Dear Courtfield Patient,
We are pleased to report that for the 5th week in a row there have been no new Coronavirus cases amongst Courtfield patients and very few in the wider Community.
A small number of our patients who have had the illness continue to experience significant fatigue, particularly in the evenings, but generally continue to improve.
Testing
Last week’s newsletter, announcing the accreditation of an accurate antibody test made by Abbott Laboratories, produced a flurry of enquiries.
At the time of writing we have received nearly 400 requests for tests-either to be carried out at the practice with the nurse, or via the home testing kits.
This was certainly a huge challenge for the admin team who have coped magnificently with making appointments and preparing home testing kits.
At the time of writing, all requests for tests have been met, with most of you receiving a telephone call or e-mail from Dr Ladbrooke within 24 hours of your result being available.
Whilst the majority of you have managed to successfully obtain the blood necessary via finger prick testing, we are aware that a small number of you have found this very difficult, particularly families with children.
If this is the case, then please make an appointment with the nurse for the blood to be taken at the practice – you will only be charged only for that appointment and not the failed finger prick test.
Some of you have contacted us about the Roche test which is the test that the government have commissioned for the National Health Service .
The Abbott test which is currently being offered by our Lab , claims 100% sensitivity and 99.5% specificity.
The Roche test is only very slightly superior in claiming 100% sensitivity and 99.8% specificity .Our lab have informed us that they will be offering this once it is available, but that may not be until mid /end June.
For those of you who would still like to take the test, then please email enquiries@courtfieldpp.co.uk rather than phone (to prevent the lines becoming jammed for those of you with other enquiries).
If you have any queries about the test or wish to discuss your results please text Dr Ladbrooke directly on 07801 748 692.
Results so far
An analysis of the first 100 results have proved interesting .
19/100 tested positive .
17 were adults-9 men out of 32 (28%) and 8 women out of 46( 15%) tested.
Only 2 children out of 22(7%) assessed, tested positive
The majority of patients(94) took the test because they believed they may have had symptoms in the past few months that could have been due to Coronavirus or had been in contact with someone who had had the illness..
Only 6 patients took the test and had not had symptoms. They were hoping that they may have had Covid-19 without knowing it. Unfortunately for them, all six were negative.
One patient was pleasantly surprised by his positive result as he had had only mild laryngitis and a headache.
5 patients were surprised by their negative result as the timing and severity of their symptoms fitted clinically with a diagnosis of Covid-19.
Discussion with families who took the test, confirmed the current view that children have very mild symptoms.
In several families where the parents were ill with high fever and cough, children often did not develop symptoms nor develop antibodies.
This may be due to children having fewer “ACE2 receptors” in the upper respiratory tract for the virus to bind to, sort of “Teflon toddlers”
Interpretation of the results
The numbers tested so far are too small to draw any firm conclusions, but we thought they were interesting to share with you.
The most interesting theme to emerge from discussion with you about your results, was how surprising some of the negative results were, particularly where loss of taste was a symptom ,as this is so characteristic of this infection.
At least one wine connoisseur has needed reassurance that their perfectly honed taste buds should eventually return to normal!
Whilst it may well be that the Covid-19 like symptoms were due to a different virus, our observation fits with observations from more formal studies – one published in Spain last week, in which a surprisingly low 5% of the population were found to have antibodies and another on testing people on the Diamond Princess cruise liner ,(which was the highly infected boat that had to berth in Yokahama at the beginning of this pandemic) when only 10% of passengers were found to have made IgG antibodies despite a significantly higher incidence of disease.
This may be because IgG antibodies are just one of the many immune defence systems we used to battle against coronavirus .Other antibodies such as IgA which are found in saliva and the back of the nose or cellular immunity produced by lymphocytes may play a significant role in defending us against coronavirus, and providing immunity in the future.
Unfortunately there are no easy tests available to check this theory , but it may well be that those patients who were convinced they had coronavirus, did indeed have the illness and are now protected by one or more of the defence mechanisms described above .
Certificates of immunity
Whilst many countries are introducing antigen testing (the throat and nose swab looking for presence of the virus itself),before allowing entry into their countries , we are not aware of any country at the present time that will accept a positive antibody test as “ proof of immunity” .As explained last week ,it is not certain that the presence of antibodies will indeed prevent us from catching Coronavirus again (although logically that should be the case).
However, if you do need formal written confirmation of the results of either antigen or antibody testing, it is important that you attend the practice with suitable ID for us to oversee the test in order to produce a legally watertight document. We hope you will understand that we will not be able to produce a “certificate”, if we cannot be certain it was indeed you that did the test.
Updates on treatment
During a webinar hosted at the Royal Society of Medicine ,Professor Sir Michael Rawlings,Clinical Pharmacologist and chairman of the Medicines and Health Regulation Authority discussed with Professor Stuart Ralston ,(Professor of Rheumatology at the Centre for Genomic and Experimental Medicine at the University of Edinburgh), current issues in treatment of COVID-19
A brief summary follows:
- Use of Ibuprofen( Nurofen):No evidence that it worsens the severity of COVID-19 or makes people more susceptible to catching it
- Angiotensin Converting Enzyme inhibitors(ACEI’s) and Angiotensin Receptor Blockers(ARB’s).These are medicines used in high blood pressure and heart disease ):large observational clinical studies have shown no aAssociation betweenuse of ACEIs or ARBs and increased severity of COVID-19
- Chloroquine and Hydroxychloroquine :there is currently no evidence that these medicines are effective in treating COVID-19,although continue to be the subject of a large ( 12,00 patient) trial being conducted at Oxford University
- Azithromycin:Useful in patients with worsening respiratory symptoms, although still not proven to have antiviral properties ( despite the theoretical boost to interferon levels discussed in last week’s Bulletin)
- Remdesivir:Recent study published in The Lancet showed small benefit in terms of reduced hospital admission but as yet no benefit in terms of mortality
- Steroids:Should be avoided in patients in the early stages of COVID-19 who are only mildly symptomatic, but paradoxically may be useful in patients with more severe disease in hospital.
- For patients in hospital use of medicines to thin the blood ( anticoagulants), inhaled Interferon, and use of convalescent plasma require further good quality clinical data to prove their effectiveness but all look promising treatments.
- Vaccines:The Oxford University trial is moving rapidly forwards , but still a case of fingers crossed!
PPE
Whilst it would be helpful if you could bring your own masks to your appointments, we will continue to provide these at the practice.
We thought you would also be interested in our “Designer Visors” (modelled here without shame by Dr Ebba Khalil & Dr Clare Thompson) which we received through a charitable organisation. Hope that will help relieve the slightly austere environment at Courtfield at the moment.