Coronavirus COVID-19 *Updated 29.03.2021*

HealthcarePublic Health
Written By Martin Saweirs
coronavirus

Recent Updates

***29.03.2021***

Vaccination availability via the private sector

I know I have emailed many patients directly regarding this query, but I wanted to give this point slightly more clarity. Whilst many of us thought that by the summer of 2021 Covid-19 vaccinations many be available privately in the UK, this is looking exceedingly unlikely.

Therefore, as it stands currently, Covid-19 vaccines are solely available via the NHS, and I am advising anyone eligible for NHS care to register and they will be called accordingly for their vaccination.

It goes without saying that the rollout is going incredibly well, and this huge national effort is proving very successful. I am happy to write to any of my patients’ NHS doctors to inform them of existing medical conditions and share medical history, of course, so please do let us know and we will arrange this.

If and when this situation changes, and the vaccinations become available privately, I will update this page accordingly.

***15.05.2020***

Testing now available - same day results

I am happy to announce that I am now offering all forms of testing for Covid-19. Below I explain a little about the different tests available:

1. Throat swab PCR test - to see if you have the virus currently

This is the test done for two reasons:

  • For travel to the majority of countries

  • For when you are actively ill, coughing/feverish etc to see if you have the virus at that point in time.

I have swab kits for this if needed, but these are to be done by patients at home.

I can courier a sample kit to you - the kit is really easy to use, instructions are included, then you can return this to the lab via post/courier.

Results take 24 hours or so to be returned once the sample is received into the lab.

2. Antibody blood testing - to see if you have been exposed to the virus 

The premise here is that if antibodies are detected, you have had the virus at some point and developed antibodies against it. The government and health organisations are being very cautious about whether or not this means you're immune, but it is very likely that this means you will have some degree of immunity. What we really don't know is how long any immunity may last, and this is still the subject of ongoing research. 

There are two types of antibody test I can offer, but I will primarily be offering the newly available lab-based test:

a) The lab-based antibody blood test, run by The Doctors Lab using the Abbott Laboratories test

  • Approved for use by Public Health England

  • This is 100% sensitive, and 99.5% specific - so incredibly accurate

  • One tube of blood is sent to the lab, results take a few hours but potentially up to 24 hours

  • It detects a long term antibody called IgG, so to ensure the result is as accurate as possible the blood test should be done at least 3 weeks after any suspected illness, as it takes this long to make good levels of IgG

  • If you have had no symptoms, it can be done at any time

b) Finger-prick antibody blood test, from Matrix Diagnostics

  • Results take 15 minutes, done in the clinic

  • These are between 97-99% sensitive, so there is a small possibility that a negative result is incorrect. Given this, I would suggest using this only if you have had lots of highly suggestive symptoms of Covid-19, and if the test is negative, then a confirmatory lab test (above) can be done

  • Approved for use by The MHRA (Medicines and Healthcare products Regulatory Agency)

I can undertake either of the above in a standard 30 minute appointment - click to book here and simply indicate in the booking information that you would like a test.

If you have any questions at all about the testing, what type is best for you, implications of testing or costs, please do get in touch via the contact page for a quick response.

***02.05.2020***

It has been a really difficult few weeks for everyone in the UK and I know some of you have really battled with symptoms of Covid-19, not just personally but in your families too. After much consideration I have decided to return to clinic to offer face to face appointments at 55 Harley Street from Monday 4th May 2020.

The last 5 weeks have proven overwhelmingly popular for video and phone consultations, so I've decided to keep them available for online booking.  The online booking is also active again for face-to-face clinic appointments, and can be accessed by clicking here.

Despite the remote consultations proving very useful over the last 5 weeks,  there are certain aspects of patient care that can't be met by video or telephone consultations alone and require patients to be seen in person. 

My concern is delaying face to face appointments further may lead to potentially important conditions not being discussed, diagnosed and treated in a timely fashion. I am therefore keen to get back into the clinic to see you all - for issues old, new, and anything that has been put off!  

Please rest assured that, for both your and my safety, I will be taking all sensible precautions relevant to my work, including appropriate decontamination techniques and PPE, including wearing gloves and face masks etc.  Please do not be too alarmed therefore If I open the door wearing these! I’m looking forward to getting back to work and seeing you all soon.

***28.03.2020***

I have spoken to lots of my patients over the past week via video and telephone consultations, and have unfortunately had some experience of close family members needing to be hospitalised due to Covid-19.

Whilst many people will just get mild to moderate cold-like symptoms, there are a few patterns I am noticing from those who are unwell enough to seek my input. We are all aware of the persistent cough, but the main problematic symptoms people are reporting to me include:

  • Fever which is very persistent - lots of you have noted the fever seems fairly solid for 3-5 consecutive days, coming down a little but not much with paracetamol before finally breaking

  • Debilitating headache - this seems to be a sensation of constant pressure, all over the head, and again seems to be minimally relieved by painkillers. This is likely related to the fever and resultant dehydration, so do try and keep really well hydrated

  • Nausea and vomiting - again this is a really difficult one to treat, but numerous patients I have spoken to have had this to some extent or other. It has a significantly negative impact on the first two points as it really limits some people’s fluid intake

  • Day 7-9 possible deterioration point, chest tightness and increased breathing rate - this is a very rough timing, but it seems that this is point at which, if things are going to worsen, they can do so relatively quickly. I was on a video consultation with two such people at this stage of the illness, and their difficulty was apparent - both were unable to speak in full sentences due to a fast breathing rate. A normal adult breathing rate is about 12-18 breaths per minute - these were elevated up to nearly 40 per minute.

    The other symptom consistently described is a real sense of chest tightness and constriction - a real inability to take anywhere near a full breath in. This in itself can cause a huge degree of anxiety and trigger a rather negative spiral of breathlessness.

Thankfully both patients have done well with prompt hospital input and oxygen support for the breathing.

I have also spoken to numerous patients who have got to day 10+ and are gradually improving. Tentatively, it seems like their improvement then gradually continues on past this potential deterioration point.

I realise all of the above is just observational but it reflects the issues that are frequently being raised with me by patients. I’ll continue to update this as ever with any new information.

***24.03.2020***

Vulnerable groups - 12 week isolation

The government has released a list of conditions which it considers to be very high risk, and vulnerable to the worst outcomes of a Covid-19 infection.

These include, but are not limited to:

  • those who have received an organ transplant

  • suffer from certain types of cancers

  • or are on medications to suppress their immune system

The full list of conditions can be found HERE - GOV.UK COVID-19 VULNERABLE CONDITIONS

The upshot of this is that those with any of the above conditions are being strongly advised to self-isolate as a precaution for a period of 12 weeks

If your condition is not listed, or are worried about your specific condition, please do get in touch anytime and we can discuss further.

***18.03.2020***

1. Potential caution over ibuprofen and anti-inflammatory use (NSAID)

There have been reports from France recently that ibuprofen use has been observed to be linked to a worse outcome in active covid-19 infections in some people. The data behind this is as of yet unpublished and has not been analysed, but the MHRA and NICE are currently looking into this on behalf of NHS England.

The WHO has been fairly clear to not recommend avoiding ibuprofen as below:

As it stands, I would give the following advice:

  • use paracetamol first if you have suspected symptoms

  • ibuprofen can be used after this if there is ongoing discomfort

If you are already prescribed anti-inflammatories please consult your doctor before making any changes at all.

2. Testing to be increased

The NHS is planning to increase testing to 25,000 per day over the next four weeks. This is a huge increase but will be prioritised for hospital patients and front-line staff quite understandably.

I am continuing my search to find a reputable and reliable provider of testing kits and will update my patients in due course when I do. I am really aware of how much anxiety and stress this causing you and your families, so I am trying hard to find a solution.

3. School closures, possible herald of tighter lock-downs to come

From Friday 20th March all schools across the UK will close indefinitely. As London is the site of the vast majority of the UK’s case, we may be in for tighter lock-downs to come. The next week or so will hopefully give us more information, and I will update in due course.

***16.03.2020***

Today the UK Government and Public Health England have released updated guidance on self-isolation.

As things stand, if you have any of the following symptoms:

  • You have a new onset/persistent cough

  • or you have a temperature of 37.8C (100F) or higher

Then the following will apply:

  • Anyone with symptoms should stay at home for at least 7 days - but you need to remain there until your temperature returns to below 37.8C, even if this takes longer than 7 days

  • If you live with other people, they should stay at home for at least 14 days - this is to avoid spreading the infection outside the home by taking into account the incubation period of the virus

  • After 14 days, anyone you live with who does not have symptoms can return to their normal routine.

  • But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days.

So all a bit confusing if I am honest. To be more clear I would personally aim for at least 14 days of self-isolation regardless - but I stress that is my opinion and recommendation.

If your symptoms are worsening, or are continuing at the end of your isolation period, then the guidance is to use the NHS 111 Coronavius service here: https://111.nhs.uk/covid-19/

It is vitally important as I said below that the following groups are kept as well shielded and protected from any contact with potentially infectious people:

  • Over 70s

  • Significant long term health conditions

  • Pregnancy (this can reduce your immune response although there is no clear evidence direct harm will come to your developing baby)

  • Those who are immunosuppressed

I will continue to update this as more information becomes available and as always please do contact me if there are any questions at all.

***14.03.2020***

As I write this, there is relentless reporting on the global spread of Coronavrius Covid-19. There is a mass of circulating information about it, and much of it is causing understandable concern, anxiety and panic. I know many of my patients, of all ages, have been extremely worried about this and in contact with me so I thought it would be useful to put something in writing.

Despite all the rather daunting headlines and figures, I must state that for the vast majority of people, this will be a mild and self-limiting illness and may even be difficult to distinguish from the common cold. However, for a subset of our society – particularly those over the age of 70 (especially when combined with other medical conditions) this has the potential to be very serious.

As I am sure you are all aware, Public Health England has released updated guidance about symptoms and seeing a medical professional. Currently, we are unable to see you face-to-face in a clinic if:

  • You have a new onset/persistent cough

  • or you have a temperature of 37.8C (100F) or higher

Anyone with the above is now advised they must self-isolate for 7 days – this means staying in your own home for the full period of time.

But what can you do to help yourself during this time?

1.     Taking analgesia regularly – to bring down fever and ease discomfort

The recommended adult dose of paracetamol is 1000 milligrams four times a day - in the UK that is two 500 milligram tablets for each dose.

(Advice about ibuprofen has changed - please see 18.03.2020 update)

Make sure it is taken regularly, and not just when you are feeling feverish – it will have a more sustained and effective impact.

Childrens’ doses vary by age and can be found on the bottles.

2.     Drink water regularly – LOTS OF IT

When you are feverish you become very easily dehydrated. Maintaining your hydration is fundamental to helping your body fight the virus effectively.

Usually I would recommend people drink 2-2.5L of water per day when they are well. When unwell however, I would recommend people drink even more, somewhere in the region of 3-3.5L if possible.

It will mean more trips to the bathroom, but making sure you are passing a good volume of clear urine is a good indicator that you are maintaining good hydration.

You may have read something about drinking plenty to wash the virus into your stomach, where the acid will kill it – quite simply, this is nonsense, and you should drink to hydrate. 

 
 

3.     Washing your hands regularly – with soap and water ideally

We have all heard this over, and over, and over again, but it is vital to stopping spread of the virus.

Make sure you wash the backs of your hands, between your fingers (which act as gutters and reservoirs for viruses), and your thumbs – everyone forgets their thumbs.

Make sure you wash for at least 20 seconds or so too. And don’t then sneeze into your hands – otherwise wash them again. 

4.     Maintain distance from relatives/family members

Ideally this is about 2m if possible – as the current consensus is 2 metres is the distance the virus can be spread by cough droplets.

Try and sanitise hard surfaces – coronaviruses can survive for several days on metal, plastics and ceramic.

It is important to try and sleep alone during this time too, as such close contact makes it easy to pass this on.

Absolutely do not visit elderly relatives in care homes/hospitals, or people with medical conditions that are significantly reducing their immune systems (chemotherapy patients are a prime example).

Who is most at risk?

It is members of our society over the age of 70 who should be most vigilant and we should be most considerate of. For reasons we do not fully understand as of yet, they are most at risk of having the more severe complications of Covid-19, including significant pneumonias that may ultimately need hospital intensive care support. As I mentioned earlier, children and adults are overwhelmingly likely to be mildly affected, but they can act as vectors to spread the disease to older people.

In general, older people also have other existing health problems – be that diabetes, high blood pressure, or chest problems like emphysema. The combination of existing health issues and age makes people particularly vulnerable.

However, for all the younger people out there with asthma, well-controlled diabetes, mildly high blood pressure etc, please do not worry that this makes you hugely more susceptible to the worst effects of Covid-19, as the main determinator of outcome seems to be age.  

Testing for Covid-19

The current state of testing people for this in the UK is as follows:

  • Only patients admitted to hospital with suspected Covid-19 will be tested

  • Private testing is unavailable in the UK

The latter is something I have been asked a lot over the last 2 weeks, and sadly there is no commercially available test for Covid-19 in the private sector.

What to do if your condition worsens?

If your cough is significantly worsening over the 7 days, or you are suffering from increasing shortness of breath you will need to consult with NHS 111 by dialling 111 from your phone.

I am of course available by phone, video consultation or email for my patients to discuss any worries or concerns, and discuss next steps.

What is to come?

Many countries have gone into full lock-down, closing borders and instigating full social isolation to try and mitigate the spread of the virus (Singapore, Taiwan and Japan are good examples). The UK has taken a different approach to dealing with this outbreak by trying to encourage some level of herd immunity by aiming to allow lower level spread of the virus – and only time will tell if this is the correct course of action.  

This is a very fluid situation, and things are sure to change over the coming weeks, with possible school/university/public space closures, so I will be sure to update this blog as news and guidance from Public Health England changes.

Martin Saweirs
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