COVID 19 Q&A 6th April 2020

As COVID-19 cases and fatalities are rising it is understandable there is mounting anxiety amongst the public. There is an overwhelming amount of information to keep abreast of and some misinformation especially via certain media sources and social media platforms that can be difficult to evaluate when going through such uncertain and quickly evolving times.

We have received various questions recently regarding COVID-19 and in answering these, we hope that you may find some clarity too.

There have been lots of variable symptoms reported for coronavirus – can you explain these?

The most common presenting clinical features of COVID-19 include persistent dry cough and fever. There are other symptoms which are associated with COVID-19 to a lesser degree but nevertheless can be reported including productive cough, sore throat and runny nose. Although guidance currently is to self-isolate if you have a new persistent cough or fever, if you feel otherwise unwell with these sort of symptoms it would be wise to self-isolate (given how widespread the virus now is) as a precautionary measure and seek medical advice on whether this is the best course of action.

The British Society for Rhinologists and ENT UK have also recently suggested it may be worthwhile advising patients presenting with anosmia -or loss of sense of smell – to self-isolate as there has been a link to this as a presenting symptom of COVID-19. Studies in South Korea, where testing was very widespread, showed that loss of sense of smell was the predominant symptom in around 30% of positive cases.

The typical clinical course for Corona virus is fever which can last up to around 12 days and dry cough which can continue for 3 weeks. Problems with difficulty breathing and severe infection tend to occur after day 7 and peak around day 10 of infection, should they occur.

I have symptoms, when should I seek advice from a doctor?

Fortunately, most people who are infected with COVID-19 have mild to moderate symptoms that can be managed at home. Around 1 in 5 may require hospitalisation. If you feel that your symptoms are getting worse and you are unable to do basic activities in your home e.g. read a book or watch TV, you are experiencing any difficulty breathing or discomfort in the chest you should seek advice. Currently the advice is to go to the NHS 111 website which will go through your symptoms and will advise you based on your responses e.g. to contact your doctor for advice, to call an ambulance or that you should call 111 as you may need an urgent assessment.

If you do not feel that your condition is getting worse but would like advice, you may also call your GP for this.

I think I have had Covid 19, I am getting better temperature is now normal, but have difficulty taking a deep breath and a little discomfort. Does doing any breathing exercises help or general exercise help?

Whilst you are recovering from COVID-19 it is important to try and rest as much as possible to allow your immune system to overcome the infection.

Gentle breathing exercises may help you feel more comfortable, especially if you have any underlying lung conditions, for example:

• ‘Blow as you go’ to make activities easier e.g. taking a deep breath in before you stand up and breathe out through pursed lips as you stand.
• ‘Paced breathing’ when you are active e.g. walking up stairs where you can pace your steps to taking a breath in and taking a breath out.
• ‘Pursed lips’ breathing where you breathe in gently through your nose and out through pursed lips.
• An upright position is generally helpful when you are having shortness of breath.

It is important to stress that if you are worried about your breathing e.g. it is stopping you from being able to do your usual activities, you are struggling to speak full sentences, your condition is getting worse or you have an underlying condition that could mean you could get more seriously unwell, then you must seek medical advice quickly.

How long is the recovery process and is there anything I can do to facilitate recovery?

The recovery process is variable from one individual to another. In general most people recover within 7 days. If you are feeling better, you are able to end self-isolation after a week, however, if you have ongoing fever, or are not yet feeling better, then it is advisable to continue to self-isolate until you are better.

Paracetamol can help alleviate symptoms such as fever. There were some case reports from Europe linking ibuprofen to possible worse outcomes in COVID-19 infection, so whilst more robust scientific evidence is awaited to address this question, the advice currently is to use paracetamol in preference to ibuprofen.

Other things that you could do to facilitate recovery include ensuring you have plenty of rest, drink plenty of fluids, eat a healthy diet, and you may wish to consider supplements which may boost your immune response such as vitamin C and vitamin D.

How do you know definitively that you’ve had it?

Current testing available is to find out if you have COVID-19 and at present these are being reserved for those individuals potentially requiring hospital admission and, more lately, for NHS staff to help determine whether they are able to return to work if they are isolating.

When we face a pathogen such as a virus, our body’s defence system mounts a response to produce antibodies which can be stored in our immune memory so that if we are faced with the same pathogen again, we would mount an antibody response to destroy it before it can affect our body.

Therefore, the only way to test is through an antibody test. We don’t have this available as yet although work is underway to ensure a good quality test is available as soon as possible. What we also need to know is what levels of antibody confer immunity and for how long we would be protected.

Is there anything I can do to help my immune system and prevent me from getting COVID-19

All of us are susceptible to catching COVID-19 especially now as the virus is becoming more widespread

We cannot place enough emphasis right now on how crucial it is to follow government guidance on social distancing – that is staying at home and working from home unless it is essential for you to go out to work, only going out for essential shopping or medication, and not meeting with anyone from another household including your friends and family.

If you do go out maintain a distance of 2 meters from other people and try to avoid using public transport, especially at rush hour.

Besides this, regular hand hygiene with warm soap + water/hand sanitiser and avoiding touching your eyes and face will help lower the risk of transmission of the virus.

Those who are in ‘extremely vulnerable’ groups will have now received a letter from the government asking you to ‘self-isolate’ and avoid all face to face contacts for 12 weeks.

Although there is some evidence linking certain foods and vitamins to enhancing your immune system the main things you can do to support your immune system is to eat a balanced and varied diet, exercise regularly, keep well hydrated and ensure you are having sufficient rest and sleep.

Should we wearing masks and gloves when we go shopping for food?

Currently, the WHO recommends masks to be used if you are a healthcare worker or if you are caring for someone who has COVID-19. You may also use one if you have COVID-19 symptoms although if this is the case you should be following government advice to self-isolate any way.

There is no evidence that wearing a mask e.g. to go to the supermarket will reduce your risk of catching an infection.

Masks need to be used correctly, be disposed of carefully and are only effective if used in conjunction with careful hand hygiene.

Most of the available surgical masks are single use meaning you need to change it each time you need a mask otherwise you may be more at risk from contamination. Masks with filters e.g. the FFP2, FFP3 and N95 masks are more effective at filtering out harmful particles and may be seen used by front line healthcare workers in the intensive care units. Many masks are in short supply worldwide and therefore it is not helpful when they are being used inappropriately.

PHE have recently updated their guidance on the type of masks/PPE health care workers should be wearing. As for members of the public, guidance has not yet changed, but it is worth watching this space as the virus becomes more widespread.

Gloves, latex or non-latex, can be helpful to reduce risk of transmission but again only if used correctly, disposed of carefully and followed by hand washing. Gloves are of no use if you contaminate them and then touch your face or, for example, your mobile phone that you later hold up against your face as you are simply transmitting the virus via your gloved hand.

Should I stop any of my medication for high blood pressure?

There has been some recent hypotheses that certain drugs used in the treatment of hypertension and heart disease e.g. ACE inhibitors and ARBs could be associated with more serious COVID-19 infection. Expert professional bodies including the British Society for Cardiovascular Disease have said that there is insufficient evidence to speculate that there is such a link but there are clear risks of patients stopping these medications.

The guidance is to continue taking these medications unless otherwise advised by your doctor.

Data so far has shown that individuals with a history of diabetes and cardiovascular disease are at higher risk of more serious outcomes if infected with COVID-19 so it goes without saying that controlling these diseases through medication and lifestyle is as important as ever.

Asthma – is there any evidence that people with asthma will lead to a worse outcome with COVID-19 infection?

Every individual who has asthma has a different experience of the disease and will vary from being mild sufferers to those who have had hospital and intensive care admissions because of serious asthma attacks. The more severe the asthma the more likely you could be susceptible to severe illness from COVID-19 infection.

Asthma UK provides good guidance for asthmatics on how to protect themselves during the COVID pandemic and more specific criteria pointing out who should consider self-isolating for 12 weeks or ‘shielding themselves as they may be much more vulnerable

Why am I at a higher risk as a pregnant woman and is there a risk I can pass it on to my baby?

As this is a new virus we are still learning about the effects of coronavirus infection during pregnancy and this is most likely the reason why pregnant women have been cautioned to be stringent about social distancing. So far, there is no  evidence that pregnant women are more likely to be seriously unwell with COVID 19 than other healthy adults.

There is no evidence to suggest an increased risk of miscarriage.

Initial reports from China showed no evidence of the virus passing from mother to baby during pregnancy or birth however on 26 March 2020 there was one case in Wuhan reported where vertical transmission may have occurred, but this requires further investigation.

In all cases reported of newborn babies developing coronavirus soon after birth, the baby was well. It is also considered unlikely that if you have the virus it would cause problems with the baby’s development.

Some babies born to women with symptoms of Coronavirus in China have been born prematurely but it is unclear whether it was recommended for the baby to be born early to preserve the mother’s health rather that the virus causing early labour

The Royal College of Obstetricians and Gynaecologists are regularly updating their guidance on COVID-19 and pregnancy as more information comes to light

My daughter is having a baby. If I have been isolated and they have been isolating for at least 7 days after the birth, can I visit her?

Unfortunately the answer has to be no. You should not visit members of another household, even friends and family to help reduce the risk of transmission of infection.

Remember, some individuals may be asymptomatic but still be infectious and there are different ways infection can spread e.g. airborne droplets, contaminated surfaces etc.

This is a challenging time for new mother’s who will be going through the tough newborn period without the support they had expected from family, friends, mum and baby groups. But this distancing is vital to ensure everyone in the community is protected from the spread of COVID 19. If you are a friend, relative or neighbour of a new mother, think of ways you can support them virtually whether it is regular video call chats to see how they are getting on or dropping off nappies, baby supplies or food shopping.

We are conscious that as we learn more, advice and guidance may change and the questions that are more pertinent to the public will also change. Please get in touch with London City Healthcare if you’d like to hear more from us through a Q&A like this.