News

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.