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
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.
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.
BBC information resources on COVID-19
What do I need to know about the coronavirus?
- LIVE UPDATES: Global News
- HOW IS THE UK PLANNING FOR AN OUTBREAK: How prepared are we?
- WHAT ARE THE SYMPTOMS? A simple guide
- WAYS TO PREVENT CATCHING IT: How to wash your hands
- HOW TO SELF-ISOLATE: What you need to know
- WHERE ARE WE WITH A VACCINE? Progress so far
- A VISUAL GUIDE TO THE OUTBREAK: Virus maps and charts
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.
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:
- Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.
- 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.
- 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.
- 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 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
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.
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.
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 firstname.lastname@example.org
- 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
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.
What is a dry continuous cough? What if I have a runny nose? How high is a high temperature?
This BBC video answers all these questions and more.