Cold Bite: There’s nothing poetic about ‘breathless’ Kashmir

[FPK Photo/Kaisar Ali.]

Spring may not be far behind, but Kashmir’s long winter persists even in the season of renewal. The nippy air heavy with dust continues to leave many breathless. In the post-covid era where chest complications are still a matter of investigation, Kashmir’s woes stem from its struggle to feel some normal air. Those who flock to plains during cold season return to face the protracted weather blues back home. And then comes the signature spring shower—the post 2014 deluge dread—unleashing a sense of submerging and making muck of Kashmir’s good old idea of romantica.

Inside his SKIMS chamber, reverberating with relentless coughing and sneezing, Dr. Syed Mudasir Qadri apparently calls it a radical poetry of nature that heaves chests with suffocation if not with sentiments in the cold season. But beyond troubling wind pipes and blocking nostrils, the cold season may take its huge toll on mental health. “Mood can take a dip in winters,” Dr. Qadri underlines the winter woe of Kashmir hailed for its melancholy. “Depression increases in the cold season.”

All this makes winter a bigger grief for Kashmir beyond the hypnotic image created by bards and Bollywood. And that grief often rears its ugly head in the form of frequent bereavements. There’s a noticeable increase in both death and illness rates compared to other seasons in the cold season. Respiratory diseases are particularly prevalent, leading to many premature and unfortunate deaths.

Despite this, many people resign themselves to the belief that such occurrences are simply the will of God and a sign that their time has come. “More patients are admitted in the hospitals with Pneumonias, Asthma exacerbations, COPD complications and heart failure during winters,” continues Dr. Qadri, holding Additional Professorship at Department of Internal and Pulmonary Medicine, SKIMS Soura. “Patients suffering from other chronic diseases are also prone to develop infections.”

While these health complications hold life hostage in the valley—celebrated for its snow-capped peaks and shimmering landscape—Dr. Syed Mudasir Qadri details the cold distress in depth during his freewheeling talk with Free Press Kashmir.

Dr Syed Mudasir Qadri.

Cold season is no longer a season of retreat in the valley, it’s haunting for a host of reasons. And one of them being its chilling effect on elders!

Yes, cold weather does have an impact on one’s health especially in the elderly and the patients who have underlying respiratory illnesses or other chronic conditions. It has been found that colder temperatures weaken the body’s immune response and increase the susceptibility to viral infections especially in the upper respiratory tract, thus increasing the chances of cold and flu. Dry air and viral-load play their obnoxious part. Plus the heating methods adopted by us further dries up the ambient air that we breathe in our homes. When elderly people inhale this dry air, the mucous membranes of the respiratory tract also become dry and the first line of defence is lost making them vulnerable to infections.

The cold air itself may precipitate bronchospasm (spasm of smaller airways) becoming a reason for Chronic obstructive pulmonary disease (COPD) and asthma exacerbations. Therefore, we need to keep ourselves and our elders warm and take a good and nutritious diet to strengthen our immune system.

But are there any notable differences in the types of respiratory disorders or other illnesses that are more prevalent during winters compared to other seasons in the valley.

Yes, in winters we see more cases of respiratory illnesses caused by viruses like seasonal flu, common cold, sore throat, etc. More patients are admitted in the hospitals with Pneumonias, Asthma exacerbations, COPD complications, heart failure, etc. Apart from this, patients suffering from other chronic diseases or who are immunocompromised are also prone to develop infections or complications. Many illnesses also worsen during winter months, such as certain connective tissue disorders such as scleroderma, arthritides.

Then, there are conditions that arise directly because of winter exposure, like chilblains, frostbite and hypothermia. People also gain weight during winters because of a shift of balance towards consumption rather than spending. People spend more hours indoors than outdoors and their exercise time is either completely gone or restricted. Winters may take its toll on mental health as well. Mood can take a dip in the winter season, so depressive disorders also increase.

Alright, let’s address the elephant in the room for a change now. Why is the cold season now being increasingly linked to a spike in heart attacks and strokes in Kashmir?

See, winter is known as the common cold and flu season but it is true that the incidence of heart attacks and strokes increases in this season. The cold temperature per se causes the blood vessels to constrict (to prevent heat loss) and this can raise the blood pressure and increase the risk of heart attack and stroke. Also, if a virus causing the respiratory illness also reaches the heart, that may add to the illness as well and may cause cardiac arrhythmias which may lead to sudden death. Patients with ischemic heart disease, hypertension or cerebrovascular disease should very strictly follow their medical advice and prescribed treatment plans.

Nevertheless, the fear of heart attack, stroke, or high blood pressure from the cold should not stop someone from exercising. Therefore, it is better to start with a light warmup exercise and then slowly condition your body for the routine exercise that is being followed.

Also, studies suggest that the extent of COPD in Kashmir is somewhere between 15-18%. How does winter affect the incidence and severity of conditions like asthma and COPD, and what role does this play in the overall mortality rate?

Yes, a previous research by our department at SKIMS revealed that the prevalence of COPD (above 40 years of age) in Kashmir is 14.8% among females and 17.3% among males. In winters, these patients are more prone to exacerbations and sometimes they develop cardiac dysfunction as well and are admitted with heart failure. Many of these patients who belong to the advanced stages of the disease face significant morbidity and mortality.

I would rather say that the winter season is a big test for these patients and we always advise them to go for the recommended vaccinations (for influenza and pneumococcus) and keep themselves warm, be very regular with their medications, maintain a good hygiene and avoid contact with any person with flu like symptoms or common cold.

Doctor Sb, reports also suggest around 10,000 people die in Jammu and Kashmir every year due to diseases attributable to air pollution which increases considerably in winter as a haze of smog is a familiar sight in Kashmir winters. What impact, if any, does seasonal variation in air quality have on respiratory health and mortality rates during winter?

I’m not sure about the exact numbers, but yes, air pollution directly affects people with pre-existing lung conditions like Asthma, COPD and ILDs etc. They face the major brunt and blow—causing frequent exacerbations and hospital admissions—leading to increased morbidity and mortality in these patients.

This indeed sounds disturbing, but are there specific factors related to winter that increase the cross infection?

Be it kangers or blowers, all heating measures have their own issues. What’s common is that artificial heating causes further drying of the ambient air which is not good for health. This should be countered by humidifying the room air. At the end of the day, the idea should be maintaining proper personal and environmental hygiene.

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