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?

COVID-19 Omicron variant update.

Many will have seen the reports emerging in the media of a new variant of COVID-19 referred to as Omicron. Concerns are based on a couple of things:

  1. it carries a large number of ‘spike protein’ changes that we think will help it resist our current immune status and infect the UK population – potentially causing a 5th wave of the pandemic.
  2. it has been identified in multiple countries including the UK in a matter of a few days so it does seem to have the potential to spread quite rapidly!

We don’t have much information on how ill the few people who were infected by this variant are though initial comments suggest symptoms have been mild so far and these concerns are based on a few cases – the next few weeks will be spent gathering this important data.

Regardless of this, government advisers have already announced bringing forward booster vaccinations for those who have not already had one. Everyone over 18 will now receive a booster 3 months after they completed the full course of their first vaccination. For most people, their first (primary) course consisted of 2 jabs. However, there were some people e.g. those who are severely immunocompromised, who needed 3 vaccinations to complete their first (primary) course of vaccination and they will now receive a fourth jab (technically be their first booster vaccination).

Our summary – this is certainly one for us to watch carefully. Mutations to spike proteins may help a virus to evade our immunity but they can also reduce how infectious the virus is, so even if this thing can spread like the ‘Delta’ variant that is sweeping the world it may only cause mild disease compared with Delta and it may not transmit to new people as easily. At the moment we just don’t know what will happen.
The key is to watch its progress over the next few weeks, we will know a lot more then.
Until then, keep protecting yourself by hand washing, spacing, facemasks and ventilate enclosed areas AND go for your booster vaccination when called.

Vaccine Types

Vaccines. Something most, if not all of us, are familiar with. MMR (Measles, Mumps & Rubella), TB (Tuberculosis), Smallpox, Chicken Pox, and the more recent HPV (Human Papillomavirus) and Covid-19 vaccines are just a few of the many available to protect us from harmful pathogens (an organism that causes disease like bacteria or viruses – aka ‘germs’). But what exactly is a vaccine, and how does it protect us?

 

Firstly, to understand vaccines, it helps to have a fundamental understanding of the immune system. The immune system is the body’s natural defence against harmful pathogens. It is a complex system of organs and cells that work together to help fight off infection caused by invading pathogens. When a ‘germ’ enters our body, the immune system triggers a series of responses to identify and destroy it.

Outward signs we are having an immune response are:

  • A raised temperature (fever) and uncontrollable shivering (Rigors).
  • Inflammation; this can be internal or visible on the skin’s surface – for example, from a cut.
  • Coughing & Sneezing (mucus traps germs, which are then removed by the action of coughing or sneezing).

Types of immunity:

Innate (also called nonspecific or natural) immunity:  We are born with a combination of physical (skin and mucous membranes in the respiratory and gastrointestinal tracts), chemical (for example, stomach acid, mucous, saliva and tears contain enzymes that breakdown the cell wall of many bacteria1), and cellular (natural killer cells, macrophages, eosinophils are just a few2) defences against pathogens. Innate immunity is a type of general protection designed to immediately respond to the presence of a pathogen.

Adaptive immunity: The adaptive, or acquired, immune response is more specific to an invading pathogen and occurs after exposure to an antigen (a toxin or foreign substance which induces an immune response) either from a pathogen or vaccination.3

Below is an excellent video from TedEd that provides a simple yet detailed explanation of how the immune system works.  

Types of vaccines

There are several different types of vaccines that use various mechanisms to ‘teach’ our immune systems how to fight off specific pathogens. These are:

Inactivated vaccines

Inactivated vaccines use a version of the pathogen that has been killed. These vaccines generally require several doses or boosters for immunity to be ongoing. Examples include Flu, Hepatitis A and Polio.

Live-attenuated vaccines

A live-attenuated vaccine uses a weakened live version of the pathogen, mimicking natural infection without causing serious disease. Examples include Measles, Mumps, Rubella, and Chickenpox.

Messenger RNA (mRNA) vaccines

An mRNA vaccine contains no actual part of the pathogen (alive or dead). This new type of vaccine works by teaching our cells how to make a protein that will in turn, trigger an immune response. In the context of Covid-19 (the only mRNA vaccine approved for use in the form of the Pfizer and Moderna vaccinations), the vaccine instructs our cells in making a protein found on the surface of the Covid-19 virus (the spike protein). This causes our bodies to create antibodies. After delivering the instructions, the mRNA is immediately broken down.4

Subunit, recombinant, polysaccharide, and conjugate vaccines

Subunit, recombinant, polysaccharide, and conjugate vaccines do not contain any whole bacteria or viruses. These vaccines use a piece from the pathogen’s surface —like its protein, to elicit a focused immune response. Examples include Hib (Haemophilus influenzae type b), Hepatitis B, HPV (Human papillomavirus), Whooping cough (part of the DTaP combined vaccine), Pneumococcal and Meningococcal disease.5

Toxoid vaccines

Toxoid vaccines are used to protect against pathogens that cause the release of toxins. In these cases, it is the toxins that we need to be protected from. Toxoid vaccines use an inactivated (dead) version of the toxin produced by the pathogen to trigger an immune response. Examples include Tetanus and Diphtheria.6

Viral Vector

A viral vector vaccine uses a modified version of a different virus (the vector) to deliver information in the form of a genetic code from a pathogen to our cells. In the case of the AstraZeneca and Janssen/Johnson & Johnson vaccines and Covid-19, for example, this code teaches the body to make copies of the spike proteins – so if exposure to the actual virus occurs, the body will recognise it and know how to fight it off.7 

 

The video below was developed by Typhoidland and The Vaccine Knowledge Project and describes what happens inside our cells when we are infected with a virus – using Covid-19 as the example.

 

References

  1. Science Learning Hub. (2010). The body’s first line of defence. Available: https://www.sciencelearn.org.nz/resources/177-the-body-s-first-line-of-defence Last accessed 18 Nov 2021.
  2. Khan Academy. (Unknown). Innate Immunity. Available: https://www.khanacademy.org/test-prep/mcat/organ-systems/the-immune-system/a/innate-immunity Last accessed 18 Nov 2021.
  3. Molnar, C., & Gair, J. (2015). Concepts of Biology – 1st Canadian Edition. BCcampus. Retrieved from https://opentextbc.ca/biology/
  4. Mayo Clinic Staff. (Nov 2021). Different types of COVID-19 vaccines: How they work. Available: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/different-types-of-covid-19-vaccines/art-20506465 Last accessed 19 Nov 2021.
  5. Office of Infectious Disease and HIV/AIDS Policy (OIDP). (2021). Vaccine Types. Available: https://www.hhs.gov/immunization/basics/types/index.html Last accessed 16 Nov 2021.
  6. Vaccine Knowledge Project. (2021). Types of vaccine. Available: https://vk.ovg.ox.ac.uk/vk/types-of-vaccine Last accessed 17 Nov 2021.
  7. CDC. (Oct 2021). Understanding Viral Vector COVID-19 Vaccines. Available: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/viralvector.html#:~:text=First%2C%20COVID%2D19%20viral%20vector,is%20called%20a%20spike%20protein Last accessed 19 Nov 2021.

Aspergillosis and the benefits of gentle exercise – a patient’s perspective

Image of a male and female exercising in their home. Both individuals are in a squat position with their hands out in front of them. Palms facing inwards.

A happy senior couple indoors at home, doing exercise indoors.

Cecilia Williams suffers from aspergillosis in the form of an aspergilloma and Chronic Pulmonary Aspergillosis (CPA). In this post, Cecilia talks about how a light but regular exercise regime has helped improve her health and wellbeing.

 

I downloaded the exercise guide (available here) in September this year. My oxygen levels had been dreadful, and I wanted to do some form of at-home pulmonary rehabilitation. I was surprised that the exercises in the programme were to be undertaken daily, as previous pulmonary programmes at the hospital were only three times a week. However, this programme was a lot simpler.

I do a stretching routine for a few minutes before the exercises, and I have now introduced 2.5kg weights, but I would do them without weights when I first started. I started at the lowest number of reps for the seated and standing exercises and have gradually increased to the recommended sets. I take my time to do the exercises as I can get breathless, and the time it takes depends on the kind of day I’m having. I break the 30-minute step into two; one first thing in the morning and one after lunch. If I go for a walk outside, I just do the other exercises and no step routine. I make a conscious effort to concentrate on my breathing as indicated on the chart. I use the breathing techniques recommended by Phil (National Aspergillosis Centre Specialist Physiotherapist, video available here), which has been my go-to for getting my breathing back to normal.

When I started this programme, my oxygen saturation levels were poor. I was breathless for long periods, and I would suffer all day with terrible nasal congestion and postnasal drip – I was forever steaming with menthol crystals. Incorporating the exercises and breathing techniques into my daily routine (first thing in the morning in my bedroom with the windows open) has had a profound effect. My congestion clears easier without steaming. I can take deeper breaths and hold my breath for longer. I have noticed the time it takes for me to recover from episodes of low oxygen levels and breathlessness has also improved. I do all the exercises on the table; the balance ones are essential, and with time and practice, I am improving – though I haven’t started doing them with my eyes closed – I am not there yet! I hope that writing my account of the benefits even the lightest of exercise programmes has gives others confidence and encouragement to undertake an at-home exercise programme.

 

If you want to know more about exercising with aspergillosis, our Specialist Physiotherapist Phil Langdon has a talk available via our YouTube channel here. 

Vitamin D supplements

Between about late March and September each year in the UK most of us are able to generate enough vitamin D from sunlight exposure, but from the months of October to March our bodies do not get enough vitamin D from sunlight. A lack of vitamin D affects teeth, muscles and can lead to bone deformities. Whilst there isn’t specific evidence that vitamin D affects aspergillosis, deficiency has been linked with other chronic illnesses.

Vitamin D can be found in foods such as oily fish, red meat and egg yolks but the NHS recommends that everyone takes vitamin D supplements between October to March to ensure we have sufficiently high levels. The recommended dose for adults and children over 1 is 10 micrograms (or 400 IU) per day.

Vitamin D supplements can be bought from most pharmacies or supermarkets.

Herd immunity to COVID-19 – is it achievable?

What is herd immunity?

Herd immunity to a transmissible infectious agent is achieved when enough people in a population become immune to infection (either naturally or through vaccination) that transmission rates decline. Not every person in the population has to be immune for this to happen, but when the risk of those that aren’t immune coming into contact with someone transmitting the infection become so low that the disease is not able to spread/maintain transmission rate, then we have reached herd immunity.

Each infection differs in contagiousness and so has a different percentage of the population that needs to be immune to achieve herd immunity.

What about COVID-19?

Scientists estimated near the start of the outbreak in 2020 that 60-70% of the population might need to be immune to get herd immunity. However, it is becoming increasingly clear that this pandemic is not behaving as simply as it first seemed. Transmission rates remain high even though up to 95% of the UK population are thought to carry antibodies to COVID-19 and should be at least partially immune.

Why isn’t it happening?

  • The vaccine doesn’t completely stop transmission

There are a number of reasons why herd immunity against COVID-19 is appearing to be an elusive target. Firstly, it is important to make clear that whilst the vaccine does reduce the risk of becoming seriously ill from the virus, it only partially blocks transmission. A new study suggests that a person who is fully vaccinated with the Pfizer vaccine and becomes infected with the delta variant is 65% less likely to pass it on compared to an infected non-vaccinated person, and a fully vaccinated person with the AstraZeneca vaccine is 36% less likely to pass it on. These are overall very positive results, especially because the delta variant of COVID-19 is more contagious than the alpha variant against which the vaccine was designed, yet they show that transmission can still occur even from a fully vaccinated person. Most people in the UK owe their immunity to one of the vaccines mentioned in the research article, so herd immunity will be difficult to achieve because our current vaccines don’t guarantee that spreading will be stopped even amongst vaccinated people.

Interestingly, according to the study mentioned above, after about 3 months from the 2nd vaccine, the transmission doesn’t seem to be stopped at all and if you are infected you become just as likely to pass it on as someone who isn’t vaccinated. Still, if you are vaccinated you are much less likely to catch it and become ill so some benefits remain, and of course, there is a booster vaccine program after 6 months from the 2nd vaccine which are intended to restore the block to transmission.

Read the full study here – https://bit.ly/3Be5FIu

  • Variants

One of the main things stopping the eradication of COVID-19 are new viral variants. A new variant such as delta is capable of causing new waves of infection, especially when vaccine rollout is not yet complete. These new variants may be more transmissible and can be slightly more vaccine-resistant. Therefore, it is key for the majority of the population to become immune before these new variants have time to adapt and emerge.

  • Vaccine rollout

Vaccine rollout has not been even among age groups nor between countries. At time of writing in the UK (October 2021), about 79% of people over 12 are double vaccinated. However, vaccinations for 12–15-year-olds didn’t start until September 2021 and those under 12 are not yet being offered a vaccine. This means that whilst the older, more vulnerable people have been vaccinated for some time, the virus has now begun spreading among unvaccinated children (who could then pass it on to their older relatives/people they are in close contact with). In other words, the virus still has a large unprotected population group to infect who have low immunity and so it can continue to spread. Not only this, but although the UK is ahead in terms of vaccine rollout, other countries are not so immune and international travel will continue to be a route by which COVID-19 and its variants are able to spread worldwide.

Vaccine hesitancy has been another big issue in preventing herd immunity. The more people that don’t get vaccinated, the less likely it is that herd immunity will be achieved as it relies on the majority of the population being immune.

  • Social behaviour

In the UK, most restrictions are now lifted and mask-wearing and social distancing are no longer legal requirements. Inevitably, people mixing means the virus is now able to spread more easily amongst those that aren’t yet immune and that otherwise wouldn’t have come into contact had restrictions still been in place. In an ideal world, restrictions would remain until herd immunity is achieved, however, this seems unrealistic.

So what does this mean for the future?

Eradication of COVID-19 through herd immunity is not as close as we’d once hoped; it seems we must adapt to a new normal and accept that this virus may be with us for some time as immunity naturally waxes and wanes – much like it does to the common cold and flu. That being said, the success of the vaccination program in the UK would suggest that the worst of the pandemic in terms of severe illness and death is mostly behind us (the prospect of newer, more deadly variants optimistically put aside for now) and as immunity continues to increase with booster vaccines and further natural exposure to COVID-19 infection, it will no longer be such a deadly virus.
Some scientists predict that COVID-19 may become something like the flu with seasonal peaks causing low numbers of hospitalisations and death. Perhaps ‘herd immunity’ will become an annual cycle of vulnerability to infection (though not necessarily vulnerability to severe symptoms), with natural immunity backed up by annual booster vaccines.

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