Human Nutrition and Dietetics
QUESTIONS WE HAVE ANSWERED
Is there sufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19?
Short answer: No
The content of this document is correct as of 17/09/2020.
1.Can a Classroom Feeding Observation for Dysphagia take place within a Pod?
2.When conducting a Classroom Feeding Observation for Dysphagia do parents of children in the same Pod as the patient need to be informed of, and consent to, the observation?
1.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
2.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
The content of this document is correct as of 18/09/2020.
This response was based on the Department of Education COVID-19 Response Plan for Reopening our Primary and Special Schools, version 2, published in August 2020. Access this document here.
1.What is current guidance for cleaning a room after a hands-on physiotherapy session?
2.What are the current recommended products for effectively cleaning surfaces?
3.Do I have to wait a certain amount of time to clean my treatment room after a session?
1.Clean with detergent and water followed by rinsing and drying. If a surface is suspected or known to have been contaminated by infectious material a disinfected should be used after cleaning.
2.A neutral detergent with water for cleaning and a chlorine-based product, such as sodium hypochlorite, for disinfecting.
3.HSPC cleaning protocols do not stipulate that a certain amount of time should be left between seeing a patient and cleaning. HSPC guidelines state that COVID-19 virus droplets produced by an infected patient will land on surfaces “within minutes” of production. They do not state how many minutes precisely. Research has found that large droplets fall within 1 second while smaller droplets can take up to 9 minutes to fall to the ground.
The content of this answer is correct as of 02/10/2020
Can the below tests be administered via telepractice?
- Beery-Buktenica Developmental Test of Visual-Motor Integration
- Detailed assessment of speed of handwriting (DASH)
Yes, both Beery and the DASH have publisher recommendations for administration via telepractice. Detailed instructions for the DASH can be found here and detailed instructions for the Beery can be found here.
Both tests are published by Pearson. The DASH telepractice information is available on the Pearson UK website but it does not appear on their US website. For the Beery, vice versa, the telepractice information is available on the Pearson US website and does not appear on their UK website.
What is the impact on return to work for patients with COVID-19 who have been hospitalised?
In Ireland, 3,676 people have been hospitalised because of COVID-19. There is no information on the consequent work status of these individuals. This is also the case on the global stage. There are indications from small scale studies and research on similar diseases (SARS & MERS) that some individuals hospitalised with COVID-19 will experience delayed return to work. Fatigue and breathlessness are the most common post-discharge symptoms. Scientists and professional bodies are calling for occupational therapists and other allied health professionals to prepare for the surge in demand for services but more research is needed to determine the long-term consequences of a COVID-19 hospitalisation and its impact on return to work.
The content of this document is correct as of 08/10/2020.
Do I need to wear a mask if maintaining a 2m distance in a treatment room while delivering face-to-face CBT in Primary Care?
The National Public Health Emergency Team (NPHET) has recommended that healthcare workers use a surgical mask for all patient care activities when a safe distance (2m) cannot be maintained. This implies that when a 2m distance can be maintained a mask is not necessary. However, the NPHET guidance does not state this explicitly and does not address the issues of room size/occupancy or duration of contact. The European Centre for Disease Prevention and Control considers maintaining a 2m distance in a closed environment, such as a treatment room, as low-risk for exposure to COVID-19. The HSE Health Protection Surveillance Centre state that in low-risk circumstances, where wearing a mask may impact on patient care, a clear face visor is an acceptable alternative.
The content of this document is correct as of 30/09/2020.
These documents were used to answer this question:
- Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
- Health Protection Surveillance Centre (2020). Guiding principles for Infection Prevention and Control when returning to routine General Practice during pandemic COVID-19 v2.1. HSE: July 2020.
- European Centre for Disease Prevention and Control (2020). Public health management of persons having had contact with cases of novel coronavirus in the European Union. ECDC: February 2020.
Dr Liz Kingston, member of the RapidInfo4U Panel of Experienced Clinicians and Lecturer at the University of Limerick, with a clinical speciality in infection prevention and control, was consulted to answer this question.
This document has been prepared on behalf of the British Dietetic Association Critical Care Specialist Group by the following working group of Critical Care Dietitians from various NHS Trusts, Addenbrookes Hospital Cambridge and Kings College Hospital London.
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Bear, D., Terblanche, E., Davies, C., Duff, S., & Fixter, L. (2020). Critical Care Specialist Group (CCSG) of the BDA Guidance on management of nutrition and dietetic services during the COVID 19 pandemic. The Association of UK Dietitians, 1, 8.
This document has been developed by members from the Critical Care Dietitians Specialist Group of the British Dietetic Association taking into account current recommendations for planning and local experiences to date. In the absence of evidence-based guidance in this area, this document draws on experiences and knowledge obtained from those already working with critically ill patients with COVID-19, including international colleagues.
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Barazzoni, R., Bischoff, S. C., Breda, J., Wickramasinghe, K., Krznaric, Z., Nitzan, D., … & Singer, P. (2020). ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection.
ESPEN is the European Society for Clinical Nutrition and Metabolism. This editorial discusses the acute respiratory complications that require intensive care unit (ICU) management that are a major cause of morbidity and mortality in COVID-19 patients. Patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely older adults and polymorbid individuals and malnourished people in general. ICU stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing per se a relevant risk factor for higher morbidity and mortality in chronic and acute disease. Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may per se directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity. Prevention, diagnosis and treatment of malnutrition should therefore be routinely included in the management of COVID-19 patients. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing concise guidance for nutritional management of COVID-19 patients by proposing 10 practical recommendations. The practical guidance is focused to those in the ICU setting or in the presence of older age and polymorbidity, which are independently associated with malnutrition and its negative impact on patient survival.
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CONTENT FROM SCIENTIFIC JOURNALS
This article proposes a flow chart and ten key issues for optimizing the nutrition management of COVID-19 patients in the ICU.
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Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals.
The majority of documents encouraged the consumption of fruits, vegetables, and whole-grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system.
Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected.
There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.
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This article discusses the health disparities in nutrition and obesity which correlate closely with the alarming racial and ethnic disparities related to Covid-19.
Black, Latinx, and Native Americans are experiencing disproportionate burdens of infections, hospitalizations, and deaths from SARS-CoV-2 (Covid-19). Similar disparities are observed in other countries where minority groups face hurdles in accessing health, education, and social services as well as affordable, healthy food. These stark manifestations of health inequities have emerged in the wake of a body of evidence linking obesity and obesity-related chronic diseases, such as hypertension, diabetes, and cardiovascular disease — conditions that disproportionately affect disadvantaged populations — with severe outcomes from Covid-19.
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Robinson, E., Boyland, E., Chisholm, A., Harrold, J., Maloney, N. G., Marty, L., … & Hardman, C. A. (2020). Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite, 104853.
This study examined weight-related behaviours and weight management barriers among UK adults (n = 2002) during April–May of the 2020 COVID-19 social lockdown.
UK adults completed an online survey including measures relating to physical activity, diet quality, overeating and how mental/physical health had been affected by lockdown. Participants also reported on perceived changes in weight-related behaviours and whether they had experienced barriers to weight management, compared to before the lockdown.
The study reports that many participants reported negative changes in eating and physical activity behaviour (e.g. 56% reported snacking more frequently) and experiencing barriers to weight management (e.g. problems with motivation and control around food) compared to before lockdown. These trends were particularly pronounced among participants with higher BMI. During lockdown, in this study sample, higher BMI was associated with lower levels of physical activity and diet quality, and a greater reported frequency of overeating.
This study found that reporting a decline in mental health because of the COVID-19 crisis was predictive of greater overeating and lower physical activity in lockdown.
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High Level of Food Insecurity among Families with Children Seeking Routine Care during the Pandemic
Abrams, S. A., Avalos, A., Gray, M., & Hawthorne, K. M. (2020). High Level of Food Insecurity among Families with Children Seeking Routine Care at Federally Qualified Health Centers during the COVID-19 Pandemic. The journal of pediatrics: X, 100044.
Clinicians in two federally qualified health centers in the US state of Texas assessed food insecurity during pediatric visits during the COVID-19 pandemic using the validated American Academy of Pediatrics 2-question food security screen. Interviews of 200 families found approximately half of families reported food insecurity. 94% of the food insecure families indicated worsening of food insecurity during the pandemic. The findings strongly suggest screening of food security be part of routine pediatric care.
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OTHER REPUTABLE REPOSITORIES & USEFUL CONTENT
The Irish Nutrition & Dietetic Institute (INDI) is the professional organisation for dietitians in Ireland representing almost 800 Dietitians and Student Dietitians nationwide.
INDI has formed a task and finish group to develop resources to support practice druing the pandemmic. They are available for you in the INDI E-Learning centre.
There are two areas in the E-learning centre – one for clinical dietetic practice and one as a signpost for general information which may be useful (non-urgent, non-acute, general healthy eating).
These documents have been developed and/or collated by Dr Anne Griffin, Ruth Kilcawley, Carmel O Hanlon, Jennifer Feighan, Ruth Reidy, Mairead Aherne and Lisa Shanahan using material from a variety of sources.
The INDI E-Learning centre also contains a forum to share experience, provide support and seek knowledge. This forum is private and is not moderated.
To access the E-Learning Centre: Please follow this link https://learning.indi.ie/course/index.php?categoryid=8 then click on the ‘Resources for Dietitians’ course and click LOG IN AS GUEST from the login screen.
Fresenius Kabi is a global healthcare company that specializes in lifesaving medicines and technologies for infusion, transfusion and clinical nutrition. They have compiled COVID-19 updates and useful documents here.
RapidInfo4U is part of the Irish Government’s national coordinated research and innovation response to the COVID-19 pandemic. RapidInfo4U is funded by a Health Research Board COVID-19 Pandemic – Rapid response funding award and managed by the Health Implementation Science and Technology cluster at the University of Limerick.