COVID-19 update – 8th October 2020
Many of us can be forgiven for avoiding the news and COVID-19 updates out of sheer exhaustion from the negative impact the virus has had on our lives.
Thinking back to the early days of the pandemic when most of us tuned in daily to the Downing Street Coronavirus broadcasts with a mixture of curiosity and apprehension, much has changed. Or has it?
Covid-19 has taken the lives of many loved ones, affected businesses, family life, the economy and the mental and physical wellbeing of almost every individual for the best part of 2020. It is understandable there is a sense of fatigue and waning interest in the virus.
Sadly, Covid-19 has not lost interest in us. It has not disappeared and has to be acknowledged by all of us if we are to avoid the losses we faced earlier in the year, especially as we approach the challenges of winter and flu season.
Cases
Looking at data published on the Public Health England dashboard, it is clear that the number of daily reported cases has gone up significantly since the peak of the pandemic in April.
Latest figures show the daily reported cases at over 12000 on 5th October 2020, whereas these figures were around 5500 daily reported cases in early April.
A major change since the peak of the pandemic has been testing capacity and this rise in figures may be reflective of more symptomatic people having access to the test than before, when only the sickest of patients being hospitalised were offered tests.
Interestingly and reassuringly, the reported deaths within 28 days of a positive COVID test have fallen, as have the number of patients requiring hospitalisation and mechanical ventilation. The million dollar question is just why?
Reducing mortality
The most likely contributor to reduced mortality and complications is the adherence to social distancing, face coverings, hand hygiene and working from home.
For now we simply do not have enough evidence to support the theory of herd immunity. There have been suggestions that some individuals who have not been exposed to COVID-19 may have a type of white cell that can recognise the virus, due to previous exposure to other coronaviruses e.g. the common cold.
Whether this might prevent or lessen the impact of infection in people with COVID-19 is not yet known.
It is estimated that only around 20% of the UK population have antibodies to coronavirus in their blood and, even now, we still don’t fully understand how our immune system deals with this virus.
Whilst rigorous trials are underway looking into therapies for COVID-19, it is unclear how much of an impact our knowledge of treatment has had on outcomes so far. Nevertheless, these safe pathways of investigating treatments should not be circumvented by non-evidence based theories. That risks patients being given therapies with potentially little benefit and possibly serious adverse effects.
As an example, the recovery trial in the UK has recruited over 12000 hospitalised patients since March and has provided us evidence of the benefit of the anti-inflammatory dexamethasone in improving survival in hospitalised patients whereas the much ‘hyped’ hydroxychloroquine has been proven ineffective.
Antibody testing
Antibody testing on an individual level provides evidence of whether you have been exposed to COVID-19 already and may help to attribute symptoms that may otherwise be unexplained.
A negative result means you probably weren’t exposed to the virus, however, there is a possibility you may have been and your antibody levels are no longer detectable.
On a population level, antibody testing helps provide a greater understanding of the spread of the virus.
Although there are signs, we still don’t yet know if you are definitely immune to COVID-19, or if you cannot still spread the virus to other people even if you have a positive test result.
Therefore, the advice remains to practice social distancing guidance, wear face coverings and practice regular hand hygiene even if you have evidence of past exposure to the virus.
Vaccination
Since COVID-19 emerged in January over 200 vaccine candidates have been put into development. A vaccine aims to stimulate the body’s immune system to produce antibodies to fight off disease, which are then stored in the immune ‘memory’ to prevent disease in the future.
Vaccine development is complex and usually takes several years. While researchers are confident that a vaccine should be available in 2021 this would be the fastest that any vaccine has been developed after humans have faced a new pathogen.
Vaccine development undergoes several stages or ‘phases’ where the vaccine is tested on larger and larger human cohorts to safely simulate mass adoption of the vaccine and to pick up possible adverse effects of the vaccine.
Many trials are now progressing into the third phase of testing on thousands of individuals but the actual date of approval, manufacturing and distribution of the vaccines is not yet known.
The Oxford vaccine trial was halted in September due to a participant developing an adverse reaction, although it has since been claimed that this reaction may not have been caused by the vaccine itself and the trial is set to resume. Other promising trials are underway in the UK by the University of Cambridge and Imperial College.
What do we need to do now?
Despite the reduction in hospitalisation and death from COVID-19 since our peak in April, it is as important now to continue to follow social distancing measures, practice regular hand hygiene, wear face coverings in indoor public spaces and work from home if possible.
These measures will also reduce the spread of flu and as the winter flu season is upon us, reducing this pressure will improve our ability to manage patients with COVID-19 and minimise complications and death rates.
COVID-19 has a broad range of clinical presentations but the advice remains the same; if you have a fever OR a new persistent cough OR a change in your sense of smell or taste you must self-isolate (and your household must self-isolate for 14 days) and arrange a COVID-19 test via nhs.uk or 119.
What about children?
Inevitably, children returning to school are going to be exposed to viral pathogens and many experience symptoms of coughs and colds. Where it is extremely difficult to clinically differentiate between COVID-19 and the common cold, the above guidance must be followed in exactly the same way or advice sought from your GP or NHS 111 if you are unclear.
For example, if your child has a runny nose and new persistent cough but no fever, you would self-isolate and arrange testing. Or, if your child has a raised temperature but no other obvious symptoms, self-isolate and arrange testing.
Conversely, if your child has a runny nose but no fever or cough and they feel well enough to go to school they do not need isolation or testing.
The difficulty we face currently is in trying to resume a sense of normal life when COVID-19 has not actually left us yet. It can feel like an impossible balance, but the measures proven to have reduced the rate of spread remain in government guidance and may be a relatively small price to pay, compared to the cost of ignoring them.
If you or your family develop any symptoms and you are unsure about what to do, please contact your GP or one of the doctors at London City Healthcare who will be happy to provide support.
Dr. Sidra Malik BMBS MRCGP DRCOG DFSRH
8th October 2020
