Dear Courtfield Patient,
The positive news reported in our last Newsletter continues!
At Courtfield we have had only one family contract COVID-19 in the past 10 weeks.
Chelsea and Westminster Hospital are admitting only 3-4 patients per week.
According to the Zoe COVID symptom study led by Prof Tim Spector, rates in the UK generally have dropped 27% in the last week and we are moving close to levels of new cases per week, not seen since last August. This is despite increased social mixing as the Government gradually reduces restrictions.
The vaccine roll out has reached the stage where we can genuinely start to talk about herd immunity as the virus is starved of vulnerable individuals to infect, which also deprives it of opportunities to mutate – at least here in the UK.
Even the 3 main variants of concern (South African, Brazilian and Indian) are at least partially responsive to the vaccine and even if individuals were to be infected, the chance of them suffering severe symptoms are very significantly reduced by the vaccine.
Recent surge testing in various parts of the country e.g., in Lambeth and Southwark has NOT detected significant spread of the South African or Brazilian variant of the virus.
The main area of concern over the past few weeks has been the potential association between the Astra Zeneca (and Johnson and Johnson) vaccines and an extremely rare type of blood clot affecting the brain (known as a “cerebral venous sinus thrombosis”).
Please note, it is not possible to choose which vaccine you have at the present time. For more information on booking a vaccine please visit https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/
Unfortunately it appears that the private sector will not be given the opportunity to take part in the vaccination programme, and the only way therefore to obtain a vaccination is to register with a local NHS general practitioner.
Should I be worried?
Figures released by the Medicines and Health Regulatory Authority (MHRA) suggest that up to March 31st, it had received 79 reports of blood clots accompanied by low blood platelet count. All the cases involved people who had received their first dose of the vaccine (20 million doses).
Of those 79, a total of 19 people had died.
The 79 cases occurred in 51 women and 28 men, aged from 18 to 79.
Women may be at higher risk because they were also taking the oral contraceptive pill, which independently increases the risk of blood clots (this is NOT the case for Hormone Replacement Therapy).
Of the 19 who died, three were under the age of 30.
Out of those deaths, 14 cases involved clots forming in the veins draining the brain.
The remaining 5 cases were other kinds of thrombosis in major veins (including the gastro-intestinal tract).
The risk of dying is therefore 1 in a million-this compares to 1 in 136,000 chances of being killed by lightening or a one-year risk of dying in a car crash of 1 in 20,000 (lifetime risk 1 in 240)
the vaccine’s benefits significantly outweigh risks, although the risk-benefit balance changes with age.
It is estimated that the vaccine programme has prevented at least 6,100 deaths in adults aged over 70, but the thrombotic adverse effect seems disproportionately to affect younger adults – hence the current advice to not offer the Astra Zeneca vaccine to those under 30.
No decision has yet been made on vaccinating under 18 year olds.
According to Prof Spector, the risk of catching COVID-19, 3 weeks after the first vaccination is 1 in 74,000 each day; dropping to 1 in 114,000 per day after the 2nd vaccine.
We also know that even if you are unlucky enough to contract COVID after being vaccinated, the risk of developing serious illness or hospitalisation is extremely low indeed.
What symptoms should I be concerned about?
The MHRA has said that ‘as a precautionary measure, anyone who has symptoms four days or more after vaccination is advised to seek medical attention’.
The symptoms that should prompt concern are:
- A new-onset severe and persistent headache, which is worse on bending forward, lying down, coughing or associated with pain on eye movement
- Blurred vision
- Shortness of breath
- Chest pain
- Leg swelling
- Persistent abdominal pain (clots can rarely affect the bowel)
- Unusual skin bruising or pinpoint spots beyond the injection site (suggestive of a low platelet count)
HEADACHES AFTER ALL COVID VACCINATIONS ARE EXTREMELY COMMON AND THE VAST MAJORITY ARE BENIGN AND RESOLVE WITHIN A FEW DAYS-ALTHOUGH SOME MAY TAKE UP TO 2 WEEKS.
It is safe to take Paracetamol (max dose 2 tablets 4 times daily) – it will not mask the signs of a cerebral venous thrombosis.
What should I do if I am worried?
Please contact us and we will assess your symptoms.
If we have concerns, we will arrange a blood test in the first instance. This test (known as a d-dimer) gives us an objective way to assess risk. We will also check your platelet count.
If there is any doubt then we will arrange for a special type of brain scan-known as CT or MRI venography to be carried out, usually after discussion or assessment with a specialist.
Can I do anything to reduce risk?
Some individuals may be at higher risk of clots (e.g., those with a past history of deep vein thrombosis) and it would be sensible to have an alternative vaccine to the Astra Zeneca vaccine (i.e. Moderna or Pfizer).
There is generally no harm in taking Aspirin to try to reduce the risk of clots (75mg after food) at the same time as the vaccine, but there is as yet, no objective evidence of benefit.
TRAVELLING ABROAD ON HOLIDAY – HOW WILL IT WORK?
It is still not clear exactly how the UK “traffic light system” for travelling abroad on holiday will work, when travelling restarts (fingers crossed!) on May 17th.
The current proposals will cause significant administrative hassle, delays at airports, and considerable expense for tests (at least an extra £500-£750 for a family of 4, even to “Green Zone ” countries) and so they may well change before May 17th. We will discuss testing and travel in more detail in the next newsletter.
Courtfield is currently registered for COVID-19 travel testing, but as a small GP provider we will definitely are unlikely to be the cheapest provider available.
We are offering the Day 2 and Day 8 travel test package from Tuesday 4th May costing £270.
In order to book this please email us on firstname.lastname@example.org or call us on our main number. We will book appointments for testing and provide you with the reference number needed for the passenger locator form. Please note, we can only provide you with your reference number once payment has been processed – as per the government guidelines.
We really are edging ever closer to a more normal way of living and working.
We of course continue to provide a safe environment for you to consult and although we are happy to provide remote consultations, a recent article in the Lancet suggested that this style of consulting increased the risk of delayed or inaccurate diagnosis.
Best wishes from the team at Courtfield Private Practice