While I appreciate that you are probably feeling bombarded with news and updates about this virus, As a healthcare professional, it concerns me that growing misconceptions and myths around this rapidly-changing health crisis are causing people to feel increasingly concerned about how to keep themselves and their loved ones safe.
Patient and practitioner education is at the forefront of my practice; I am on a mission to share information and knowledge to empower people to make informed decisions about their wellbeing; this what we know to date about COVID-19.
Note: 80% of those affected with COVID-19 will be able to manage their symptoms at home without the need for medical treatment and make a full recovery.
COVID-19 is an infectious upper respiratory tract disease caused by the most recently discovered coronavirus. This new virus and condition were unknown before the outbreak began in Wuhan, China, in late December 2019. The World Health Organisation (WHO) declared the outbreak a Public Health Emergency of International Concern on 30 January 2020.
Several names are being used in the media and by medics when referring to this condition, which is confusing. The virus that results in the illness called COVID-19 is the virus called SARS-CoV-2 or Severe Acute Respiratory Syndrome Coronavirus, which is genetically similarity to the original SARS virus. On 11 February 2020, WHO formally announced a name for the new coronavirus disease: COVID-19, it would be helpful if health professionals, the media and governments used this name for clarity and to supports more public confidence.
Currently, there are seven coronaviruses known to affect humans; the most severe are SARS, MERS, and COVID-19. The other four include HCoV 229E, NL63, OC43, and HKU1, which cause 10% to 30% of all upper respiratory tract infections in adults globally.
The COVID-19 epidemic is unusual because it’s a new virus in humans and spreading much faster globally than others in the same family. The main reason for this seems to be because the incubation period is quite long and affected people can be asymptomatic; look and feel healthy, so not aware that they should be taking precautions to limit the spread of the virus.
There appears to be two types of COVID-19 virus: a more aggressive type noted in the early stages of the outbreak in Wuhan, China, and a milder form currently making up around 30% of cases. According to the International Journal of Epidemiology, COVID-19 has a high mortality rate of around 2–4% of people infected, compared to seasonal flu at about 0.1%.
It is important to note that the fatality rates of coronaviruses, including seasonal flu and COVID-19, are highly variable depending on several factors including global location, the time of year, public hygiene standards and local health services. During these health epidemics, many countries wish they had the benefit of a first-world health service such as the UK’s NHS.
Scientists believe that the mortality rate may go down as more people are being diagnosed with milder cases. Or it may go up if the virus mutates, the evidence for this is mixed at the moment. This is a dynamic and rapidly evolving situation which is leading to public confusion, misunderstandings, and increasing general anxiety.
How does COVID-19 spread?
The disease can spread from person to person through small droplets released from the nose or mouth when a person with the virus coughs or exhales; research suggests you need to be within 2 metres to be a risk.
These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth.
Current evidence suggests that COVID-19 can live on plastic, metal and other hard surfaces for 24 to 72hours, but its numbers will decline after a few hours. Coronaviruses can survive for 15 to 20 minutes on the skin, which is why frequent handwashing is being recommended.
People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets, current evidence suggests you need at least 15 minutes direct contact to be a risk.
Therefore, it is essential to self-isolate if you have been exposed or are feeling unwell with the symptoms mentioned below.
Signs and symptoms
Because the family of coronaviruses share many symptoms it can be difficult and sometimes impossible to tell the difference between them based on symptoms alone. Did you know there are more than 200 different viruses, including strains of coronavirus and that causes the common cold? Most common colds start with a scratchy sore throat, and while they can make us miserable, they are very rarely debilitating, and importantly this is not how COVID-19 presents.
Symptoms of COVID-19
Fever / Shortness of breath / Dry cough / Tiredness.
Some people may also experience nasal congestion, runny nose, a sore throat, aches and pains or diarrhoea. Symptoms usually begin gradually and are mild; some people will become infected but won’t develop any symptoms;this is a normal finding for any viral infection.
If there’s a chance you could have COVID-19, call your GP or 111. You will be advised to self-isolate and may require swab testing. Currently this is only be offer to people who have travelled to affected areas, or been in contact with someone with the virus.
About 80% of those affected recover with no need for special treatment, managing their symptoms at home. Around 20% of people who gets COVID-19 will become severely ill, developing breathing difficulties, severe acute respiratory syndrome, pneumonia or kidney failure. Sadly some people will not recover from these complications. People at particular risk are the elderly, and those with comprised immunity or with underlying medical conditions such as heart problems or diabetes.
What we know
Scientists have reported the incubation period as between 2 to 14 days, but it could extend out to 24 days. Most people affected will present with symptoms in 5 to 6 days. This means they could be infectious for some time but not feel unwell; this is of concern because the virus can spread before a person becomes symptomatic.
Children and COVID-19
Children seem less susceptible to COVID-19; most confirmed cases reported from China have occurred in adults. From limited information published from past SARS-CoV outbreaks, infections among children were relatively uncommon.
It appears that children who contract COVID-19 tend to have mildly affected, and are more likely to develop gastrointestinal symptoms such as vomiting and diarrhoea, before or alongside the usual symptoms.
Pregnant women and breastfeeding mothers.
There is no published data about the effects of contracting Covid-19 on pregnant woman; it’s just too early — remember this disease has only been in the human population for 68 days at the time of writing (March 07). To date, none of the pregnant women who have contracted Covid -19 has passed it on to their babies, and samples of amniotic fluid have been virus-free. Importantly the virus has not been found in breast milk either.
The risk of adverse infant outcomes such as preterm births is not known, but based on limited data there have been reports of some premature births, and low-weight babies among women tested positive for COVID-19 during their pregnancy. However, it is not clear if these outcomes are related or because of other factors.
Local maternity services have assured my pregnant patients that women in good health with low-risk uncomplicated pregnancies should not be unduly concerned about COVID-19. They have advised following the general guidelines; frequent hand washing and to avoid touching their face.
There have been two cases of confirmed Covid-19 neonatal infection to date published in peer-reviewed literature. One was an infant diagnosed 17 days after birth; subsequently, the mother and nanny were confirmed to have the virus. The other was a newborn found to be infected 36 hours following delivery.
Note: Might be a time to encourage new mothers to nest’n’rest at home for a few weeks if possible following the birth of their baby. There was a time last century when women were nurtured and supported at home for a few weeks as they adjusted to motherhood. It still happens in some so-called ‘less developed cultures’. Interestingly, these women report less maternal stress, easier breastfeeding and lower rates of postnatal depression.
Previous coronavirus outbreaks and pregnancy
If you do an online search about pregnancy and Covid-19, you will find articles linking to other coronaviruses, remember there are several in this group of viruses. So let’s clarify what we know, this is important because the differing names can cause genuine stress and fear and that’s the worse thing any of us can of for our health.
An analysis of previous SARS and MERS outbreaks shows that there has never been a confirmed case of maternal-foetal coronavirus transmission. It’s worth mentioning that there appears to be a link between miscarriage and foetal abnormalities between the SARS virus outbreak of 2002–2003 and the more recent MERS outbreak. According to an article in the Lancet, there were 12 women reported being Covid-19 infected while pregnant, who experienced the following adverse clinical outcomes: four miscarriages in the first trimester, two in the second and third trimester, and a newborn with intrauterine growth restriction.
There are many reasons for miscarriage, and the cause is often not identified, which can intensify an already distressing experience for the women, her partner and extended family. If you are pregnant, planning to get pregnant, or just had a baby and are concerned, please speak with your GP or health visitor.
How to reduce your risk of catching or spreading COVID-19
The most effective strategy to reduce catching or spreading this virus is scrupulous personal hygiene; frequent hand washing and not touching your face eyes/nose/mouth. Studies show that only 5% of people wash their hands thoroughly or long enough to kill infection-causing critters!
Coronaviruses are “enveloped viruses”, which have a fat or lipid coating and spiky surface that allow easier binding to target tissues. This is good news because this coating and the spikes makes coronaviruses more susceptible to water, disinfectants and alcohol-based sanitisers. Thorough handwashing is best as the water, soap, and friction produced by rubbing hands to make a lather along with thorough rinsing will eliminate the virus either by killing or washing it away.
Hand washing tips
Wash your hands with soap and water often — do this for at least 20 seconds. Interestingly the temperature of the water is not essential in reducing risk; warm water is for our comfort only.
Rinse hands in running water; I know this may seem wasteful in a time of environmental concern, but genuinely this is best practice and safety comes first.
Always wash your hands when you get home or into work.
Wash your hands before handling food and eating.
Wash your hands before applying make-up.
Wash your hands after you cough, sneeze or use a tissue.
Wash your hands after handling pets and their waste.
Wash your hands after caring for anyone ill, or with a comprised immune system.
WASH YOUR HANDS MORE OFTEN.
It is also important to dry your hands properly; wet or damp hands increase transmission risk. Paper towels are best used outside of the home. Remember to avoid touching the tap and the door after washing your hands; use a paper towel to turn off the tap and open door.
If shaking your hands dry in public loos was your usual behaviour, that won’t be adequate at this time, and air driers are best avoided too.
At home; remember to use a separate hand towel to dry your hands which you hang up to dry between washes. Change it frequently, perhaps daily, especially in bigger households.
Side note: I hear news of public and workplace lavatories running low on soap and paper towels. Which simply confirms our poor hand washing habits — yuk!. Perhaps by the time this virus passes, we will have developed a new habit of better personal hand hygiene.
Use an alcohol-based hand sanitiser if soap and water are not available. While hand sanitisers have some efficacy, less virus is removed than by thorough handwashing. Research shows that hand sanitisers need to be a minimum of 60% alcohol to be effective. There is no evidence that non-alcohol or natural versions are effective on Covid-19.
Note: Washing with soap and water is best for children and those with skin sensitivities, as prolonged use of alcohol gel causes skin drying.
Practice respiratory hygiene
Make sure you, and the people around you, follow good respiratory hygiene, what this means in practice is covering your mouth and nose with a tissue if you cough or sneeze and disposing of the used tissue immediately —remember droplets spread the virus, and it loves warm damp enviroments.
Then wash your hands or use hand sanitiser if soap and water are not available. If you don’t have a tissue sneeze or cough into your bent elbow or your sleeve, yes I know that sounds gross, but it’s safer for everyone than using your hands.
Keep your hands away from your face.
Do not touch your face; eyes, nose or mouth if your hands are not clean; most adults subconsciously touch their face 200 plus times a day!
At home, disinfect doorknobs, taps, toilet flushers, metal door plates, keys, Tv remote controls, the car steering wheel and handbrake. Plus plastic children toys and any hard surfaces likely to transmit germs. Commercially available disinfectants, sprays, and wipes will work, and steam cleaning above 50C is useful, but remember that the virus will eventually die after a few days.
Disinfect your devices, did you know that the average smartphone carries more bugs than a public toilet seat?!
Note: At present, there is no evidence that natural cleaners such a vinegar, lemon juice or essential oils including tea tree, are useful in killing Covid-19.
Self-isolation, what does this mean?
If there’s a chance you could have contracted COVID-19, call your GP, check your surgery website or call 111. You will be advised to self-isolate and may require swab testing. What this means in practical terms is:
What this means in practical terms is:
Staying away from people and remaining at home for 14 days or longer if recommended. Do not go out, to work or any public place for the duration of your quarantine.
Do not use public transport or taxis unless otherwise advised.
You will help support from family members, friends, or delivery services to do errands for you and get food delivered .
Try to avoid visitors entering your home — it’s okay for friends, family or delivery drivers to drop off food- at the doorstep and received the post, but you should not be signing the keypads used by delivery services.
No one should enter your home unless you have an emergency; for example your heating breaks down, please notify them in advance that you are in self-isolation.
Note: Self-isolation means everyone in your household should also follow these guidelines. That means if you have school-aged children, they should be off school and remain indoors along with any other adults who share your home. I appreciate this presents a potentially huge problem for freelancers, the self-employed, GIG and contract workers who are not entitled to sickness benefit.
If you are in self-isolation and struggling the following Uk bases services may be helpful;
Samaritans — www.samaritans. org.uk / T: 116 123 (free 24-hour helpline)
Mind — www.mind.org.uk/ T: 0300 123 3393
Anxiety UK www.anxietyuk.org.uk / T: 03444 775 774
The Money Advice Service. www.moneyadviceservice.org.uk
ASSIST trauma care Information and specialist help for people with PTSD and anyone supporting them. www.assisttraumacare.org.uk
Should you use face masks
Face masks if you can still buy them may be useful for people with active symptoms as they will catch coughs and sneezes, but in reality, these folks should be in isolation.
Wearing a face mask is a sensible precaution if you are taking care of a someone with suspected Covid -19 infection, remember to dispose of it properly, and then wash your hands.
For everyone else, they are ineffective at best because they are often poorly fitted, which encourages frequent face touching to make adjustments which will increase transmission risks.
Note: Healthcare professionals wear face masks primarily to protect their patients, not to defend themselves.
Treatment for COVID-19
Like many viruses, including the common cold, there is currently no specific treatment for COVID-19; there are options to relieve the symptoms of fever, etc. while your body fights the illness. Remember you’ll need to stay in isolation away from other people until you’ve fully recovered, and this may require further swab testing. The most critical self-help and community strategy is hand washing, avoiding touching your face and self-isolation.
What else can you do?
People have asked me if any lifestyle changes can reduce their risk of catching or spreading Covid 19.
If you are one of life’s tactile folk, it would be prudent to pause from hugging, kissing, handshaking or fist-bumping your friends and colleagues until the crisis has passed.
Smokers should seek support to stop, as it increases your risk of all respiratory illnesses, and the complications associated with these conditions
Asthmatics should ensure they have adequate supplies of their medication.
We know that people who are well-nourished and take moderate exercise regularly are better equipped to fight off illness.
Research shows that poor sleep comprises the immune system and increases susceptibility to viral respiratory illnesses.
Interestingly high sugar consumption can interfere with proper immune function, which is why people with diabetes are at more risk of all illness.
Prolonged and chronic stress also comprises immunity.
Studies have shown that:
Vitamin D helps prevent upper respiratory infections, and most people in the UK will have low Vitamin D during the winter.
Studies show that people, especially the older population, already taking Vitamin C supplements, can reduce the duration of viral respiratory symptoms.
Zinc lozenges can also help decrease symptom severity, as sucking them slows down or stops viruses at the back of the throat.
Coronavirus myths busted
Post and parcels from China can spread Covid-19
Scientists have said that from previous coronavirus outbreaks. Covid-19 cannot survive on letters or packages for the extended period time needed to reach these shores.
You can get coronavirus and Covid-19 from eating Chinese food
No, you cannot, it’s safe to eat at your local Chinese restaurant.
Everyone with COVID-19 dies
This statement is also untrue.
Antibiotics kill COVID-19
Antibiotics only kill bacteria; they do not affect viruses.
Cats, dogs and other pets spread COVID-19
Although the dog of a Hong Kong sufferer also tested positive for COVID-19, according to the WHO, there is little evidence that pets can spread it. Scientists are still debating the importance of this finding to the epidemic. It’s likely; the virus was only present on the dog’s mouth and nose because it came into contact with a contaminated surface. However, washing your hands after touching your pets will reduce your risk of contracting salmonella, E.coli and other nasty critters
The virus originated in a laboratory in China.
Despite these ongoing rumours, there is no evidence that this is true. Some researchers believe that Covid-19 passed from animals to humans, probably from bats as that was the case in the 2003 SARS outbreak.
The virus will die off in the spring and summer when the temperatures are warmer.
Some viruses, such as cold and flu viruses, seem spread more readily in the colder months, but that does not mean that they cease when the weather becomes milder. In the case of Covid-19 scientists do not know how temperature changes will influence its behaviour.
Covid-19 is the deadliest virus to humans.
While Covid-19 appears to be more severe than other coronavirus when compared to influenza, Ebola is more deadly and has a higher mortality rate.
Remember the 5 essential tips:
- Most people affected with COVID-19 will make a full recovery.
- Wash your hands frequently and dry them thoroughly.
- Keep your hands away from your face; mouth, nose or eyes.
- Avoid contact with affected people and those in self-isolation.
- Call your GP or 111 if you believe you have been infected, and follow their advice. Do not go to your doctor’s surgery, pharmacy or hospital. NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do. Use this service if:
i.You think you might have coronavirus.
ii.You have been to a country or area with a high risk of coronavirus.
iii. Or you have been in close contact with someone with coronavirus.
This information is not intended to replace information from health authorities including NHS, Public Health England or WHO. Please check for updates on your GP’s website; it will be on the homepage or via a link to the the most up to date government advice.
At this stage, I am not unduly concerned about Covid-19 in the general population. It is worth noting that in the UK 150,000 people of all ages develop Sepsis each year, and 44,000 will die of this often late-diagnosed silently presenting condition.
More, 30,000 people died because of Pneumonia in 2018; it’s one of the deadliest infections with the very young and people over-65s being the most vulnerable. It is a known complication of any respiratory disease, and the number rises in the winter months.
If this is of concern, adults aged 65 or over, plus children and adults with certain long-term health conditions that increase their risk of complications should take up the free pneumococcal vaccine as recommended. Doctors also offer it to babies as protection from the bacteria that can lead to Septicaemia which can trigger Meningitis and Sepsis.