Dear Friends and Patients,
A challenging time awaits us. In addition to the practical logistic information which has already been circulated, I wanted to send you some advice and share some of my personal thoughts regarding the current COVID-19 situation and risks, particularly regarding in the UK. These are my own thoughts and understandings as of the morning of the 15th March 2020. There will be other opinions, and statistics will change.
This is what I am telling my family:
- Wash hands. The importance of this cannot be underlined enough. Twenty seconds, count out loud, include wrists. Again and again. Just do it. No exceptions.
- Symptoms of COVID-19 are fever (above 37.8C) and dry cough, often painful, shortness of breath, fatigue and can also be sore throat, runny nose, headache. It does not need to be all of these symptoms, but does tend to be fever, cough and shortness of breath.
- The infection is spread by water droplets when somebody cough or sneezes. The virus can last in the air for ten minutes after being coughed/sneezed out. It can last on hard surfaces for four days and soft surfaces for up to nine days.
- A mask will protect you from somebody who coughs or sneezes straight at you, but not from the sides. You must not touch your face as infection on your hands can spread to your eyes, nose and mouth easily – and is most likely transmissible by your hands after touching something. If the mask is worn for awhile it becomes moist and permeable and not protective. Fiddling with a mask increases the risk of infection. (if you are prone to touching your face, as most of us are, practice not to at home by putting vinegar on your hands to make you realise how much you touch your face and help you to break the habit).
- Once infected, symptoms manifest themselves on average on day five after exposure, but from day two up to day fourteen. There are apparently a few cases in China of it presenting at 21+ days post exposure, but this is the exception.
- Children particularly under the age of fifteen do not have the protein in their lungs that COVID-19 attaches to, so they are generally more protected. They can/will get a more mild flu like illness but unlikely therefore to get the secondary viral pneumonia we are worried about. They are however still vectors for infection and will be shedding and spreading the virus. So they can bring it into households, to the immuno-supressed and the elderly. If a family member is unwell at home (elderly/adult/adolescent or child), all family members, including children in the same household should also be at home for seven days. Only remote playdates by FaceTime or Skype. No playdates for children in person at all, at any time.
- The data from Italy is extensively published; analysis of morbidity and mortality figures updated twice-weekly by age, group and by region.
- As of 12th March 2020 nobody has died under the age of thirty. Out of 1016 deaths at that time, between age 30-39 there were two deaths, between the age of 40-49 there have been four deaths, between the age of 50-59 there have been 25 deaths, between age 60-69 there were eighty deaths, between age 70-79 there were 362 deaths and the remaining deaths were over this age. The mortality rate increases for each decade above this and with increasing pathology. Protecting our older population is imperative.
- Over the past few days it looks like more young (20-49) people are getting infected but numbers are thankfully still relatively small.
- I am concerned numbers will get worse as more data comes through and access to healthcare and respirators decreases due to sheer volume.
- If one has had the infection once, one cannot get it again. This is generally the idea. There are reports from China of people being infected for a second time but few.
- But there is rumour the virus is mutating and if one has COVID-19 once, then one is not immune to the mutated form. The original and mutated strain will ultimately be related and it makes sense that the original infection will at least provide some immunity but not complete immunity.
- Immunosuppressed patients – I have already been in touch with my patients who are immunosuppressed. If you have not been contacted please contact my secretary. If indicated they have been prescribed a course of antibiotics in reserve to start at the onset of infective symptoms. You should speak with me/your doctor about this at the time. The main complication of Corona virus is viral pneumonia and antibiotics do not help with this. Immuno-supressed patients and people particularly with lung and/or cardiovascular disease and/or diabetes have an increased risk of developing a secondary bacterial pneumonia in 12-17% (it looks like) of cases. It is for this reason they have the antibiotics in reserve to start at the onset of symptoms, to reduce the incidence of this happening.
- People under the care of specialists for ESTABLISHED lung disease, immunosuppression, cancer, diabetes, rheumatological disease, cardiovascular disease etc should be in touch with their specialist/GP. Doctors are being inundated and should ideally not be contacted by the worried well unless necessary. That does NOT mean you should not disturb the doctor. It just means a conversation is not for a social reassuring chat.
- Do not visit elderly relatives in their homes, and especially nursing homes. Call regularly though, be in close contact. It can get lonely and they can be scared. Offer kindness and support. Don’t talk about doom and gloom. Try to stay upbeat and keep them upbeat. Skype and FaceTime can be a great company.
- Over the years I have given boosters vaccine against Pneumonia and flu injections to the over 65 population and at risk patients who were willing to have this. So the majority of my patents who fall into this category have this extra protection.
- Do not stop or change your usual medication without speaking to your doctor. There is a rumour certain blood pressure medicines make you more susceptible to infection. This does not appear to be the case.
- People 60 and over: STAY HOME. If you need to go out, do so only every few days, plan what you need to do, what you are going to buy ahead of time, get there quickly, avoid other people, pay contactless ideally, then go home, wash your hands and do not touch your face. Try to stay 2 metres (6 feet) away from other people in shops and on the street. Get family and friends to deliver things and leave it on your door step. Order online. And DO NOT go out if you have cold or flu symptoms. Full stop.
- You should of course avoid crowds.
- Travelling abroad for work or pleasure – do not do it.
- Travelling abroad to go home/abroad – do it now. Do not delay. Many borders are already closed. It is important to be settled quickly and isolate. If travelling to elderly parents, self-isolate for 14 days before seeing them.
- The UK not testing for COVID-19: this is a decision at government level. It is frustrating and I do not agree with it.
- The UK’s decision not to close schools now: again this is a decision at government level. They are very likely to close, just not yet. There has been a call for the government to publish the models they are basing their predictions and advice upon. Hopefully this will be published shortly and will help to instil confidence in their decisions. Current guidelines are different that what the WHO is advising and this is understandably making the public uneasy.
I received an email late last night that my son’s school is now closed until mid-April and likely longer. I am relieved.
- In the UK private hospitals are not currently taking COVID-19 patients; they will manage other medical issues.
What to do if you fear you have COVID-19:
- If you are unwell, with fever and cough, or however mild cold/flu symptoms, self-isolate. This means stay home for seven days. Even if you are feeling well within 24 hours. No flexibility or exceptions to this. In the UK we will not know if your infection symptoms are due to COVID-19 or not, so always assume it is. If you get mild symptoms then that is good – you will have developed some immunity. But you need to do this self-isolation for every cold/infection you get… as you will not know if that particular time was COVID-19 or not, as there will be no test available to confirm. If testing becomes more widely available this will change. Only people in hospital are being tested. Currently there is no testing available privately either.
- It is not a time to be stoic and “sweat out a cold”. If one developed symptoms of cold/flu then by using symptomatic relief, this can help to keep a fever down, it helps us to feel a little better, be able to drink more, eat more, sleep better and this in turn supports our body to help fight the virus.
- I often explain it as: if the medicines can help reduce one’s fever a little, the body saves some energy which can be better used to fight the virus instead of using those resources on fighting the fever. Taking over the counter cold and flu medications are not strong enough to mask anything sinister; but they can take the edge off things and help us support our bodies better whilst it fights the infection.
- Drink plenty of fluids. With fever we have an increased risk of dehydration. Sip little and often.
- Do NOT “starve a fever”; eat small amounts often – dry toast, broth/soup with noodles/rice, crackers etc. Avoid milk and dairy (unless you really feel like it and your body is telling you it wants it). For children then important thing is they eat – so whatever they will eat is acceptable.
- At the first onset of symptoms take Ibuprofen (if you are NOT allergic and DO NOT have a stomach ulcer or asthma and are known to tolerate this) after food three times daily, ideally at 6-8 hours intervals. You can do this for 2-3 days as “self-medication”. If you need this for longer you should speak with a doctor. One can also take Paracetamol/Panadol/Day Nurse & Night Nurse or what your chemist advises every 4-6 hours. Maximum 4 times in 24 hours. Importantly, take the dose advised. Do not take one 500mg paracetamol instead of the full 1 gram (2x 500mg). Don’t tickle the problem but rather take the advised dose for maximum effect. This is not the time for “I really do not like taking medicines” (I don’t either, but we can do this for another infection, not this one).
- If you have previously been told you cannot take the above medicines, or medications in these groups (i.e. so you cannot take non steroid anti-inflammatory drugs, abbreviated to NSAIDs, classically asthmatics cannot unless they have previously taken them without a problem) then it is not the time to start and you should speak with your doctor before deciding what to take.
- If you have infection, it is best to sleep in a separate bedroom from everybody else at home, and have your own bathroom to use if possible. You should stay at 5 m distance from people in the home ideally. Your food should be left outside your door. This should be for 7 days. Obviously a parent or guardian must stay with a child.
Medical Care Plans:
- Stay home and self-isolate.
- If you are unwell call your doctor. (You can also call NHS 111 for advice).
- You will be given an initial triage. You will be offered a Telephone/FaceTime consultation with the doctor. The doctor will prioritise these by order of who is most unwell. If you are deteriorating please call back.
- We will liaise with all patients who need to speak with a doctor by telephone/FaceTime who are worried they are unwell and/or deteriorating. We will give you a time frame in which we will contact you. Unfortunately we are anticipating a large volume of Telephone/FaceTime consultations and it is not possible to give an exact time you will receive your call. We will ask you your temperature (so know what it is and monitor it) to tell us if you are eating/drinking, if you are passing urine etc.
- We might send you some equipment to test a few measurements yourself which might include an oxygen saturation monitor (which is indicated in particular for somebody with an underlying lung condition):
Some people are choosing to purchase oxygen saturation monitors themselves to have in reserve. An oxygen saturation monitor is clipped onto the end of a person’s finger.
It works as follows:
When we breathe in, our lungs pick up oxygen and this goes into the arterial blood stream and is delivered around the body. The most accurate way of checking a persons oxygen saturation (how much of the blood is saturated with oxygen) is via a blood sample from an artery (this is done in hospital). A more rudimentary check is by checking one’s peripheral oxygen saturation (if one is wearing nail varnish, then this will interfere with the measurement. If one’s finger is cold – often when we have a fever our hands and feet can be cold – this will interfere with the measurement. It is important to heat up the fingers). With a bad lung infection the oxygen saturation goes down. It is possible to get an idea of the level of oxygen in the blood by checking with the oxygen saturation monitor.
Normal levels tend to be 96% and above (we do not usually get to 100% unless we are on oxygen). It can be lower in a person with lung disease. When we have infection our levels dip lower than this. If one is developing a secondary significant chest infection or Pneumonia (or for example during other respiratory compromise, so for example an asthma attack), one’s levels will dip much further.
Some people are choosing to buy the oxygen saturation monitor themselves online – I know Amazon has very many, as do many pharmacies, the practice has some. Basically, should you purchase an oxygen saturation monitor and become unwell, then we can advise you on the monitoring of your oxygen saturation. Some people find it a useful piece of equipment to have in reserve.
- If you require examination, we will advise you where to go to have this done (touched upon in email sent overnight).
Finally, the responsibility for all of us who are well:
- As much as possible, keep healthy: sleep, do not skip meals, do some exercises and stretches at home (but don’t suddenly decide to train for the olympics and injure yourself, it is not the time for this), do some deep breathing, there are so many relaxation apps (don’t just download them, use them), speak with friends and family and be positive. Plan what you will do, the amazing places you travel to, and friends and family you will see again when this is over. Sit as a family to eat meals. Please do not dramatise the apocalypse now. We are so so far from there. We just need to be sensible, cautious and importantly considerate to those who are less immune and more vulnerable.