Coronavirus – Practical Advice

Updated Version – 20/03/2020

NEW: Going to the supermarket

New evidence emerging on Coronavirus survival on surfaces. This was actually sent to me by one of my patients!

Be careful when you go to the supermarket. The shopping trollies, self check outs, cash, pushing in pin numbers etc, all potentially dangerous. And there are no handwashing or disinfecting facilities at the entrance / exit. Then you touch your car keys, steering wheel and gear shift. Consider washing goods, fruit etc with soapy water. You dont know who has touched it before. And all the Coronavirus infected people have to shop, too. Most of them are mildly sick. We really need supermarkets to provide disinfection or handwashing facilities at their entrances / exits because we cannot stop food shopping during the crisis.

Self isolation advice: Read here if you have symptoms and here if you don’t.

Introduction

The article below is for my subscribers to my website www.nhsevent.info. I wanted to put some information together that may help you in your journey in these uncertain times. Please be aware that this article is not written by a Coronavirus expert, but by a GP. Some of the messages may be soon out of date, others may be valuable for a long time.

Why is Coronavirus important?

Coronavirus is a new virus. There is no immunity in our population. Therefore potentially up to 80% of us can get it (but its likely to be much lower). Most people just have a cough and a fever or a fever alone. But some patients, particularly the elderly, patients with chronic conditions or an impaired immune system are more at risk of serious illness or even death. Many of us think it is like a flu / viral pneumonia, but we still have a lot to learn and don’t know everything. And crucially, unlike the flu, we do not have a vaccination available to us.

I am having a hip replacement in a hospital, tomorrow, should I cancel?

You should talk to your hospital if you are high risk or if you have any signs of a viral infection including symptoms of Coronavirus. All hospitals are required to put their patients safety first. They will cancel your operation if necessary. You really only should go ahead with a procedure if you are low risk. If you are very worried about not getting your procedure done, because you are in a lot of pain and most routine procedures will soon be stopped, try to call your consultants secretary and get put into a slot as soon as possible.

I cannot get any Hand Gel, what should I do to disinfect my hands?

Regular handwashing will remove 99.9% of all virus and bacteria on your hands. You do need to keep your skin moisturised, though. There is usually the principle of “viral load”. To get infected by any virus you need a good number of the virus into your system, usually about 1000. Few conditions, like Hepatitis, require less virus to become infected and people with reduced immunity also may need less virus. We don’t know what the viral load for Coronavirus is, but as handwashing with soap binds the virus it is a good strategy.

How about sending my kids to school?

While the schools have not closed yet, you should be careful if your child is on immunosuppressant drugs, is severely obese, has severe asthma or needs a flu jab for any other reason. You should also now separate vulnerable adults living in the same household as your children. Children are vectors (transmitters) of this disease, but healthy children seem to very rarely get seriously sick with this. They also will provide “herd immunity” for society in the future.

Areas of risk

Anything you have touched with dirty hands or others have touched is an area at risk, so wash or wipe it. Supermarkets are so full of people, they are like viral kettles, now. So what is high risk? The list is endless, but start here: Supermarket trolleys, supermarket self check outs, your steering wheel and gearshift, your mobile phone, not washing hands before eating. Public door knobs and door handles. Anything your kids touch unawares.  Wash your hands before you eat. Don’t eat finger food from buffets where others eat, too. Again, the list is endless.

NEW: How can I disinfect my toilet seat / doorhandles etc with what is still available in supermarkets?

Household bleach is a powerful disinfectant. Use small amounts, as advised on the label, in water and use to disinfect all surfaces that are resistant to it (dont blame me for a bleached surface, try a small area first in an invisible place). Always read the label. Also ensure to wear gloves and don’t bring into your eyes. After you have disinfected areas, wash away bleach with water. Alternatively, you may find disinfectant washing up liquid or other household disinfectants. The list is long.

I can’t get any facemasks

Most facemasks are only bits of tissue that cannot filter the virus. Virus filter masks are not easily available and currently quite expensive. But not to worry. What usually carries the virus are little droplets, that you cough or sneeze out when you first get a virus (in fact a recently published small article published on Sunday March 8th by a group of German scientists (not peer reviewed, not yet confirmed) suggests it is most infectious in the early stages and mild cases. And these droplets can be filtered by tissue. May this be the reason why the government has reduced the viral symptoms isolation period to 7 days, because the virus is not as contagious once the sneezing / early symptoms stop (pure speculation!)? But what does this mean if it is true?: Even a scarf, a pullover with high collar or a couple of pieces of normal kitchen roll secured with 2 rubber rings in front of your face provide good protection against the droplets and can help with some basic protection against any virus in caCatch it bin it kill itse somebody coughs or sneezes at you. Just replace it frequently.

My relative is on Chemotherapy / Radiotherapy for cancer, can I visit them?

No, you shouldnt. If you (have to) visit older or sick or vulnerable relatives or they are dependent on you, ensure they and you frequently wash their hands, door-handles and everything you or they touch. Keep a 2m distance whenever possible. Cover your face with tissue when you sneeze, cough or speak loudly (your relative may be hard of hearing). Ask them to cover their faces with a handkerchief or any other fabrics while you are around.

I am worried about getting my prescription medication

There is no worry, supplies are reasonably good at the moment. Try not to stockpile, order as you usually would.

I am worried about Paracetamol being completely sold out

The problem is that people are stockpiling. If everybody only buys what they need we will be fine. I am sure Paracetamol manufacturers will try to increase output in the next few weeks as long as supplies are not hampered by other factors. Remember, Paracetamol is a comfort drug, it isn’t really curing anything. If you have an illness, it makes you feel better, but by lowering your temparature you also decrease your metabolism and your temperature is increased to be able to make antibodies quicker. Use your current supplies sparingly.

What is better, handgel or handwashing?

It depends. But if you use handgel you leave a film on your hands that can in some gels later provide a breeding ground for germs. So frequent handwashing is vital.

I am vulnerable myself because of Type II diabetes .

You now need to self isolate. At the same time try to improve your self care and reduce your sugar levels if possible. Even lowering your weight by a stone may reduce your sugars so much that your immune system can kick in again. Patients with high sugar levels paralyse their immune system. If you are overweight: By acting now and going onto the 800 calorie diet immediately you may be able to build up your immunity in time for Coronavirus.

I have another condition that reduces my immune system

You should now self isolate. Read here for more information

What else can I do to reduce my risk of severe illness or death with Coronavirus?

  1. Stop smoking. Within 3 days of stopping, all the Carbon Monoxide in your blood is gone and the oxygenation of your blood will improve. Within 6 weeks the little hair in your bronchi will grow back to naturally get rid of debris, bacteria and germs. This gives you a better chance with Coronavirus as it causes breathing problems in severe cases.
  1. Ensure you eat a balanced diet not deficient of any nutrients you need
    • Increase your vegetable intake massively (at least 5-a-day, better 9-a-day!)
    • Reduce salt in your diet (to reduce your blood pressure)
    • Reduce fats and sugar in your diet (general drivers of obesity, pre-diabetes and diabetes)
    • Eat fresh food, cook yourself (avoid additives and bad fats, know what goes into your dinner!)
    • Avoid food additives, the list is endless.
    • Alcohol in moderation (also driver of obesity and impairing the natural defences of your liver)
  1. Loose weight (obese people have a higher risk of pre-diabetes and diabetes and many other conditions that can affect your immune system and resilience
  2. Keep well hydrated
  3. Be active, do plenty of exercise (not in a crowded gym, outdoors is better at the moment or at home with your own equipment or indeed without equipment like Pilates or Yoga.

When I am sick or worried with a cough or fever, I need to see my GP, right?

No, please dont come into the surgery, call NHS 111 or 999, depending on the severity of your symptoms. If they advise to call your GP, then contact the surgery via telephone or online (where available).

“I never get the flu, I don’t even have the flu vaccine, even if the surgery texts me. Therefore I won’t get Coronavirus”

You may be of ruddy good health and never get any problems, but you also may be relying on a phenomenon called “herd immunity”. It depends on the virus, but generally, if 70-90% of a population are immune to a virus, the rest won’t get it, because a virus cannot spread sufficiently. Therefore turning down vaccinations that are offered to you is usually unwise, because 1) you don’t protect yourself and 2) you don’t contribute to the greater good of “herd immunity”. Again, a person with health problems is more at risk and that is the reason, why they are the first patients we contact for the annual flu vaccine.

Important Links on self isolation:

Self Isolation with symptoms: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/

Self isolation without symptoms: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Dr M Kittel, March 12th 2020, updated March 14th