The New York Times on the dangers of mould
Those living with aspergillosis know all too well the risks associated with mould exposure. It can be difficult, however, to sort fact from horror story on the internet sometimes. Damp and mould in the home can be a serious issue, both for those with and without pre-existing illnesses — it is therefore very important to understand the risks and take measures to identify and prevent any sources of mould growth. The New York Times has written a very useful article, quoting Professor David Denning of the National Aspergillosis Centre, on the known health consequences of mouldy homes and the importance, and difficulty, of removing the fungus.
Read the article here:
Mold Can Make Your Family Sick. Here’s How to Get Rid of It.
For more advice:
- How do I… find the source of the damp?
- How do I… remove mould from my washing machine?
- How do I… make my private landlord fix my damp home?
- How do I… make the council fix my damp home?
- How do I… keep my home dry?
Extraordinary images of Aspergillus restrictus
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In 2017, the Dutch Central Bureau of Fungal Cultures was renamed the Westerdijk Fungal Biodiversity Institute, after Johanna Westerdijk. Westerdijk was the first female professor of The Netherlands and director of the centre from 1907 to 1952. She had a great interest in fungi and, under her leadership, the institute's collection grew to be the largest in the world. A century on from her appointment as professor, Westerdijk's accomplishments were celebrated with the centre's renaming and the unveiling of several extraordinary images of Aspergillus restrictus.
A. restrictus is a mould that can grow in environments with very limited water. The species is often found in indoor air and house dust, and is considered a potential cause of respiratory issues; A. restrictus can also contribute towards cereal and cotton rot. In this project, high resolution images of the species were taken at various magnifications, using both light and electron microscopy. These images, copied below, allow the viewer to zoom in on the structure of the mould at differing levels of detail. This means that we can explore the various stages of fungal growth, from different angles and magnifications. For reference, simplified diagrams of the Aspergillus life cycle and structure are included first.
Images of Aspergillus restrictus:
An Aspergillus restrictus colony, measuring approximately 1 cm (bar = 1 mm). White aerial hyphae can be seen throughout the colony.[/caption]
An image taken closer to the centre of the colony (bar = 0.5 mm). White aerial hyphae and green columnar conidiophores can be seen throughout.
These images, produced by the Westerdijk Fungal Biodiversity Institute, show the structure and development of Aspergillus restrictus in incredible detail. There are several surprising questions and discoveries that arise from this level of detail. For example, the clockwise twisting of conidial rows has not previously been described, and the chemical composition of the material found on the phialide surfaces is unknown. Therefore, this technology not only provides us with these impressive images, but may also lead to further research and greater understanding of the structure and development of fungi. Greater knowledge of Aspergillus growth and function can assist in the development of drugs which impede its growth.
Read the full paper: Jan Dijksterhuis, Wim van Egmond and Andrew Yarwood (2020), From colony to rodlet: “A six meter long portrait of the xerophilic fungus Aspergillus restrictus decorates the hall of the Westerdijk institute.”
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May 31st: Shielding Advice Updated by Public Health England
Many people with Chronic Pulmonary Aspergillosis were asked to shield themselves from exposure to the coronavirus COVID-19 in March 2020 as they were thought to be especially vulnerable to the consequences of infection by the respiratory virus.
Back in March 2020 the COVID-19 pandemic was progressing rapidly and there was some doubt about how well we might be able to contain it in the UK using a variety of social spacing measures, consequently, it was appropriate for the most vulnerable to be especially protected. We also knew relatively little about the virus and how it is transmitted, which groups might be more vulnerable to infection and severe symptoms.
More recently, by late May 2020 the pandemic in the UK is currently well under control with the number of cases in the community falling rapidly week on week, estimated at 17% between May 10 and 21st (AskZoe).
There is a real risk that extending shielding will have an overall detrimental impact on health, particularly on the mental health of those shielding, so it is important that we limit the numbers of people to those who absolutely have to, and ease up restrictions on those that have to carry on when it is deemed safe enough to do so.
The overall authority in England is Public Health England (PHE) and they released updated guidelines for people who are shielding here on 31st May 2020.
What has changed
The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels are substantially lower now than when shielding was first introduced.
People who are shielding remain vulnerable and should continue to take precautions but can now leave their home if they wish, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time. If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.
Read further information on schools and the workplace for those living in households where people are shielding. This guidance remains advisory.
Advice for Wales (updated but there may be some differences to PHE advice)
Advice for Scotland (not yet changed so are now different to England & Wales)
Advice for Northern Ireland (not yet changed but may change on June 8th)
Can I have ABPA without asthma?
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[et_pb_column type="4_4"][et_pb_text admin_label="Text"]Allergic bronchopulmonary aspergillosis (ABPA) generally occurs in patients with asthma or cystic fibrosis. Little is known about ABPA in patients without asthma — entitled "ABPA sans asthma" — despite it having first been described in the 1980s. A recent study, performed by Dr Valliappan Muthu and colleagues at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, has looked at the records of ABPA patients with and without asthma, in order to find clinical differences between the two disease subsets.
The study included 530 patients, with 7% of those identified as having ABPA sans asthma. This is the largest known investigation of the disease to date. However, as the research was conducted retrospectively at a specialist centre, and ABPA sans asthma is a difficult condition to diagnose, the true number of those affected is unknown.
Certain similarities were found between the two disease types. There were similar rates of coughing up blood (haemoptysis) and coughing up mucus plugs. Bronchiectasis, a condition where the airways are widened and inflamed, was found more often in those without asthma (97.3% vs 83.2%). However, the extent to which the lung was affected by bronchiectasis was similar in both groups.
Lung function tests (spirometry) were significantly better in those without asthma: normal spirometry was found in 53.1% of those without asthma, in comparison to 27.7% of those with asthma. Furthermore, ABPA sans asthma patients were significantly less likely to experience ABPA exacerbations.
To sum up, this study found that those experiencing ABPA sans asthma were likely to have better lung function and fewer exacerbations than those with ABPA and asthma. However, clinical symptoms, such as mucus pugs and haemoptysis occurred at similar rates and bronchiectasis was more common in ABPA sans asthma patients. This was the largest study to date on this subset of ABPA; however, further research is required to understand the condition better.
Full paper: Muthu et al. (2019), Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: A distinct subset of ABPA with a lesser risk of exacerbation[/et_pb_text][/et_pb_column]
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Living with a lung condition during the COVID-19 pandemic: patient stories
The current pandemic is a frightening time for us all, but it can be especially nerve-wracking for those already living with lung conditions. The European Lung Foundation has compiled 4 stories from individuals living with pre-existing lung diseases, and their experiences living through this period. One contribution is from an aspergillosis patient and co-founder of the Aspergillosis Trust, Sandra Hicks, and has been copied below. To read all of the contributions, or share your own experience, click here.
The Aspergillosis Trust has also continued to collect and share the experiences of those living with aspergillosis during this time. To read and share stories, or find out more about the Trust's work, click here to visit their website.
Sandra Hicks:
During the last weekend of February 2020, I had a bit more of a productive cough than usual. I stayed in bed, as I felt even more fatigued than usual and that’s already a lot! I have aspergillosis, Nontuberculous Mycobacteria (NTM), asthma and bronchiectasis colonised with Pseudomonas. The reason for these unusual infections is a rare primary immunodeficiency (PID) syndrome, which means that my immune system doesn’t make antibodies very well.
On 1 March, I had a severe pain in my right side, it felt to me like I had pulled a muscle between my ribs and another in my neck. The pain was so bad that I could hardly cough and I certainly couldn’t breathe in deeply. I also had worsening shortness of breath. I realised it was better to get on top of the pain, to be able to clear my lungs. I had a productive cough, not a persistent, dry cough as listed in the COVID-19 symptoms. I felt it didn’t really match with the description of the ‘red flags’ for COVID-19. I didn’t have a sore throat at any point. I did have a high temperature, which went up to 39.5°C during the first week of March. I also had headaches and dizziness, but didn’t lose my sense of taste or smell. The final symptom was coughing-up dark red, thick mucous (haemoptysis) a few times a day, for several weeks. I have never had haemoptysis to that extent ever before, or that dark a red (although the mucous can sometimes be ‘pinky’ in colour).
My routine CT scan which I have for the aspergillosis showed improvements and did not reflect the development of haemoptysis. So it seemed to me like something else was going on in addition to the usual lung problems.
I had phone consultations instead of outpatient clinic appointments with two consultants. The first one was with my mycology consultant on 25 March. He felt that it was possible that I could have had COVID-19. We discussed options for my regular treatment. Should I go into hospital daily for my 14 days of IV caspofungin, or should I delay treatment? Even if I hadn’t had COVID-19, I am in the shielding category and had been advised to stay at home for 12 weeks. The balance of risks were in favour of starting treatment sooner. This was due to the lower numbers of cases of COVID-19 in the UK at that time, compared to the rest of Europe. I was concerned that if we followed the same pattern as Italy, Spain and France, then in the next 2-3 weeks, the number of cases and deaths would rise hugely. When that cycle of treatment started on 30 March, there were 1,408 deaths from COVID-19 reported in the UK. On Easter Sunday, 12April the last day of treatment, there were 10,612 deaths reported in the UK. It was a very scary time, having to go into hospital daily during those two weeks. If I had delayed treatment, the hospital might not have had capacity to treat me. My lung condition could also have deteriorated. I may have been at greater risk of catching COVID-19 too. Looking back, it turned out to be the right decision for me.
My immunology consultant also said on 27 March in another phone appointment, that it was possible I’d had COVID-19. However, there is no way of knowing for sure if I have. COVID-19 blood tests look for the presence of antibodies produced by the immune system. If these antibodies are present, then that means a person has had the infection in the past. However, these tests might not be accurate in people with primary immunodeficiency syndromes, because we don’t always make antibodies properly. The consultant said that they do not yet know for sure whether having COVID-19 means that you will develop immunity. He also said that if patients need to come in for procedures then they take measures to prevent infection: they pull the curtains in between beds, everyone wears masks, staff also wear aprons and gloves.
So, I still don’t know if I have had COVID-19, but it is possible! I will probably never know either. If this was mild or moderate COVID-19, it was still bad enough on top of the usual lung conditions.
It is an incredibly sad situation that so many people have lost their lives prematurely. The current total number of deaths in the UK is 34, 636 (18 may). It’s so important to stay at home for those of us with lung disease, who are most at risk. I personally don’t see a ‘quick fix’ for this pandemic and it is possible there will be a second and third wave. I am looking forward to the vaccine being available, so it protects more people.
COVID isolation: Mental well-being while staying at home
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https://www.youtube.com/watch?v=Uye-jTS1MYA
The UK NHS has released a list of helpful resources to assist in safeguarding your mental health during this current COVID isolation period. We have reproduced some of it here for the purpose of allowing indexing of the many sections, hopefully making access a bit quicker and easier.
Taking care of your mind as well as your body is really important while staying at home because of coronavirus (COVID-19).
You may feel bored, frustrated or lonely. You may also be low, worried or anxious, or concerned about your finances, your health or those close to you.
It's important to remember that it is OK to feel this way and that everyone reacts differently. Remember, this situation is temporary and, for most of us, these feelings will pass. Staying at home may be difficult, but you are helping to protect yourself and others by doing it.
The tips and advice here are things you can do now to help you keep on top of your mental wellbeing and cope with how you may feel while staying at home. Make sure you get further support if you feel you need it.
The government also has wider guidance on staying at home as a result of coronavirus.
To read the complete NHS page 'Worried about coronavirus' click here.
For a more complete resource on mental health see the NHS page 'Every Mind Matters'.
1. Find out about your employment and benefits rights
You may be worried about work and money while you have to stay home – these issues can have a big effect on your mental health.
If you have not already, talk with your employer about working from home, and learn about your sick pay and benefits rights. Knowing the details about what the coronavirus outbreak means for you (England and Wales only) can reduce worry and help you feel more in control.
2. Plan practical things
Work out how you can get any household supplies you need. You could try asking neighbours or family friends, or find a delivery service.
Continue accessing treatment and support for any existing physical or mental health problems where possible. Let services know you are staying at home, and discuss how to continue receiving support.
If you need regular medicine, you might be able to order repeat prescriptions by phone, or online via a website or app. Contact your GP and ask if they offer this. You can also ask your pharmacy about getting your medicine delivered, or ask someone else to collect it for you.
If you support or care for others, either in your home or by visiting them regularly, think about who can help out while you are staying at home. Let your local authority (England, Scotland and Wales only) know if you provide care or support someone you do not live with. Carers UK has further advice on creating a contingency plan.
3. Stay connected with others
Maintaining healthy relationships with people you trust is important for your mental wellbeing. Think about how you can stay in touch with friends and family while you are all staying at home – by phone, messaging, video calls or social media – whether it's people you usually see often, or connecting with old friends.
Lots of people are finding the current situation difficult, so staying in touch could help them too.
4. Talk about your worries
It's normal to feel a bit worried, scared or helpless about the current situation. Remember: it is OK to share your concerns with others you trust – and doing so may help them too.
If you cannot speak to someone you know or if doing so has not helped, there are plenty of helplines you can try instead.
5. Look after your body
Our physical health has a big impact on how we feel. At times like these, it can be easy to fall into unhealthy patterns of behaviour that end up making you feel worse.
Try to eat healthy, well-balanced meals, drink enough water and exercise regularly. Avoid smoking or drugs, and try not to drink too much alcohol.
You can leave your house, alone or with members of your household, for 1 form of exercise a day – like a walk, run or bike ride. But make you keep a safe 2-metre distance from others. Or you could try one of our easy 10-minute home workouts.
6. Stay on top of difficult feelings
Concern about the coronavirus outbreak is perfectly normal. However, some people may experience intense anxiety that can affect their day-to-day life.
Try to focus on the things you can control, such as how you act, who you speak to and where you get information from.
It's fine to acknowledge that some things are outside of your control, but if constant thoughts about the situation are making you feel anxious or overwhelmed, try some ideas to help manage your anxiety.
7. Do not stay glued to the news
Try to limit the time you spend watching, reading or listening to coverage of the outbreak, including on social media, and think about turning off breaking-news alerts on your phone.
You could set yourself a specific time to read updates or limit yourself to checking a couple of times a day.
Use trustworthy sources – such as GOV.UK or the NHS website – and fact-check information from the news, social media or other people.
8. Carry on doing things you enjoy
If we are feeling worried, anxious, lonely or low, we may stop doing things we usually enjoy.
Make an effort to focus on your favourite hobby if it is something you can still do at home. If not, picking something new to learn at home might help.
There are lots of free tutorials and courses online, and people are coming up with inventive ways to do things, like hosting online pub quizzes and music concerts.
9. Take time to relax
This can help with difficult emotions and worries, and improve our wellbeing. Relaxation techniques can also help deal with feelings of anxiety.
10. Think about your new daily routine
Life is changing for a while and you are likely to see some disruption to your normal routine. Think about how you can adapt and create positive new routines and set yourself goals.
You might find it helpful to write a plan for your day or your week. If you are working from home, try to get up and get ready in the same way as normal, keep to the same hours you would normally work and stick to the same sleeping schedule.
You could set a new time for a daily home workout, and pick a regular time to clean, read, watch a TV programme or film, or cook.
11. Look after your sleep
Good-quality sleep makes a big difference to how we feel, so it's important to get enough.
Try to maintain your regular sleeping pattern and stick to good sleep practices.
12. Keep your mind active
Read, write, play games, do crosswords, complete sudoku puzzles, finish jigsaws, or try drawing and painting.
Whatever it is, find something that works for you.
15th May 2020: Shielding advice to continue until the end of June.
The original shielding letters and advice that have been sent out to people who are highly vulnerable to COVID-19 (coronavirus) infection stated that all recipients of the letter should completely isolate themselves from physical contact, not go outside of their homes for 12 weeks.
This advice was sent to all patients of the National Aspergillosis Centre (NAC) who have chronic pulmonary aspergillosis (CPA).
Patients who have allergic bronchopulmonary aspergillosis (ABPA), severe asthma and forms of aspergillosis other than CPA were informed of their vulnerability status by their local respiratory clinic or GP. Some will have been told to shield, others not but all shielding advice was to remain in place for 12 weeks from the day of receipt of the letter.
That advice for people shielding has now been amended to say that all shielding people should continue shielding until the end of June 2020.
Latest advice from Welsh government
Latest advice from Scottish government
Latest advice from Northern Ireland
May 11th 2020: UK Government updated advice for vulnerable people during the COVID-19 epidemic
General population
Now that an overwhelming peak of COVID-19 cases has been avoided in the UK, at least for the time being UK government has advised the UK general population that:
- People and employers should stay safe in public spaces and workplaces by following “Covid-19 secure” guidelines. This should enable more people to go back to work, where they cannot work from home, and encourage more vulnerable children and the children of critical workers to go to school or childcare as already permitted
- You should stay safe when you leave home: washing your hands regularly, maintaining social distancing, and ensuring you do not gather in groups of more than two, except with members of your household or for other specific exceptions set out in law
- You must continue to stay home except for a limited set of reasons but - in line with scientific advice - can take part in more outdoor activities from Wednesday 13 May
See the full document for details
A large group of people, assessed as particularly vulnerable must take further action and observe the following additional guidelines:
There are two classes of people referred to as vulnerable. These are the 'vulnerable' and the 'highly vulnerable'. There are new instructions for both groups (HM Gov update 11th May 2020)
Vulnerable people
Clinically vulnerable people are those who are:
- aged 70 or older (regardless of medical conditions)
- under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab as an adult each year on medical grounds):
- chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
- chronic heart disease, such as heart failure
- chronic kidney disease
- chronic liver disease, such as hepatitis
- chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
- diabetes
- a weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets
- being seriously overweight (a body mass index (BMI) of 40 or above)
- pregnant women
In addition, there may be people who do not fit in any of the categories listed above, but who have been advised that they are clinically vulnerable by their GP or other health professional.
All people who fall into this category must stay at home as much as possible, and take particular care to avoid contact with others outside of their household if they go out.
Highly vulnerable people
This is the group who have received a 'Shielding letter' or other instruction from a medical authority such as their GP. Their updated instructions do not seem to have been substantially changed and can be found here. This group of people need to stay at home, do not go out, keep shielding. The Government is currently advising people to shield until the end of June and is regularly monitoring this position.
FAQ's
Does easing restrictions apply to healthy 70 year olds and over? (see section 2)
How long will shielding be in place? (see section 2.2)
April 17th: Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19
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HM governments latest update for people who may be extremely vulnerable. You can find the full guidelines here.
In particular NOTE: guidelines on registering as a highly vulnerable patient.
Background and scope of guidance
This guidance is for people who are clinically extremely vulnerable, including children. It’s also for their family, friends and carers.
People who are clinically extremely vulnerable should have received a letter telling them they’re in this group or been told by their GP.
It’s for situations where a clinically extremely vulnerable person is living at home, with or without additional support. This includes clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs.
If you have been told that you’re clinically extremely vulnerable, you should:
- follow the advice in this guidance
- register online even if you do not need additional support now
Who is ‘clinically extremely vulnerable’?
Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place someone at greatest risk of severe illness from COVID-19.
Clinically extremely vulnerable people may include the following people. Disease severity, history or treatment levels will also affect who is in the group.
- Solid organ transplant recipients.
- People with specific cancers:
- people with cancer who are undergoing active chemotherapy
- people with lung cancer who are undergoing radical radiotherapy
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
- People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
- People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe combined immunodeficiency (SCID), homozygous sickle cell).
- People on immunosuppression therapies sufficient to significantly increase risk of infection.
- Women who are pregnant with significant heart disease, congenital or acquired.
People who fall in this group should have been contacted to tell them they are clinically extremely vulnerable.
If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.
Check this is the right guidance for you
There’s different guidance if you are not clinically extremely vulnerable.
Follow the different guidance if any of the following apply to you:
- you do not have any of the conditions that makes you clinically extremely vulnerable
- you have not been told by your GP or specialist that you’re clinically extremely vulnerable or received a letter
Staying at home and shielding
You’re strongly advised to stay at home at all times and avoid any face-to-face contact if you’re clinically extremely vulnerable to protect yourself.
This is called ‘shielding’.
Shielding means:
- Do not leave your house.
- Do not attend any gatherings. This includes gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
- Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.
The Government is currently advising people to shield until the end of June and is regularly monitoring this position.
Handwashing and respiratory hygiene
There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:
- wash your hands more often with soap and water for at least 20 seconds or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and after you eat or handle food
- avoid touching your eyes, nose, and mouth with unwashed hands
- avoid close contact with people who have symptoms
- cover your cough or sneeze with a tissue, then throw the tissue in a bin
- clean and disinfect frequently touched objects and surfaces in the home
Register for support
Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support, for example, essential groceries delivered to your home.
Please register even if:
- you do not need support now
- you’ve received your letter from the NHS
Register for support
- register online
- call 0800 028 8327
Please have your NHS number with you when you register. This will at the top of the letter you have received letting you know you are clinically extremely vulnerable, or on any prescriptions.
Letters to clinically extremely vulnerable people
The NHS in England has contacted clinically extremely vulnerable people with the conditions listed above to provide further advice.
If you have not received a letter or you have not been contacted by your GP but you’re still concerned, you should discuss your concerns with your GP or hospital clinician.
Help with food and medicines if you’re shielding
Ask family, friends and neighbours to support you and use online services.
If you cannot get the help you need, the government can help by delivering essential groceries and support. It may take time for support offered through this service to arrive. If you have not received a letter from the NHS then you may not be able to receive the support offered through this service. If you need urgent food or care, please contact your local council.
Getting your prescriptions
Prescriptions will continue to cover the same length of time as usual.
If you do not currently have your prescriptions collected or delivered, you can arrange this by:
- Asking someone who can pick up your prescription from the local pharmacy (this is the best option, if possible).
- Contacting your pharmacy to ask them to help you find a volunteer (who will have been ID checked) or deliver it to you.
You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.
If you receive support from health and social care organisations, for example, if you have care provided for you through the local authority or health care system, this will continue as normal.
Your health or social care provider will be asked to take additional precautions to make sure that you are protected. The advice for formal carers is included in the home care provision.
Visits from essential carers
Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of coronavirus. Everyone coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there.
If your main carer becomes unwell
Speak to your carers about back-up plans for your care in case your main carer is unwell and needs to self-isolate.
You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.
Living with other people
The rest of your household do not need to start shielding themselves, but they should do what they can to support you in shielding and to carefully follow guidance on social distancing.
At home you should:
- Minimise the time other people living with you spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.
- Keep 2 metres (3 steps) away from people you live with and encourage them to sleep in a different bed where possible. If you can, use a separate bathroom from the rest of the household. Use separate towels from the other people in your house, both for drying themselves after bathing or showering and for hand-hygiene purposes.
- If you share a toilet and bathroom with others, it’s important that they are cleaned every time after use (for example, wiping surfaces you have come into contact with). Consider drawing up a rota for bathing, with you using the facilities first.
- If you share a kitchen with others, avoid using it while they’re present. If you can, take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry the family’s used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and warm water and dry them thoroughly. If you are using your own utensils, remember to use a separate tea towel for drying these.
- Everyone in your household should regularly wash their hands, avoid touching their face, and clean frequently touched surfaces.
If the rest of your household are able to follow this guidance, there is no need for them to take the full protective measures to keep you safe.
If you do not want to be shielded
Shielding is for your personal protection. It’s your choice to decide whether to follow the measures we advise.
For example, if you have a terminal illness, or have been given a prognosis of less than 6 months to live, or have some other special circumstances, you may decide not to undertake shielding.
This will be a deeply personal decision. We advise calling your GP or specialist to discuss this.
Symptoms of coronavirus (COVID-19)
The most common symptoms of coronavirus (COVID-19) are recent onset of one or both of the following:
- new continuous cough
- high temperature (above 37.8°C)
If you develop symptoms
If you think you have developed symptoms of COVID-19 such as a new, continuous cough or fever, seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms.
In an emergency, call 999 if you’re seriously ill. Do this as soon as you get symptoms.
Do not visit the GP, pharmacy, urgent care centre or a hospital.
Prepare a single hospital bag. This will help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus. Your bag should include:
- your emergency contact
- a list of the medications you take (including dose and frequency)
- any information on your planned care appointments
- things you would need for an overnight stay (for example, snacks, pyjamas, toothbrush, medication)
- your advanced care plan (only if you have one)
Hospital and GP appointments if you’re shielding
Everyone should access medical assistance online or by phone wherever possible.
However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP or specialist to ensure you continue to receive the care you need and determine which of these appointments are absolutely essential.
Your hospital may need to cancel or postpone some clinics and appointments. You should contact your hospital or clinic to confirm appointments.
Looking after your mental wellbeing
Social isolation, reduction in physical activity, unpredictability and changes in routine can all contribute to increasing stress.
Many people, including those without existing mental health needs, may feel anxious. For example, how it could affect support with daily living, ongoing care arrangements with health providers, support with medication and changes in their daily routines.
If you’re receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, please contact your key worker or care coordinator or provider to review your care plan. If you have additional needs, please contact your key worker or care coordinator to develop a safety or crisis plan.
Understandably, you may find that shielding and distancing can be boring or frustrating. You may find your mood and feelings are affected and you may feel low, worried or have problems sleeping and you might miss being outside with other people.
At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.
Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading, or listening to media coverage of the outbreak. It may help to only check the news at set times or limit this to a couple of times a day.
Try to focus on the things you can control, such as your behaviour, who you speak to and who you get information from. Every Mind Matters provides simple tips and advice to start taking better care of your mental health.
If you’re struggling with your mental health, please see the NHS mental health and wellbeing advice website for self-assessment, audio guides and tools that you can use.
If you’re still struggling after several weeks and it’s affecting your daily life, please contact NHS 111 online. If you have no internet access, you should call NHS 111.
Staying mentally and physically active
There are simple things you can do that may help, to stay mentally and physically active during this time such as:
- look for ideas of exercises you can do at home on the NHS website
- spend time doing things you enjoy such as reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV
- try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and drugs
- try spending time with the windows open to let in the fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight, or get out into any private space, keeping at least 2 metres away from your neighbours and household members if you are sitting on your doorstep
Staying connected with family and friends
Use support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone, by post or online.
Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling if you want to.
Remember, it is OK to share your concerns with others you trust and in doing so you may end up providing support to them, too. Or you might want to try an NHS recommended helpline.
Unpaid carers who provide care for someone who is clinically extremely vulnerable
If you’re caring for someone who is clinically extremely vulnerable, there are some simple steps that you can take to protect them and to reduce their risk.
Ensure you follow advice on good hygiene:
- only provide care that is essential
- wash your hands when you arrive and often, using soap and water for at least 20 seconds or use hand sanitiser
- cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- put used tissues in the bin immediately and wash your hands afterwards
- do not visit or provide care if you are unwell and make alternative arrangements for their care
- provide information on who they should call if they feel unwell, how to use NHS 111 online coronavirus service and leave the number for NHS 111 prominently displayed
- find out about different sources of support that could be used and accessing further advice on creating a contingency plan is available from Carers UK
- look after your own wellbeing and physical health during this time. See further information from Every Mind Matters
More information on providing unpaid care is available.
People living in long-term care facilities, for the elderly or people with special needs
This guidance also applies to clinically extremely vulnerable people living in long-term care facilities. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such people to ensure this guidance is strictly adhered to.
Parents and schools with clinically extremely vulnerable children
This guidance also applies to clinically extremely vulnerable children in mainstream and special schools. If you live with a child who is clinically extremely vulnerable you should try to follow the advice on living with other people, you should continue to have physical contact to provide essential care.
NICE Guidance for Respiratory Patients with regard to COVID-19
The National Institute for Health and Clinical Excellence (NICE) guides the UK NHS and its clinicians as well a social care professionals when good, balanced and well-researched opinions are needed for a new situation, or an update is needed for an existing medical condition. Consequently NICE has brought out a series of guidelines for SARS-CoV-2 (COVID-19) coronavirus infections as the epidemic has developed and doctors may refer to those guidelines for the best way to treat their infected patients who also have a respiratory disease.
NICE can also respond to specific questions from clinicians and some questions relate to people with respiratory disease. We know that some steroid medication can leave patients slightly more vulnerable to some types of infection, so the question was posed "is it better to stop taking steroid medication to help prevent a COVID-19 infection or shall we advise patients to continue taking steroid medication to control their symptoms".
- The first set of guidelines were designed for doctors treating patients with asthma and importantly defines exactly what they mean by severe asthma which is
"severe asthma is defined by the European Respiratory Society and American Thoracic Society as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller, and/or systemic corticosteroids to prevent it from becoming or remaining 'uncontrolled' despite this therapy"
As you might expect much of the document is quite technical, but it is clear that severe asthma patients who get a COVID-19 infection are to continue to use their normal medication including corticosteroid just as they did before infection.
- The second set of relevant guidelines refers to people who have Chronic Obstructive Pulmonary Disease (COPD).
"The new guidance on community-based care of patients with COPD says all patients, including those with suspected or confirmed COVID-19, should continue taking their regular inhaled and oral medicines in line with their individualised self-management plan".
NICE says there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19, so patients established on these drugs should continue to use them, and delay any planned trials of withdrawal. Patients on long-term oral corticosteroids should also be told to continue taking them at the prescribed dose.