetables. She also suggests cutting back on meat and having one or two plant-based meals a week, which as well as being good for your health is also good for the planet.

Mental health

The 2021 Healthy Ireland survey revealed that 81 per cent of people reported feeling less socially connected due to the Covid restrictions. This was common among all age groups, although those aged 45-54 and women were more likely to be affected. Furthermore, 30 per cent of those surveyed reported a worsening of their mental health since the start of the pandemic.

General practice has been at the coalface of the pandemic from day one, and the vast majority of people with mental health difficulties are treated successfully in primary care.

Dr Brian Osborne is a GP in Galway and assistant medical director with the Irish College of General Practitioners. He says the Covid-19 crisis has had "profound economic, social and educational impacts".

“General practice is seeing at first hand the effects of the pandemic on the mental health of the population. Grief, financial loss, being out of work for the first time and isolation are major events in the lives of people. Individuals are presenting with increased levels of stress, irritability and poor sleep. Patients are presenting more commonly with loneliness, anxiety and depression,” he explains.

Coupled with people presenting with new onset anxiety and depression, Osborne says GPs are also seeing people with enduring mental illnesses such as schizophrenia and bipolar disorder, experiencing more serious relapses.

'It is important to say that the social determinants of mental health are hugely significant and people from socially disadvantaged areas are more severely affected'

He adds that while the pandemic has affected the mental health of all age groups, in his experience, young people in their late teens and early 20s have been particularly negatively impacted, with increased presentations of anxiety, depression and eating disorders seen in this cohort.

According to Osborne, “a whole host of other groups also face particular psychological challenges brought on by the crisis; children being kept out of school faced uncertainty and anxiety and it is vital that the schools remain open not just for education but for the social and psychological wellbeing of our children and young people. The elderly and those with pre-existing conditions face increased stress over the threat of infection.

“It is important to say that the social determinants of mental health are hugely significant and people from socially disadvantaged areas are more severely affected,” he adds.

Commenting on ways people can look after their mental health, Osborne says that developing a regular structure to your day, keeping active and staying connected with friends and family can all help to improve feelings of security.

He also says there are some practical things people can do to mind their mental health, which include maintaining regular exercise and sleep routines, avoiding excess alcohol, and having a healthy balanced diet.

Finally Osborne advises that anyone who is concerned about their mental health should contact their GP. “General practice is open and GPs are available to address concerns that patients may have,” he says.

Feet

Being stuck at home or restricted to within a few kilometres of your house for daily exercise led to a number of people walking more or taking up running for the first time during lockdown. While any increased activity is great for your health, if you don't wear the proper running shoes while attempting your first "couch to 5K" your feet will suffer – something Joe Egan, a podiatrist in Blackrock, Co Dublin, has seen a lot of over the past two years.

He has seen an increase in blisters, heel pain, fallen arches and foot and ankle injuries as a result of ill-fitting running shoes.

However, for Egan, a council member of Podiatry Ireland, the Society of Chiropodists and Podiatrists of Ireland, the biggest concern has been the impact of lockdowns on his patients with diabetes.

People with diabetes need to have regular check-ups of their feet to prevent a condition called diabetic neuropathy which, if left untreated, can, in extreme cases, lead to amputation.

Egan says that during lockdown his diabetic patients were not attending for their regular check-ups and, as a result, he saw an increase in preventable diabetic foot ulcers and, sadly, digital (toe) amputations.

He says that in 2015-2020 there were a total of five digital amputations in his diabetic patients or about one a year. However, between 2020 to the end of this year there were four such amputations; two a year.

There were some positives for our feet thanks to the pandemic, however, particularly for women who, rather than having to wear uncomfortable high heels to the office could opt instead for comfortable trainers while working from home, which Egan says are better for your feet.

He advises that one of the best things you can do for your feet is to wear comfortable shoes.

“Make sure that your shoes are comfortable, that you are not in discomfort... if it’s sore, it’s sore for a reason,” he says.

He also advises that people get their feet checked once a year by a registered podiatrist and if they have any issues with their feet to get them checked out.

As we return to hybrid working in the near future, Egan also advises that for those days that we are working from home to wear a good pair of runners, which he says should be treated as equally as important as the shoes you would wear in the office.

Heart

The pandemic has meant that many of us are working from home and, as a result, are sitting down for longer periods of time, which is not good news for your heart.

Last September, the European Society of Cardiology published new guidelines on the prevention of cardiovascular disease.

For the first time ever the guidelines recommended that people aim to reduce their sitting time and engage in at least light activity throughout the day.

A significant percentage of the worldwide population, in particular the European population, shows high levels of sitting time and physical inactivity.

The Irish Heart Foundation has long highlighted the risks associated with increased sitting time and heart disease and stroke, and has worked to increase awareness of this risk factor through a number of public health awareness campaigns such as Escape Your Chair, which aims to inform and advise about the dangers of sitting down for too long.

A survey by the Irish Heart Foundation revealed that more than half of people working from home in Ireland as a result of the Covid-19 restrictions were sitting down for an average of two hours and 40 minutes longer per day.

Conducted by Ipsos MRBI in August 2020, the survey found that more than half of all workers in Ireland were working from home since restrictions began, with 53 per cent of them sitting down for longer than when in the office or their usual place of work.

It is recommended that we get 30 minutes of moderate-intensity activity at least five days a week. However, this does not counteract the damage caused to our health by sitting for long periods of time.

The bottom line is that sitting down for too long can increase your risk of heart disease and stroke so make it a new year’s resolution to sit less and move more in 2022.

The Irish Heart Foundation has also highlighted concerns that people suffering from heart attack or stroke have delayed presenting to hospital due to a number of factors such as a fear of contracting Covid, or not wanting to burden the health service.

Its important to remember that a heart attack or stroke is a medical emergency so do not delay in calling 999 immediately if you have any symptoms.

Eyes

If you have been wearing your face mask correctly for the past two years, your eyes should be the only thing that is visible on your face. While mask wearing is one of the cornerstones of Covid-19 prevention, they have had a previously unknown impact on our eye health.

John Weldon, president of Optometry Ireland (formerly the Association of Optometrists Ireland), says the biggest issue seen by optometrists as a result of the pandemic has been the emergence of a new condition called mask associated dry eye.

Weldon explains that when you wear a face mask, your hot breath is circulated behind the mask and some of it goes into your eyes. The many bacteria that live in our mouths and the hotness of the breath can cause ocular irritation and dryness of the eyes. He adds that optometrists are also seeing a higher number of eye infections in contact lens wearers since the beginning of the pandemic, which he suggests is also as a result of mask wearing.

Spending more time at home during the pandemic has also meant spending increasing time looking at screens both for work and for leisure, and while not unique to Covid, there has been a massive worldwide increase in the prevalence of short-sightedness or myopia, which studies have shown is linked to increasing screen use.

“If we hadn’t been dealing with the worldwide pandemic of Covid, we would certainly be talking about the worldwide increase of myopia or short-sightedness,” Weldon says.

In relation to looking after your eye health Weldon advises that everyone should get their eyes checked with their local optometrist.

He says the ergonomics of the home office are important, how the screen is set up, the lighting, and so on, as well as remembering to regularly interrupt our screen time.

He advises that a handy mnemonic to remember is 20/20/20/20 whereby every 20 minutes while you are working, you should take 20 seconds, blink 20 times and try to refocus on something 20m away. This interrupts the task and allows the eyes to refocus.

Teeth

Any parent stuck at home during lockdown will remember the unrelenting demands for food and snacks from small children, they literally never stopped. Unfortunately, too many sugary snacks are bad news for kids’ teeth.

Dr Kieran O'Connor is a dentist in Youghal, Co Cork, and vice-chairman of the General Practitioner Committee of the Irish Dental Association.

O’Connor says that earlier in the pandemic, when the restrictions kept us all at home and schools were closed, dentists advised on the importance of “keeping social distance from the treat cupboard”, in an effort to reduce the amount of sugar children were eating, to protect their teeth and gums.

He also says children were not brushing their teeth as much when schools were closed.

“Children love to brush their teeth before they go to school so when they weren’t going to school, children weren’t brushing their teeth in the morning.”

'Change your toothbrush for the new year. Make sure your toothbrush is changed regularly'

Like other healthcare professionals, dentists have also seen the impact of lockdown on their patients’ oral health, particularly in relation to delayed diagnoses leading to poorer outcomes. These include things like preventable extractions and oral cancers that would have been spotted earlier if it wasn’t for some people’s real fears of leaving home.

According to O’Connor, dentists have also seen an increase in the prevalence of teeth clenching and grinding as a result of stress, and this has been widely reported since the onset of the pandemic.

“People can get headaches, they can get discomfort in the jawline and then some people start cracking teeth,” he says.

He advises people try to build in some structured relaxation time into their day for things like mindfulness or yoga, for example.

“All the things that are good for general wellbeing will help all that as well.”

A rather unexpected side effect of working from home seen by dentists in the past two years has been an increase in demand for orthodontic and cosmetic treatments.

“Lots of people are spending their working day on Zoom or other platforms. They’re looking at their smiles on the screen. They didn’t do it before so certainly there has been an increase in demand for orthodontic treatment and cosmetic treatment,” O’Connor says.

For Dr Aoife Lally, a specialist in skin cancer, one of the biggest concerns she has seen are delayed skin cancer presentations as a result of the pandemic

Asked for advice on ways to keep your smile healthy in the new year, O’Connor says we should try to minimise sugary snacks and if you are having them, then eat them with your main meal and not in between. This is because when you have a big meal you have a lot of saliva in your mouth, which clears the sugar more effectively. If you have a sweet in between meals, that sugar potentially stays in your mouth longer and increases your risk of decay, he explains.

He also advises that we treat ourselves to a new toothbrush in the new year.

“Change your toothbrush for the new year. Make sure your toothbrush is changed regularly, make sure that you spend time doing your tooth brushing, make it part of your routine,” O’Connor says.

It is recommended that we spend two minutes brushing our teeth while others may need to take longer.

“In general terms if you spend two minutes, you will do a good job, “ he says.

Skin

Apart from mask wearing, which some have suggested has resulted in a new skin condition called “mascne” (mask acne), the other big preventative measure in the fight against Covid-19 has been hand washing, which has also affected our skin.

According to Dr Aoife Lally, consultant dermatologist at St Vincent's University Hospital in Dublin, and associate professor at the School of Medicine at University College Dublin, increased hand washing has led to an increase in hand dermatitis or eczema, particularly among healthcare workers, and this was a much bigger issue than mascne.

“Masks will make a lot of skin conditions worse, potentially. But very few people have to wear their masks all day, every day. It is a thing, but not something that I am seeing a tremendous amount of... But... anything where you have prolonged occlusion of the skin with a moist, warm environment, that can make certain conditions worse, such as eczema, such as acne, but I have only seen mild flares.”

However, for Lally, a specialist in skin cancer, one of the biggest concerns she has seen are delayed skin cancer presentations as a result of the pandemic.

She says that as a result of people not seeking help for skin changes or being reluctant to contact their GP during the pandemic, they have been presenting with later more advanced disease.

'Sunscreen, sunscreen, sunscreen, that's it... really we should all be wearing sunscreen all year round. Sun protection would be my big tip'

“These tend to be older people who are a bit frail, and they generally take the guidelines very seriously. They have a fear of coming in to hospitals, given their fear about Covid. And so I definitely think people are presenting with later stage tumours due to fear of Covid and because the referrals dropped off in the initial stages in 2020 we’re still paying catch-up with that... Certainly I am seeing people 18 months down the line who have had something very obvious on their skin that they have delayed getting attention with.”

Most patients are seen in the rapid access skin cancer clinic in St Vincent’s within six weeks. Therefore, Lally explains, patients are not waiting to be seen in the clinic, however they are delaying seeking attention.

“It means that their treatment is then a little more complex if they present a bit later: they have bigger surgery and they may need other treatments whereas if they present earlier, the surgery is usually more straightforward.”

Lally says it is important for anyone who has any concerns about a changing skin lesion or any new lesion on their skin that looks different, also known as “the ugly duckling” sign (most normal moles on your body resemble one another, while melanomas stand out like ugly ducklings in comparison), to attend their GP who would then refer them on if appropriate.

According to Lally, the best thing you can do to improve the health of your skin is to wear sunscreen.

“Sunscreen, sunscreen, sunscreen, that’s it... really we should all be wearing sunscreen all year round. Sun protection would be my big tip,” she says.