08 May 2020

Although no diet or supplement can prevent you catching COVID-19, people who are malnourished are at greater risk from the disease and many people with diet related diseases are also at increased risk. As health and care services across Northern Ireland continue to tackle the COVID-19 pandemic, dietitians are playing a vital and underrecognised role. From ensuring critically ill patients in Intensive Care Units (ICU) get the nutrition they need, to supporting vulnerable people as they self-isolate, Northern Ireland’s dietitians have been on the frontline, adapting how they work across a wide range of areas.

Karen Robinson and Niamh Collins are Critical Care Dietitians working for Belfast Health and Social Care Trust, and are on the frontline treating COVID-19 patients in ICU. Karen says;

“We use our knowledge, skills and expertise to manage the complex issues seen in critically unwell COVID-19 patients. For example, the drugs used to sedate people in ICU contains calories (from fat) which need to be accounted for when prescribing feeding regimens. Overfeeding calories is harmful to ICU patients when they are acutely ill.”

Niamh says; “Multi-organ failure is another complication seen in critically unwell patients. Dietitians need to take into consideration the treatments and interventions patients are having, to ensure nutritional needs are met safely. The patient condition can change quickly during an ICU admission, critical care dietitians have to be flexible and reactive to changes which occur.”

This support does not stop when a person leaves the ICU. Dietitians have a pivotal role in supporting a patient’s recovery and rehab. They can minimise the long-term impact of COVID 19 by improving nutrition after ICU.

For the many people with pre-existing health conditions who are self-isolating due to COVID-19, dietitians are also playing an important role. For people with conditions such diabetes, COPD and malnutrition, dietitians have been providing advice and support to help them stay as healthy as possible even if they have to stay at home.

Judith Thompson is a Diabetes Specialist Dietitian from Belfast Health & Social Care Trust who has been working alongside the Diabetes Network for NI and Diabetes UK to provide a regional diabetes helpline:

“People with diabetes are at a higher risk of severe illness if they develop COVID-19.” Judith says. “It is therefore vital that everyone with diabetes aims to keep their blood glucose levels well controlled. Diabetes Specialist Dietitians work within diabetes teams to support people to make dietary and lifestyle changes to help manage their diabetes better. We also provide specialist carbohydrate counting advice for those with Type 1 diabetes. If anyone has any dietary concerns, it is important that they contact their diabetes team for support.

“For those who are not under a designated diabetes team, this helpline can offer input from a dietitian who will provide individual advice and information on how to access ongoing dietetic support.”

For some people who are self-isolating, further support is needed. They may not have friends or families who can shop for them, and accessing deliveries can be difficult. Dietitians are working with local councils to ensure that food parcels delivered to the most in need, as well as those following special diets for medical, religious or cultural reasons, contain suitable and nutritious food.

Dietitian Katie Hunter has worked alongside voluntary and community groups as well as Belfast City Council to shape the food packs sent out across the city;

“It is even more important during these challenging times that the most vulnerable individuals and families within our communities are being given the opportunity and support to access nutritious food. As a public health dietitian, I have responded to this need by providing guidance to local councils and community organisations to ensure food parcels can not only make nutritious meals, but also where possible to make sure the contents go further and add variety to diets. This guidance is now being shared and used regionally across Northern Ireland.

“We have also set up a helpline for volunteers in the greater Belfast area to get advice from community dietitians on suitable items to provide to those individuals who follow special diets for medical conditions such as diabetes, coeliac disease and cystic fibrosis.”

Of course, even with the COVID-19 pandemic having a huge impact, many people with other health conditions also need support. Brenda Nugent is Assistant Dietetic Manager at Belfast HSC and has been working as part of a team of paediatric dietitians who are using technology to ensure children and their parents can continue to access support:

“Our team responded immediately to the need to scale back inpatient work and cancel outpatient clinics. We set up eighteen virtual general clinics a week to ensure we meet the needs of our patients and their families. The regional specialised clinical areas such as ketogenic, gastroenterology and allergy patients are all being assessed online. These have proven to be very successful in such a short period of time – we have ensured the safety of our patients as well as staff by reducing foot fall and ensuring social distancing.”

Nicola McStravick, Clinical Specialist Dietitian in Inherited Metabolic Disorders and Diabetes, has also been utilising virtual clinics to support new mothers and their vulnerable babies.

“The virtual clinics for our maternity patients ensure these women have regular contact with the specialist dietitians and contact details should concerns arise. During the COVID-19 period, the Specialist IMD dietitians have also facilitated safe and timely discharge for our women after their babies are born. In the early post-delivery phase, mothers are offered daily phone calls due to their high-risk metabolic disorder. These calls have limited the amount of time needed for mothers and their babies to remain in hospital.”