Coronavirus COVID-19 (SARS-CoV-2): Precautions if you have Aspergillosis (April 4th)

Coronavirus precautions

Over the last few weeks, many of us in the UK have been careful to socially distance ourselves from others in order to slow down the spread of the SARS-CoV-2 (COVID-19) viral outbreak. The requirements are as follows:

Stay at home

  • Only go outside for food, health reasons or work (but only if you cannot work from home)
  • If you go out, stay 2 metres (6ft) away from other people at all times
  • Wash your hands as soon as you get home

Do not meet others, even friends or family.

You can spread the virus even if you don’t have symptoms.

See UK Gov link for full details

These precautions are effective and appropriate for almost everyone, however, there are a few people who are more vulnerable due to age or a specific health condition and may need to take further precautions. Some, but certainly not all patients with aspergillosis will fall into that category, and in some cases will have to be individually considered by your doctor.

If you fall into the extremely vulnerable category you will be informed by a letter from UKgov, your GP, you local hospital doctor or for some (those with CPA) from the National Aspergillosis Centre. This is known as the shielding letter.

If you are extremely vulnerable

The UK government have severe asthma and severe COPD as conditions that put people at high risk from the coronavirus COVID-19 outbreak. The full document published by Public Health England(March 24th) which also contains links to a large number of other relevant documents can be accessed here. Aspergillosis refers to a range of diseases and individual cases, some of which may fall into the high-risk category but some will not. 

The main points (in addition to maintaining good handwashing, cough into tissues) are:

  1. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.
  2. Do not leave your house.
  3. Do not attend any gatherings. This includes gatherings of friends and families in private spaces for example family homes, weddings and religious services.
  4. Do not go out for shopping, leisure or travel and, when arranging food or medication deliveries, these should be left at the door to minimise contact.
  5. Keep in touch using remote technology such as phone, internet, and social media.

All people at high risk are being informed of this by text/email/letter over the next week so that they are fully aware of what they must do to protect themselves.

In our discussions with aspergillosis patients, a few more points relating to social isolating that are not fully covered by the above document have been raised, so we will try to answer them here – if you have more questions please join our Facebook group and discuss it there.

Can I use my garden?

If you have a private garden and can maintain social distancing from neighbours and other people living in your home the answer is yes.

Deliveries: can I catch the virus?

There is a specific research paper that answers some of these questions. COVID-19 survival on a variety of surfaces was measured under one set of conditions:

 

SARS-CoV-2 is the current virus (2020 outbreak) which appears as red markers in each graph. We can see that the length of time it takes for the virus to lose half of its infectious particles (ie the half-life) is shortest for cardboard(3-4hrs) and copper (1 hr), so any virus on cardboard packaging should last the least amount of time, whereas the half-life was 6-7 hours for plastic, or roughly twice as long.

Given that someone who is infected by SARS-CoV-2 (COVID-19) can produce over a million viruses in their throat, we can see that a single cough could contain hundreds of thousands. If that number landed in cardboard it would take over 2 days for the virus to ‘die-off’, twice as long as that for plastic. Clearly it is sensible to take precautions with deliveries depending on what they are wrapped in and wipe them down with sanitiser containing more than 60% alcohol or bleach, or this US EPA document is very useful describing a large choice of disinfectants.

How easy is it to be infected if someone is coughing?

The paper above shows that the half-life of the virus under standard conditions as an aerosol ie after a cough or sneeze is similar to copper and can stay in the air for at least an hour, though the majority are thought to sink to the floor within 2-metre area in minutes. It will take 12-24 hours to die-off in air, perhaps longer under non-standard conditions (e.g. warmer temperature or higher humidity) but perhaps longer when it lands depending on the surface it lands on. This is why thorough hand washing is vital to prevent the settled virus from being passed on, and 2-metre spacing keeps us away from direct aerosols in the event of someone coughing.

Should I be cleaning my phone?

The figures given above for the survival of the virus on plastic are helpful when you realise that we all carry around a plastic screen, hold it in our hands, put it up against our faces. If any viruses land on our phones they can remain viable for over 4 days. For that reason, we should be cleaning our phones regularly, at least daily. Use alcohol-based wipes – this article gives more detail.

Disinfecting surfaces: What should I use?

Confusingly different disinfectants need to be used in different ways, and different surfaces may need different disinfectants. The best disinfectants for your hands & skin are preferably soap & running water as the soap unsticks & disables the virus and the water washed it off and dilutes the virus in your skin very efficiently – hot water with soap best of all. If you cannot access running water then hand sanitisers containing at least 60% alcohol (NOT just soap & surfactants) are effective until you can wash your hands properly.

NOTE that most wet wipes/baby wipes are designed to clean and NOT kill coronavirus.

For other surfaces, there are a range of useful disinfectants but some are no good for disinfecting surfaces covered in virus and many need to be left on the surface for longer than you think! Thankfully this document from the US Environmental Protection Agency is very informative.

Cleaning & disinfecting in a home with confirmed or suspected SARS-CoV-2

Cleaning an area that has been exposed to SARS-CoV-2 eg after someone in a house has been diagnosed as Coronavirus positive and has left

COVID-19 monitoring

Help researchers monitor the coronavirus spread using this simple App.

Myths to ignore

World Health Authority on Myths

Live Science (US-based) myths

BBC part 1

  • Garlic
  • Drink water
  • Ice cream
  • Drinkable silver (colloidal silver)

and part 2

  • Holding your breath
  • Home-made hand sanitizer
  • The virus can survive on surfaces for a month
  • Cow urine

I haven’t received a shielding letter, what do I do?

Letters are still being sent out, you may yet receive one and until then the general advice is to socially distance yourself from everyone (see above) rather than shield yourself. For people with asthma who have not received a letter Asthma UK have released some guidelines suggesting further action

For people with chronic lung disease, the British Lung Foundation have released some helpful guidelines.

How do I… cope with hair loss?

Certain medications prescribed for aspergillosis may cause some hair loss. Losing your hair can be very difficult, and can affect your self-esteem; unfortunately there is a social stigma attached to hair loss and this can affect many people’s confidence, but there are ways to cope.

Join a support group:

Joining a support group is a great way to meet other people going through the same experiences as you, and to share tips and coping skills with one another.

  • Local support groups: Alopecia UK has several local support groups based around the UK. Click here to find your closest meeting.
  • Online support groups: If you are unable to attend a local meeting, or you’d just prefer to find support online there are Facebook support groups for the UK and worldwide community: Alopecia UK Facebook group and World Alopecia Community. Here you can ask questions and share your experiences with others who suffer from hair loss. You can also use the aspergillosis support groups on Facebook to talk to others also coping with aspergillosis and associated problems: Aspergillosis Support (Private) and Aspergillosis Support

Talk about it:

Hair loss can hugely affect your confidence and self-esteem. Talking about it with your family and friends can help them understand what support you need from them, and help you to understand that they don’t see you any differently.

If you are really struggling, you might want to seek help from your doctor. The lack of control over this sudden change in your appearance (as well as coping with a chronic illness) can make people very vulnerable to mental illnesses. It is important to try and recognise this and tackle it as early as possible – for more information on recognising and avoiding depression, click here.

Cover up:

There are several different ways to cover up hair loss, from small bald patches to more severe cases. More detailed information on the tips listed below can be found here.

  • Haircuts and hairstyles: smaller bald patches can often be hidden with the right hairstyle. An experienced hairdresser will be able to help you choose the best haircut to cover up patches. If you’re worried about going into a salon, find a hairdresser who does home-visits. There are also many videos on YouTube that show you tips and tricks to style your hair over patches
  • Wigs: With more severe hair loss, you might want to try a wig. There are many different types out there, so Alopecia UK has put together a detailed guide to choosing a wig.
  • Head coverings: Headscarves, hats, head tattoos and camouflage products are all good and fairly cheap ways to cover up hair loss. These can be very individual and allow you to be flexible with your appearance.
  • Make up: Losing eyebrow and eyelash hair can change your appearance more than you think, which can be upsetting. Make up tips, such as wearing fake eyelashes or drawing eyebrows on with a pencil can help disguise facial hair loss. There are also more permanent options, such as eyebrow tattoos, that can help you achieve a more natural look.

However you choose to deal with hair loss, there is plenty of support, tips and advice out there for you to access!

How do I… describe symptoms to my doctor?

This subject is often glossed over, after all, how hard can it be to describe how you feel? The answer is that it is all too often pretty difficult!

The initial conversation between you and your doctor is usually one of the most vital few minutes you will spend with your doctor, as your subsequent diagnosis and treatment is strongly guided by what information you impart. For many of us, it may seem a simple process as long as the symptom is simple to describe and in an obvious place – for example, if you have a sharp pain in your knee it is easy to pinpoint. However, what if you have a rather less well defined uncomfortable sensation in your chest? You can’t describe it as a pain and you can’t point at the location with any accuracy other than ‘it’s on the left side’.

There might also be additional information that you can collect prior to the conversation (eg. for symptoms that come and go it can be useful to keep a diary). There are also apps for use on a smartphone that can help you record symptoms and other factors important to the management of your health.

Your doctor is skilled at guiding your thoughts to reach a quick conclusion, but it is worthwhile giving your first conversation some thought, to ensure that you are giving accurate information that you are happy describes what is happening. There are several tips and tricks that can help with this in this document in WikiHow. Some of the tips are reproduced below:.

Learn the basics of describing symptoms. There are four basic elements you should use to describe symptoms. Learning these will help you figure out your symptoms and best convey them to your doctor.[1]

  • Tell your doctor how your symptoms feel. For example, if you’re experiencing headaches, use descriptive words like sharp, dull, stabbing, or throbbing. You can use these kinds of terms to describe many physical symptoms.
  • Explain to or show your doctor the exact location in or on which you’re experiencing your symptoms. You want to be as specific as possible so say “the front of my kneecap is swollen and has throbbing pain” instead of something general like “I have pain on my leg.”[3] You should also note if the symptoms extend to another location.
  • Mention how long you’ve had your symptoms. The more specific date you can pinpoint, the easier it may be for your doctor to figure out what is causing your symptoms.[4]
  • Note how frequently you have or notice symptoms. This information can also help your doctor figure out what’s causing your symptoms. For example, you could say “I feel symptoms every day, especially after I work out,” or “I only notice my symptoms occasionally, like every few days.”

2. Figure out and write down your symptoms. It’s important to recognize your specific symptoms and write them down before you see your doctor. Not only will this help you best describe your symptoms, but will also ensure that you don’t forget to include any symptoms and how they affect you.[5]

  • Make sure to take your list of symptoms, including the basic information on them, to your appointment with you.
  • Note if symptoms are connected to specific activities, injuries, times of day, food or beverages, and anything else that exacerbates them. Also note if they affect your life in any way.[6]

3.  Bring a current and cumulative patient profile to the appointment. A comprehensive profile of yourself as a patient includes information on conditions, hospitalizations, or surgeries you’ve had, what medications you have taken or are currently taking, and any allergy to medications or foods. This will help ensure that you don’t forget any vital information and also help your doctor understand your medical history.[7]

  • You may not end up needing to refer to it, but if questions about your medical history come up, having your patient profile available will maximize the time you can spend discussing your current medical issue(s).[8]
  • Bring your current medication bottles, which list the name & dose information. Make sure to include any herbal supplements you take as well.[9]
  • You can create a patient profile by summarizing your medical history on a piece of paper.

4. Make a list of questions you have for your doctor. Write down a list of questions related to your most pressing concerns about your symptoms before you go to your doctor. This can also help maximize your visit and the time used describing your symptoms.[10]

  • Address any concerns or worries you have in your questions.

The article goes on to provide really good help with the conversation as it develops – it is well worth reading through next time you have to see your doctor!

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