Infection For a very long time, medical science has assumed that infectious diseases are caused by the presence of a pathogen and weakness in the
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
I am at a loss.
My mother was diagnosed in 2017 with Aspergillious.
Prior to this for around 8 years she has been treated as a COPD condition gradually getting worse.
She now can barely walk talk eat breath, yet no one is considering that she may still have Aspergillus !
Does anyone think that it could actually still be this fungal infection?
obviously there is much more detail and symptoms but didn’t want to post just yet. Really looking for some support and guidance
For a very long time, medical science has assumed that infectious diseases are caused by the presence of a pathogen and weakness in the infected person or the host as it is often known, which allows the pathogen to grow and infect. The weakness could be for example a weakened immune system caused by a genetic illness or immune-suppressive treatment such as is used for transplant patients.
We assumed that inside our bodies there was mostly a sterile environment, and one reason we might become ill could be a pathogen getting into one of those sterile areas and then growing uncontrollably. One of those sterile area’s was our lungs – so 30-40 years ago most would have concluded that aspergillosis was caused by an Aspergillus spore getting deep into the lungs of the recipient and then managing to grow.
Around the year 2000 we started to be able to look at our internal spaces in more detail and identify any microbes that might be present, What was found was a surprise, for example, we could find many microbes; bacteria, fungi and virus’ growing in our lungs without causing any harmful symptoms. It is common to find Aspergillus fumigatus (ie the pathogen that we assume causes aspergillosis most of the time) present in the lungs of most of us where it lives without causing aspergillosis. How is that possible and what is the difference between that situation and the allergy & infections caused in the lungs of an aspergillosis patient?
We quickly learned that microbes could establish harmless communities, living in harmony with each other and with our immune system. This community was named the human microbiome and included all microbes who live within and on us. Huge numbers live in our gut, especially in our large intestine which is the last section of our digestive system to receive our food before it is ejected via the rectum.
Our Microbial Friends
It has emerged then that A. fumigatus can be controlled by its microbial neighbours (our microbiome) working in a tightly controlled partnership with our immune system.
The fungal pathogen interacts with the host to calm the host’s response to the pathogen and uses parts of the host’s immune system to do this. In this way the host and pathogen tolerate each other and do little harm, however, it has been demonstrated that if parts of the host’s fungal recognition system are not working then the host will initiate an aggressive inflammatory response. This is not unlike the situation in ABPA where one of the major problems is the host over-responding to the fungus.
We are also given an example of the microbiome controlling the host’s immune response to a fungal pathogen. Resistance to infection can be increased by the microbial population in the gut sensing a signal – presumably in food ingested by the host. This means that environmental factors can influence the rejection of a pathogen by its microbial neighbours – the message we might take from this is to look after our gut microbiome, and it will look after us. This also holds for the microbes in our lungs, where we have seen differences in the types and location of bacteria in the upper and lower airways that seem to be consistent with the microbiome controlling inflammation – the authors speculate that we need to look at what happens when we challenge these lung microbiotas with a highly inflammatory pathogen such as Aspergillus fumigatus.
The microbiome is also self-regulating as long as it is kept healthy. Bacteria can attack fungi, fungi can attack bacteria in an ongoing battle for food. Host pathogens can be eliminated completely from the microbiome by other microbes.
Different microbiomes in a different part of our body can interact and control diseases such as asthma (ie. lung microbiome interacting with gut microbiome) – so what you eat may influence the microbes in your gut microbiome and that can have an impact on your asthma, for example.
I must warn you that lots of the observations mentioned above are based on very few experiments so far, and mostly on animal model systems and Candida rather than Aspergillus so we must be cautious in our interpretation with regard to aspergillosis, however there are a few take-home messages worth bearing in mind.
- Most healthy people seem to have very healthy, highly diverse microbiomes – so look after yours with a well-balanced diet containing lots of plant material, lots of fibre
- Researchers seem to be turning our assumptions of what infection is on its head – they seem to be saying that inflammation causes infection, rather than infection causes inflammation.
- What you eat can have a direct impact on the amount of inflammation your body uses in response to what it perceives as a pathogen.
It can’t be that diseases like asthma and ABPA are caused by an unhealthy microbiome can it?
Current research seems to be suggesting that it may play a part, so the value of someone with aspergillosis doing what they can to promote a healthy community of microbes within themselves cannot be overstated.
Those people shielding in those areas should consult their local medical services for information in continuing or extending shielding,
An outbreak of coronavirus (COVID-19) has been identified in parts of Greater Manchester, East Lancashire, and West Yorkshire. The government and relevant local authorities are acting together to control the spread of the virus. From 31 July 2020, if you live in these parts of Greater Manchester, East Lancashire and West Yorkshire, you should follow these rules when meeting people who you do not live with. Separate guidance advises on the similar rules imposed in Leicester.
Affected local areas
- Greater Manchester:
- City of Manchester
- Blackburn with Darwen
- West Yorkshire:
If you live in one of the affected areas, in order to help prevent the spread of coronavirus, you should not:
- meet people you do not live with inside a private home or garden, except where you have formed a support bubble (or for other limited exemptions to be specified in law).
- visit someone else’s home or garden even if they live outside of the affected areas.
- socialise with people you do not live with in other indoor public venues – such as pubs, restaurants, cafes, shops, places of worship, community centres, leisure and entertainment venues, or visitor attractions. You may attend these venues with people you live with (or are in a support bubble with), but should avoid interaction with others. If you run such a business, you should take steps to ensure people do not interact with people they do not live with, in line with COVID-19 Secure guidance.
The government will pass new laws to enforce the changes to meeting people in private homes and gardens. The police will be able to take action against those that break these rules, including asking people to disperse and issuing fixed penalty notices (starting at £100 – halving to £50 if paid in the first 14 days – and doubling for subsequent offences).
In Blackburn with Darwen and Bradford, the following premises must remain closed by law:
- indoor gyms
- indoor fitness and dance studios
- indoor sports courts and facilities
- indoor swimming pools, including indoor facilities at water parks
Changes in restrictions
Does my household include close family members?
Your household – as defined in law – is only the people you live with. If you have formed a support bubble (which must include a single adult household i.e. people who live alone or single parents with dependent children aged under 18) these can be treated as if they are members of your household.
What will be illegal?
It will be illegal for people who do not live together to meet in a private home or garden, except for limited exceptions to be set out in law. You should not host or visit people you do not live with, unless they are in your support bubble. If you live in the affected areas, you should not visit someone’s home or garden regardless of whether this is in or outside of the restricted area.
Can I still meet indoors with people in my support bubble?
Yes. Where people from single adult households (people who live alone or single parents with dependent children aged under 18) have formed a support bubble with another household, they can continue to visit each other, stay overnight, and visit other public places as if they were one household.
Can I still meet people outdoors?
In line with the national guidance, you can continue to meet in public outdoor spaces in groups of no more than six people, unless the group includes only people from two households. You cannot meet people you do not live within a private garden.
At all times, you should socially distance from people you do not live with – unless they are in your support bubble.
I live in this area. Can I still meet with my family and friends to celebrate Eid?
Due to higher rates of infection, if you live in this area you should not host or visit friends and family in each other’s homes or gardens. It will shortly be illegal to do so, unless specific exemptions apply. You also should not meet friends and family in other venues – including restaurants or cafes.
Up to two households, or six people from any number of households may meet outdoors (excluding people’s gardens) where there is a lower risk of infection. If you do so, you should still socially distance from those you do not live with, and avoid physical contact.
You may attend a mosque or other place or worship, where Covid-19 Secure guidance applies, but you must socially distance from people outside of your household. This means maintaining a distance of 2 metres, or 1 metre with mitigations (such as wearing face coverings). We recommend at this time that, if possible, prayer/religious services take place outdoors.
Can I still go to work in this area?
Yes. People living inside and outside of this area can continue to travel in and out for work. Workplaces must implement Covid-19 Secure guidance.
I live in this area. Can I still go to cafes, restaurants, the gym and other public places?
Yes. But you should only go with members of your own household – even if you are going outside of the restricted area.
I live in the area. Can people from outside of the lockdown area visit me at my house?
No. This will be illegal.
Do I still have to shield if I live in this area?
Clinically extremely vulnerable people will no longer have to follow the shielding guidance from the 1 August, unless they live in Blackburn with Darwen in the North West and other local affected areas across England where shielding continues.
Can I visit a care home?
You should not visit friends or family in care homes, other than in exceptional circumstances. Care homes should restrict visits to these circumstances.
Can I still have my wedding if it’s in the lockdown area?
Weddings and civil partnership ceremonies in these areas can still go ahead. No more than 30 people should attend a marriage or civil partnership, where this can be safely accommodated with social distancing in a COVID-19 secure venue. Further guidance can be found here.
Large wedding receptions or parties should not currently be taking place and any celebration after the ceremony should follow the broader social distancing guidance of involving no more than two households in any location or, if outdoors, up to six people from different households.
Can I travel outside of the lockdown area to attend a wedding ceremony?
Can I travel into the lockdown area to attend a wedding ceremony?
Yes. Weddings should be limited to no more than 30 people and subject to COVID-19 Secure guidelines.
People living outside the lockdown areas may travel into the areas to attend a wedding, but should not go into a private home or garden.
Can I still visit a place of worship in the lockdown area?
Yes, but you must socially distance from people outside of your household. This means maintaining a distance of 2 metres, or 1 metre with mitigations (e.g. face coverings). We recommend at this time that if possible prayer/religious services take place outdoors.
Can funerals still take place in the lockdown areas?
Yes. Funerals should be limited to no more than 30 people and subject to COVID-19 Secure guidelines.
People living outside the lockdown areas may travel into the areas to attend a funeral.
Can I holiday in the lockdown area, or visit shops, leisure facilities, or cafes in it?
Yes. However, you must avoid socialising with people indoors when doing so.
Can I travel in a car with someone I do not live with?
You should try not to share a vehicle with those outside your household or social bubble. If you need to, try to:
- share the transport with the same people each time
- keep to small groups of people at any one time
- open windows for ventilation
- travel side by side or behind other people, rather than facing them, where seating arrangements allow face away from each other
- consider seating arrangements to maximise distance between people in the vehicle
- clean your car between journeys using standard cleaning products – make sure you clean door handles and other areas that people may touch
- ask the driver and passengers to wear a face covering
The Department for Transport has provided specific guidance on using private vehicles. Please see their guidance on private cars and other vehicles for more information on car sharing and traveling with people outside your household group.
In these worrying times it can be difficult to take our mind off the current situation, particularly without the opportunity to access usual entertainment, like popping into a museum or going to the cinema. However, in response to the pandemic many celebrities and creative minds have turned to the internet, to keep us entertained while we’re stuck at home. If you know where to look, there is a huge amount of material online, from exercise videos, to live stand up and pub quizzes. Many are free, or raise money for charity. We have compiled a number of these here:
Stay fit and learn a new a new talent with these dance lessons from strictly professional Oti.
A weekly live-streamed comedy show. Every Saturday at 7pm. Tickets cost £2, with money going to the performers and The Trussell Trust.
If you’re missing your local pub quiz, there are quizzes nearly every day of the week to be found. Every Thursday and Saturday, a general pub quiz is hosted live on YouTube from 8pm. On Fridays there is a guest host and there are shorter themed quizzes on other days. Watch live or find a backlog on YouTube. If you’d rather curate your own pub quiz to test friends and family at home or over Zoom, there have been a huge amount of questions posted online recently.
The European Lung Foundation has produced a useful Q and A session, to answer all of your questions about COVID-19 and existing lung conditions:
There is also a series of videos about COVID-19 in various patients produced by the European Respiratory Society – these are aimed at experts but may be interesting/of use to patients