Dear Courtfield Patient,
Welcome to the Courtfield Christmas Covid newsletter.Since we last wrote, the unwelcome arrival in the past 2 weeks of the highly infectious Omicron variant is necessarily forcing the UK back into more restrictive measures.Although the slope of this next wave will undoubtedly be a record breaking steep one, the evidence from South Africa where this variant was first described, is that symptoms are generally much milder, with a much lower proportion of hospitalisations and deaths compared to the Delta variant – and this in a country with low vaccination uptake and a significant amount of immunosuppression due to HIV disease. Daily case numbers are already starting to drop in Guateng Province as the virus starts to run out of people to infect. If the UK follows the same timeline, it seems likely that cases will increase rapidly before reaching a peak in approximately 3 weeks’ time before starting to decline. The overwhelming majority of cases in South Africa had mild symptoms, and for those that were hospitalised a significantly smaller proportion required oxygen compared to Delta. (Some caution is necessary in extrapolating this data to the UK as South Africa has a much younger population).

Mild symptoms reflect our experience so far at Courtfield – indeed only two patients (one of whom declined vaccination) has been ill enough to require hospitalisation in the past 4 months.

Evidence from South Africa suggests that the main presenting symptoms are slightly different to the Delta variant with headache, fatigue, back pain, blocked nose   and sore throat being particularly common with a lower incidence of cough, fever and loss of taste and smell. Early data from the UK (Zoe symptom tracker) confirms these new clinical features.
How can I reduce my risk of catching the virus? The single most important action is to get your third dose of vaccine. Evidence from Israel demonstrates that whilst two doses of vaccine do confer some protection (and reduces risk of hospitalisation by 70% compared to the unvaccinated) a third dose substantially increases protection.
Latest figures from the Office for National Statistics show that 2/3 of patients in hospital are unvaccinated. Minimalising social contact, maintaining good ventilation indoors, regular handwashing and wearing masks indoors in crowded places will also help (a study published in the BMJ last month reviewing all recent studies on mask wearing confirmed the effectiveness of facemasks in reducing transmission of the virus). Boosting Vitamin D levels by taking a supplement of 2,000units daily should also boost the body’s immune response. Is there any good news? Yes indeed!  This week the UK became the first county in the world to start dispensing the anti-viral home treatment -“Molnupiravir” to 10,000 vulnerable patients, as part of a trial run by Oxford University (the Panoramic Study). The trial is open to all those with a positive PCR test aged over 50 or those aged 18-49 with underlying health conditions such as emphysema. This drug targets the genetic material in the middle of the virus (which unlike the spike protein is less likely to change with mutations). It is most effective if given in the first 5 days of onset of symptoms and preferably in the first 48 hours.A study published in Atlanta has already demonstrated a 50% reduction in rates of hospitalisation compared to placebo.

Another recently developed anti-viral home treatment (Paxlovid) has been shown in trials to be even more effective and to reduce the risk of hospitalisation and death by 89%.
At the same time a trial of an injectable anti-viral drug (Ronapreve) is also starting in the community.
How can I access these drugs?

Things are moving fast with announcements within the last week that Covid Medicines Delivery Units (CMDUs) will be set up across the country. Please click here for more information

Could the arrival of Omicron even be good news?
Even the more infectious Omicron variant may in the medium term be good news, because by rapidly infecting large numbers of people (the vast majority of whom will only experience mild symptoms due to our impressive vaccine uptake), we may achieve “herd immunity” far sooner than would have been the case with the more dangerous (but more slowly spreading) delta variant, i.e., fingers crossed by the Spring the overwhelming majority of us will be immune, either through infection or via vaccination.
It may not be as bad as it seems on the news – a note of caution when interpreting the numbers in the media

Over the next few weeks, the media will be reporting dramatic increases in the numbers of patients in hospital with Covid.

With the inevitable rise in overall case numbers in the next few weeks, many patients admitted to hospital for non-Covid reasons will inflate these figures, as they will be found to be positive on routine testing (many of whom will be asymptomatic).

ONS data shows that of 5986 patients with Covid in hospital in England on 14th December only 4387 were admitted because of COVID i.e., news media COVID in- patient statistics are currently inflated by 27%-a proportion that is likely to increase further as Omicron becomes more prevalent (the first patient who sadly died this week was reported as dying with Omicron and not from Omicron).
Christmas at Courtfield  Opening times:Apart from the official holiday days we will be open throughout the Christmas period but closing slightly earlier on Christmas Eve at 3pm and New Year’s Eve at 5pm. Our out of hours service, DoctorCall will however be available when we are closed. Contact details: 0344 257 0345.In order to keep everybody safe when visiting the practice, please could you

  1. Attend for your appointment on time
  2. Please come alone for your appointment unless you need help
  3. Only one adult to accompany children

In association with the current surge of infections, we are experiencing unprecedented demand for telephone and email consultations.We are aware that we are taking longer to get back to you all, but all requests for telephone/e-mail replies will receive a response within 24 hours. Priority will be given to those with most urgent clinical need (please do not use e-mail for urgent requests). In order to free up consultation time for urgent appointments we are not taking bookings for routine adult medicals for the time being.

We understand the frustration that waiting longer than usual for a response causes, but please treat our administrative staff with the courtesy that they deserve when working under pressure in these immensely difficult times.

PCR TRAVEL TESTING (DAY 2 AND FIT TO FLY)PCR testing for day 2 and fit to fly tests are currently on hold until January. MERRY CHRISTMAS AND HAPPY NEW YEAR TO ALL Best wishes from the team at Courtfield Private Practice