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

 

 

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.

Coronavirus (COVID-19) Social distancing introduced

24th March: Social distancing measures extended

The government last night asked us all to stay at home to protect each other and reduce pressure on the NHS. 

Full information on staying at home and away from others is available from the government website

People with CPA are classed as extremely vulnerable. Stay at home at all times and avoid any face-to-face contact for at least 12 weeks. More guidance on shielding and protecting people defined on medical grounds as extremely vulnerable is available from Public Health England.

17th March: Social distancing measures introduced

The government has issued guidance is for everyone advising on social distancing measures we should all be taking to reduce social interaction between people in order to reduce the transmission of coronavirus (COVID-19). It is intended for use in situations where people are living in their own homes, with or without additional support from friends, family and carers. If you live in a residential care setting guidance is available.

Government advice is for everyone aged 70 and over, regardless of medical conditions, to follow social distancing measures. Full guidance on the social distancing measures we should all be taking to reduce social interaction between people in order to reduce the transmission of coronavirus is available on gov.uk. This includes information for people with pre-existing health conditions including asthma and COPD. Please read it.

GOVERNMENT ADVICE ON SOCIAL DISTANCING

 

12th March: Precautionary increase in protective measures advised

COVID-19 is starting to spread in an unconstrained manner in the UK with over 460 cases identified. This makes it a little more likely that the virus will spread through the community, increasing the number of cases. UK government measures are slowing this spread down so the total number is still relatively small, with only a handful of cases in each area so the chances any one person will be infected are still really small, but if you are a chronic respiratory disease patient with a disease such as aspergillosis you are at slightly higher risk of infection. Consequently we are recommending that you use additional protective measures.
In addition to frequent handwashing, no touching of your face and limiting direct contact with other people the suggestion is that you start social distancing so that any infectious person will find it very difficult to pass on the virus. The link explains everything in detail but essentially you avoid groups, people with symptoms, close contact ie less than 2 metres away from someone for more than 15mins. Also minimise use of public transport.

 

9th March : YOUR QUESTIONS ANSWERED BY A RESPIRATORY EXPERT

A useful series of questions specifically aimed at bronchiectasis, COPD, asthma, cystic fibrosis and more. Written by European Respiratory Society (ERS) expert Professor James Chalmers. 

Answers to common questions about COVID-19 from the NHS

Public health Advice

British Thoracic Society guidance – UK region specific

BBC information resources on COVID-19

What do I need to know about the coronavirus?

How can I protect myself from air pollution?

Air pollution is increasingly reported as being something we need to improve if we are to prevent damaging the health of millions of people. Anyone who experienced the ‘pea-souper’ fogs of the 1960s and earlier needs little introduction to the subject, but the Clean Air Acts in the UK in 1956, 1963 and 1993 sorted that out didn’t they? After all, we don’t see those dreadful weather conditions any more do we and now that we no longer burn coal very much those chimneys belching black smoke are a thing of the past?

In truth, conditions are very much better now compared with the 50s but we are a long way from eliminating the air pollution problem, The rise of the motor car and diesel goods transport is a major factor and the harmful, irritant gasses released are much less obvious so tend to be hidden. In the UK these pollutants are now closely monitored by the Environmental Agency and include nitrogen dioxide, sulfur dioxide, carbon monoxide, pm2.5 particulates.

Exposure to airway irritants is still very common outside the home – the popularity of wood-burning stoves in urban and suburban areas is a good example of a new trend that can make matters worse. Bonfires and fireworks are a problem at some times of the year and Global Warming may also lead to increased risk of uncontrolled burning such as happened on the moors surrounding Manchester in 2018 and happens in the US and are currently ongoing in large parts of Australia. Burning causes vast quantities of very fine dust particles and gasses to be released that someone with asthma can find very disabling and after the ongoing bushfires National Asthma Council Australia have published useful help about how to cope with asthma if you find yourself in a smoky area.

An excellent review of the harm air pollution can do to our health and a call to government to take action was released in 2018 by the Royal College of Physicians (Every breath we take: the lifelong impact of air pollution ) and it has been followed up two years later in 2020 when, rather discouragingly they note that some chances to change things have already been missed and progress has been minimal: https://www.rcplondon.ac.uk/news/reducing-air-pollution-uk-progress-report-2018

Is there anything we can do to reduce prevent us from inhaling these irritants?

The British Lung Foundation has an extensive article on this subject for outdoor air. They aren’t particularly supportive about the use of facemasks but some aspergillosis patients report that there is some benefit, especially when travelling or gardening.

Indoors as long as we keep doors and windows closed we can keep out a lot of the pollution in the outside air, but of course, it is not always possible to do so as we also need to vent out excess moisture from our homes at regular intervals eg when we shower, bathe, cook or do the laundry. Air filters for use in the home have long been available varying from the token small device to large floor standing devices but are they any good? The answer is that they can reliably clean some things out of the air provided that they are big enough to suit your room size. Good Housekeeping has written a useful guide.

There is a freely available world map of air pollution at https://waqi.info/

map of air pollution

 

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