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Breast feeding lowers the risk of breast cancer

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We are all aware of the numerous benefits of breastfeeding. Not many however may be aware of the reduced risk of breast cancer with breastfeeding. On this Breast cancer awareness month October, let me tell you a bit about these benefits.

The baby must be exclusively breastfed for 6 months, as recommended by the WHO and most paediatric and gynaecological associations including IAP. This means that the baby needs no water, formula or liquids and solids. Breastfeeding provides the baby with all the energy and nutrients they need. After 6 months, solid and semi-solid food can slowly be introduced into the baby’s diet while you continue to breastfeed the baby. The longer you breastfeed, the more is the protection against breast cancer. In fact, a study found that for every one year that the baby is breastfed, the risks of breast cancer go down by 4 % or so. This study compared women who breastfed their babies compared to those who didn’t. Moreover, there’s also protection against ovarian cancer. There is a 63% less chance of this cancer for women who feed their babies for one year and the risk further reduces if you feed them for longer than one year.A study of more than 60,000 women published in an international journal also found that women with a family history of breast cancer reduced their risk of getting the disease before menopause by around 60%. So if there is a family history of breast cancer, there’s even greater benefits and need for breastfeeding. There’s also a greater body of evidence that shows that breastfeeding also reduces the chance of more aggressive and difficult to treat cancers.

 

Also, remember that there is a lower chance of both premenopausal and postmenopausal breast cancer. The reason for this is that during pregnancy, childbirth and lactation, the menstrual periods stop. When there are no periods, there are hormonal changes. Estrogen, the hormone that is believed to cause breast and ovarian cancer goes down, thereby limiting the risks. And obviously, the longer these periods of no menstruation, the more the protection afforded. In addition, when women breastfeed, for some time there is no ovulation; so lessened chances of ovarian cancer. During pregnancy and breastfeeding, there is also some shedding of breast tissue cells. This removes cells with potential DNA damage, again reducing the chances of breast cancer.

And there’s one more reason. When pregnant and breastfeeding, you eat a more healthy diet that is rich in antioxidants, fruits, green vegetables and whole grains and nuts. There is ideally no intake of alcohol and smoking, both of which are known to cause cancer. There is a greater focus on leading a healthier life, including exercising. Breastfeeding also helps in burning calories and reducing weight. Ideal body weight and lack of obesity are also known to reduce the risk of not just breast cancer but many other cancers as well.

Breastfeeding, as we all know, also protect against obesity, diabetes, high blood pressure.

 

Now lets talk about benefits for a breast fed baby. Mother’s milk is laden with antibodies which protect babies against gut , ear , eye and respiratory infections including childhood asthma. These babies have less chances of type 1 diabetes and childhood obesity. Less obese babies have a lesser chance of many cancers like postmenopausal breast, uterine, oesophageal, rectal and kidney cancers. Longer the baby is breast fed , lesser the chances of many allergies. Aren’t these a lot of reasons to breast feed your baby.

 

Do remember to keep doing breast self-examinations, clinical breast examinations by your doctor, ultrasound of the breast after the age of 25 years and also mammography after the age of 40 years.

Breast cancer is a deadly disease but breast milk is the elixir that can beat this terrible cancer. So despite the challenges to breastfeeding, pledge to breastfeed and take care of your own health NOW!

Lets talk about the methods of contraception beyond old school

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Let’s deviate a bit from the classical methods of contraception and talk about some of the new kids on the block .

Some of the newer methods are the contraceptive patches, vaginal rings , implants, injectables and intrauterine system containing hormones.

They may not have taken the Indian woman by the storm but its important she knows about them and takes a calculated choice about using them.

CONTRACEPTIVE PATCH:

The contraceptive patch is a combined estrogen and progesterone patch which can be applied on the skin of the shoulder, upper back, abdomen, buttock or upper arm. They are very similar in composition to oral contraceptive pills but good for women who don’t want to or forget to take the pill every day. These need to be applied every week for 3 weeks are removed after that and a fresh one is applied after a gap of one week. In this 4 th week when the patch is not applied, the user will get her menstrual period. Ideally, this should be started on the first day of the period and if it is started on any other day, additional backup is needed for a week.

Some additional benefits include a lesser menstrual blood flow, lesser iron deficiency anaemia and lesser cramps. They can be used during bathing, swimming, sports etc.

However, some studies have shown a slightly higher chance of clots in the legs, though these are not proven in other trials. People who are obese with a BMI greater than 30 kg/m2 should not use them.

INTRAUTERINE CONTRACEPTIVE DEVICE AND SYSTEM CONTAINING PROGESTERONE

The IUCDS which contain copper have become sleeker, they can now be used even in young girls who have not yet  borne children . Earlier it was contraindicated in this group of girls. It is a method which is low maintenance. These can be inserted by the health care provider for a period of 3-10 years and unlike the oral pills one doesn’t  need to take them everyday. There is a risk of pelvic infection, especially if one has multiple sexual partners, there may be heavier periods and if it fails, a chance of tubal ectopic pregnancy as well.

The hormone containing IUD is the MIRENA which is effective in a number of associated conditions like heavy bleeding, cramping , endometriosis and correction of anemia owing to its property  of reduced blood flow.

The common side effects though ,are irregular bleeding or spotting , which generally get better after 3-4 months of use. They may also cause stoppage of bleeding or amenorrhoea .

They are highly effective and no fuss, and a lot of women are switching over to these as a method of contraception.

 

IMPLANTS

Contraceptive implants contain a rod around 4 cm long which contains the hormone etonogestrel. It is inserted by a doctor certified to carry out a minor procedure ,under local anaesthesia ,in your  non dominant upper arm, under the skin. It is easily felt by the recipient if properly inserted. This method too is a hormonal method, small quantities of the hormone released every day . It is removed after 3 years by another simple procedure. This implant is recommended for women who are breast feeding, in whom oestrogen is contraindicated and in women who prefer a non fussy, get it forget it approach.

Side effects include irregular spotting and occasionally stoppage of menstruation . It can be removed at any time if you wish to become pregnant or if you desire removal due to side effects.It has a quick return to fertility and while it is used it has very good efficacy. It is a preferred method in the west, though not so much in India currently .

INJECTABLE CONTRACEPTIVES

These have been available for many years and consist of the progesterone DMPA which is inserted once in every 3 months. The compliance of this has been poor due to the side effects of irregular spotting and amenorrhoea. Some weight gain has also been reported.

VAGINAL RING

Another method soon to hit the markets is the contraceptive vaginal ring which is a soft ring that contains hormones, inserted high up in the vagina. It is used for 3 weeks and then removed for 1 week in which the user gets her periods. It is easy to insert and remove and is not uncomfortable. It is not felt by her partner either at the time of sexual intercourse.

Remember to talk to your doctor to help you make a choice depending on your personality, lifestyle, goals and objectives. Associated conditions too. Also be assured that if one method doesn’t suit you, there are many others in this bouquet.

CONTRACEPTION – HOW TO CHOOSE WHATS BEST FOR YOU

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There is a whole basket of birth control methods that are available, often so confusing. My aim is to run you through some of these so that you can choose what is appropriate for you. The best person to guide you is your doctor.Choose what is best for you.Also, do not worry, if one does not suit you; there are many alternatives that you can try till you find one that is good for you.

The methods available are :

  • Condoms [male]
  • Condoms [female]
  • Caps
  • Diaphragms
  • Combined pills
  • Progesterone only pills
  • Contraceptive implant
  • Contraceptive injection
  • Contraceptive patch
  • Intrauterine device [ copper containing and hormone containing]
  • Vaginal ring
  • Rhythm method

Permanent methods:

  • Tubectomy
  • Vasectomy

Condoms and other barrier methods like cervical caps and diaphragms prevent sexually transmitted diseases as well.

WHO CAN USE THE COMBINED PILL?

Combined estrogen and progesterone pills help by preventing ovulation [release of the egg], by preventing the egg to be fertilised by the sperm or by making cervical mucous thick. When used correctly, the pill is 99% effective in preventing pregnancy.

Your doctor will take a proper history and rule out contraindications to take the pill. The pill may not be good for you if:

  • You are a smoker and are 35 years or older
  • Stopped smoking less than a year ago and are 35 years of age or more
  • Are extremely overweight
  • Take certain medicines which may interact with these pills
  • Have had blood clots in a vein or a stroke
  • Have a family history of blood clots or stroke
  • Have heart disease or severe hypertension
  • Have severe migraines or depression
  • Have breast cancer or genital cancer
  • Gall bladder disease
  • Diabetes

Immediately post-delivery when you are breastfeeding your baby

You will highly benefit from these pills even if you have heavy bleeding, fibroids, ovarian cysts, endometriosis, PCOS, symptoms of PMS and many other problems like acne and abnormal hair growth.

Remember, though that these pills do not protect against STDs

WHO IS A GOOD CANDIDATE FOR A CONTRACEPTIVE IMPLANT OR HORMONE CONTAINING IUD?

If you forget to take a pill everyday and find doing so very troublesome , a hormone containing implant or IUD is good for you . It can be inserted for a period of 3-5 years . Also, it is indicated where estrogen is not indicated especially for girls who are breast feeding . It reduces heavy bleeding and period pain .

Remember however that it requires insertion by a doctor .

WHO CAN USE THE PROGESTERONE ONLY PILL?

If you’re above 35 years of age, a smoker , are breast feeding your baby and don’t have a problem about taking the pill everyday or with irregular bleeding or spotting or no periods (amenorrhea ) while you use this POP.

WHO NEEDS A PERMANENT METHOD OF BIRTH CONTROL?

A vasectomy or tubectomy is suited for someone who’s completed their family and does not want any more children. These methods are generally irreversible; they have a small chance of reversal depending on many factors. You must be very sure before you opt for these procedures.

There is a method that suits everyone ; just let your doctor find the one which will help you prevent an unwanted pregnancy and unnecessary and occasionally risky terminations

Benefits of Breastfeeding

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Why breastfeed? 

There are numerous benefits of breastfeeding for the mom and baby, some of which extend lifelong. 

The biggest reason is that nature intended it this way . Breast milk contains just the right amount of macro and micronutrients, antioxidants, enzymes, immune properties and antibodies from the mom. The mother’s mature immune system prepares antibodies against common microbes and these antibodies are released in the mother’s milk. They coat the lining of the baby’s gastrointestinal system and protect them against illnesses, often for life . Moreover, breast milk is at the right temperature and is not infected, unlike bottles and nipples. 

HUMAN MILK IS NATURALLY BEST FOR HUMAN BABIES.

Breastfeeding moms lose weight earlier. They burn around 500 extra calories per day and become fitter earlier. 

Moreover the uterus of breastfeeding moms contracts and returns to pre-pregnant normal size earlier. Blood loss following delivery is also less due to the same reason.

Lesser chances of anaemia.

There are fewer chances of urinary tract infection. 

As the mom bonds with the baby with this skin to skin contact, there are happy hormones that are released and that leads to fewer chances of Post Partum blues and depression. There is a greater feeling of self-esteem and confidence which is emotionally rewarding.

Breastfed babies cry less and this shapes their behaviour for life. These moms are able to read their babies cues more and are more relaxed. 

It is easier to travel without the issues of carrying bottles and associated products like formula feeds. 

Whatever be the class of women, this is definitely a much more pocket-friendly alternative to feeding. 

For a lifetime, moms who breastfeed are protected from breast cancer, ovarian cancer, endometriosis, osteoporosis , diabetes and hypertension, to name a few illnesses. 

Aren’t these reasons good enough reasons to breastfeed ….

 

Now let’s consider the benefits to the baby.

Babies whose moms breastfeed them have less diarrhoea, constipation, gastroenteritis and preterm necrotising enterocolitis.

They have a stronger respiratory system and fewer chances of colds, pneumonia and other related illnesses

Lesser chances of ear infections like otitis media 

Lesser chances of bacterial meningitis, eye infections and better vision.

There is overall better health and less hospitalisation. 

 

These babies will grow up to be healthier children in later years too with less likelihood of allergies, asthma, eczema, obesity, childhood diabetes and a host of other benefits. If I start enumerating all the benefits it would probably take me all day.

 

So why not breastfeed? The obvious benefits are healthier, fitter moms with fitter, emotionally balanced babies and children; physically and mentally sound for a lifetime. And a more pocket-friendly, eco-friendly, natural option! To my mind, it’s totally a win-win practice!  Give up the thought of the bottle and give your baby that nectar now! 

 

WHAT IS GESTATIONAL DIABETES?

0 Comments read Women Health

Sheetal (name changed) ,a 30-year-old Primigravida ,went for a blood test called an OGTT with 75 glucose load at 24 weeks pregnancy and was appalled when the results showed high blood sugars. She had a family history of Diabetes in both parents but prior to her pregnancy, she never had high blood sugars.

Sheetal is a typical case of Gestational DM, which is diagnosed for the first time during pregnancy. There is good news though. This affects your health and your baby’s but you can control it easily by diet, exercise, lifestyle modifications and occasionally medication. The bad news however is that it may lead to Type 2 Diabetes later in life and your baby too may suffer from childhood obesity and Diabetes.

RISK FACTORS

  • Obesity
  • Family history of DM
  • Race: We Asians are at a higher risk compared to Whites
  • If you’ve had a previous pregnancy with GDM or Prediabetes
  • If you’ve delivered a baby with a birth weight of 4.1 kg or more

WHAT ARE THE SYMPTOMS OF GDM?

There aren’t many symptoms except maybe increased thirst or urination. Most times it’s only detected when we test for sugars at 24-28 weeks or in the case of high-risk patients, at the first antenatal visit.

COMPLICATIONS:

Let’s divide these into complications for you and for your baby

For your baby, it may lead to

  • Increased birth weight
  • Birth injuries like shoulder dystocia and collar bone fractures etc.
  • 3 times greater risk of a Caesarean delivery
  • 4 times greater risk of NICU care
  • Hypoglycemia and some other biochemical derangements after delivery
  • Breathing difficulties, Respiratory Distress Syndrome
  • Stillbirths
  • Greater chance of obesity and DM later in life

For you, it may lead to

  • Increased chance of difficult vaginal delivery owing to a big baby
  • Vaginal and perineal tears
  • Caesarean delivery
  • Future DM

PREVENTION OF GDM:

As with most lifestyle illnesses prevention and first-line treatment is by lifestyle changes. Eating a healthy diet rich in green vegetables and fruits

lean meat, whole grains high in nutrition and low in calories and fats. Simple carbohydrates like sugars and desserts are to be limited. Regular meals and snacks with small portion sizes are desired. Talk to your nutritionist or doctor to help you with a diet chart.

Exercising 5-6 times a week for at least 30-45 minutes, unless contraindicated by your doctor is most vital.

Cutting alcohol and smoking completely is required and maintaining a healthy weight even before you become pregnant is vital to ease your journey with GDM.

You should not gain more weight than recommended.

TREATMENT

As mentioned above , lifestyle modifications are crucial to controlling high blood sugars in GDM, which in turn reduce the complications of the disease.

You will need to buy a glucometer and monitor your blood sugar levels 4 or more times a day.

Medication like Insulin or oral hypoglycaemic drugs may be needed depending on your blood sugar control or lack of it; the dose being adjusted accordingly.Most times it is only 10-20% patients who need medication.

Your baby’s growth is monitored by serial ultrasounds and other tests including checking for the amniotic fluid volume and Dopplers to determine blood flows.

Delivery is done at around 38 weeks or even later if all is well; your doctor is the best judge of it and you must have a frank and detailed chat with her about the birth plan . Sometimes, however a preterm delivery may happen owing to complications of the disease.

Following delivery ,your blood sugars will be checked , one OGTT will be repeated 6 weeks later and then you will need follow up at least every 2-3 years if not more frequently .

 

REMEMBER GDM IS EASILY CONTROLLED WITH DIET,EXERCISE, HEALTHY LIVING AND MEDICINES AND PREVENTION IS ALSO BY LIFESTYLE CHANGES. LETS STAY FIT AND BEAT THESE LIFESTYLE ILLNESSES -LETS BEGIN BEFORE PREGNANCY;IN FACT,LETS BEGIN NOW!

What to pack in your labour bag

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Congratulations. Now that you are 36-37 weeks pregnant, you must keep your labour bag packed and ready just in case you go into labour before that or in case your doctor tells you that you need to deliver before your EDD for some reason. 

Let’s keep this short and simple. A checklist that you need to keep handy. Just tick off these in your labour bag. Ready, steady, GO…..

FOR YOU

  • All your medical files and reports
  • Your Insurance card and ID copies
  • Birth plan, if any
  • Cash or Credit /Debit cards

YOUR CLOTHES

  • Loose flowing gowns or loungewear [if you don’t want to wear the hospital gown]-Front opening ones are best
  • Nursing bras your size
  • Breast pads
  • Comfortable panties, cotton ones
  • Slip-on shoes or chappals
  • Warm socks, if it’s cold.  [The labour room AC may be quite cold too]
  • Towels
  • Something that helps you relax, like music or books
  • Sanitary pads [large absorbable ones]
  • Clothes to go home in 
  • Most hospitals have a post-delivery photo op too before you get discharged, so get the pretty maternity outfits you want to be clicked in

TOILETRIES

  • Comb or hairbrush
  • Toothbrush and paste
  • Your favourite shampoo and conditioner
  • Moisturiser, face cream and lip balm 
  • Body lotion or oil 
  • Your favourite massage oil
  • Hairbands and scrunchies
  • Deo spray 
  • Glasses, contact lenses, lens solution and lens case 

ACCESSORIES

Nipple balm or butter,if you prefer to use one [though I prescribe desi ghee or your own milk lightly rubbed over the nipple as an emollient]

Phone charger 

FOR YOUR BABY

  • Thin, soft clothes or warm rompers and layers if its winter
  • Baby suits, vests and sleepsuits
  • Caps 
  • Mittens
  • Socks
  • Nappies or disposable diapers
  • Sheets for the little one-for their cot and for wrapping them in
  • Baby quilts or blankets
  • An outfit for going home in 
  • A baby car seat

FOR YOUR PARTNER

  • Toiletries and shaving kit
  • Clothing and PJS/ comfortable lounge clothes
  • Pillow and light sleeping bag [if needed ]
  • Laptop
  • Mobile phone and charger

All You Need To Know About Covid Vaccination For Pregnant Women

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The long-term effects and safety of the vaccine on the foetus and child have yet not been established.

 

-Dr. Shelly Singh, MBBS, MD (Obstetrics and Gynecology) Senior Consultant – Obstetrics & Gynecology, Rosewalk Hospital, Delhi

Which group of pregnant women are at risk?

All pregnant women are at risk and they should definitely get the vaccine. A special mention for women who are:

Click here to read more

Menstrual Cups- A More Sustainable Way of Feminine Hygiene

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Menstrual cup

What is a Menstrual Cup? 

Menstrual cups are small, flexible, funnel-shaped cups made of silicone or rubber that are inserted inside the vagina to collect menstrual blood. They’ve been around since the 1930s but did not gain favour till recently when they’ve resurfaced as an eco-friendly method of feminine hygiene. 

Why use menstrual cups? 

If you’re interested in menstrual cups do speak to your gynaecologist. 

  • Menstrual cups are pocket friendly. They cost much less than the sanitary napkins and tampons you need to buy every month. 
  • They are safer to use compared to tampons as they collect rather than absorbing blood. They hold much more blood and need to be changed after 6-12 hours depending on the flow. Tampons, on the other hand, need to be changed 4-8 hourly. 
  • Tampons can cause the Toxic Shock Syndrome; since cups don’t absorb blood they are less likely to be a source of infection by bacterial invasion. 
  • These menstrual cups cause less odour unlike sanitary pads and tampons as they don’t absorb blood which comes in contact with environmental air that causes a bad smell. 
  • They are more eco friendly. Most can be used for up to 1 year or longer ( though some are disposable too); that means fewer trees cut and less waste in landfills due to pads, cloths and tampons. 
  • You can wear menstrual cups with an IUD during place though the thread of the IUD may need to be cut shorter so that it doesn’t get pulled out with the cup.
  • You can use it during sex as well. Most well-fitted cups are not even felt by you or your partner during intercourse. 

What are the disadvantages of using Menstrual Cups? 

  • They may be difficult to insert or remove initially till practice makes perfect.
  • The removal of a cup may be messy especially in public toilets and some people may be embarrassed doing the same. You need to carry bottles of water and tissue paper to clean them. Also, you may initially find it tough to pinch the base of the cup to release the vacuum and then pull at the stem. 
  • It may be tough to find the right fit. 
  • They may cause vaginal irritation if they are not cleaned or cared for properly.

How to use the menstrual cup?

Menstrual cups are available online and in different sizes. You need to get a size that’s appropriate for you. Please speak to your health care provider regarding the same. 

You need to wash your hands, apply a water-based lube or water to the rim of the cup,  fold the cup ( different styles of folding seen in the images) and insert it inside the vagina rim up. The cup is then rotated and it sits in the vagina just below the cervix after a vacuum is created. 

Once it is properly placed it is very comfortable and you won’t feel it . The seal of the cup is such that leaks are prevented. 

How to remove the cup? 

You need to empty the cup 6-12 hours later depending on the flow. Wash your hands, insert the index finger and thumb inside the vagina , feel the stem of the cup and reach up to the base. Pinch the base, release the vacuum and then pull at the stem bringing the cup out . This can now be emptied of blood, washed and re-inserted inside.

Reusable cups can be used from 6 months to 10 years while disposable ones can be thrown away after use.

Price of the menstrual cup? 

Most menstrual cups available online come at a price of 200 Rs up to around 1000 Rs. They come with a cloth bag in which the cup can be stored when not in use. 

So make an informed choice – your body, your choices! The menstrual cup is indeed a way of empowering yourself, of clean and safe periods and a hygienic and more eco-friendly and sustainable way of life! 

Make your daughter ready to hit her periods

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I’ve been asked to keep this really short and sweet. 

So let me, in my capacity as a mum myself and a gynaecologist try and make it a bit easier for you to educate your girls about the first period or “menarche”. Here’s what you can tell her. You may begin by making a diagram of the uterus ( your biology books will help ) or take the help of the net.

 

What are periods? 

Periods are bleeding along with shedding of some tissue of the uterus which happen every month in a young lady who can now bear a baby . Tell her that periods will come every 21-45 days. They may last 4-7 days. And they’re not more than 2-3 tablespoonfuls. She may fear she’ll gush like a tap. Reassure her that it’s not that much at all. Also when you tell her this openly she does not think it’s shameful or scary. You may tell her that you too have them and that she’s now joined the league of young women. 

 

When will she have her first periods? 

Generally at 11-12 years, though it may happen as early as 10 years and as late as 16 years depending on her body clock. We expect periods 2 years after the development of breast buds and about 6 months after pubic and armpit hair. 

 

What will happen if she starts bleeding suddenly in school? 

It’s a good idea to keep an emergency kit in her school bag or locker. This contains a panty liner, a sanitary pad and a clean panty. Most schools also have sanitary napkins handy so a trusted teacher and nurse in the infirmary may help. Tell her not to be scared of “ leaking” and if it happens she can just throw that panty away and use a fresh one. Also, tell her that other girls in her class are also going through similar changes and they can watch each other’s backs. 

 

What should she use during periods? 

There are some wonderful pictures on parenting sites on the net that show sanitary pads, tampons and menstrual cups. You can be a hands-on mum by showing her a sanitary pad that can be stuck on the panty using one of your own. It’s best, to begin with, these. Tampons can also be used but it’s better to use them slightly later once she gets used to her periods. You must teach her how to insert tampons( the teen ones which are narrowest) since it seems terrifying to insert these. 

You have to teach her hygiene. Tampons and pads must be changed every 4-8 hours depending on the flow. And she must wash herself every time she uses the washroom; keep herself clean since menstrual blood can lead to infection and bad odour. Disposal of napkins and tampons must be taught to your young one. It’s important to wrap it in a newspaper and dispose of this in the bin rather than flushing it down. 

 

What are the other things that can accompany periods? 

Tell her that there may be cramps, backache, thigh pain and headaches that may happen. But these can easily be cured with simple pain killers or a hot water bottle on the abdomen. Exercising may also help to take care of all this. 

In a nutshell, tell her this is part of a normal growing up process.  Empower her to continue with normal activities including sports and involve her in the beautiful world of youthfulness. Your little girl is now a young lady …. and do remember your own attitudes about menses will train her for life. So here’s to knowledgeable mommies with their assured, educated and empowered adolescent daughters capable of taking on menstruation and everything that comes with it! 

All You Need To Know About Covid Vaccination For Pregnant Women

0 Comments read Women Health

-Dr. Shelly Singh, MBBS, MD (Obstetrics and Gynecology) Senior Consultant – Obstetrics & Gynecology, Rosewalk Hospital, Delhi

Which group of pregnant women are at risk?

All pregnant women are at risk and they should definitely get the vaccine. A special mention for women who are:

  • Health line workers
  • Obese
  • Suffering from comorbid conditions
  • Hypertensive
  • Diabetic
  • More likely to get an infection due to living in areas that have a high load of cases
  • Older than 35 years of age
  • Have a history of clotting in the limbs
  • Exposed to people outside the household
  • Living in crowded areas and unable to practice social distancing
Click here to read more