Hand Hygiene
COVID19
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CORONAVIRUS FAQ

Our local Covid-19 (Coronavirus) expert, Dr Matt Watts answers your queries about the Virus

If you are looking for immediate guidance on Coronavirus, please consult the NHS information here.

Below you will find further information about the virus, how it spreads, the precautions you can take, the symptoms and also information on social distancing, shielding and self isolation.

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Symptoms and treatments

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How can I tell if I have Coronavirus?

The short answer is that it’s very difficult to tell for sure, but since the Coronavirus is rapidly spreading in the UK at the time of writing (March 2020) then, if you get a new cough, cold, or flu like illness then it’s very likely that Coronavirus is the culprit.

 

However, the two key symptoms are fever (a temperature above 37.8C) OR new continuous cough. You do not need to have both symptoms.

 

However, any symptom you might get with a viral illness can occur: Fatigue, shortness of breath, aching muscles, sore throat, headache, chills, nasal congestion, nausea or vomiting and diarrhoea have all been reported.

 

One interesting emerging theory is that this Coronavirus causes a loss of taste or smell, and this symptom may occur a few days before becoming unwell with any other symptom. This is important, because it’s an unusual symptom that doesn’t occur as often with other viral illnesses, so may help to tell Coronavirus apart from another cough or cold.. However, we must stress that this has not been reliably confirmed, and it is certainly possible to have Coronavirus without having a change in your sense of taste and smell.

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Do I need to call a doctor if I think I have Coronavirus?

Not unless you are significantly unwell or are in a high risk group. You will most likely get symptoms much like an ordinary cough or cold, and, like any other ordinary cough or cold, these do not need medical attention.

 

Take Paracetamol, drink plenty of fluids and follow the self isolation advice

 

You can expect to have symptoms for around 7 to 10 days. After that you should significantly improve.

 

Of course, you should contact a doctor if you are concerned you are becoming more unwell with Coronavirus symptoms, via the 111 service.

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What treatments are there for Coronavirus?

We’ve all heard “There is no cure for the common cold”. Unfortunately, because this Coronavirus is very similar, the same is true, even though it is much more deadly. There is not, yet, any single drug we can give that we know will “kill” the virus.

 

All over the world research is going on at a pace which is absolutely unprecedented. 50 scientific papers were published on COVID-19 in the first 20 days of it’s discovery in January. By the end of February, there were over 300. At this point we are into the thousands.

 

One of the problems is that there is so much research going on, it’s very hard to spot the really important trends, and the media will often pick up on a single research paper, without looking at how it fits into the wider picture. For this reason you should be extremely cautious about any new report claiming “scientists have found a cure” or naming a particular drug as a “wonder drug” for COVID-19.

 

Just because there are no established treatments which “kill” the virus doesn’t mean nothing can be done. Usually, given time, a person’s own body can and will deal with the virus, but will need medical support while it does so. This can include extra IV fluids, Oxygen, sometimes ventilation – a machine which inflates the lungs for a patient if they cannot breath for themselves.

 

Most cases of coronavirus will need none of these things, but you can help yourself at home by taking paracetamol for high temperatures , and drinking plenty of fluids. When fighting an infection, your body typically uses more than twice as much fluid as normal, so bear this in mind in your fluid intake.

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Virus transmission and reducing the risk

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How can I catch the Coronavirus?

Coronavirus get into the body through “mucous membranes”. That means any moist surface of the body: The nose, the mouth, throat or eyes. If a Viral particle comes into contact with one of those areas, it is likely to cause infection.

 

There are 3 main ways this can happen:

 

  • Large droplet transmission – When people talk, cough or sneeze, tiny  droplets of moisture travel out into the air. These contain viral particles, which can come directly into contact with another person, by being inhaled. The most dangerous distance for this is within 2 meters of another person, but we should be aware that in fact, this spread may occur at greater distances, so 2 meters is a minimum recommended distance. Larger distances are better

 

  • Fomite transmission – A fomite is any surface that a virus travels on. Bob has the virus, coughs on his hand, touches his computer keyboard, transfers the virus to the computer keyboard, Sally then touches the keyboard, then touches her hand to her mouth and contracts the virus. In that example, the computer keyboard is a “fomite”. This is why the wash your hands  message is so critical.

 

  • Fine aerosol transmission – This is similar to the first kind of transmission, but requires the virus particle to be hardy enough to survive, not in a comparatively large droplet of fluid, but bound to specks of dust or particles in the air. The difference with this, is that if a virus can do this it can “hang” in the air of a room for hours and remain infective. Initially, it was thought that SARS-Cov-2, the Coronavirus could not spread like this. However, a study published on 17th March 2020 in the New England Journal of Medicine has demonstrated that virus particles can survive in the air for at least up to 3 hours and still be viable to infect cells in a lab. This makes it likely some degree of fine aerosol transmission is possible. This makes transmission in public places extremely difficult to combat even by two meter social distancing, and is one of the reasons why increasingly we may see the government moving to ever more stringent measures of “lock down”. 

    https://www.nejm.org/doi/10.1056/NEJMc2004973

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How long can coronavirus live on surfaces?

Any surface the virus lands on can become a surface which the virus can then be transmitted to another person from. We call these surfaces “fomites”. The virus can live on different surfaces for different amounts of time.

 

A study from The New England Journal of Medicine suggests the following times for how long the virus can live on different surfaces:

 

Copper – up to 4 hours

Cardboard – up to 24 hours

Stainless steel – up to 48 hours

Plastics – up to 72 hours

 

It should be noted this is the time for there to be virtually no detectable viral particles. The viral particles reduce gradually over that time, so the risk of infection on the surface gradually drops to zero over that time, and we don’t know exactly how many viable viral particles need to be on a surface to cause human infection.

https://www.nejm.org/doi/10.1056/NEJMc2004973

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How can I reduce coronavirus transmission risk in my home?

It can be tempting to either not worry at all and carry on as normal, or, to go overboard and think you need to clean everything all the time.

 

What is important is to be logical and divide every surface and object into your house into “exposed” and “unexposed”.

 

The virus cannot “appear” anywhere by magic. It can only get on a surface if it has been transmitted to that surface. So your stuff tucked away in cupboards for months cannot have the virus on it, but your front door handle, which has been touched by many people might though.

 

Two things can kill the virus: Time and Cleaning

 

Given enough time, the virus will die on most surfaces. Current research  suggests it will live for up to 24 hours on cardboard, 48 hours on some metals, and 72 hours on some plastics. You could consider leaving packages arriving in the post unopened for 24 hours to allow time for the virus to die.

 

The virus can be killed on any surface with the use of any disinfecting cleaner, or even soapy water. It dies quite quickly on fabrics, and is killed by high temperature clothes washing

 

If you wish to take every measure possible to keep your internal home environment clean, consider any item that comes into your house, and any surface that item then touches to be an infection risk.

 

Consider therefore having clothes you wear outside the house, and clothes you wear inside the house. Change immediately from one to the other when you come in.

 

Most importantly – wash your hands between touching things which may have been exposed to the virus, and things which have not to avoid contamination of the rest of your home.

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Virus information

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What is a virus?

We have heard about  “coronavirus” it is worth answering a more general question: What is a  virus?

 

Inside each cell of your body is your DNA, the blueprint for your body.  DNA is a long chain of proteins strung together. Your DNA contains instructions for making new copies of cells in your body.

 

Each cell of your body copies itself to make new cells, for growth and repair of your body, using the copy of DNA – the blueprint – that the cell has stored within it.

 

Viruses are nothing more than strands of DNA (or RNA – which is very similar). DNA will break down very quickly floating about in the air, so the virus has its DNA wrapped in a layer of fat to protect it.

Soap breaks down fat. Which is why washing your hands is so important – it destroys the protective fat layer around the outside of the virus and destroys it.

 

If you don’t wash your hands, the virus gets into the body, and invades your cells, replacing your DNA with virus DNA. It changes the “blueprint plans” inside your cell, replacing them with instructions not to make new copies of the cell, but to make new viruses. The cell can’t tell the difference, so when it tries to make a copy of itself, it will produce copies of viruses instead. The virus turns cells in your body into virus factories – which in turn invade more healthy cells – making more viruses.

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What is Coronavirus?

Coronavirus is actually a family of viruses. You will have almost certainly have caught one of the other members of the family in the past – they cause common colds, and flu like illnesses.

 

However, in recent years a few new Coronaviruses have cropped up. The one at the centre of this outbreak is called SARS-Cov-2, and illness that it causes is called “Coronavirus Disease 2019” – which is shortened to “COVID-19”.

 

It’s got a “2” at the end of it’s name because SARS-Cov-1 was the “SARS” virus of which caused a number of deaths during a smaller outbreak a few years ago. The two viruses share some some similarities, but are also very different.

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So if Coronaviruses normally cause common colds, why is this Coronavirus so deadly?

In one sense, the COVID-19 virus is  just another coronavirus – which is why for a lot of people it will do nothing more than give them a mild or moderate flu like illness, but there is a problem:

 

The COVID-19 virus is a brand new virus to humans. Your immune system has never “seen” it before, and doesn’t know how to fight it. That makes your bodies response highly unpredictable.

 

The one group for whom that isn’t usually a problem is children. For children, every virus they meet is brand new, and their immune system works in a very different way as a result. That’s why, for children, catching COVID-19 coronavirus is often very much like catching any other virus for a child. They might get a cough, a cold, a temperature, and improve again in a few days. It is extremely rare for a primary school aged child to get seriously unwell with Coronavirus infections.

 

(Please note: Babies and very young children are a different to older children. Any feverish illness in a baby under 3 months of age should be very urgently assessed by a doctor, and any pre-school age child who seems more than mildly unwell with a feverish illness is worth discussing with a doctor if you have concerns.)

 

However, something happens to our immune system as we become adults. It is no longer as good at learning how to cope with brand new viruses as it was when we were children.

 

This is why chicken pox is generally a mild illness if you catch it as a child, but if you somehow avoid it as a child and don’t catch it until you are an adult you can become seriously unwell with it. Chicken pox can even be occasionally fatal for an adult.

 

When a brand new virus like SARS-Cov-2 comes along, we are all put in the same position as an adult who hasn’t had chicken pox – we just don’t know how our immune system will react if we catch it, and the risk of a bad reaction rises the older you are.

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Self isolating, social distancing and shielding

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I’m confused about Self Isolating, Social Distancing and Shielding? What’s the difference?

Self Isolating – This refers to the process of keeping yourself separated from other people by staying completely at home when you either have symptoms of Coronavirus, or other people in your household have symptoms and you might be incubating them. This will be for between 7 and 14 days.

 

Social Distancing – This refers to a wide range of measures everyone should be taking to prevent the spread of Coronavirus. This includes not handshaking, keeping at least 2 meters apart, working from home where possible, and not making unnecessary social contact. This will be ongoing throughout the crisis.

 

Shielding – Some individuals who are at particularly high risk of getting seriously unwell or dying from Coronavirus will be completely stopping going outside their houses. This will be for the duration of the crisis.

 

Note: The “social distancing” measure for everyone now includes not going outside apart from essential work, and essential journeys for food or medical reasons, or one act of exercise per day. This now means that these three different terms overlap somewhat.

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Questions on Self Isolation

When should I self Isolate?

 

You should self isolate if you or any member of your family have one of the two key symptoms of Coronavirus: New Continuous cough, or a fever (Temperature raised about 37.8C).

 

You should self-isolate for the full period of time you are supposed to isolate. It doesn’t matter if you feel better before the end of this time – still self-isolate for the full period of time.

 

If you have a fever for any amount of time – you should start self isolation.

 

Many people are confused about what is a new continuous cough.

 

First, it must be “new”. If you have had a long standing cough, you do not need to self isolate unless there is a sudden change for the worse in your cough.

 

Second, it should be “continuous”. There is no very clear definition of this, but if you have had more than two or three bouts of coughing in one 24 hour period, you should start to self isolate.

 

How long should I self isolate for?

 

The key thing to remember is that if you catch Coronavirus, you could be infectious for up to 14 days before you show symptoms, until up to 7 days after the symptoms start

 

If you develop symptoms – you should self isolate for 7 days from the start of the symptoms – either a new continuous cough, or a fever (temperature >37.8C.

 

If someone else in your house has symptoms, you should isolate for 14 days from when they started to be unwell. If you remain well at the end of that time you can leave isolation. However, if you develop symptoms yourself at any point during the 14 days, you should start to isolate for 7 days from the day that you became unwell. 

 

For example: If you became unwell on day 14, for example, you would need to self isolate until day 21. If you became unwell on day 2, you would be free to leave isolation earlier than originally planned, on day 9.

 

How should I self Isolate?

 

Self-isolation means coming into the minimum amount of contact possible with any other human being. Go home and stay there. You should under no circumstances come into contact with someone outside of your household apart from in an emergency. While the two meter rule is a good general rule for “social distancing”, if you actually know you are infectious, even this is not really sufficient, and you should try and avoid any face to face contact with other people whatsoever for the full period of isolation.

 

If other people in your household do not yet have symptoms, but you do, you may wish to isolate from them as well in order to prevent them from catching the infection. However, if you all live together, it is very likely they will have caught it from you before you started to show symptoms, so isolating from them may be ineffective. You should still do this if you have anyone who is in a vulnerable group in your household.

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Questions on Social Distancing

I’m washing my hands regularly, and staying 2 meters away from people. Am I social distancing enough?

 

No. Not anymore. The guidance has changed. This is partly due to the spreading nature of the epidemic, and partly due to learning more about the nature of the Coronavirus.

 

Social distancing for everyone now means:

 

Stay at home. Leave your house only when it is essential to do so.

 

Work from home. Only go in to work if you cannot work from home.

 

Avoid any gathering of more than two or three people, other than the people you live with, in person, at any time for any non essential reason.

 

I’m young, fit and healthy - should I be Social Distancing?

 

Absolutely YES. In the early phases of the outbreak, government advice was initially a little unclear on this point, and led people to believe that only the elderly should be social distancing, but the guidance to everybody is now extremely clear. You should not be leaving your house without extremely good reason to do so. You should work from home if you possibly can. Stay at home.

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Questions on Shielding

What is shielding and how is it different to social distancing?

 

The gap between “social distancing” and “shielding” has narrowed, because government advice to everybody is to not leave the house unless essential to do so. However, those in the shielding group, who are the most vulnerable,  are advised to not leave the house for really any reason other than a medical emergency. This includes shopping, or collecting medication. They are advised to make arrangements for delivery for these things. Government plans to make provision for helping with this, but the plans on exactly how this will happen have not fully taken form yet.

 

How do I know if I should be shielding?

 

There are three groups of people who should be shielding and all of them should be informed.

 

The first group will get a text message or letter from the government telling them that they should be, (Please note, the government has sent everybody in the country a text message telling them to stay at home – the shielding text message is different)

 

The second group will be informed by their hospital consultant or their team.

 

The third group will be informed by their GP.

 

The first group have already been informed. Notification of the other groups will be forthcoming over the next few days and weeks.

 

I haven’t been told I should be shielding, how do I know if I am in the shielding group?

 

It is worth noting that age alone, if you are otherwise fit and well, is not a shielding reason, although of course, you should be taking very strict social distancing measures, which are, in fact, very similar.

 

If you are simply elderly, but otherwise well, you may choose to act as if you are shielding, and have someone deliver food to your house etc, and not leave. This is a sensible measure to take, particularly for the extremely elderly, but will not put you in the “official” shielding category.

 

The shielding group is largely made up of those people who stand the most risk of becoming seriously unwell if they develop COVID-19 illness from the coronavirus, and in particular, those most likely to require ITU care if they become unwell. It consists of the  following:

 

  • Organ transplant patients
     

  • Patients with cancer undergoing active chemotherapy or radiotherapy and other special cancer treatments (immunotherapy, protein kinase inhibitors, PARP inhibitors)
     

  • Patients with Leukaemia, lymphoma or myeloma
     

  • Bone marrow transplant patients
     

  • Severe respiratory illnesses: Cystic fibrosis, severe asthma/COPD
     

  • Rare diseases of the metabolism (e.g. SCID, Sickle Cell Disease)
     

  • People on high doses of  long term immunosuppression medication (Including: Cyclosporine, cyclophosphamide, azathioprine, leflunomide, methotrexate, mycophenolate)
     

  • Pregnant women with heart disease
     

  • If you have had your spleen removed
     

  • If you are taking more than 20mg of Prednisolone daily, on a long term basis (more than 4 weeks continuously)
     

  • Other patients assessed by their GP or specialist as being at especially high risk