Every season brings its own set of health issues, and winters are no exception. November, December, January, and in some places, February are the coldest months of the year in most countries worldwide. This includes Pakistan. In winter, days are very short and remain covered in dense fog, and the nights are quite long. Extreme weather changes make it difficult to acclimatize. As a result, some of us get sick.

The risk of hypothermia or low body temperature is high in winter. The human body is always trying to maintain a temperature of 98.6° Fahrenheit or 37° Centigrade. Hypothermia occurs when our body loses heat faster than it can produce it. A study published in the Annals of Medicine and Surgery defined accidental hypothermia “as a decrease in core body temperature to less than 35° C (95° F)”. It’s challenging to ascertain the severity of illness in hypothermia patients. A case study in America reported that about 1,500 Americans die annually, with the young and elderly especially vulnerable to severe hypothermia, which is a temperature of less than 28° C. One would expect hypothermic patients to shiver. However, severely hypothermic patients are unable to shiver as they become quite lethargic and limp with gradually deteriorating consciousness. In fact, such patients should be covered first as compared to patients who are shivering, fully oriented and conscious. The heart in these hypothermic patients is unresponsive to cardiopulmonary resuscitation (CPR), medications and defibrillation attempts. Therefore, they have to be warmed first before attempting any form of survival assistance measures. It is important to remember that death should not be declared without trained healthcare professionals’ advice.

In cases of mild hypothermia patients who are vitally stable and maintaining body temperatures between 32 and 35° C, active-passive external rewarming measures are adequate. These include covering the shivering patient with all kinds of dry, warm clothing, which can be easily done by people around the patient. Once the patient is received in the emergency department, they should be provided with warm, humidified oxygen via mask as well as warm bags of saline to sensitive areas such as the axilla (armpits), groin, back and chest. Moreover, in all kinds of hypothermia, large volumes of warm intravenous (IV) fluids are infused so that blood vessels become wider or dilated.

During winters, there is fog and the air is humidified. If there is pollution in the air, the fog mixes with it and creates smog. People with congested lungs should not go outside, especially in the mornings. In the later days of winter, the cold, dry winds make the airways dry, causing irritation and swelling; this will result in an increased frequency of dyspnea attacks in asthmatics at frequent intervals. They should increase the inhaler doses after consultation with their doctors. In addition to all this, flu vaccination is essential for the elderly, asthmatics and other lung conditions during the winter season.

According to a leading medical journal (JPMA), in the elderly, the clinical features of pneumonia are non-specific and can be fatal within a few hours, especially the pneumococcal variety. Its vaccine must be given to those with low immunity every five years. For safeguarding the elderly, regular checks by general physicians and making sure regular prescriptions are filled in advance are some of the useful measures that can be taken.

According to the World Health Organisation, pneumonia causes 70,000 infant deaths annually in Pakistan, mostly in the winter season. Simple precautionary measures like keeping an eye out for symptoms such as fever, coughing and body aches, adequate indoor heating and wearing warm clothes are helpful in this regard. Dry fruits, like figs, raisins and apricots are great sources of Vitamin C. Moreover, all dry fruits are packed with antioxidants, which help boost the immunity level of the body. Thus, adding dry fruits to the winter diet can be a sure-shot way of fighting against infections.

Like other countries of the world, in Pakistan, the frequency of heart attacks increases during the winter. This is due to the narrowing of blood vessels, called vasoconstriction. Vasoconstriction occurs in response to certain substances (chemicals) in the body. Once it occurs, it leads to increased pulse and blood pressure. A higher pulse and BP mean that the heart needs to work harder in order to pump blood. Signs and symptoms of a heart attack include sweating, shortness of breath; and chest, shoulder, back and upper abdominal pain. Our bodies tend to be less active during this season, which might put us at greater risk of having heart problems. A few ways to control adverse heart symptoms include regular blood pressure checks, taking your blood pressure medications religiously, keeping your distance from highly salty foods and ensuring regular exercise.

Depression rates seem to increase during the winter seasons. It is believed to be in part stimulated by the change in light intensity, as the number of daylight hours decreases in the colder months. This causes an imbalance in the hormones which control mood, such as serotonin, also called the ‘feel good chemical of the body’. Another one, called melatonin, helps regulate sleep. Some people react strongly to the changes in these hormones, with symptoms mostly starting in the autumn season. Feeling hopeless, sluggish or tired, losing sleep and craving high-carbohydrate foods are some of the symptoms felt in this disorder, called winter blues. If these symptoms are accompanied by depression features, then it is called Seasonal Affective Disorder. Some of the measures that can be taken to beat the winter blues include keeping a regular sleep schedule, using artificial light, spending some time outdoors, physical activity and socialising and limiting use of caffeine.

The fog and smog cause road safety issues due to reduced visibility and slippery roads. A study conducted in Pakistan observed a 34 percent increase in road traffic accidents due to fog during the winter season. In villages, tractors and goods transportation vehicles were the main culprits. Preventive measures include the use of fog lights, driving within speed limits and maintaining a safe distance between two vehicles.

Conjunctivitis, which is redness and swelling of the outer layer of the eye, can occur due to pollutants in the smog during the cold months, especially in areas of the country where the temperature falls below zero degrees Celsius. In addition, having eye infections during winter can affect vision which in turn can contribute to road traffic accidents.

Skin dryness increases during the winter season in all age groups but is more pronounced in extremes of age. Although it is normal, it can become problematic if it is associated with itch, redness and scaliness, causing small cracks and bleeds. Some important causes include cold winds, sitting in front of the heater, taking long warm baths and feeling less thirsty. This can trigger excessive dryness of the skin called eczema or, in some cases, allergies causing a condition commonly called “the winter itch.” Precautionary measures include avoiding using soaps and shampoos with harsh chemicals, taking less than ten-minute baths, eating good quality omega-3 fatty foods such as fish and nuts, drinking less caffeine and tea, and regularly moisturising your skin, ideally with natural oils or perfume-free lotions.

Some tips for staying healthy during winter:

1- Practicing good hand hygiene can prevent a lot of infectious diseases, for example, diarrhoea and respiratory (airway) diseases.

2- Washing hands for up to 20 seconds each time, covering mouth with a tissue when coughing or sneezing. If you don’t have access to tissue, use your elbow instead of your hands to cover the mouth

3- Avoid social activities when you are sick.

4- For healthy heart and lungs, be sure you are getting 150 minutes per week of moderate exercise.

5- Staying hydrated makes you feel fresh and your skin moist. In addition to water, herbal teas and broth-based soups can help you feel energetic and warm.

6- Ensure you wear appropriate clothing and keep yourself warm.

The writer is a family physician