Dear Courtfield Patient,
Introduction
As predicted in our last newsletter, the combination of relaxation of lockdown, reopening of schools and the arrival of autumn, has led to a progressive rise in cases of COVID-19 in the past 3 weeks.
Whilst on the surface this may seem alarming, the seasonal rise in cases is exactly what we would have expected at this time of year, and the vast majority of individuals have very mild symptoms, (or in some cases no symptoms at all).
At Courtfield, we have had 5 positive cases in the past 2 weeks, all of whom have had very mild symptoms indeed.
Most patients can be safely managed in the community, and although the number of hospital admissions are rising, there is no significant pressure on our local hospitals at the present time.
Putting COVID-19 in perspective:
Although tragically the number of deaths is now rising, yesterday’s figure of 49 deaths, compares to over 900 daily deaths from cancer and heart disease, and the Office for National Statistics (ONS) data show that COVID-19 is currently the 24th leading cause of death in the UK, accounting for 1.4% of the total number of deaths in the past month.
Reassuringly, since our last newsletter, there have been no further deaths in children due to COVID-19 and the current figure of 6 compares to 188 children who died as a consequence of Influenza during the 2018-2019 flu season (ONS data).
Please don’t delay in checking out new symptoms
At Courtfield, we have sadly experienced our first case of a delayed diagnosis of cancer associated with the restrictions imposed by COVID-19.
Please, please do not delay in contacting us, if for any reason you are worried about ANY new symptom, but particularly if you are experiencing unexplained fatigue, weight loss, a cough lasting more than 2 weeks, abdominal pain, a change of bowel habit or unexplained rectal or vaginal bleeding, change in a mole or any new “lumps or bumps”.
All our private hospitals are open with good access to diagnostic facilities.
Is it possible to distinguish COVID-19 from other upper respiratory infections which circulate in the winter months?
The short answer to that question is no.
COVID-19 is however very unlikely to be the cause if the only symptom is a runny nose or sore throat and there is no associated cough or fever. Indeed the Royal College of Pediatricians and Child Health published guidelines this month advising that children should be allowed to attend school if they only have a sore throat or runny nose, and furthermore that testing for, COVID-19 is not necessary in such cases.
Nonetheless, a large study in the British Medical Journal earlier this month demonstrated that a blocked or runny nose is seen in 20% of children with COVID-19, (but usually together with fever and cough).
Interestingly, this study also showed that children are much more likely than adults to present with abdominal pain and vomiting.
Should I have a flu vaccine this year?
This is definitely the year to avoid influenza if possible!
Influenza and COVID-19 circulating in the community at the same time can make accurate diagnosis and appropriate treatment difficult (for example dexamethasone is usually helpful in the more severe stages of COVID but can be harmful in patients with influenza (source: Infectious Diseases Society of America).
Evidence from China suggest that individuals who have both infections at the same time have worse outcomes.
On a positive note the evidence from all southern hemisphere countries (who are just coming out of their winter) is that cases of influenza have been significantly less than in previous flu seasons – probably due to increased social distancing, improved hygiene, and the wearing of face masks.
Hopefully this will also be the case during the winter months in the northern hemisphere, but of course, we cannot be certain.
Therefore having an influenza vaccine (and possibly also pneumonia vaccine) seems a simple and sensible precaution this year.
Side effects occur in less than 10% of individuals, and are usually limited to a sore arm at the injection site, fever or mild flu-like symptoms which last less than 48 hours.
We will be running a series of Influenza and pneumonia vaccination clinics over the next few weeks at Courtfield, and it is likely that local pharmacies will also be joining in the effort to get as many of us as possible vaccinated against influenza this year.
Testing
Frustratingly there has been no progress in formal ratification of more rapid antigen testing (nose swab only testing and saliva sampling, which give results within 15minutes are still being evaluated), so the uncomfortable throat and nose swab is still the only approved antigen test available (believe us – we hate swabbing you as much as you hate being swabbed!).
After some frustrating delays in the past few weeks, our laboratory is now back on track, and processing all tests within 24 hours.
We are operating extra clinics for those of you who are asymptomatic but need a swab for work, school or travel.
For those of you with symptoms, tests can be carried out at home, or at designated times at the practice each day (when the building is otherwise unoccupied).
Quarantine rules
Despite good evidence to support the use of testing to reduce quarantine times, the UK government has not changed the rules on quarantine i.e. isolation for 14 days for anybody who has been in contact with case of COVID-19 (or 10 days from the onset of symptoms for those who have the illness), is still unavoidable, even with a negative test result at 7 days.
Are antibody levels maintained after COVID infection?
Five Courtfield patients who tested positive in May for Covid-19 antibodies were interested in checking their antibody status again this month. Two tested negative.
This result is in line with a paper published in the Journal of the American Medical Association earlier this month which showed that 58% of patients lose their positive antibody status after 2-3 months. While on the surface this may appear to be bad news, it is very likely that ‘ memory lymphocytes’ (which cannot be measured) will respond to any further coronavirus exposure by ramping up production of antibodies to fight off the virus (this is supported by the evidence from those few cases where patients are infected for a 2nd time, who generally tend to have a much milder illness).
Any news on the vaccine?
The news from our contact involved in the Oxford University/AstraZeneca vaccine continues to be very positive. Phase 3 trials are due to conclude in the next few weeks, and if the results are positive, there is a real possibility that we could have a vaccine in the New Year.
What is happening at Courtfield?
We remain open Monday through Friday (8.30am-6pm) – and also on Saturday mornings, backed up by our colleagues from Concierge Doctor outside of our normal working hours (which we will enhance ourselves, as we did during lockdown, if activity increases significantly).
You should expect to be questioned by our reception team to make sure you do not pose a Covid-19 risk when booking your appointment.
Masks must be worn immediately on entering the building and you should also gel your hands on entering and leaving the building.
We will try to keep waiting times to an absolute minimum – please attend on time for your appointment i.e. neither early nor late.
If you do have to wait, you will be at a safe distance from other patients.
Please, attend alone for your appointment wherever possible and we ask that only one adult accompany a child to their appointment.
If you have possible symptoms of COVID-19 and we agree a face to face assessment is necessary, then we will take most of the clinical history over the phone, so that the time spent in the building is kept to a minimum.
Please don’t think we are being rude if we immediately focus on the clinical examination when you arrive -keeping consultation length to a minimum is all part of keeping everybody in the building as safe as possible.
We believe we are operating a safe environment to assess your problem face-to-face, but if you prefer to be visited at home or to consult ‘remotely’, then please let our reception team know.
Keeping ourselves safe
Last week, the Courtfield Doctors all had the “fun” of being professionally fitted with the best possible FFP3 face masks as it is clear that we are all going to see more cases of COVID-19 (hopefully in its mildest form) over the next few months.
Keeping yourselves safe
Please remain vigilant and respect the rules on social distancing, regular hand washing and wearing masks indoors.
As there is now clear evidence that patients with low Vitamin D have significantly worse outcomes if they contract COVID-19. Taking 1000 units of Vitamin D daily is sensible. (Vitamin D at this dose has no side effects). Levels can be measured with a simple blood test if you prefer.
There has also never been a better reason to lose weight and stop smoking!
You may also wish to consider buying a “pulse oximeter”, which come in both pediatric and adult versions. These can easily be purchased on line and typically cost around £30 (the pediatrics pulse oximeter is slightly more).This is a simple to use finger probe, which assesses the level of oxygen in the blood (as well as your pulse rate).
For any of you unlucky enough to contract COVID-19, this is an extremely useful tool for assessing (along with temperature and pulse) the severity of your illness and a good indicator of whether hospital referral for oxygen therapy may be indicated.
Whilst we undoubtedly have a long winter ahead of us, please be aware that all epidemics have a beginning, middle and an end. THIS ONE WILL BE NO DIFFERENT!
Please do not hesitate to e-mail us if you have any questions.