Here are 19 tips from the Nutritional Support Unit at Vall d'Hebron Hospital to stay in top health during COVID-19 lockdown.

Healthy habits 

Below are a series of tips relating to healthy habits in terms of exercise, food and drink, leisure and rest.

• Organise your intake. Split it up into 4-5 meals a day and avoid skipping the main ones. Organise the times of main meals in advance and try to keep them the same each day.
• Plan ahead! Put together family meal plans on a weekly basis, making sure they feature all the food groups. This will allow you to shop more efficiently and buy only the food items you need.
• Write a shopping list! Adapt it to the weekly meal plan. Buy the fresh ingredients you need and remember that dry and tinned products are a great option (dried beans, rice and pasta, tinned tuna, artichokes, etc.). Avoid impulse buys and food wastage.

Eat and drink healthily

The foundation for a healthy diet is one which is varied, featuring fruit, vegetables, animal and vegetable protein, cereals, eggs, dairy products and dried fruits and nuts. Processed foods and sugary drinks should only be consumed occasionally and water should be the main drink.

• Proper hydration is very important for the body. Water is the best drink. Try to have a bottle or glass of water nearby to make sure you continuously hydrate with 1.5 to 2 litres per day. There is no need to wait until you are thirsty. Teas and broths are also healthy options, but it is a good idea to avoid sugary, fizzy and alcoholic drinks.
• 3+2 = 5 a day! Fruit and vegetables should make up a major part of your diet. You should include, as a minimum, two portions of vegetable a day and three fruits throughout the day. Make sure that your meal plan includes one portion of cooked vegetable and a citrus fruit.
• Cereals form the basis of our diet. Think wholemeal! We recommend eating the wholemeal versions of pasta, bread, cereals and rice. There are other cereals too: quinoa, oats, rye, millet, buckwheat...
• Use olive oil for dressings and for cooking with. It is the best fat there is, a source of healthy fat and a Mediterranean food, which is why it is sometimes called 'liquid gold'.
• Protein-rich foods should feature every day, at lunch or in your evening meal. Meat, fish and eggs offer animal proteins and pulses offer vegetable protein.
• We recommend eating meat three to four times a week. Prioritise white meat (rabbit, chicken, turkey) and restrict red meat (beef, lamb por pork) to once or twice a week. In terms of processed meat, such as sausages, hamburgers and fatty cured sausages, only use them occasionally, as they are high in fat and unhealthy additives.
• We recommend eating fish three to four times a week. White fish (sole, hake, cod, etc.) should be combined with oily fish (salmon, tuna, sardines, etc.). You could freeze it to avoid the risk of anisakis infection.
• When it comes to eggs, the recommended weekly consumption has gone up. They can now be eaten three to four times a week.
• Regular consumption of dairy products and derivatives is important for your bone and immune health. Dairy is a very important and complete food group. These products are a key source of calcium and fat-soluble vitamins. Semi-skimmed and skimmed dairy products are recommended.
• If you have a lactose intolerance, lactose-free milk and derivatives are available on the market. If you have an allergy to cow's milk protein or an aversion to milk, opt for vegetable drinks. Remember that vegetable drinks do not have the same nutritional profile as cow's milk. Wherever possible, each yoghurts and cheese.
• Eat pulses at least three times a week. They are a great source of fibre and protein. They are easy to store and very versatile when it comes to including them in a meal. This food group includes lentils, peas, chickpeas and soya, among others.
• A handful of dried fruits and nuts provides a lot of energy, healthy fat and fibre. We recommend eating some each day. A handful as a mid-morning or afternoon snack is a very healthy option, but do not eat too many as they are high in fat.
• Avoid excessive consumption of superfluous foods like cakes, treats, processed foods, soft drinks and alcoholic beverages. Regular consumption leads to health issues in the medium term. Save them for special occasions.
• When it comes to cooking food, griddle, steamer, wok and en papillote are the healthiest options.

Rest and physical activity

Remember that, as always, a healthy diet should be accompanied by good rest and physical activity:

• Make the most of your free time to do activities you have been meaning to get around to or hobbies you do not normally have time for. Have a go at cooking or discovering new recipes, reading or doing manual tasks.
• Incorporate physical activity into your daily routine. We recommend incorporating sufficient aerobic exercise. You can find exercise tables and videos online.
• If you have a balcony, terrace or window, try to make sure you get between 20 and 30 minutes of sunlight every day.
• Do not forget to rest. Sleep between 7 and 8 hours a night. Try to stick to regular timetables.

Elderly people and risk of intection

Although no direct relationship between elder people and the risk of SARS-CoV-2 coronavirus has been shown, older people suffering from COVID-19 infection are more likely to develop severe complications. This is related to the aging and chronic diseases that this group suffers most often.

In fact, according to the European Society for Geriatric Medicine, the analysis of current data shows that mortality rates in infected patients over the age of 80 are about 15 %; whereas this value decreases to falls to less than 0.5 % in people under the age of 50.

Prevention measures

Elderly people, in particular those who are more fragile and with chronic pathologies (respiratory, heart, kidney, or diabetes, among others), must follow strict preventive measures to minimize the risk of infection. In addition to the usual principles, some guidelines can be followed which reduce a possible infection such as:

• Home confinement. Elderly people, especially those over the age of 80, must be confined to their homes and shy away from the street, except in emergency situations. In the event of symptoms or other medical problems, they should contact their Primary Care Center and follow the guidelines given.
• Restriction of visits and contact. Visits to this group should be reduced to those of their carers or family members who care for them, who look after their daily needs. They should avoid contact with family and friends with symptoms of respiratory infections, as well as with children and adolescents.
• Extreme hygiene measures. Both home cleaning and hygiene measures should be enhanced to prevent contagion or infection. 
• To do physical exercise. It is important that they continue, despite being at home, doing the same or similar physical activity: they can take a walk or do a simple stretching routine indoors to help the body stay active.

Guidelines for caregivers and family members

People or relatives caring for the elderly must maintain a holistic view of the needs of this group. Also, being in constant physical and social contact with the people in charge, they must enhance some of the measures to avoid being a transmission vehicle. Thus, they must be concise in hygiene, especially of the hands, using soap and water or antiseptic solutions, and drying with disposable wipes.

It is also important not to neglect communication. Despite confinement at home and the restriction of visits to the elderly, it is important that socialization is not lost and that the community can be isolated. For this reason, it is advisable to promote non-face-to-face communication channels, such as telephone, video conferencing, WhatsApp or social networks.

In the event that the caregiver has any symptoms related to COVID-19 (cough, fever or general malaise), it is advisable to delegate to another caregiver or family member their responsibilities to prevent infection and consult with the specialist.

In critical times such as these, people can suffer from stress and anxiety due to the powerlessness and/or frustration they feel as a result of the situation. All of this can wreak havoc on very important physiological variables, such as rest and sleep. Following a series of guidelines and measures every day can help avoid this.

How can we apply this to the current situation caused by COVID-19?

Sleeping is essential for many of our body’s physical and mental functions. A good sleep pattern helps us handle stress triggers better, reduces the chances of suffering from ongoing sleep problems, and strengthens our immune system, which is what our body uses to fight off diseases.

Sleep is a complex biological process that helps us assimilate new information, stay healthy, and feel well-rested and strong. But what does “sleeping well” mean, exactly?

• It means sleeping as many hours as required for our age. 
• It also means going through all the different sleep phases during our slumber.

Therefore, when we talk about sleeping well, we mean both an adequate quantity of hours and a good quality of sleep.

Advice for sleeping well

• Establish daily routines.
• Establish a regular time to go to bed and wake up, that coincide with day and night hours.
• Do some kind of moderate physical activity, adapted to your age and the current conditions.
• Avoid eating large portions and heavy foods for dinner.
• If possible, use the bed only for sleeping.
• Do not consume alcohol or other stimulants before going to bed.
• Avoid using screens and mobile devices before going to bed.
• Avoid long naps during the day. It’s best for them not to be longer than 30 minutes.
• Learn relaxation exercises and practice them during the day and before going to bed.

 The protective measures to prevent the spread of SARS-CoV-2 coronavirus are the same as in any respiratory ailment:

• Wash your hands frequently. It is necessary to maintain proper hygiene of the hands, cleaning them with soap and water or 70 % alcoholic solutions. Especially if you have been in contact with people who suffer from this condition or in their environment. In this way, we eliminate the virus from the limb.
• Cover your mouth and nose when you cough or sneeze. It is important to adopt respiratory hygiene measures. That is, when coughing or sneezing, cover your mouth and nose with tissues or with the inside of your elbow. Immediately after, you have to wash your hands following the instructions in the previous section. This prevents the spread of germs and viruses, and contaminates the objects you touch or the people around you.
• Avoid touching your eyes, nose or mouth. The spread of the SARS-CoV-2 coronavirus occurs when the respiratory secretions that are generated with the cough or sneeze of an infected person are exhaled by a healthy person or when they fall on an object or surface that the person subsequently touches and then, without disinfecting your hands, you touch your eyes, nose or mouth. That is why it is important to touch these areas after proper hand hygiene.
• It is essential to avoid close contact with people suffering from acute respiratory infections and coughing, sneezing or expectoration. You have to keep a distance of two meters and not share personal belongings.
• It is essential not to share objects such as cutlery, glasses or napkins; food or other objects without cleaning them properly.
• If you have symptoms of malaise, cough, fever and difficulty breathing, call 061 and follow their instructions.

The World Health Organization (WHO) has declared the coronavirus SARS-CoV-2 as an international public health crisis, therefore it is advisable to avoid trips that are not strictly necessary to the areas affected by the coronavirus SARS-CoV-2.

On the one hand, if you have an unavoidable trip to one of these areas, it is advisable to follow the general measures indicated above to reduce the risk of infection and, in addition:

• Do not approach live or dead domestic or wild animals and their secretions or droppings in markets or farms.
• Do not consume products of animal origin (meat or undercooked or raw food).
• In the case of elderly people or those with health problems, who may be at risk of serious illness, they must evaluate the trip together with a healthcare professional at an international vaccination center.

On the other hand, if it is a person who has returned from an affected area, you have to follow the following recommendations:

• If the person is well, they can continue with their social, work and educational life; but has to monitor the health status during the 14 days following your arrival. In case of general malaise, cough, fever or feeling of shortness of breath, call 061 and follow the indications. Remember to report not only the symptoms you have, but also the area you have visited.
• If, when returning from the trip, the person has the symptoms indicated above, has to call 061 to assess how to act and the instructions to follow.