Inadequate or improper nutrition can be dangerous in elderly patients with respiratory infections
Nutritions that we take in our body is essential for every part of the body. Diet and lifestyle of a person can tell the health of the organs inside that person. Respiratory health is included within the organs mentioned. Why we are putting great emphasis on this is because together with outbreak of infectious diseases , there will also be community spread of seasonal flu in a few weeks time. Respiratory health has become increasingly important because this can especially affect elderly people.
The role of the respiratory tract is to ensure adequate oxygen in the body so problems within this system can put a stop to all the functions of the body.
In this article, we will be discussing how elderly people should be eating for good respiratory health and how to speed up recovery in case of unavoidable respiratory infections.
What are some respiratory diseases that elderly people are more susceptible to?
- Upper respiratory tract infection
- Common colds, flus
- Lower respiratory tract infections
How elderly patients can recover from respiratory problems
Check calories intake – Weight control should be done for respiratory health. Proper checking of daily calorie intake should be done. The reason is being overweight and obesity can lead to a number of respiratory problems.
In contrast, inadequate calories can lead to symptoms such as exhaustion and increased hunger. That’s why the calorie intake should be balanced and checked. If there is difficulty calculating calories for elderly people, fortified supplements and meal replacements with proper adequate nutrition designed for elderly people can be a great alternative.
Good immune system is absolutely necessary for times of disease outbreaks. Elderly people with high calorific requirement will need immune enhancing nutrients such as proteins, vitamin C, Vitamin E, Vitamin D in their daily diet.
A good diet for older adults should include rice, bread, fruits, vegetables, lean meat with less unhealthy fat. Use less oil for frying vegetables. Steam meat with no oil.
Ensure adequate protein consumption – Both strong immune system and respiratory health during recovery need protein. Older adults on recovery from respiratory diseases should have chicken, milk, cheese, eggs, pea, and nuts in their diet.
Older adults can sometimes have difficulty taking meaty diet because of the smell. For conditions like this, supplements and meal replacements fortified with proteins can be prepared for them in order to improve their respiratory health.
Prepare smaller portions – People on recovery can have a hard time digesting the food. Smaller portions can help with difficulty in breathing while on the road of recovering from respiratory illnesses.
Frequent and small portions should be taken to speed up recovery while being well nourished.
Prepare home cooked food – Avoid outside food, instant processed food as a diet staple for recovering elderly patients. The best food are those cooked warm, with healthy oil and full of nutrition.
Reduce salt intake – Salty food can cause water retention and bloating. This can exacerbate breathing problems.
Practice breathing exercises – Early morning, after lunch, after dinner, regularly practice breathing exercises.
Taking great care of the facts mentioned above can significantly improve the recovery in older people. Elderly on the verge of recovery can have a week immune system, which is a welcoming sign for the serious infections and cause re-infection. Poor nutrition can not only prolong the recovery period but also be life-threatening.
Declining resistance of the body due to old age can be helped much with great nutrition and love and care, especially in times of Covid-19 outbreak.
The Best Diet for COPD Patients https://www.everydayhealth.com/copd/a-copd-diet.aspx Accessed Date 13 May 2020
Nutrition and COPD https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/nutrition Accessed Date 13 May 2020
Nutritional Guidelines for People with COPD https://my.clevelandclinic.org/health/articles/9451-nutritional-guidelines-for-people-with-copd Accessed Date 13 May 2020
10 best nutritious food for people over 45
Life starts at 40 years old, or so everyone says. Don’t feel down because you turned 40. Even after 40, everybody has a chance at better health, if you were to live and eat healthily. We all have seen people over 40 in other countries work full-time and have an active lifestyle, not dissimilar to that of younger people. What is the reason behind this?
Bad news is our body is slowly aging towards degeneration. Even if you’re young at heart, you will definitely notice your body is not what it used to be and it needs to be taken great care of. Some 45 year-olds can compare to the younger people in terms of their energy and vitality but some look and feel older than their age. The difference between these two people is greatly decided by how much care they put on their health. Out of all the things, diet is the most important fact you should consider.
If you’re over 45, instead of going for processed and instant food, consider the following facts for a full nutritious diet.
- Blood cholesterol lowering food
- Memory enhancing food
- Blood sugar regulating food
- Blood pressure regulating food
- Anti-inflammatory food
- Food for bone health
- Immune boosting food
- Food with anti-aging properties. Let’s see what kind of food contain these health benefits.
Top 10 food for 45 years old
Green tea helps you lose weight and also is an antioxidant. Harvard researchers say it can lower the bad cholesterol and elevates the good cholesterol in the body. The chemical polyphenols in green tea halts the intestinal absorption of bad cholesterol and helps release bad cholesterol from the body. It’s time to make a habit of drinking green tea.
If you’re over 45, start having oatmeal at least once a week for breakfast. The fibers in oats lowers LDL, the bad cholesterol by binding to the cholesterol and stops absorption by the intestine. If you’re looking to raise your good cholesterol, daily oatmeal intake is recommended.
Do not underestimate the nutritive benefits of eggplants you can easily buy from the market. Anthocyanins in eggplants improves short-term memory, has antioxidant properties, relieves cell inflammation and reduces the risk of hardening of arteries due to old age, preventing the heart disease.
Peas and beans are the best food for diabetic control among the easily accessible products at the market. A research states that people who take one serving of peas daily for 3 months have better sugar control and body weight than those who eat other fiber foods. Chickpeas are the best and they can control the blood sugar surge. Note that home cooked beans are better than processed ones.
Sweet potatoes are rich in potassium and can reduce the blood pressure raising sodium in the blood. Also it contains antioxidants called carotenoids so it can reduce the blood sugar level. It can also lower the rate at which the excess calories are stored away as fat. In a way, it won’t be storing much fat in your body. Eat your sweet potatoes roasted or boiled with a sprinkle of salt and oil, much like your nostalgic childhood snack.
Green leafy vegetables
Green leafy vegetables such as spinach should be already included in your daily diet. It contains a large amount of sulforaphane, which reduces the enzymes that cause inflammation of your bones and joints and relieve you from your chronic pain and inflammation.
With aging, the bone density also decreases, especially in women. Start taking milk and milk products, for example, yoghurt starting from now. Calcium and Vitamin D will support the integrity of your bones.
All berries, including strawberries have antioxidants called anthocyanin so they boost the immunity greatly, especially that of respiratory system. Researches state that people who have berries in their diet are less prone to colds and flus.
Guavas are high in Vitamin C, even higher than the amount in widely accepted Vitamin C food, oranges. Since it is a highly potent Vitamin C antioxidant, it protects against cell injury due to oxidation and slows down premature aging. It is also rich in fibers and proteins so it can control blood sugar level and aid weight loss.
An apple a day keeps the doctor away. Apples have anti-aging properties as well. They are high in Vitamin B and Vitamin C so they can improve your skin health and will enable you to age gracefully.
Age is just a number when you eat well and have a healthy lifestyle even if you’re over 45. You will be able to stay as active and healthy as younger people.
Why hydration and nutrition are essential for the recovery
It’s a distress to be sick. Sick children miss school and miss playing outside. Adults miss work and their responsibilities. Family members have to put in more effort besides their own daily jobs to take care of the sick member. So, it is best to protect yourselves from getting sick.
However, no matter how healthy a person is, everybody is bound to fall sick at least one or two times a year. We get exposed to a lot of people and things outside so we are always at high risk for contracting illnesses. If you’re wondering why we need proper nutrition and hydration for faster recovery, this article will be able to help.
Hydration and Food Nutrition
Nutrition should be discussed in terms of two parts: food nutrition and hydration for a person to get healthier.
The daily energy expenditure of a person is sourced from the food we take. For repair and maintenance of the cells, proper functioning of internal organs and for good immunity, food provides a lot of health benefits. Especially at times of sickness, we have to depend a lot on food nutrition to get better.
Most people stay in bed and refuse eating when they fall sick. This can further prolong the process of recovery from your fever and illness. That’s why when you are not in good health, you need to fill in more of your nutritious food. Instead of frying meat, cook up a soup with vegetables and have more fruits. Good nutrition is necessary for better functions of the body after being sick. It can also nourish the immune system so that the immune system will be more efficient in fighting against bacteria and germs.
Note that eating more doesn’t mean eating more of every kind of food but more of food with great nutritional value. Overly sugary food, oily food, instant processed food, food with preservatives are not beneficial in a person’s recovery process.
Besides nutrition, another essential element to a person’s body is water. Food can help function of the body to work faster. A body loses its water by sweating during its daily functions. Replenish your water loss with proper hydration, fruits with high water content.
When you’re sick, your body loses more water. Inadequate hydration can cause dryness in your throat and mouth and germs will attach to these areas and multiply in numbers. Dehydration can affect the performance of the immune system and prolong the recovery period.
While it’s important to hydrate yourself frequently when sick, tea, ginger soup, chicken soup, vegetables and fruits with high water content can also be taken.
What are some other ways to do when you’re sick?
The most important thing is to take care of your nutrition, water intake and fully rest. Sleep and nap as necessary. Work can wait. Humidifiers can cleanse the air and increase moisture in your house. Doing vigorous exercise or sports, going outside and socializing should be avoided.
We wish our readers of Hello Sayarwon to have a healthier and happier life.
How your diet can be crucial to fight against diseases
The calories, nutritions that the body needs come mostly from the diet. Diet plays a large role in an individual’s health. Eating a healthy diet and leading a healthy lifestyle can let a person be happy, healthy and free from any kind of diseases.
What is a healthy diet?
Eating a healthy diet is not just meant for gaining or losing weight.
A healthy diet means eating a well-balanced nutritious diet for the purpose of a healthy body without overeating or undereating, while maintaining a healthy bodyweight. There can be other reasons for going on a diet such as boosting an immune system and preventing from anemia.
How can an individual undergo a proper well-balanced healthy diet?
If a person is healthy, his immune system will be at its full potential to defend against infections.
There are many kinds of food that are supporting the immune system and widely accepted by the dieticians. For example – berries, salmon, beef, eggs, asparagus, chocolate, avocado. Other food has its own natural health benefits for the body as well.
Dark green vegetables such as kale, broccoli, cabbage, milk, soya bean, nuts should be taken in well proportionately in support to fight against obesity, hypertension, diabetes, heart diseases and other long-term debilitating diseases.
Garlic, onions, grapes, citrus fruits, cinnamon and apple cider vinegar can reduce the risk of entry of germs and contracting infectious diseases.
According to nutritionist, Dr. Jorge Hager, what people put into their body can predict what diseases they are more prone to. For example, a person with diabetes or hypertension might have consumed a lot of salt and sugar in his diet prior to the diagnosis.
A poor diet leads to a number of horrid diseases, and with a simple tweak in healthier versions of diets can prevent a lot of people from long term diseases.
Reason everybody should have a healthy diet
Today, there are more diseases circling around and outbreak of newer, more serious infectious diseases. A good diet is, without a doubt, the best way to prevent against diseases, and also the suitable way to fight off infections.
Experts say lifestyle, diet and genes decide a person’s health and well-being, two of which, lifestyle and diets are modifiable factors. These factors will decide a disease will advance or put a stoppage on itself.
We would like to conclude this article with a quote from Dr. Jorge Hager, a nutritionist. Food is the medicine we consume daily. Let’s eat a proper and well-balanced diet to fight against diseases.
The role of antioxidants and immune system and how can you improve that
For healthier and happier days ahead, we need to be free of diseases. To make it happen, our first line of defense against infections – our immune system needs to be at its best.
Does the immune system make a difference?
Immunity is basically the fortress for the body defending against invaders. From mild colds to more serious infections, the immune system can elevate resilience to foreign bodies and germs.
Especially at this time of Covid-19 pandemic with pending vaccines and treatments, the natural body defense system, the immunity is protecting us from the adversities. Moreover, the dangers of some incurable diseases can only be fought off by the immune system.
We can make or break our immune system unknowingly. But before we talk about the immunity, we should first talk about the substances that are greatly supportive for our immune system – the antioxidants.
What are antioxidants?
Antioxidants are substances that protect the cells against injury by free radicals, and disruption of molecular imbalance. Free radicals are constantly being produced in excess in our body due to polluted environment – air, water, etc.
How many types of antioxidants are there?
- Endogenous antioxidants – products of our own body’s metabolism
- Exogenous antioxidants – what we get from our diet, external sources.
Role of antioxidants in our body
Oxidants (free radicals) are waste materials from our cells. They need to be effectively removed. If not, they can disrupt our body’s metabolic activities and cause cell breakdown.
Excessive free radicals in the body can cause heart diseases, cancer, joint pain, respiratory disease and even stroke. It can also damage the immune system, which can consequently put the person at higher risk for catching colds, flus and other infectious illnesses.
To help prevent these outcomes, we need the antioxidant for metabolic balance in our bodies. Antioxidants are necessary compounds for the overall health of the body including skin, immune system. The body needs the antioxidants for it to be able to prevent certain diseases.
How can we obtain more antioxidants?
We usually can get our antioxidants from one of the two ways:
- Food and
- Vitamin A – Milk products, eggs, liver
- Beta-carotenes (precursors of vitamin A) – Carrots, French beans, mangoes, spinach and other red, orange and green fruits and vegetables
- Vitamin C – berries, guava, bell peppers, all citrus fruits including oranges
- Vitamin E – almonds, sunflower seeds, vegetable oils, leafy green vegetables
- Lycopene – red and pink pigmented fruits such as tomatoes, watermelons
- Lutein – corns, papayas, oranges and green leafy vegetables
- Selenium – Rice, corn, flour, eggs, nuts, cheese, peas and beans.
You can derive antioxidants from these food as well as from the fortified supplements and meal replacements specially produced for older people with low appetite.
Besides food, exercising daily can also produce antioxidants.
- Stretching are some of the options that are suitable for every age. Regular exercise can boost the immunity in older people as well as prevent muscle weakness and declining bone density. For a happier and healthier aging, take care of your older family members to have good nourishment and regular exercise.
How can antioxidants benefit our health? https://www.medicalnewstoday.com/articles/301506 Accessed Date 22 April 2020
The role of antioxidant supplement in immune system, neoplastic, and neurodegenerative disorders: a point of view for an assessment of the risk/benefit profile https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-7-29 Accessed Date 22 April 2020
Can Antioxidants Really Improve Immune Health? https://www.naturesbest.co.uk/our-blog/can-antioxidants-really-improve-immune-health/ Accessed Date 22 April 2020
First defense barriers of the body and how to strengthen them
When there is an entry of foreign body into the body, whether it be a germ or a toxic substance, they are faced off by our immune system. In fighting a disease, there are two types of immunity: mainly
Innate immunity which is the immediate response to an infection and we are all born with it and adaptive or acquired immunity which develops after first exposure with an infection and produces antibodies against the germs the next time it enters.
We will be talking about the innate immunity or natural immunity in this article on how they work and how we can strengthen this system.
The first line of defenses
The first line of defenses is what we can easily see from the outside and through which a tiny particle of germ can easily enter. They include:
Skin is the largest organ in the body. It serves as a giant fort, covering and protecting the body from any possible harmful substances. It is also waterproof. Naturally, both the good and bacteria cohabit on the skin. However, as long as the skin is intact, no germ can enter into the body.
- Respiratory system
The respiratory system has many natural defenses. The nose responds to a foreign particle by sneezing. Or it can produce mucus and swallow the particle whole. That is why a runny nose and mucous production happens. If the particle is not removed by these mechanisms, the trachea contains small hairs called cilia which cannot be seen with naked eye. They have the ability to sweep away the germs and particles.
- Digestive system
Similarly, digestive system has its own natural defense system. We vomit when we ingest something that is harmful to our body. Moreover, the gut consists of the mucous lining which is a barrier between the gut and blood so that infections don’t easily enter into the bloodstream. There is also stomach acids that can effectively kill many kinds of infections.
Along the epithelial lining of the digestive system, there are many living good bacteria. We can safely say the stomach and intestines are filthiest internal organs in the body. A lot of guarding mechanisms reside here to prevent the spread of germs from this area.
What can we do for a great first line of immunity?
- Sunlight can be very harmful to the skin. Free radicals and oxidants results from repeated exposure to sunlight can damage the skin and compromise the immune system. Putting on sunscreen, consumption of the antioxidants; Vitamin C and vitamin E rich food can help protect the skin.
- Dehydration can also cause wrinkling of the skin and it becomes more vulnerable to the infections. It’s important to hydrate yourself throughout the day.
- Skin needs constant renewal. Shedding old skin cells and replacing with new skin cells is crucial to a germ resistant physical barrier. For forming new cells, amino acids are necessary, therefore the adequate intake of protein is also important.
- Skin problems can facilitate entry of germs. Proper and fast wound healing is important and collagen can accelerate wound healing. Vitamin C and zinc can also help with the wound healing.
- Respiratory system
The air we breathe contains dust, particles and many infectious germs. For us to be able to withstand the aerial pollution, we need to boost our respiratory immunity as well.
- Vitamin E – Vitamin E in nuts can reduce inflammation in cells and relieve the tracheal congestion. It also has antioxidant properties, therefore protect the respiratory cells from injury. It also aids in transfer of oxygen by the red blood cells.
- Vitamin A – Vitamin A is mostly found in green and yellow fruits and it can improve asthma and protects against cell injury.
- Vitamin C – A good antioxidant, vitamin C can also lessen cell turnover.
- Magnesium – It can improve the elasticity of bronchi and bronchioles and facilitate entry of more air into the lungs.
- Digestive system
- Good bacteria (probiotics) – They can be found in many milk and milk products. Probiotics in the gut lining can reduce the risk of stomach problems and diarrhea.
- Prebiotics – They are food for the good bacteria (probiotics) and they can be easily found in many fermented foods such as kimchi. Probiotics can maintain the gut health while prebiotics are necessary to nourish and populate the healthy bacteria.
- Vitamin C – It can reduce cell injury in stomach and intestines.
- Zinc – It promotes wound healing in gut epithelial lining. Zinc can also quicken the recovery time after diarrheal episodes.
Natural immune defenses need to be strong to reduce the risk for any kind of infections. The habits and methods mentioned above can improve the immune system in every way. It is best if you eat whole organic food but for older people or those with underlying diseases who are unable to consume enough nutritious food, meal replacements and supplements are great alternatives.
The role of proteins and vitamins in the defense against infections
To eat whole foods, avoid getting sick and get fit are health advices often people receive. Maintaining good health goes beyond the surface level health. For a body to be actually strong and healthy even if there is an infection, you need to take care of the body’s very own immune system to be able to fend for yourselves against the diseases.
How can you enhance the immune system?
Exercise and avoidance of smoking and alcohol are important for a good immune system, however, the most important of all is eating wholesome and healthy food.
Whole foods are direct sources of disease fighting essential elements making up the immune system.
How these vitamins and minerals play a role in building a strong immunity will be explained in the following part.
Proteins are building blocks of tissues and also responsible for tissue renewal and repair. They also make up a huge part of the defense system in combat for bacteria and viruses. Proteins and amino acids also provide structural support of the immune cells and function.
It is known to everyone that vitamin C and immune system go hand in hand. A misconception of vitamin C is that it can only be obtained from sour citrus fruits. Other abundant sources of Vitamin C are green vegetables, guava, strawberry, papaya and bell peppers.
Vitamin E has antioxidant properties that are beneficial to enhancing the body immunity. While being a great nutrient for the skin, Vitamin E is one of the most useful vitamins in forming a barrier against infectious diseases.
Almonds, peanuts, sunflower seeds, broccoli and spinach are some examples for rich sources of Vitamin E.
Vibrant colored fruits contain a chemical component called carotenoids. Carotenoids in carrots, sweet potatoes, pumpkins and melons are converted into Vitamin A when they are absorbed into the body.
We cannot forget Vitamin D when we talk about immunity boosting vitamins. We can obtain Vitamin D mostly from natural sunlight and some from some food such as tuna and egg yolk. Daily requirement of Vitamin D can also be acquired from Vitamin D supplements and meal replacements.
Folate is the natural form of folic acid while folic acid is a converted form to be readily used by the body. While its main role is to improve eyesight and brain development, it also takes part function of the immune system.
You can get folates from green vegetables, peas, beans and folate supplements.
Taking part in transporting oxygen to cells, iron makes one of the most crucial minerals for the immune system. Insufficient iron in the body can cause pallor and weakness which can also decline the performance of the immune function.
Red meat, seafood, peas, beans, broccoli, kale and iron supplements are good sources of iron.
Selenium also has great effects on the body’s immunity. It can protect the body from many diseases. It can even slow down the over activity in response of the cells in case of cancers and autoimmune diseases. Garlic, broccoli, sardines and tuna are great sources of selenium.
Rich sources of zinc such as shellfish, lean meat, peas, yoghurt and lentils are important for the body immunity. Zinc enhances the protective barrier against germs and reduce inflammation and pain in the body.
Eating a well-balanced diet including meat, fish, fruits and vegetables is one way to get adequate amount of elements needed for protective function of the body. Alternatively, you can take supplements infused with all the minerals and vitamins needed for the body. Fill your body with good nutrients and take care of your immune system to stay away from the infections.
How do you take care of your elderly loved ones amid of overwhelming infections these days?
We live in a time where the emerging illnesses have become as advanced as the ever changing and innovative world. Some are preventable, some are not. Some diseases are not only unpreventable but also highly infectious. Young people may be able to withstand the new health crises. However, our grandparents and parents have become less resistant to the infectious diseases.
They took great care of us to raise us when we were young. Now it is time for us to take care of them. So, how can we care for our beloved family members to be happy and healthy in their old age?
Are the number and rate of infections on the rise?
As many as the type of infections, the way these infections are transmitted are also just as many. A disease can be transmitted via sweat, or it can be air-borne. A virus can be spread through close contact or via droplets released from coughing and sneezing. Some infections are transferred through the body fluids like blood.
How do we prevent our beloved older family members from these infections?
Infections, if treated properly, can get better however, some infections can be serious and life threatening. Prevention is still better than cure. Here are some practical ways we can do to help prevent infections as well as improve well-being of our family members.
Encourage frequent handwashing.
Hands carry the most germs in our body. These hands come in contact with everything we touch. We also use them to put food into the mouth and touch our faces. Hand hygiene is very important because most of the infectious diseases we catch are caused by the germs on the hand. Ask your grandparents to wash their hands frequently with soap after touching dirty things, before meals, and after going out.
Prepare good nutrition for them.
Well balanced diets can improve the immune system and are able to fight off numerous infections. Daily meals of elderly family members should include adequate amount of proteins, vitamins and minerals and fiber. Try to prepare one meat or fish, rice and vegetables in every day meals for them.
If they have not much an appetite, we can incorporate some nutrition supplements into their diet as well. Being well nourished is an effective way to protect against infectious diseases.
Remind them to drink water.
Older adults tend to drink less water. Water also has a significant role in maintaining a healthy immune system so make sure your parents drink enough water throughout the day. Put water bottles where they can see or pour a glass of water for them.
Make sure they are getting enough sleep.
With older age, adults tend to sleep less. Sleep deprivation in long term can have serious effects on the body immunity. Older adults should at least get 6 hours of sleep every night.
Try getting your parents and grandparents to exercise at least 15 minutes every day. Good examples of exercise for older adults are slow walking and yoga.
Avoid unnecessary visits to hospitals.
Healthcare facilities such as hospitals and clinics are also the breeding ground for most of the infectious diseases. Avoid these places unless it is required.
Do shopping for them.
Shop in behalf of your older family members for their food, medicine and daily amenities. Social distancing is also an effective way to prevent against infections.
Take care of their personal hygiene.
Personal hygiene is key to good health. Regular clipping and cleaning nails, hair washing and showers should also be taken great care of.
Clean the house regularly.
Some places in the house can also be full of germs. It is important to clean the house every day, disinfect weekly. Regularly change the bedsheets and pillowcases.
Vaccination is not only for children. Older adults should be vaccinated for preventable infections such as seasonal flu and hepatitis. It is important to vaccinate in advance to prevent the unwanted consequences from these infections.
Let’s protect our beloved older family members from nasty infections with the use of the practices discussed above.
A Guide To Caring For Elderly Parents https://www.aginginplace.org/a-guide-to-caring-for-elderly-parents/ Accessed Date 22 April 2020
Family Caregiver Tips: Infection Risks and Prevention for the Elderly https://www.redi-nurse.com/family-caregiver-tips-infection-risks-and-prevention-for-the-elderly Accessed Date 22 April 2020
Coronavirus and COVID-19: Caregiving for the Elderly https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-caregiving-for-the-elderly Accessed Date 22 April 2020
Coronavirus and older people: 6 tips for families https://www.weforum.org/agenda/2020/03/coronavirus-how-can-i-look-after-older-relatives/ Accessed Date 22 April 2020