What is coronavirus?

Coronaviruses are a family of viruses that circulate among animals with some of them also known to infect humans. Bats are considered natural hosts of these viruses yet several other species of animals are also known to act as sources. Coronaviruses predominantly cause respiratory symptoms, and they have actually been around for a long time; some will cause mild symptoms like the common cold, while others are responsible for severe diseases like SARS which caused an outbreak in 2003 and MERS which started in 2012.

The reason that they are named coronaviruses is because of their characteristic shape of a circle surrounded by crown.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus that has not been previously identified in humans. The novel coronavirus was detected in Wuhan, China in 2019 and is closely related genetically to the SARS-CoV-1 virus.

COVID-19 is the name given to the disease associated with the virus.

What is a pandemic?

The World Health Organisation (WHO) has now declared this a pandemic. A pandemic is when the disease not only spreads between exceptionally large numbers of people across regions, but throughout the world too.

Are coronavirus and the influenza virus similar?

While the viruses that cause both COVID-19 and seasonal influenza are transmitted from person-to-person and may cause similar symptoms, the two viruses are very different and do not behave in the same way.

Research estimates that between 15 000 and 75 000 people die prematurely due to causes associated with seasonal influenza infection each year in the EU, the UK, Norway, Iceland and Liechtenstein. This is approximately 1 in every 1 000 people who are infected. Despite the relatively low mortality rate for seasonal influenza, many people die from the disease due to the large number of people who contract it each year.

The concern about COVID-19 is that, unlike influenza, there is no vaccine and no specific treatment for the disease. It also appears to be more transmissible than seasonal influenza. As it is a new virus, nobody has prior immunity, which means that the entire human population is potentially susceptible to SARS-CoV-2 infection.

How does it spread?

The virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or speaks. These droplets are too heavy to hang in the air and they quickly fall on floors or surfaces.

Most cases of Covid -19 globally have evidence of human to human transmission. The two routes by which it can be spread are:

  • Directly through close contact with an infected person (within 2 m) respiratory droplets can enter the eyes, mouth, nose or airways. The risk increases the longer someone has close contact with an infected person who has symptoms.
  • Indirectly by touching of a surface, object or the hand of an infected person contaminated with COVID 19, and then touching one’s own mouth nose or eyes and transferring this.

While animals are believed to be the original source, the virus spread is now from person to person (human-to-human transmission). There is not enough epidemiological information at this time to determine how easily this virus spreads between people, but it is currently estimated that, on average, one infected person will infect between two and three other people.

How long can the virus last on surfaces?

The WHO estimates the lifetime of the virus is between a few hours and a few days but this is subject to ongoing research.

A study published in the New England Journal of Medicine showed that plastic is the surface that the virus remains viable on the longest, which is up to 72 hours. On stainless steel the virus was detected up to 48 hours after application, paper and cardboard it was 24 hours and for copper the virus lived for just 4 hours.

What is the incubation period?

The incubation period for COVID-19 (i.e. the time between exposure to the virus and onset of symptoms) is currently estimated to be between one and 14 days, but is most commonly around 5 days. This is why if a household contact has symptoms and you don’t, you still have to self-isolate for 14 days.

We know that the virus can be transmitted when people who are infected show symptoms such as coughing. There is also some evidence suggesting that transmission can occur from a person that is infected even two days before showing symptoms; however, uncertainties remain about the effect of transmission by non-symptomatic persons.

How severe is COVID-19 infection?

Preliminary data from the UK show that around 20% of diagnosed COVID-19 cases are hospitalised and 5% have severe illness requiring ventilatory support. Hospitalisation rates are higher for those aged 60 years and above, and for those with other underlying health conditions.

What are the key symptoms of COVID-19?

The majority of people (80%) who are infected with coronavirus may have no symptoms, or will experience a mild set of symptoms which can be well managed at home.

The symptoms include:

  • Fever (a temperature above 37.8°C) or if you don’t have a thermometer when your skin feels hot to touch.
  • New and continuous cough. This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours, or if you usually have a cough it might be worse than usual.
  • Shortness of breath and difficulty breathing
  • Tiredness and fatigue
  • Headaches
  • Sore throat
  • Aches and pains
  • Loss of sense of smell and taste

If you have a fever and/or a new continuous cough you need to self isolate immediately for 7 days, if a member of your household has this you need to self isolate for 14 days.

If you cannot manage your symptoms at home, your condition is getting worse, you have persistent symptoms after a week, or you are unable to do everyday tasks then you do need to seek help.

If it is not an emergency contact NHS 111 online, or if you have no internet access call 111. If it is an emergency please dial 999 and be very clear in telling the call handler that you have likely coronavirus. GP surgeries are still open and have even remained open over the bank holidays, so whilst they have changed their way of working to telephone and sometimes video consults, they continue to be there for patients – please do not hesitate to call your surgery if you need help for this or anything else as you would have normally.

Are some people more at risk than others?

Elderly people above 70 years of age and those with underlying health conditions (e.g. hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer) are considered to be more at risk of developing severe symptoms. Men in these groups also appear to be at a slightly higher risk than women.

How do I treat this?

Self isolate, get plenty of rest, use over-the-counter medicines like paracetamol to keep your fever down, drink plenty of fluids and avoid alcohol as this will make you more dehydrated. 1 in 5 people who contract COVID-19 will need to go to hospital, and around 15% of cases need oxygen to help, and 5% experience critical infections requiring ventilation. Those at high risk of severe critical infections include people who are older and those with underlying health conditions.

Other medicines you may find helpful like cough medicines or cold and flu remedies, and throat lozenges may also help the symptoms. To be clear, antibiotics will not improve coronavirus as antibiotics are used for bacterial infections and this is a viral infection. You should only use antibiotics as and when prescribed by your doctor, and this may be for a concurrent bacterial infection.

There are many traditional and herbal remedy suggestions that are trending, but there is no evidence to support these aiding recovery from COVID-19.

Other treatments

We are to have the world’s biggest trial of drugs to treat COVID 19 patients in the UK-the RECOVERY trial has recruited over 5000 patients in 165 NHS hospitals around the UK in just a month which is way ahead of similar trials in the US and Europe which have a few hundred. The team expects to be the first to have some definitive data sometime in June. There has been a lot of press about anti retroviral medication used in HIV treatment, the anti-malarial drug hydroxychloroquine, and azithromycin which is an antibiotic and they are both being tested separately in the RECOVERY trial but there is no real evidence to support its use at the present time.

There are a number of papers but with little absolute evidence for us to convert into treatment protocols.

They are also in discussions about introducing convalescent plasma-which is blood from people who have recovered that contains antibodies against the virus.

Are NSAIDS bad?

Simple painkillers to lower fevers include paracetamol and ibuprofen, there had been a claim that nonsteroidal anti-inflammatory medications (NSAIDs) e.g. ibuprofen could actually increase the risk of severe COVID-19 infection and complications from research in France, but on 14th April the U.K.’s commission on human medicines published guidance stating that there is currently insufficient evidence to establish a link between use of ibuprofen or other nonsteroidal anti-inflammatory drugs and susceptibility to contracting COVID-19 or worsening symptoms. Patients therefore can take paracetamol or ibuprofen.

How can I avoid getting infected?

The virus enters your body via your eyes, nose and/or mouth, so it is important to avoid touching your face with unwashed hands.

Washing of hands with soap and water for at least 20 seconds, or cleaning hands thoroughly with alcohol-based solutions, gels or tissues is recommended in all settings. It is also recommended to stay 2m or more away from people infected with COVID-19 who are showing symptoms, to reduce the risk of infection through respiratory droplets.

How can I avoid infecting others?

If you are unwell with symptoms of COVID-19 self isolate for 7 days.

Cough or sneeze into your elbow or use a tissue. If you use a tissue, dispose of it carefully after a single use.

Wash your hands with soap and water for at least 20 seconds.

Stay two metres or more away from people to reduce the risk of spreading the virus through respiratory droplets.

Consider wearing a cloth mask (medical masks should only be used as PPE for frontline healthcare workers) when out in public after your 7 day self isolation ends.

What is physical distancing and why and how should I do it?

Physical distancing aims to reduce physical contact between potentially infected people and healthy people, or between population groups with high rates of transmission and others with low or no level of transmission. The objective of this is to decrease or interrupt the spread of COVID-19.

On a personal level, you can help perform physical distancing measures by staying at least 2m apart from people who are not members of your household, voluntarily self-isolating if you know you have the virus that causes COVID-19, or if you have suggestive respiratory symptoms, or if you belong to a high-risk group (i.e. you are aged 70 years or more, or you have an underlying health condition).

Social distancing vs physical distancing

The language that we use right now is incredibly important and looking at the impact of this. Some form of physical distancing is likely to continue for the longer term, until we have a vaccine. Social distancing should only be applied physically, otherwise, we should be actively seeking ways of engaging with our family, friends, and colleagues through mediums that work for everyone-whether that is picking up the phone and having a conversation, texting, writing letters or cards or emails, use of our technology using apps like WhatsApp, FaceTime or Houseparty and Microsoft Teams.

We have very rapidly seen how effective many industries can be working from home, and how quickly we get on board with remote working and meetings from our living rooms. What is also lovely is when people interact socially virtually e.g. playing games online with their family and friends, having dinner whilst on Facetime, and even having dance parties via Houseparty! Methods to connect continue to evolve as lockdown has been extended and people understand the seriousness of the situation.

Where are we with vaccines?

There are over a hundred projects for vaccine development and the Phase One clinical trial is now underway at Oxford. Around 500 volunteers will be given either the vaccine for coronavirus or a licensed meningitis jab. That way they can tell whether the experimental vaccine is more likely to cause side effects such as a sore arm, fever, or a headache.

They should also be able to see at an early stage whether people given the new vaccine are less likely to get COVID-19 than the control group who have been given the meningitis jab.

Its effectiveness will then need to be confirmed in further phases of trials, involving as many as 5,000 people.

The researchers have said they may have the vaccine by September 2020, but it is more likely to be next year

Where are we on testing?

There are two types of test, and Preventicum offer both tests which are PHE approved.

  • A PCR swab test to find out if you currently have the SARS-CoV-2 coronavirus
    • The COVID-19 PCR assay test is suitable for you if you have symptoms of COVID-19 or if you have been in contact with someone with symptoms. The test we offer is approved by PHE and involves a swab taken from your nose and throat. This is analysed using RT-PCR testing and shows if you currently have COVID-19. The results are available in 3 working days
  • An antibody test to find out if you have previously had COVID-19
    • The antibody test is a blood test to check immune response if you have previously been infected with SARS-CoV-2 coronavirus using gold standard laboratory methods. This is most accurate if done 14 days or more after the first symptoms of infection. The antibody test was approved by PHE on 14th May and the results are available in 24 hours.

We are delighted to announce that we are now able to offer the two types of Public Health England (PHE) approved home testing for COVID-19, both available to buy on our website from 18th May.

We don’t know how long immunity lasts for as there have been reports of people being infected again in China and South Korea. Dr Ryan, executive director of the WHO’s emergencies programme has stated that there is limited evidence that coronavirus survivors guarantee future immunity to the disease, so those who have already had the virus may be at risk of being reinfected. We will continue to update here as further data emerges.

Am I protected against COVID-19 if I had the influenza vaccine this year?

Influenza and the virus that causes COVID-19 are two very different viruses and the seasonal influenza vaccine will not protect against COVID-19.

Masks or no masks?

This is certainly a complicated area and a recent study by Prof Tricia Greenhalgh and Jeremy Howard published on 13 April reviews the science behind this. When you speak tiny droplets are ejected from your mouth, if you are infectious these contain the particles of the virus, only the very largest droplets end up surviving more than 0.1 seconds before drying out and turning into droplet nuclei that are 3 to 5 times smaller than the original droplet itself but they still contain some virus. So it’s much easier to block droplets as they come out of your mouth when they are much larger, compared to blocking them as they approach the face of a non-infected person who is on the receiving end of those droplets.

There have been lots of debates about the effectiveness of masks and this assumes that the purpose of the mask is to protect the wearer. Cloth masks are relatively poor (though they state not entirely ineffective) at this. For 100% protection the wearer needs a properly fitted medical respirator (such as an N95) but cloth masks worn by an infected person are highly effective at protecting the people around them, this is known as source control. And it is source control that matters in the debate about whether the public should wear masks. If you have COVID 19 and cough on someone from 8 inches away, wearing cotton mask will reduce the amount of virus you transmit to that person by 36 times, and it is even more effective than a surgical mask.

Just how effective mask wearing is depends on 3 things: how well the mask blocks the virus, what proportion of the public wear masks, and the transmission rate of the disease.

So whilst not every piece of scientific evidence supports mask wearing, most of the points in the same direction. The latest review leads to the conclusion to wear a mask. Surgical masks and N95,FFP3 masks etc. should be reserved for the healthcare profession where PPE is vital and also resources are dwindling for those at the frontline. But members of the public could even consider make a cloth mask at home for use when out and about to limit the spread of infection.

Wearing a mask does not replace hand washing and social distancing, but if you have a cloth mask using it is not a bad idea when out.

Race and coronavirus- is there a link?

There is now an official enquiry to investigate why people from black and minority ethnic backgrounds appear to be disproportionally affected by coronavirus. Early figures showed 35% of almost 2000 patients in ITU in the UK are black or from another ethnic minority background despite the BAME people making up only 14% of the population. Concerns were raised after the first 12 doctors who died are all non white. Many possible causes like health inequalities high levels of heart disease/diabetes kidney disease exist in this population, families are also more likely to live in more crowded multigenerational household than their white counterparts, 30% of UK Bangladeshi population live in overcrowded houses compared with 2% of the white British population. A disproportionate amount of key workers who are not working from home including bus drivers are from a BAME background and vitamin D deficiency may also play a role – research is ongoing.

References and helpful links:

https://www.gov.uk/coronavirus

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

https://111.nhs.uk/covid-19/

https://111.nhs.uk/isolation-note

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.youtube.com/user/NHSChoices

https://www.nhs.uk/conditions/coronavirus-covid-19/staying-at-home-to-avoid-getting-coronavirus/staying-at-home-and-away-from-other-people/

https://www.gov.uk/government/publications/coronavirus-outbreak-faqs-what-you-can-and-cant-do/coronavirus-outbreak-faqs-what-you-can-and-cant-do

https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/

https://www.nhs.uk/conditions/coronavirus-covid-19/help-the-nhs-respond-to-coronavirus/

https://www.cruse.org.uk/get-help/coronavirus-dealing-bereavement-and-grief

https://patient.info/news-and-features/how-to-stay-healthy-while-working-at-home

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

Exercise:

https://patient.info/news-and-features/how-to-exercise-at-homein-isolation

https://www.thebodycoach.com/blog/pe-with-joe-1254.html

https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

https://7minuteworkout.jnj.com/

https://apps.apple.com/gb/app/glo-yoga-and-meditation/id1023475268

https://apps.apple.com/gb/app/asana-rebel-get-in-shape/id1067860796

https://apps.apple.com/gb/app/gaia-tv-discover-mindful-yoga/id821068605

Mental Health:

https://www.headspace.com/

https://www.calm.com/

https://www.nhs.uk/oneyou/every-mind-matters/coronavirus-covid-19-staying-at-home-tips/

https://patient.info/news-and-features/covid-19-how-to-manage-mood-swings-during-coronavirus-lockdown

https://patient.info/news-and-features/covid-19-how-to-cope-with-loneliness-during-the-coronavirus-pandemic

Nutrition

https://www.myfitnesspal.com/

https://thedoctorskitchen.com/

https://www.bda.uk.com/resource/covid-19-corona-virus-advice-for-the-general-public.html

Facemasks

https://www.bmj.com/content/bmj/369/bmj.m1435.full.pdf

https://www.preprints.org/manuscript/202004.0203/v1

https://www.fast.ai/2020/04/20/skeptics-masks/

https://www.itv.com/news/london/2020-04-21/diy-face-mask-dr-ellie-cannon-makes-a-protective-mask-from-a-piece-of-cloth/