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Advice and Guidance Shared by Shropshire Health Boss on Coronavirus and How People Can Stay Safe

Advice on how people can stay safe, and keep others safe, during the coronavirus (COVID-19) outbreak, has been shared by Dr Julian Povey, GP and Chair of Shropshire Clinical Commissioning Group (CCG).

Speaking on the Jim Hawkins Show for BBC Radio Shropshire, Dr Povey impressed to listeners how everyone should be practising social distancing (reducing social interactions in order to reduce the transmission of coronavirus), as well as washing their hands frequently and for at least 20 seconds.

For those individuals with symptoms of coronavirus, (a new continuous cough and/or a high temperature) it is imperative they are kept away from healthcare facilities, such as GP practices and A&E’s.

If an individual’s symptoms get worse their first port of call is 111 online (111.nhs.uk).

During the interview, Dr Povey also took a number of questions from listeners ranging from coronavirus symptoms, to what to do if a person has underlying health conditions.

To listen to the full interview, just click here.

Questions:

What are the symptoms of coronavirus?

Coronavirus is a very infectious viral disease that originated in Wuhan Province in China but now has spread across the world. 

The predominant symptoms for people to look out for are a new continuous cough and/or high temperature - although it can look a lot like seasonal flu.

The key thing is that we have to follow the Government’s advice on social distancing. If you get the symptoms, you need to self-isolate for seven days. Those living in your household will need to isolate for 14 days. 

If you have symptoms, how long are you ill for, and at what point do you start feeling better?

The advice is that you need to self-isolate for seven days from the first symptoms, so the majority of the severe infection is in that first period of time. After that you can continue with a cough.

You will feel unwell for between five and ten days from the start of the first symptoms, but a lot of people will be reasonably better within the first week.

What we know is that 80% of people will either have no symptoms or minimal symptoms, 15% will have severe symptoms, and 5% of people will need to be ventilated and looked after in an intensive care unit.

How long could someone have been carrying the virus around before the first symptoms appear?

It’s difficult to know, but there is an incubation period - the time between when you first get the virus and when you exhibit the symptoms. This can be anywhere between a few days and a fortnight.

There is no exact answer, but we suspect that people are spreading the virus very early in the illness. That’s why as soon as you get the symptoms you MUST self-isolate.

With self-isolation, what ideally would you want people to do?

You need to self-isolate either when you have symptoms, if you are in a household with someone with symptoms, or if you are in the very vulnerable group that will be written to directly with advice this week.

You will need to stay in your house, plus if there are other people in the household you will need to stay two metres away from them.

You will need to do everything remotely, so if you need to speak to the doctor or the nurse you will need to do so either over the telephone or online. People will also need to leave things outside your door if they are bringing things to the house. 

It may be that people with symptoms need to be seen by a health professional, but it will be explained to patients how to get this help.

If your condition deteriorates when you are in isolation, the first port of call is 111 online (111.nhs.uk), if you have access to the internet. If not, then you will need to call 111.

There have been reports of significant delays on 111 calls – at what point should you call 999 instead?

If you have severe breathing difficulties, are unable to speak in sentences, are feeling incredibly short of breath at rest, or are deteriorating rapidly, then you should call 999.

However in less severe instances, 111 online should be your first port of call or ring 111 if you don’t have online access. 

I have high bloody pressure which is controlled by two separate lots of medication, and my kids are very concerned because I need to get some general food shopping. My daughter is messaging me saying I’m not to go out because I’m classed as ‘high-risk’. Can I go out or do I stay in for the next 12 weeks?

There is a new group that will be contacted directly this week and these people will need to stay in strict isolation for 12 weeks, however this individual wouldn’t fall into that group.

The 12 week isolation period is for a very specific group of people including those who have had organ transplants, specific cancers and having chemotherapy or immunotherapy, very severe respiratory conditions; cystic fibrosis, severe asthma, severe COPD, genetic disorders and people on immunosuppressant’s.

But for everyone we are advising social distancing, which means only doing essential journeys.

Basically the vulnerable group where we recommend stringent social distancing are people who would qualify for the free flu jab. So that’s people over 70, people with long-term respiratory problems, long-term heart disease, kidney problems, liver disease, Parkinson’s, multiple sclerosis, problems with their spleen or weakened immune systems, for example.

If you need to go out for essentials, that’s fine, but you need to limit to essential journeys (food, medicines or seeing your doctor) and to ideally keep two metres away from people.

 

Am I still okay to take my dog for a walk?

Exercise is very important but we need to do so two metres away from anyone else, or solo.

It’s about being sensible - this is going to go on for a long time so we need to have a way of looking after our wellbeing and mental health.

However this does not apply if you are in that very strict group - those people who will be written to. These people will be asked to go to more extraordinary efforts and will need more support.

There is a website currently being developed for those people who don’t have that community support – this will also be explained in the letter that goes out to these patients.

My husband has Stage 3 COPD and is therefore vulnerable, I work in a Primary School, so if my husband has to isolate for 12 weeks will I be off for the same length of time?

 

A large number of people with COPD will be in the vulnerable group and therefore advised on stringent social distancing rather than 12 weeks of isolation. But, if you are living with someone in this group you need to try to maintain boundaries within the house where possible, and stay two metres away.

If you’re in the isolation group, with severe respiratory conditions, then try to keep them in a different room, use different bathrooms, and stay away from each other as much as possible.

I work in a doctor’s surgery on reception, so I’m dealing with patients, but I’ve also had a mitral valve replacement, and I’m looking after my mum who’s 91 and has emphysema. Am I at risk and should I be going to work?

With the mitral valve replacement, this individual falls into the vulnerable group and we try to recommend stringent social distancing. Ideally that would mean working away from direct patient contact.

In a GP practice it would be sensible to work away from the frontline – perhaps some back office work, or if possible working from home.

Try to separate things in the house, try to stay two metres away from each other to limit that contact.

We still need key workers but it needs to be a balance, so if you’re in that vulnerable group you’ll need to speak to your employer about minimising your exposure to others.  

I’ve asked the pharmacist if he’s selling masks and he said ‘yes’. I’m over 75 but can I use a mask to go over to my chemist or the Spar and come back?

At 75, you are in an at-risk group so you need to take those stringent social distancing measures.

Evidence also suggests that masks aren’t really going to do anything – they might provide false reassurance and make you touch your face more.

The message is to make sure you are washing your hands frequently, use gels if possible and don’t touch your face because that’s how the infection will spread.

Certainly, if you have the infection then having a mask may limit the spread of droplets, so for healthcare professionals who are caring for people they need to wear a mask. However for an individual popping to the shops they won’t be particularly effective.

One thing that is important is that people don’t need to order medicines early, or order medicines that they haven’t used for a long time through our Prescription Ordering Direct (POD) service.

We are seeing a huge increase in the levels of calls to the service which has led to an increase in the number of staff as well as an email ordering service being set up.

I can understand why people are scared but the supply chain is fine for medicines. We are asking patients not to order their medicines too early and also not to order them unnecessarily.

There is also advice that if you have a week’s worth of medication - don’t contact POD, you only need to do so if you are running low.

I’m going into hospital for an emergency procedure to have the stent redone in my heart and the consultant has brought it forward to Friday. I’m wondering how safe the hospitals are?

At the moment the situation around the country is rapidly evolving. Hospitals in London are becoming very busy and they have to divide the hospitals up into two sections - one section looking after those people with coronavirus and the other for people without it.

Locally, we are not experiencing these problems and the hospital would not continue with the procedure if it was deemed to be unsafe.

The two hotspots are London and Wolverhampton. Given Wolverhampton’s just down the road, why is that and how concerned should we be about this?

It seems to be the bigger, specialist hospitals that have been getting the patients with coronavirus (mainly due to their facilities and equipment) but as the situation evolves, other hospitals will probably be affected in the same way. We’re in the foothills of the problem and it’s only building up.

As a GP, are you still seeing people face-to-face?

Things have changed dramatically over the last week and we’ve moved towards a triage system where we are advising anyone with symptoms of coronavirus to contact 111 online. We are also trying to deal with patients remotely via telephone or online.

We are trying to limit the number of people we see, plus we are encouraging everyone to socially distance to reduce the risk of catching the infection and then spreading it. Most people will find at the moment that their healthcare will be done remotely.

If you are a possible coronavirus patient, your surgery will give you instructions on what to do which could mean using a separate entrance or a separate room.

It’s likely that we’ll see this change over the coming weeks as the situation evolves.

People who have been following the number of confirmed cases in their council area are seeing the figure for Shropshire, Telford and Wrekin vary between 0 and 4. Who is being tested and can we trust these numbers? 

Testing is now targeted at those people who go into hospital with respiratory symptoms or who are in intensive care.

There will be an antibody blood test developed soon to check whether patients have had coronavirus which will no doubt be very useful to have.

A widely shared Facebook post says that COPD patients can contact their GP practices for ‘rescue packs’ – can we get some clarification on this?

People who have COPD are very prone to infections so we provide them with antibiotics that they can be used if their condition deteriorates.

Because coronavirus is a viral infection the only real help is supportive care for these patients.

COPD patients will previously have had discussions with their GP, or their COPD nurse, and had these recuse packs already. If you’ve had one before, it’s likely you will be offered one again. However, if you have not it’s a good idea to ring up your GP and discuss this with them.

My wife is over 60, works for the NHS and has Type 2 diabetes and high blood pressure. She’s in a sealed department, there are no windows, and it is ventilated by air conditioning - is she okay to work?

She is not likely to be in the self-isolating group but in the vulnerable group where we encourage social distancing, as well as different ways of working.

Obviously home working is not available to everyone but it is worth a conversation with her line manager. 

I am Type 2 diabetic with high blood pressure, and it’s not well controlled. Do I need to stay at home? Likewise; a key worker who is Type 1 diabetic also asked what the best thing is to do.

Again, both of these people are going to fall into the vulnerable category where we want people to stringently look at social distancing.

Generally, and for most people, the main risk is your age, diabetes will give a slight increased risk but it is the elderly groups who are really hit hard by the illness. As your age increases, the risk increases as well. 

For the latest information on coronavirus (COVID-19), including the symptoms and how to slow the spread, please visit: www.nhs.uk/conditions/coronavirus-covid-19.