The country, no. The world, has been stunned by this recent pandemic. You probably have your ears filled with coronavirus news every minute of everyday, and the more we hear it, the closer to us it feels. And even more so, the more helpless and vulnerable we feel. But what does it mean for the NHS? And how will that impact you and your loved ones?
First, a crash course on the coronavirus:
What is it? Coronaviruses are actually common around the world and have been for a long time. What you see referred to as COVID-19 is simply a new strain of the virus. In other words, it is a new mutation. Much like how the flu virus can change every year - which is why you get a yearly vaccine suitable for that particular strain. And like the flu, 'anyone' can catch it, it is an all inclusive condition, but the effects will certainly vary from person to person, and those with existing respiratory conditions, frail elderly or immune deficiencies may experience more severe symptoms with less favourable outcomes.
How is it passed on? Right now, this is still not 100% confirmed. The two theories are that it is spread via droplets when a person coughs/sneezes that can survive for a particular time on surfaces including hands and clothes etc, and if those droplets enter another person through their mouth, eyes, or nose, they can potentially contract the virus. The other is that it is airborne, this is scarier as it would mean the virus can be spread simply by breathing it in as it has the ability to travel in the air, making it highly contagious. At the moment - although the world health organisation (WHO) is advising that airborne precautions be taken, it is more likely that COVID-19 it is not this contagious. Having said that, until 100% confirmed, it may be better to assume it is.
So what does that mean for you? If you do potentially come into contact with an infected person and they pass it onto you, the things to look out for are: 1: a new dry cough - either continuous for over an hour, or 3 or more episodes of coughing over 24hours.
2: an increased body temperature.
The advice at the moment is, if you get either of these symptoms, you self isolate yourself for 7 days from the time you notice symptoms if you live alone. If you live with others, they should isolate for 14 days, but you as the original source still only need to for 7 days.
Why is this? The incubation period is thought to be between 2-14 days. Which means that those in your household may still be contagious to others if they have contracted the virus even if they do not show any symptoms for up to 14 days. It is only after this time that we can with some level on confidence say that the likelihood of infecting others is lowered.
What can you do? The advise is everywhere, wash your hands often, cover your mouth and nose with disposable tissue when you cough, avoid or limit touching your face or eating with out proper hand hygiene, avoid crowded spaces, be considerate that others may react much worse than you if they catch The virus.
So what's the NHS doing about it?
If your symptoms are mild or even moderate, you're advised to stay home and self isolate, you can call 111 for some advice but don't assume you will be tested or taken into hospital or seen at home. Its important to consider that there are only several labs in the country that are able to test for the coronavirus at the moment. Therefore it is taking upto 48 hours from getting swabbed to receiving results within hospital. The management of resources is therefore being focused and concentrated for those highest risk or most severe presentations. However, if you are a health worker, your hospital/place of work will have a dedicated HR communications team phone number that you can call for specific advice. If you don't know it, make sure to ask your team lead or manager.
The first action of the NHS and government was to unofficially restrict movement and the risk of spreading the corona virus to those most vulnerable. If you have family or friends in hospital, visiting hours will therefore have been removed with only specific special exceptions. Visits to your GP will also be limited with a preference for telephone consultations or advice via 111.
If you or a loved one were expecting to have a planned surgery - if this is non urgent iit probably has been, or will be cancelled for a future date to be confirmed. As an idea, your NHS physio outpatient appointment may be cancelled or rearranged, a knee replacement surgery or a cosmetic surgery etc will be deemed as non urgent. Unfortunately but understandably, you will be asked to tolerate your pain or discomfort a little longer in this instance.
If you or a family member are already in hospital and are deemed to be medically stable, although you may not feel ready to go home, you will be discharged home. When your doctor says you are 'medically stable', they don't mean there is nothing wrong with you. They mean that your condition is at a stage that does not require specialist attention any longer and you can be just as well managed at home.
Those who are staying in hospital are either awaiting further necessary investigations or management before they can be deemed safe enough to be managed out of hospital. For example a patient with an existing heart condition and a suspected heart attack or raised markers in their blood indicating a high chance of another heart attack if they are not properly medically managed, they would be kept in hospital due to the higher chance of them becoming severely unwell outside of an acute setting.
If you are concerned about the safety of your loved one at home as they are alone, or have recurrent falls or are having difficulty coping at home, this is considered more of a social problem than a medical problem. They will not be placed into a situation that they are unsafe, but options will be explored on how best to facilitate them leaving hospital - either back to their own home, a family members home, a community hospital, residential home or temporary supported living facility etc. Normally, this process can be a long process that can at times last several weeks. During this pandemic however, the NHS is introducing multiple pathways that can have you home or an alternative destination away from hospital within 48 hours if you don't need to be in hospital.
All this of-course is in an attempt to create space within the NHS to accommodate a potential large influx of patients, it is estimated in the next 2-4 week's (of writing this blog 20/03/20), there will be increasing numbers of confirmed coronavirus cases who require hospital admission. Just how many, there is no way of telling. It may be incredibly high, or it may be underwhelming, what is logical however is to plan for the worst to ensure those who need attention the most have access to it
Furthermore, within the NHS structure itself, staff are being redirected into areas they are most needed. For example theatre nurses who's surgeries have been cancelled will be asked to support medical and respiratory or specially opened wards. All non essential staff training that does not improve staffs ability to deal with the coronavirus or respiratory issues will also be postponed.
Lastly, as you can see the NHS and the government are taking this very seriously. Having said that however, we at PhysioChain also feel it is important to maintain our spirit not of fear, but of power, love and self control. These are trying times, but the human race has and will continue to overcome challenges. By taking care of your bodies, taking care of your minds, and taking care/being considerate of one another, you too hold a very powerful tool during this. Be informed, do not be pushed into panic.
And a last reminder on what to do should you come into contact with someone with a confirmed coronavirus diagnosis.
1 - contact your local health protection team on https://www.gov.uk/health-protection-team
2 - you may be asked to self isolate for a period of time between 7-14 days https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection
3 - you may be actively followed up by your health protection team if appropriate
4 - if new or existing symptoms worsen within your 7 day period of isolation, you should contact 111 to be reassessed
5 - if you're unwell enough to be taken into hospital you will be swabbed to be tested for the virus
6-if the results return and are positive for coronavirus, you will be treated for it whilst in hospital
Fehr, A & Perlman, S. (2015). "Coronaviruses: An Overview of Their Replication and Pathogenesis". Methods Mol biol. 1282. 1-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/pdf/nihms671207.pdf
Ghebreyesus, T & Swaminathan, S. (2020). "Scientists are sprinting to outpace the novel coronavirus". The Lancet, 395(10226). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30420-7/fulltext
Kampf, G, Todt, D, Pfaender, S 7 Steinmann, E. (2020). "Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents". Journal of Hospital Infection, 104, 246-251. https://www.journalofhospitalinfection.com/article/S0195-6701(20)30046-3/fulltext
NHS (no date) "Coronavirus (COVID-19)". Available at: https://www.nhs.uk/conditions/coronavirus-covid-19/