Corticosteroid use and COVID-19

Today (30th March 2020), we noticed a sharp increase in the number of visitors to a particular page of the Aspergillus Website.

The page is called ‘Medications that Weaken Your Immune System and Fungal Infections (CDC)’. We know that many people are worried and struggling to understand if and how their susceptibility to infection with SARS-CoV-2 (COVID-19) is changed by their existing medications.

It is worth noting that the article on the Aspergillus Website is written with specific reference to how medicines, such as corticosteroids and TNF (tumor necrosis factor) inhibitors, increase the risk of fungal infections. It is not written about bacterial or viral infections.

Many medications for asthma, which lots of people have in addition to allergic aspergillosis, contain corticosteroids that are inhaled. Currently, there is no evidence that people who use inhaled corticosteroids are at an increased risk of contracting COVID-19.

The Centre for Evidence-Based Medicine in Oxford has published a useful article on this subject that points out that a COVID-19 infection in an asthmatic may trigger an asthma attack, and it is of greater benefit to the patient to prevent or control that attack than it would be to stop inhaled corticosteroids in an attempt to decrease the risk of  COVID-19 infection. There is even a hint that some types of asthma medication can inhibit coronavirus infection, but the evidence is not based on COVID-19.

Many of our more severe aspergillosis patients also take oral corticosteroids to try to control their breathlessness. During flare-ups, the dose can get quite high for a short time. Needless to say, it is critically important that these patients complete the increased dose as prescribed by their doctor. Patients on long term maintenance steroids must not reduce their dose as this will not offer additional protection against COVID-19. Maintaining good control of your condition is very important in reducing risk of complications. For patients on long term steroids shielding is also particularly important.

Overall, people with chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, bronchitis or CPA are considered at increased risk of severe illness from coronavirus (COVID-19) regardless of corticosteroid use. These people should closely follow the guidance on social distancing available from Public Heath England.

ANNOUNCEMENT for all patients of the National Aspergillosis Centre

NAC CARES

The National Aspergillosis Centre(NAC)  is situated in the Manchester University NHS Foundation Trust (MFT) at Wythenshawe, Manchester, UK. As the coronavirus SARS-CoV-2 outbreak spreads throughout the UK all hospitals are having to devote most of their activity to help with treating people who have been infected by coronavirus and who are having severe symptoms. Consequently, MFT is shutting down normal outpatient clinics to release staff from their normal duties until at least 1st June 2020. NAC patients are high risk so we have developed our policy to inform and carry on caring for our patents during this time. All patients will get a letter explaining all of this in addition to this note.

NAC Outpatient clinics (26/03/2020)

  • MFT has instructed for all out-patient clinics to be cancelled from 26/03/20.
  • All new NAC patient appointments will be re-scheduled until after 31/05/20.
  • A letter has now been sent to all NAC patients with follow-up appointments from 26/03/20 until 31/05/20 to advise them that their face to face appointment has now been converted to a telephone appointment that will be conducted in the same week as their scheduled appointment.
  • In order to significantly reduce the number of consultations patients have been asked in this letter to call our secretarial team to re-arrange their appointment unless it is absolutely necessary.
  • Two attempts will be made to telephone each patient; thereafter if no contact can be made their appointment will be re-scheduled by 3 to 6 months.
  • If patients are deemed by a consultant to require face to face review following telephone consultation they will be booked into NAC clinic on a Friday morning. No face to face consultations will occur on a Wednesday P.M or Thursday A.M.
  • If a patient requiring face to face review has symptoms suggestive of COVID-19 they will be asked to self-isolate for 7 days prior to being reviewed in the hospital.
  • Telephone consultations will be held during the same week as the patient scheduled appointment. Due to staffing constraints scheduled appointment times cannot be adhered to. Where blood or sputum sampling is required to inform patient management postal packs will be sent out to patient homes.
  • Patients that telephone NAC clinic administrators will be assessed, re-scheduled until after 31/05/20 or passed to a specialist nurse.
  • Patients who contact the booking centre should be directed to email idandnacadmin@mft.nhs.uk
  • Weekly patient Zoom support meetings are now taking place every day 10am. Register at https://zoom.us/meeting/register/uZQocO-trj8pElzq-0Z9wqj4p-xoVd0CGg
  • Monthly patients support meetings at NAC will now take place online at the same address, starting 02/04/2020

 

 

Covert infections and the spread of coronavirus

Yesterday, the Prime Minister introduced strict limitations on when and how we can move about and live our lives. He said we should leave our homes only if absolutely necessary. Why is this so important?

The Scientific Journal, Nature, has published an interesting and informative article about the proportion of people with mild or no symptoms of COVID-19 who could be spreading the virus and this information highlights why limiting our movements can help to reduce the spread of coronavirus.

The first important question is how many people are contracting this virus but are experiencing few or no symptoms? It is thought that the number may be quite high because there have been many community acquired infections where the patient has no links to known COVID-19 cases and has not travelled to any area with a large outbreak.

Those people with few or no symptoms may be totally unaware they have the virus and continue to behave as normal. The article calls COVID-19 infections of this sort ‘covert infections’.

Understanding the covert infection rate is crucial if we are to slow the spread of the virus and prevent new outbreaks.

One study that the article reports on looked at 565 Japanese citizens who were all evacuated from Wuhan in February. They were regularly monitored and tested. 13 were infected but 4 (31%) had no symptoms.

The Diamond Princess cruise ship, which was quarantined with 3711 people on board, was another opportunity to study covert infections. There were 700 infections on the ship and 18% of those showed no symptoms. The authors of this study pointed out though that the average age of the people on the cruise ship was relatively high and this could have affected the data because older people tend to experience worse symptoms than younger people.

Finally, there is a suggestion that children may experience mild or no symptoms in 56% of cases.

All of this data show just how important it is to enforce extreme social distancing measures if we are to stop the virus from spreading.

Take a look at the article, it’s available for free on the Nature website.

Seasonal Viral Epidemics & COVID-19

Jon Cohen of the Journal Science has briefly reviewed a subject that we will all be interested in before much longer as the coronavirus COVID-19 spreads throughout the world, seasonal epidemics. This is certainly not the first time that a new coronavirus has appeared, apparently from nowhere and spread, killing people along the way. Over many years those viruses have been and gone, some with more publicity than others. Why?

Many of us might remember the SARS (Severe Acute Respiratory Syndrome) outbreak in 2002/3 which arrived in Hong Kong, briefly shocked us and caused 774 deaths.

Since then we have had MERS (Middle East respiratory syndrome) which appeared in 2012 and still occasionally pops up but spreads very slowly.

Where did they go? We didn’t develop an effective vaccine, we didn’t use a new treatment, they just disappeared. Why?

Cohen looks at these and many more disease outbreaks and the seasons they first appeared and when they disappeared – there are clear correlations.

Clearly many epidemics follow a seasonal pattern. Enveloped viruses like SARS and Influenza seem to favour the winter (SARS appeared in November 2002) but disappear during the summer months for reasons we don’t fully understand. There have been many experiments on possible causes including air humidity and sudden changes in air humidity but evidence remains inconclusive. Perhaps part of the reason is that we naturally use greater self-distance in the warmer weather? Perhaps higher temperatures or sunshine contribute? More detail here.

We can’t really conclude that SARS was defeated by summertime changes in climate as in the case of SARS there were aggressive attempts to contain it much as we are seeing now for COVID-19, so we might at least partly thank those activities for defeating SARS 2003.

COVID-19 is 80% identical to SARS  so there might be a suggestion that it too will fade as summer progresses but at the moment we cannot rely on that hope as we know too little about this new virus. Of four other coronaviruses that we know about three do disappear in the summer, but one doesn’t. COVID-19 is a lot less lethal but a much better spreader compared with SARS, and it seems to be spreading regardless of climate, so currently suggests that it will not be affected by differences in humidity or temperature.

As with many aspects of COVID-19, we must try to keep it under control as far as that is possible and wait until it shows us more of its behaviour.

For the full article click here.

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