90 Sloane Street: The Coronavirus Covid 19. 

20th March.

 Personal Protection and Risk Reduction

The Key risk areas are supermarkets or chemists. We would advise wearing a protective mask, ideally an FFP3. Also, you could consider something to cover your eyes – maybe glasses or even protective goggles. This sounds strong and extreme, but it only takes one cough from somebody just behind to give you Coronavirus. There can be a long queue in a chemist waiting for medicines, and they may be people who are unwell.

We feel that while isolation is being recommended, it may be reasonable for people to go out for walks – unless the government decrees against this – so long as they keep more than a good distance from other people. To be safe, we would suggest keeping something like 4 metres away from anyone so that if something happens, one has at least got some meterage to spare.

Protective Masks

FFP3 masks are the best type for everyday use. These have materials which filter the air when you inhale. When you exhale, a valve opens and lets the air out of the mask. On re-inhalation the valve closes, and you suck the air in through the mask material. It is necessary to check that you have a close fit, so that when you breathe in you see the material of the mask moving in towards your face, so you know you have a good seal.

As mentioned above in at-risk situations we are pretty close to thinking it is sensible to wear some protective eye cover. The route for the virus to enter you is through your mouth, your nose, and your eyes.

Elderly Patients & At-Risk Groups 

The government believes this virus is going to go through the majority of the population before it is stops. (A vaccine may well be a year away). Only when about 60% of the population has been infected is there a chance of the effect of herd immunity. The best way of doing this, therefore, is to have younger   people, who are at less risk of serious complications, take on the infection to spare those at higher risk of serious complications.

For high-risk groups it is sensible to be very careful about who comes into your home. It may be that you have a cleaner who is mixing with many others who may be at risk of COVID-19. It could be sensible to not have that person coming in as they may be your largest risk element. This again sounds very tough, but we really need to protect high-risk people from contracting Coronavirus. By taking a few simple measures one really can reduce the risk enormously.

Exercise

We would like to emphasise that taking exercise such as walking is important for your health and morale and will not put you at risk so long as you keep a decent distance from people.

Oxygen Saturation Meters

As per our emailed letter of 14th March, we see having oxygen saturation meters in your home as being the key management item of this illness. It is unpredictable who will have the more difficult and complicated illness course from COVID-19. Therefore, having an oxygen saturation meter will mean that if you develop the infection we can keep an eye on your saturation and if it is still good then we will feel reassured – however much you are aching or coughing.

How to use an Oxygen Saturation Meter

  1. Insert the batteries and read the instructions. You may find you need to try one or two different fingers. Sometimes it picks up some venous flow rather than true capillary flow and may give false low readings. Therefore, we tend to hunt around trying different fingers to find the highest reading and that is the one that counts.
  2. They may not work when wearing nail varnish.
  3. A normal oxygen saturation is between 96-98%. If you have long-standing lung disease, it may be that your oxygen saturation runs at a lower level.
  4. Illness monitoring

If your oxygen saturation drops to 94% or less, it is definitely sensible to make contact with a GP or 111. If the oxygen saturation were to fall to close to 90%, then it is likely that you will need hospital admission and you should dial 999. You can contact us as well for further advice.

Hospital Admissions

At present we think that many insurance companies are not covering admissions for Coronavirus. Also, the private hospitals seem not to be wishing to take Coronavirus cases. However, many of the private hospitals will probably be involved in government contracts. We think that obtaining private admissions for Coronavirus infections is therefore likely to be more difficult, but we are monitoring this.

How can 90 Sloane Street help you if you think you have Coronavirus

We are doing a considerable number of telephone consultations. If you ring reception and book, a time will be made for your GP to speak to you.

We feel that telephone consultations, can be very helpful and supportive, together with an oxygen saturation meter. There will naturally be a charge for these telephone consultations

However, there will be circumstances where people may have chest pains, significant shortness of breath, or borderline oxygen concentrations. We are determined to help you and we have a large amount of protective clothing equipment, so we feel entirely prepared to see patients when sensible. We think patients just being left at home to fend for themselves with no monitoring or observation is far from safe.

The Practice has also bought many spare stethoscopes and blood pressure cuffs so we can decontaminate and clean them properly. We were also lucky enough to pre-stock extensively in terms of our medicines, so we have considerable supplies of antibiotics for patients who need them. We do not advise stockpiling of antibiotics at home, other than for patients with chronic conditions when it is sensible.

Separately we have purchased several nebulisers in case people become wheezy and need nebulised salbutamol – which is the common medicine we use to open up airways for people who are wheezy. For patients who are unwell with lower oxygen saturations, we may – whilst sharing with our hospital specialist colleagues – consider giving you an oxygen concentrator to try and give you higher levels of oxygen to see if this will keep you safe level at home. It may also be that we can help some patients be discharged earlier from hospital when they are making good recoveries but still dependent on oxygen.

Whilst many patients have asked about buying oxygen concentrators, we do not advise them except in extreme cases, so that there are enough available for those who really need them.

There are also difficulties in obtaining oxygen concentrators with many of them having long delivery times that you only discover when you are just about to complete the purchase. If you are at risk, and feel that you wish to buy an oxygen concentrator, then you need to buy one that will have a variable flow rate of between 1-5/6 L (the 6 litres being the maximum flow rate) so that you can have a higher level of inspired oxygen. For any patients who do buy oxygen concentrators, they will also need to buy the tubing for having nasal prongs (which you place into your nostrils) or a mask. It is often useful to have both types of delivery system and several spares.

Separate Location for seeing patients who may have Coronavirus

Please do not come to the surgery if you have a temperature or cough, but ring Reception who will ask a doctor to speak to you and who will advise best you. We are very lucky in that we are likely to be able to use 51 Sloane Street for seeing sick patients with potential infection, thereby keeping 90 Sloane Street as a safe place for routine medical care.

Drug Treatment Developments

Chloroquine

There is serious interest and hope in Chloroquine. Speaking to the Royal Brompton today they are starting to treat patients with it and are impressed and sincerely hopeful of the difference it can make, while it is early days. Chloroquine has not been available for many weeks in pharmacies and all supplies have been commandeered by the government solely for hospital use.

Hopefully as it is a cheap drug to manufacture and off patent, (being a commonly used antimalarial) supplies will develop quickly.

We have less information on antiretroviral and will provide updates as we gain knowledge from the journals.

Ibuprofen & COVID-19

There has been some controversy about Ibuprofen. It is advised that for pain relief and lowering temperature one should initially use Paracetamol. The clarity on whether Ibuprofen could put people with Covid 19 at more risk at the moment is equivocal and therefore it is not a first choice.

Blood Pressure Treatment – ACE Inhibitors & Angiotensin Receptor Blockers

These are drugs ending in ‘pril’ such as Lisinopril and Quinopril – ACE inhibitors, or drugs ending in ‘sartan’ such as Candesartan or Losartan – which are ARBs. There has been a query as to whether these may increase risk. The European Society of Cardiology has said that they feel patients on these drugs should continue with them and that the evidence is not strong enough to suggest any change. If there is new knowledge, then we will try and update you with this.

COVID 19 and Testing

The stopping of routine 111 testing in the community means that many people now do not know if they have or have had Covid 19 infection. This has made everything much more complicated.

Please see Bulletin 2

Serological Tests

New tests have come out which measure antibodies in the blood to Covid 19. They look for IgM which is the first antibody to appear when you have an infection. They also look for IgG which is the immune system’s memory antibody which is produced later but stays forever as a marker of immune memory, whereas usually IgM disappears.

Some test kits are coming onto the market for these Covid 19 antibodies, rather like a pregnancy test. You drop a small drop of blood into a receptacle container and then add it on to the well similar one does with urine on a pregnancy test kit but with blood. You then add a buffer to it. There are different lines that show up on the plastic strip indicating if you have the presence of IgM antibodies, meaning a recent infection, or IgG, meaning you have had it sometime in the past.

While this is exciting and a really important development, there is no evidence that these kits as yet have had adequate validation. Normally when we do serology, which is the measurement of antibodies in the blood, they will give us a specific value, it is not normally binary, such as these Covid 19 testing kits.

We are glad of these developments and validated testing will hopefully be soon on its way so that those people who have had the infection can have proof and feel reassured and able to get on with things. In the knowledge that they are likely to have quite a degree of immunity unless the virus is to change.

Future Updates

We will regularly update this web site, so as to be able to communicate advice and developments.

Please look at it from time to time.

This edition has been general and broad in coverage. In future we will share more detailed information, specifically from medical journals.