Dear Courtfield patient,
As school holidays come to an end, it would seem an appropriate time for an updated newsletter.
Despite the fact that Coronavirus is still with us, we have many reasons to remain positive.
Whilst the easing of lockdown has inevitably led to an increase in the number of daily cases, this has not translated into increased admissions to Intensive Care Units nor an increase in deaths.
The number of patients in hospital continues to decrease, and is now below 1000 for the first time in several months, with less than 100 patients in intensive care.
This is probably due to the fact that the majority of new cases are in the under 40s who we know are less susceptible to the more severe forms of this illness, as well as to the possibility that there is now increased immunity in the community via IgG antibodies (which we can measure), as well as mucosal IgA protection, and T-cell immunity (which we cannot measure).
For those individuals unlucky enough to contract COVID-19, we understand so much more about this illness than we did six months ago, and now have effective evidence-based treatments for those with the most severe form of illness, especially anticoagulation, Dexamethasone, and Remdesivir.
This week an article published in the American Journal of Pathology showed significant reduction in mortality by treating patients with severe COVID-19 with convalescent plasma (containing antibodies derived from patients who have recovered from COVID-19).
The number of reported daily deaths is in low single figures, which is equivalent to the number of people who sadly lose their lives on the roads each day.
However, in the same way that we would not drive without seat belts or recklessly exceed the speed limit, we must continue to keep ourselves safe, by respecting social distancing, wearing masks (in particular in indoor crowded places), and to continue to frequently wash and gel our hands.
As we move into winter, it would also be sensible to consider taking 1000 units of vitamin D every day and to get the Influenza vaccine (as well as the Pneumonia vaccine for our more susceptible patients) as soon as it becomes available (currently due to arrive at the end of September).
COVID-19 particularly affects obese smokers, so there has never been a better incentive to lose weight and stop smoking!!
Vaccines
Five vaccines have now entered “phase 3“ trials (i.e. being tested on large numbers of individuals).
Our informal feedback about the Oxford/Astra Zeneca vaccine is very exciting, and as well as testing the vaccine in Brazil and South Africa (where the disease is more prevalent), trials of this vaccine will also soon start in the UK.
If you would like to offer to take part in this study please type in “nhscovid19vaccineresearch” on your internet search engine and this will direct you to the vaccine research registry where you can register your details.
Back to school
We now have enough evidence to be confident that children are the least likely members of the population to catch this illness, and even when they do ,they tend to have only modest symptoms or often no symptoms at all (so called “asymptomatic shedders”) .
Although there are exceptions, severe COVID-19 related illness is extremely rare in children, and although of course every death is an absolute tragedy, there have been only five reported deaths in under 18s in the UK from COVID-19.
What is less clear is how easily children can transmit the illness to adults.
The largest study looking into this (from South Korea and involving 65,000 children) was published in July and suggests that children under 10 are at least half as likely as adults to pass on the illness. The wearing of face masks for these older children would therefore seem sensible.
Furthermore, evidence from around the world has shown that in those countries where schools have been open for some time (or in Sweden where schools never properly closed), there have been no significant outbreaks of COVID-19 in schools, and reassuringly those in regular contact with the children (i.e. the teachers) have not suffered a higher incidence of COVID-19 than any other profession.
On the negative side, however, the South Korean study also suggested that children over the age of 10 were nearly as likely as adults to pass the virus to others.
Overall, it seems inevitable – as has been the case with other measures to ease lockdown-that the full reopening of schools will however lead to an increase in cases of COVID-19 in the Community.
No one can be sure to what extent the prevalence of COVID-19 will increase, and it is therefore important that those most at risk (e.g. the elderly) continue to be particularly cautious about contacts with their grandchildren until the evidence becomes clearer.
What is happening at Courtfield?
With the easing of lockdown, face to face consultations have continued to increase over the summer, particularly for health checks and routine vaccinations, although for those for those of you who prefer “remote “consultations, these will still be available.
Hospital and Consultant appointments are also becoming easier to arrange as most NHS contracts with private hospitals in London, finish at the end of August.
From the 1st of September, our opening hours will increase to 9 am to 6 pm on weekdays and 9 am to 1 pm on a Saturday morning.
To minimise risk to fellow patients, we ask that you come alone and on time to your appointment and for only one parent or guardian to attend with children.
We will check your temperature at the entrance to the reception area, and, as long as it is safe to do so, ask you to return home if it is found to be raised – one of our doctors will phone you to discuss next steps.
You will still be expected to wear masks and to gel your hands on arrival, and to remain seated in an allocated area in the waiting room away from other patients.
What do I do, if I or my child has a fever?
For those of you who develop ANY potentially infective illness over the autumn and winter months, please phone and ask to speak to one of us.
We are here to help 24/7, although it is likely that we will initially aim to manage your symptoms by means of telephone advice , provided it is safe to do so.
Whilst this may at times feel frustrating, it is important that we keep our staff and other patients in the building safe-particularly as an infected patient in the building, could lead to an inconvenient and worrying two-week quarantine for those in the building at the same time- and even temporary closure of the practice.
If a face-to-face assessment is necessary, then we will arrange this where possible away from the Practice building.
If any of you are experiencing symptoms which could be due to Covid 19 – particularly cough, shortness of breath, fever and loss of taste or smell, then please phone the practice for advice from one of our doctors, about assessment and testing.
Whilst we will be able to organise a test for you, a free test can also be organised quickly via the local NHS service at a number of local ‘drive-through testing sites. Either go to gov.uk or dial 119 to arrange a test. Results are consistently available within 24 hours.
Testing and Quarantine
We continue to offer Government approved testing both for antibodies (the “Abbot “blood test), and also the nose and throat “PCR” antigen swab which tests for active infection.
There has been some speculation in the media that a negative antigen test taken on Day 7 of quarantine would allow the current 14 day quarantine period to be reduced.
Although there is evidence from a study conducted by Imperial College that this is an effective, evidence – based approach, the UK government have not yet approved this.
You should also not attend the practice for any swabs during quarantine. If necessary, we will arrange for swabs to be sent to your home for self-testing if you still wish to be reassured that you are not carrying the virus.
Rapid saliva testing for COVID-19 infection
Saliva testing for active Coronavirus infection is currently being trialled at a number of Accident and Emergency departments in the UK, including at Chelsea and Westminster hospital.
Provided these tests prove to be accurate (and evidence from Yale University suggests that they are], this will be an enormous step forward.
Testing saliva will be easier, cheaper and quicker than the current throat and nose swab (one company- Quantum -claims to be able to get a result within 10 minutes).
The government however, is wary of approving such tests until they can be completely certain that they are accurate, given the confusion over antibody and antigen testing earlier this year.
Frustratingly, it is therefore likely to be a few weeks before these tests become widely available – watch this space!
Blood groups and COVID-19
An interesting study (from China) has shown that your blood type can affect your susceptibility to COVID-19 (although does not appear to influence the severity of the illness).
Those least susceptible belong to blood-group O and those most at risk blood belong to blood Group A.
This is thought to be due to the production of antibodies by individuals with Blood Group O that partially inhibit the virus from binding to ACE-2 receptors (the portal of entry into the cells by the virus).
These antibodies are not produced by those with Blood Group A.
Whilst this is very interesting, as we cannot change our blood type, it not a practical option for disease prevention!
Hopefully this covers the main current points of interest but please feel free to e-mail us with any questions to enquiries@courtfieldpp.co.uk and one of us will be delighted to answer them.