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

 

 

Coronavirus COVID-19 (SARS-CoV-2): Precautions if you have Aspergillosis (March 28th)

The UK government have defined aspergillosis (Chronic Pulmonary Aspergillosis (CPA) and Allergic Bronchopulmonary Aspergillosis (ABPA) 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 relavant documents can be accessed here.

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 shielding 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 leave my house?

No, if you need any food, shopping or medical supplies use delivery services, family/friends not at high risk. The UK government are planning to deliver shopping to people at high risk to avoid them having to leave home.

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

 

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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