By Ritika Sakhuja
New Delhi: The extreme decline in temperatures witnessed all over Northwest India brought along with it many health issues and a general decline in health for all, triggering a rise in hospitalisations due to morbid diseases including cardiovascular and respiratory maladies.
As the mercury dipped all over the country, with parts of Delhi reaching a debilitating 1.9℃, the India Meteorological Department (IMD) issued a warning last week informing of coldwave to severe coldwave conditions in parts of Northwest India. IMD reported that minimum temperatures were in the range of 1-3℃ in many parts of southwest Uttar Pradesh, south Haryana, Delhi and adjoining north Madhya Pradesh, and some parts of north Rajasthan. Many parts of central Madhya Pradesh, east Uttar Pradesh, western parts of Bihar, Punjab, and north Haryana saw minimum temperatures in the range of 3-7℃. The lowest minimum temperature of 0.0℃ was observed over Churu (Rajasthan), IMD reported.
The Centre for Disease Control (CDC) states that although the human body is capable of surviving abrupt changes in external conditions, it can still warm or cool itself only to a certain extent. When the natural defence mechanisms of the body begin to suffer, it can lead to concerning effects. In addition to morbidities, several health issues that damper the quality of life, like bone, joint, and muscle pain, cough and cold, respiratory diseases such as bronchitis, and even skin problems, can arise when a human body is exposed to lengthy cold conditions.
Although the weather is predicted to improve in the second half of January, the period of caution-worthy temperatures is still not over. Hence, ETHealthworld spoke to doctors to gain insights into the current status of cold-induced diseases and the necessary preventive measures that must be practised by everyone.
Hospitalisations on the rise due to killer cold waves
During this period of persistent low temperatures, hospitals across Northwest India have been reporting a surge in the number of patients suffering from respiratory or cardiac complications, viral infections, and in some cases, even neurological disturbances. Patients complained of chest pain, chest tightness, shortness of breath and coughing, and hypertension.
Listing out common ailments that are seen most frequently during unbearable cold weather, Dr Amitabha Ghosh, Consultant Internal Medicine, Manipal Hospitals, informed, “People with comorbidities are prone to catch infections, particularly respiratory tract diseases. In colder temperatures, the spread of respiratory tract infection is on the higher side, so people with co-morbidities like asthma, chronic obstructive pulmonary disease (COPD), renal disease, and diabetes can catch infections easily. Cardiovascular events like heart attacks or heart failure also increase during this time. People with arthritis especially suffer more in colder temperatures.”
AIIMS Delhi reported a 15-20 per cent rise in patients visiting the outpatient department (OPD) or emergencies with respiratory and cardiac ailments. The centre-run Dr Ram Manohar Lohia Hospital and Safdarjung Hospital also saw around a 20 per cent increase in the number of patients in OPDs. Doctors across the northwest region informed that, among the patients facing debilitating health issues, children and those above the age of 60 were the worst affected during this period. Hospitals saw a rise in admissions of homeless people with hypothermia as well as a spike in brought-dead cases.
Following this, IMD issued a red and yellow alert in several parts of Northwest India, such as Uttar Pradesh, Punjab, Haryana, Chandigarh, Rajasthan, and Uttarakhand.
Winter air can irreversibly damage the respiratory system
Each year the healthcare industry witnesses the winter season exacerbating various respiratory issues such as Chronic Obstructive Pulmonary Disease (COPD), asthma or long-term lung problems like bronchiectasis. This phenomenon can be attributed to an increase in pollution and viral infections during the fog-ridden period of extreme cold weather.
People of all ages, especially those who are moving or travelling outside their houses frequently or working in closed spaces privy to indoor pollution, tend to develop symptoms of respiratory diseases in winter. As cold air is denser and moves slowly, winter air can trap pollutants which stay suspended at the ground level, also called smog, and are therefore breathed in at a higher rate than during the summer. Additionally, cold air can’t hold as much moisture, so the air is usually drier during winter, and hence is devoid of the cleansing effect that moisture-laden air or rain has on pollution. This phenomenon leads to increased levels of air pollution during winter directly inducing respiratory complications, and severely affecting patients who have underlying lung diseases.
Viral infections are equal accomplices in the growth of respiratory complications during the winter season. Instances of pneumonia and bronchitis are widely reported during this time. Dr Jayalakshmi TK, Consultant, Pulmonology, Apollo Hospitals, informed how the winter season causes a spurt in viral infections. She said, “Cold, flu and other respiratory illnesses are more common in colder months as people prefer staying indoors. This tends to increase the spread of viral infections, allowing viruses to pass more easily from one person to another. The cold, dry air may also weaken resistance against the spread of infections.”
People living with pre-existing respiratory issues are also at a heightened risk due to disruption of the normal functioning of the respiratory process during winter. “Extremely low temperatures can also cause bronchoconstriction. In this condition, airways tend to contract due to the cold, making it harder to breathe properly. Additionally, even nasal passages get congested in an attempt to reduce the influx of cold air. This condition can be extremely dangerous for patients with underlying issues like asthma, making their health much worse,” added Dr Jayalakshmi.
Intense cold lethal for heart patients
Heart attacks and strokes due to the cold are becoming the norm as hospitals witnessed a steep jump in the number of emergency patients with chest pain and heart-related issues. Young, old or middle-aged people, all age groups were seen to be equally prone to heart-related issues during this season.
Low temperatures cause the body to regulate blood flow from the extremities to the core and vital organs to keep them warm and in a state of homeostasis. Because of this, the liver, heart, lungs, and spleen get more circulation, while fingers, toes, nose, and earlobes receive less blood circulation, making them colder. To stay warm, the human body shivers and undergoes vasoconstriction, meaning the blood vessels contract and increase blood pressure and circulation. This can also lead to hypertension in several individuals.
Dr Sreekanth B Shetty, Senior Consultant and Head, Interventional Cardiology, Sakra World Hospital informed that people with pre-existing heart issues are at greater risk during winter. He explained the phenomena of coronary vasospasm or vasoconstriction, which is often witnessed during winter, leading to a reduction in blood flow to the heart, which can lead to an increase in blood pressure. Explaining the mechanism behind heart attacks being triggered due to the cold, Dr Shetty said, “Intense cold can lead to coronary vasospasm, which can be fatal, particularly in people that already have coronary diseases. On top of the vasospasm, if a thrombus forms, which is a clot, it can occlude the artery. That is how a cold can induce a heart attack.”
“During colder weather, we see microvascular dysfunction as well, in which even the smaller branches of the artery don’t function so well. So even after opening the main artery during angioplasty in cold weather in heart attack patients, the smaller branches still experience an extremely slow blood flow. So patients with cardiac issues are at greater risk during winters,” he added.
Furthermore, unprotected exposure to the cold can also result in hypothermia, a medical condition in which body temperature gets extremely low causing biological operations of the body to slow down. Early signs of hypothermia include cold feet and hands, swollen face, pale skin, shivering, slurring of speech, drowsiness, lethargy, and confusion. In later stages, the symptoms include trouble walking, stiff limbs, slow heartbeat, shallow breathing, and loss of consciousness. If left untreated, hypothermia can be devastating as it can eventually lead to a drop in blood pressure and heart rate, causing a heart attack, kidney problems, liver damage, and in extreme cases, even death.
Falling temperatures must not be taken lightly
In response to the decline in temperatures, IMD issued a set of precautions to follow to stay protected and healthy. IMD prompted the masses not to ignore shivering or any other signs of hypothermia by seeking immediate medical intervention. Despite the increased risk of viral infection, the precautionary notice advised staying indoors to stay warm, to reduce the risk of hypothermia. If outdoors, wear several layers of loose, comfortable, warm clothing to retain the body’s core temperature, and eat adequate amounts of nutritious fat, vegetables, fruits, and other foods that are rich in energy, as their thermic effect further helps in maintaining the core temperature, recommended IMD.
As per CDC, avoid morning walks before sunrise during winter. When going out, ensure the head is covered well. CDC also recommended taking Vitamin D as its deficiency can lead to a heart attack.
To avoid the spread of viral infections, doctors suggest that COVID-19 protocols of social distancing, sanitising, and wearing masks must be followed during peak winter. If a person is experiencing symptoms of a viral infection, like a sore throat, weakness, cough, or cold, they must isolate themselves from other members of the house immediately, and avoid going to other indoor locations.
The dip in temperature is also risky for people suffering from neuro-related ailments such as epileptic seizures. As per a study published in the US National Library of Medicine, for every 1°C decrease in temperature, there was a relative risk increase of 1.016 in the number of emergency visits as a result of epilepsy. Hence it is essential for people with pre-existing neurological conditions and living in areas where temperatures fall drastically, to ensure necessary medical support is within reach. Family members of such patients must be extra-cautious as well.
It is important to note that some illnesses make it harder for the body to stay warm, such as thyroid problems make it hard to maintain a normal body temperature, diabetes can keep blood from flowing normally, and Parkinson’s disease and arthritis can make it harder to put on more clothes, use a blanket, or get out of the cold. Patients with such health issues need to take extra precautions to be proactive during intense cold weather and surround themselves with people who can help ease their incapacities.
Considering the advice of doctors and the incidence of fatal health complications caused by the steep dip in temperatures, this bone-chilling period of frigid temperatures serves as a lesson, that everyone needs to be informed of the ailments that can be induced by under-protected exposure to extremely cold weather.