COVID-19 - A resource for our patients
Isolate, Distance, Handwash and Shield. There, I’ve said it for the 3rd time. Why do I keep going on about it? Because we are currently looking at a 4% mortality globally and there is no cure. There are 7.8 billion people in the world which could mean 300 million deaths from COVID-19. To put that into context, 56 million people died worldwide in 2017 from all other causes. The only way this number could be less is by finding a cure or a way of preventing it. This does make grim reading, but it is why we now have a 3000-bed field hospital that was built in a week; the world has shut down its economy and our governments are pouring billions into the economy to support furloughed staff, the self-employed and companies.
Is there something we could do to make the odds better?
Clearly we all want to be doing what we can to improve our odds, and staying healthy, remaining active mentally and physically and continuing to take our prescribed medications is essential. The biggest factor that seems to have an impact on survival is a country’s capacity to deal with the sudden influx of severely ill patients. We believe that about 70% of people with COVID-19 will have a relatively mild illness, but about 10% will need hospital treatment. Intensive Care Units (ICUs) can save more patients when they are not overwhelmed because if there is no room your chance of survival drops rapidly. This is why the NHS is investing massively in increasing its capacity to support the sickest with the Nightingale Hospitals.
We do know that ventilating patients on their front, prone, is very effective and if you do develop the illness resting or sleeping on your front and taking regular deep breaths could help.
Are there medications that can make things worse?
There was a lot of talk about ACEi/ARB medications. These are a class of medication used to treat high blood pressure and heart disease. Some of the common drug names are Ramipril, Enalapril, Losartan, Cadesarting and Valsartan. The reason it was raised as a concern is that we believe the virus gets into our cells using a cell receptor that these medications work on. Fortunately, it has been globally accepted that if you are on these medications there is no increased risk and all current advice is that you should remain on them.
Ibuprofen is another medication that has raised concerns. This medication is often used as a painkiller and reduces inflammation. There were some early indicators that patients taking ibuprofen whilst unwell with COVID-19 had become more unwell. Following further research and guidance issued this week, there is no evidence that his medication is harmful. If you already take ibuprofen or other anti-inflammatories all current advice is that you should remain on them.
Do we already have the answer?
It would be lovely if there was already a medication that we could use to help reduce the severity of COVID-19, and a lot of hope was put on Hydroxychloroquine. Given the interest in this medication, there are numerous studies investigating this. Unfortunately, the hype this created meant that demand increased so much that those who need the medication to control their significant diseases struggled to get their usual supply. For this reason and some serious side effects, medical professionals are not prescribing this medication other than in strict research conditions.
If you have been unwell recently you would have noticed that your NHS GP spoke to you on the phone or by video and was far more likely to prescribe antibiotics. This is not because antibiotics help treat COVID-19 but we know that when you are severely unwell you can develop secondary infections which are often bacterial. This is the reason we prescribe antibiotics such as Doxycycline, Co-amoxiclav and Azithromycin.
Oxygen is most certainly needed for those that are severely unwell and high flow nasal oxygen can often be enough to stop you becoming more unwell. As oxygen levels fall we need to breathe deeper and faster, but eventually we become tired which is when we need to be ventilated. For those that suffer from asthma or COPD sometimes we need to use a Nebuliser. This is a way of delivering medication to the lungs whilst you breathe and can be life-saving if you become severely unwell with asthma but is not helpful in treating patients that don’t have asthma or COPD.
How do I know when I need any of these?
Your doctor is already very likely to have discussed if any of these treatments are needed or relevant to you. If you have severe asthma or COPD you may already be on these medications. If you are advised to speak to your doctor they will be following the latest guidance which is constantly being updated and will advise you if you need a prescription.
What are doctors looking for?
At the moment if you develop a sudden onset fever it could be COVID-19, but it is important not to ignore other illnesses.
Fever, persistent cough, fatigue and muscle aches are common with COVID-19 and from our experience of speaking to patients loss of smell is present in most people that have tested positive. Headache, shortness of breath, sore throat and diarrhoea also feature highly but could it be something else that is treatable? This is why we advise you use the online services to check that your symptoms match with COVID-19 but if there is any chance it could be something else then you will need to speak to a doctor who may want to examine you. These examinations will now be done at dedicated centres where staff have to wear protective clothing to prevent the potential spread of the disease and to protect everyone who may or may not have had COVID-19.
Could I already have had it?
In the next part, I will talk about testing. There are lots of issues here, both scientifically and politically.
COVID-19 - A resource for our patients
In my last blog, I needed to get the most urgent message across – isolation, social distancing, handwashing and shielding. It is important to start Part 2 with the same message – we must slow the spread of COVID-19.
Isolate or distance what’s the difference?
There are so many reasons you might develop a cough or fever, especially in March. So why isolate when it may not even be COVID-19?
It is a risk that we have isolated and didn’t have Coronavirus giving us a false sense of security. But it is also a risk that we haven’t had any symptoms, didn’t know we should be isolating and have subsequently been spreading the virus. A very plausible explanation for why Coronavirus is spreading so quickly is because a large number of people either don’t have symptoms or are contagious for days before they know to isolate. It would be very reassuring to think that the majority only have mild symptoms and then develop immunity, but it seems to be random at the moment with some young healthy people becoming severely ill with COVID-19.
If we don’t know whether we are contagious or not, then the only way we can slow the spread is by distance. This allows healthy people to keep working, keep the country moving and help to prevent a massive economic depression. We need everyone that is well to do as much as they can to keep the country’s economy moving.
So why isolate even when well? This really comes down to probability and weighing up the risk of someone having COVID-19 with the risk of contracting Coronavirus and spreading it before you develop symptoms or not. This is why healthcare staff are sleeping at hospitals or hotels when someone in their household develops a cough or fever. As COVID-19 becomes more widespread the risk increases and the need to double down isolation and distancing become even more necessary. This is why the message has gotten firmer and why many countries have gone to the extreme.
In short, isolating stops the spread of a possible infection, whilst distance stops the spread of infections we don’t know about, and is just as important.
It’s horrible to see data like this but with a 2 to 3 week lag from symptoms to deaths, it is astonishing what difference a week can make.
12 weeks of Shielding
In my mind, there are 2 main reasons for 3 months of shielding, treatment and vaccination. This time buys us a lot of knowledge and enables us to develop better ways of treating COVID-19 with further trial data on medications and support. I don’t think we’ll be there in 12 weeks but we will be a lot closer than we are now and the overwhelming surge in numbers may have died down. Flattening the curve stops us overwhelming the healthcare system, but it is like pulling the plaster off slowly and has much bigger consequences for all our finances.
There are many reasons why Italy has suffered. The reasons that stay at the top of the list are that few people actually believed how important it was to distance and that Italy has an older population. One reason that is particularly upsetting is that when the schools closed, the children went to their Grandparents during the day so the parents could stay at work. This then inadvertently put those that were likely to be well carriers with those that were most vulnerable. 12 weeks of shielding doesn’t help our economy but we are lucky enough to have seen what has happened in Italy and have the opportunity to shield the most vulnerable. This was a lesson we were able to learn from being 2 weeks behind the Italians.
What to look out for?
A cough and temperature are two very common symptoms, but how else do we know if you have COVID-19? One of the latest symptoms that is a little more specific to COVID-19 is the loss of smell and taste. Of course, this can happen when you have a cold but when you combine this with the general flu-like symptoms of sudden onset high temperature, aching all over and shortness of breath with a cough, it starts to become a lot more specific. There will be variation from person to person, but here is the list of symptoms we are currently looking for and their frequency:
It is important to remember that you don’t have to have all of these symptoms but if you do please log them on this Tracker App. In fact, you may have no symptoms and still have been infected with Coronavirus. If you do have any of these you should be isolating both yourself and your household and using the NHS 111 website for more information on what to do.
In Part 3 I will be talking about medications, and what we as doctors are looking for and testing.
COVID-19 - A resource for our patients
What is Coronavirus?
COVID-19 is the disease caused by the coronavirus SARS-CoV-2. It is called a Coronavirus because of how it looks under an electron microscope. We have known about this type of virus for many years having encountered SARS and MERS which are closely related. Coronavirus is an RNA virus, meaning that it is very likely to mutate as it spreads, and this is how it crossed over from another animal to humans. It is therefore also likely to change slightly from person to person and country to country which may explain some of the differences each country experiences.
Isolate and flatten the curve
The UK healthcare system is renowned for being one of the most efficient in the world. No system is designed to cope with massive changes in demand, but when there is little capacity to absorb change we need to spread that change out over time. You only have to look at what happened to toilet roll, chicken and paracetamol in the last 2 weeks to appreciate how sudden changes in behaviour can have a big impact on some of our lives.
With no treatment and no natural protections against a new disease, we are playing catch up; simultaneously learning how to recognise and treat COVID-19. What we do know is that we can slow the spread of the disease and avoid saturating our healthcare system, which is what happened in Italy 2 weeks ago. We can save over 50% of those that become seriously ill but only if we have enough Intensive Care beds. This is why the NHS is building field hospitals, converting hospital wards into Intensive Care Units and getting companies like Dyson to make ventilators. Today, 4% of those with COVID-19 in France need Intensive Care and in 3-4 days time, they will reach capacity. If we saturate the healthcare system with COVID-19 not only will those that could be saved not be but we won’t be able to care for the heart attacks, strokes, asthma attacks, allergic reactions and accidents that will continue to happen.
You can help doctors understand, predict demand and slow the spread of COVID-19 by completing a quick daily symptom tracker, please follow this link, Tracker
Distance and wash your hands
It is clear that COVID-19 spreads very quickly and easily from person to person and this is believed to be in droplets from our breath. When we cough, blow our nose or exhale the virus can be present in the moisture or fluid and is either inhaled or lands on surfaces that we touch. The virus can survive outside the body for some time depending on what surface it lands, and when someone else touches that surface they pick the virus up. Once on our hands, the virus can spread into our body via our eyes, mouth or nose if we touch those areas or put anything in our mouth that touches our hand.
Keeping 2 metres apart is to reduce the risk of inhaling droplets or them going into our eyes. This is not a guarantee as the droplets can remain in the air for several metres so the further the better.
Shield and protect the vulnerable
We know that the virus causes swelling in many of our tissues. The most affected are our lungs but our heart and other organs are also at risk. Those of us that have other illnesses or are frailer will not be able to cope with this. We know that the majority of severely ill patients are either older or have other longstanding illnesses.
When we have an infection our body develops antibodies that allow us to recognise and remove the illness. Following the incubation period of the infection, it takes about 2 weeks to produce these antibodies and it is during this time that we develop the disease. This is because we have no way of stopping the infection. When we are younger we react more aggressively and produce antibodies quicker and in larger numbers. These antibodies protect against further infections and give us immunity. This is why vaccinations are so important. We develop antibodies that protect us without getting the disease. Sometimes we need a booster and sometimes we need a new vaccination because there is a new strain of the disease, such as with flu which is also an RNA virus.
Our aim is to produce a vaccination for Coronavirus and until then we must shield the most vulnerable as we have no treatment for COVID-19.
Next, I’ll be talking about the signs and symptoms of COVID-19 and what you need to do when you think you’ve got it.
Introducing our exclusive offer with MK Health Hub
We are proud to introduce an exclusive partnership with Solihull-based gym MK Health Hub, offering our CoolSculpting® patients a package designed to help maintain their results and commit to a healthy, active lifestyle.
CoolSculpting® offers permanent fat reduction on problem areas, but it is not designed to be a weight loss procedure. In order to maintain the benefits of CoolSculpting®, both aesthetically and physiologically, patients must endeavour to continue with an active lifestyle, both eating healthily and exercising regularly.
We have joined forces with MK Health Hub to offer our CoolSculpting® patients the chance to benefit from the knowledge and expertise of the team there to ensure they are equipped with the tools needed to continue their health journey.
Daleswood CoolSculpting® patients will receive a 90-minute session at MK Health Hub where they will receive:
- A complete nutritional assessment and customised plan
- In body measurement and stats
- A microbiome recipe book and guidance on the diet
About MK Health Hub
Founded in 2001 by Matt Kendrick, MK has successfully trained, consulted, and developed an extensive fitness clientele. Matt’s skills and expertise gained notable attention, and he became a sought after and highly renowned leader in the fitness industry.
Based in Shirley, Solihull, MK Health Hub is different from other gyms, offering Personal Coaching, Small Group Personal Coaching (including Dynamic Pilates, HIT and Box Hit) and Physiotherapy.
About the Microbiome Diet
The Microbiome Diet is a lifestyle change, not a fad. Two of the main benefits of a balanced microbiome are the potential for weight loss and a boosted metabolism. The microbes in your gut are extremely influential and even dictate what you eat, what you crave and how hungry you feel. Those who are lean have been found to have more diverse microbiomes than those who are overweight.
A microbiome lacking in diversity can cause low-grade inflammation in your gut and throughout your body, contributing to weight gain or difficulty losing weight.
Besides helping with weight loss, friendly bacteria and a balanced microbiome have many other potential health benefits, including:
- Promoting better sleep
- Influencing mood
- Supporting bone development
- Producing crucial vitamins, minerals and other nutrients
- Manufacturing natural antibiotics
- Reducing fatigue
- Clearing acne and eczema
- Reducing joint and muscle pain
Unbalanced levels of gut bacteria can increase your risk of irritable bowel syndrome, infections, diabetes and heart disease.
CoolSculpting® is the UK’s only FDA approved, fat-reduction, cryolypolysis treatment. Non-surgical, with no needles, CoolSculpting® has been proven to destroy fat cells permanently and with minimal downtime. All CoolSculpting® treatments at Daleswood Health are carried out by owner and qualified medical professional, Dr. Alison Denton.
To enquire about CoolSculpting® treatment and to see if it’s right for you, contact the clinic and arrange your free consultation.
CoolSculpting now available here at Daleswood Health
2020 got off to an exciting start here at Daleswood Health with the launch of our new CoolSculpting service.
CoolSculpting is a permanent fat-reduction procedure with little to no downtime, and presents very little risk to the patient. It’s also the UK’s only FDA approved fat-reduction, cryolypolisis treatment, making it a sensible choice in a busy market.
How Does It Work?
Essentially, it’s a procedure to freeze away fat. During the treatment, fat cells are cooled to the precise temperature at which they crystallise and die, without affecting the skin and surrounding tissue. These cells are then naturally metabolised and removed from your system via an inflammatory clearing process. Unlike many other fat removal/reduction procedures, there are no needles, no need for surgery and you can resume normal activities pretty quickly.
Is It Right For Me?
We know it sounds like a fix-all solution but remember, CoolSculpting is not a weight loss procedure and shouldn’t be used in place of a healthy diet and lifestyle. However, if you have areas of stubborn fat that you can’t seem to shift despite living an active lifestyle and eating well, then it could be for you. Targeted treatment areas include all the usual culprits:
- Under the chin
- Bra fat
- Upper arm
- Back fat
- Under the buttock
- Distal thigh
Depending on the areas you want to target, Dr Alison Denton (who carries out all CoolSculpting procedures at Daleswood Health herself) will create a customised treatment plan for you during an initial consultation. This will help you to understand how many treatments you may need, and when you could expect to see results.
Why Daleswood Health?
Despite fat-reduction often being viewed as something done for purely aesthetic reasons, it is a medical procedure. At Daleswood Health, all CoolSculpting is carried out by Dr Alison Denton – Alison is the owner of Daleswood Health and a practicing GP who has undergone extensive training with the CoolSculpting team to ensure she delivers the highest quality service and the best levels of patient care. This means that patients are looked after throughout the entire procedure by a qualified medical professional rather than someone trained only in aesthetics.
We have multiple CoolSculpting systems, meaning we can treat more than one area at a time.
We recently hosted our first CoolSculpting event which took place at the clinic in January. Visitors were able to learn more about the treatment to see if it was right for them, and every attendee has since booked to return for a further consultation. We hope to hold more open evenings throughout the year, so please keep an eye on our website and social media pages for more information.