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14th July 2020 –

Re: Webinar – Coronavirus in Leicester with Professor Ivan Browne (Director of Public Health), Dr Aruna Garcea (GP), Dr Rajiv Wadhwa (GP), and Dr Tariq Kapasi (Chair)

The webinar on Thursday 9th July over Microsoft Teams hosted by Willows Health in conjunction with the Primary Care Networks of Leicester City. We hope the information presented is useful for you. The thirst for information on the subject, and the number of questions the people of Leicester had was unprecedented. We had over 2500 logins to this extraordinary online meeting – we suspect over 5000 people of Leicester attended. During the webinar over 600 questions were asked. Professor Prasad and the team tried our very best to answer some of those during the webinar, but we were unable to answer many of them (simply because of the sheer volume of them). We have tried our best to highlight he questions which are of the most relevance and provide answers to them on this question and answer sheet.

We are an organisation which is continuously trying to learn and provide a public service to the people of Leicester. In view of this, we plan on arranging a follow up webinar very soon. We intend on recruiting several front-line Doctors to answer the questions on the chat whilst the webinar is in progress. This will allow a more direct response to many of the questions asked.

It has taken a few days to formulate the answers as we are all front-line active clinicians. Just a note and a disclaimer to the answers given – the data and evidence is rapidly evolving, and the guidance may change substantially by the time you have read this document.

Please do check our website as it contains videos on Coronavirus in 16 different languages.

Finally, the questions and answers below need to be read in conjunction with watching the webinar. They are not in themselves a tool for guiding how to manage the lockdown in Leicester.

Our best wishes to you. Stay safe and stay united.

The Willows Health Team

Q&A

1. What is the best way of stopping yourself form getting Covid?
If you know how the virus spreads, you can try and implement the measures to reduce your chance of getting Covid. This includes social distancing, regular hand washing for twenty seconds and wearing a face mask in any confined place. Some people who have the virus don’t know they can infect others – therefore it is especially important to try and stay at home and leave for essential activities during the Leicester lockdown.

2. When will flu jabs become available?
They should become available in September. This year, it is vital those people who are eligible for the flu vaccine have the vaccine. This winter we need to ensure people do not have a double hit of ‘coronavirus’ and/or ‘flu’. This will put hospitals under immense pressure.

3. Can anyone have a Covid test?
Currently, anybody who has symptoms, or has had close contact with someone with Coronavirus can obtain an antigen test. Not everyone can. It is easy to book a test. Call 119 or go to the NHS website.

4. Can I still have a blood test at my GP surgery?
Yes. If you need a test, and your Doctor has recommended for you to have this, you should proceed to having a blood test performed. Do not stop yourselves from having blood tests you need to have to maintain your health in other ways. For example, you could be on medication for which regular blood tests are required – attend these appointments.

5. When is the first review of the Leicester lockdown due?
The first review is due on 18 July 2020. There is a possibility of lockdown extending, depending on the local data available.

6. How do we know our increased numbers aren’t just due for increased testing?
The proportion of positive tests to the number of tests performed was increased significantly. This shows that it was not just increased testing which increased the numbers – the data shows there is a true increase in the proportion of cases in Leicester City.

7. What makes an individual eligible for testing?
Symptoms of coronavirus in the last 14 days and/or being close to someone who has had the coronavirus.

8. I feel myself and family have shown signs of the virus months ago. How can I know if I have had the virus?
A special antibody test can detect the presence of an antibody. An antibody is something produced by the body to fight the virus. If you have a positive antibody, it means you have had coronavirus in the past. However, not all these tests are accurate, and are not currently available on the NHS.

9. Are there any indications of the true state of mental health in Leicester as a result of the pandemic?
We are sure the pandemic is causing some mental health difficulties. Whilst we do not have any data to support this, the people answering your questions are front line clinicians who are speaking to patients daily. We feel there is an increase in mental health problems because of this pandemic.

10. People with diabetes are affected, but how can we check our blood sugar levels?
Blood glucose checks are only necessary when patients who have diabetes are treated with insulin, or some medications which can ‘lower’ the blood sugar. Most patients who have type two diabetes do not require blood sugar testing strips or devices to check their blood sugar. The best way to monitor your sugar level is a blood test called HbA1c which is already performed in all patients who have diabetes – this is not a fingerpick blood test – it is normally performed at your GP practice. If you begin to feel unwell, you should speak to your Doctor who may advise more regular monitoring.

11. If someone is a carrier of Covid 19, how do they infect others around them?
By coughing, sneezing or touching surfaces when their hands have the virus. A new body of evidence suggests the virus could also be spready by aerosol spread – simply breathing the air of someone who has coronavirus around you. This is why face masks, social distancing and hand washing are very important.

12. I have COPD. Am I at increased risk?
Yes, you are at increased risk of developing complications. Typically, all patients with COPD are in the ‘moderate’ risk category from COVID infection – this may include pneumonia and hospital admission. Patients with existing underlying conditions have a higher risk of developing problems after infection with COVID.

13. I have heard the virus is ‘dampened’ in wet weather. Others have said the summer weather should help. Is this true?
No. This is not true. There is no evidence to suggest this. Remember, the most important ways to protect yourself against the virus are social distancing, handwashing regularly, wearing a face mask and following guidance in terms of where you can go to in public.

14. I have had Coronavirus. Must I worry about re-infection?
Currently, it is difficult to know if people will become re-infected with Coronavirus. There is a possibility you could be re-infected with Coronavirus. For this reason, even those people who have had coronavirus should take precautions just like everyone else.

15. Has the high community infection rate seen an increase in hospital cases?
Yes. More people have been admitted to hospital as a result of coronavirus during the last week of June up to now. The important bit to remember is that hospital can only support your body get through the virus – there are still very few ‘treatments’ available. Just because a hospital bed is available, does not mean you cannot go on to develop the severe complications of Coronavirus.

16. The virus has highlighted health inequalities. How is the city responding to this?
There is a lot of work to do in this area. We hope educating our patients through means which will allow an easy, and digestible source of information will help – this webinar, for example, is to reduce the inequality in our system. There is lots more to do.

17. If Covid can affect the lungs, why are people with asthma not on the shielding list?
It depends on the severity of someone’s asthma. Only certain types of asthma require shielding. There is no evidence to suggest mild or moderate asthma sufferers will be at greatly increased risk. Remember, shielding has significant implications – it means having to stay locked down at home with minimal visits outside. Shielding itself should not be taken lightly as it can have a toll on your mental and/or physical health.

18. How long are you contagious after having COVID?
Seven days after the onset of symptoms if you do not have a fever. It could be longer than this, if you have not fully recovered from the virus.

19. Do you need to wear gloves if you are going into a crowded shop?
We recommend you do not wear gloves. Gloves are indicated for healthcare professions who can change them after every interaction with patients. You will not have this resource. It is better not to wear gloves and wash your hands regularly, than wear gloves.

20. Does the flu and pneumonia jab help?
The flu jab is the ‘influenza’ vaccine and the ‘pneumonia’ jab you refer to is likely to be the ‘pneumococcal’ vaccination. These are important vaccinations which stop lots of people developing the flu and pneumococcal pneumonia every year. This does not protect against the coronavirus – but does protect against the flu. Remember, the flu makes people very unwell every year and results in hospital admissions.

21. Have there been any studies to show that people from black, Asian and minority ethnic groups are more prone to catching COVID?
Currently, there is little research to answer this question. The truth is likely to be for several reasons. This could include genetic factors, lifestyle factors, cultural factors, social health inequality factors, amongst others. Often patients from these backgrounds may certain factors in play which could theoretically increase the risk of developing the coronavirus infection. This could be from the high degree of diabetes (and other health conditions) in this group which could then cause the immune system to be weaker which makes it easier to develop coronavirus. Also, these groups often have large family circles, and can live in multi-generational family set ups which can mean a greater impact if one person in the household develops the coronavirus than otherwise. We are performing some research in this very area.

22. Does Leicester have more areas of deprivation than other cities? Does this contribute to increase in COVID?
Research over decades shows areas of deprivation tend to fair less well when it relates to health outcomes. This seems to be no different from the Coronavirus pandemic. People who are from areas of deprivation are likely to have to had to work during the outbreak, are likely to have other medical conditions which could increase their vulnerability to developing the virus, amongst other reasons.

23. Should I wear a mask when I am grocery shopping?
Yes! Absolutely yes. A face covering will be enough. The government issued guidance on 13 July that a face covering was essential. You may be given a £100 fine if you do not comply.

24. I have elderly parents who Have not been able to go out since the lockdown in March. They both have health conditions. What should I advise them?
Going out for a walk is important as it gives the body physical exercise, and the mind a sense of mental well-being. Whilst we can understand people to feel anxious, the risk of catching coronavirus when going for a walk is very low. A simple face covering could reduce this risk further, even though the recommendation does not stretch to wearing this everywhere (only confined places).

25. Does Hepatitis B impact the liver if you ‘catch’ COVID?
There is no evidence to suggest that it does.

26. I have been shielding since the start of lockdown and I need help and support. Where can I get this from?
Go to the Leicester City Council website – it lists all the support available. If it is easier for you go to www.willowshealthcare.org/webinars and you will be able to see a list of videos in different languages for support.

27. Do we know if the virus can mutate?
All viruses have the possibility of mutating. In some way, this is why you have a different flu vaccine every year – the virus changes every year, and so does the vaccine.

28.I have a new persistent cough with phlegm. Do I need to get tested for the Coronavirus?
Yes. Visit the NHS website or call 119.

29. Is it safe to attend hospital appointments?
Whilst it is not impossible to catch Coronavirus by attending an appointment, the risk is low as these departments are putting in place infection control strategies to reduce the risk of you meeting people during your appointment. Generally speaking, you will only be offered an appointment if it is felt to be in your best interests to do so.

30. Can young children spread the virus?
Possibly. The evidence shows they do not spread the virus in the same way at a level which was once thought. This is part of the reason as to why schools have been allowed to open.

31. Is it safe to attend personal appointments (e.g. hairdressers) outside of central Leicester (e.g. Anstey) if you are from Oadby?
No, it is not. You could spread the virus from an area of high prevalence to an area of low prevalence.

32. Do you need alcohol gel to ‘kill’ coronavirus?
Handwashing with soap and water for twenty seconds is just as effective. You do not need alcohol to ‘kill’ coronavirus.

33. Can you get the virus through your mouth?
Yes. Wash your hands regularly.

34. What will be the second wave like?
It is difficult to know. The more we all take personal responsibility to reduce our risk, the better the chances of having no, or a limited ‘second wave’. I think we all need to prepare for the winter when viruses like this are at the most challenging to manage. We may arrange a webinar in autumn to discuss what precautions people should be taking to reduce individual and collective risk.

35. I have COPD/asthma/diabetes and I haven’t been sent a letter to shield. Should I be shielding?
People who have been advised to shield were given a government issued letter. If you feel you have health conditions which mean you should be shielding, then you should contact your own GP who can make an individual risk assessment.

36. Can GPs still see patients with Covid symptoms?
Yes. To make it safer for patients, we are consulting via telephone or video. If you need to be seen, a face to face appointment will be arranged for you.

37. Can you ‘walk us through’ how a patient who is being hospitalised for coronavirus in Leicester is managed from the point of admission via A&E?
The ambulance service may re-direct the patient to the Leicester Glenfield Hospital or the A&E department. Generally, a patient will only be kept in if there is a clinical need to do so. Often, in a patient who is very unwell with coronavirus, they will require oxygen treatment to help keep their blood oxygen levels up. They will normally stay on a Coronavirus ‘red’ zone to limit the spread of infections to other patients or staff members.

38. If someone gets sick in the house, what is the best course of action?
Isolate yourself in a room with a bathroom if possible, trying not to share towels between each other. Eat separately. The affected person should try and use a face mask or covering. Ventilate the home and ensure appropriate cleansing and sanitising.

39. What mental health support is available?
During times of uncertainty and stress there is added pressure on people with mental health issues which might worsen their illness. For patients with undiagnosed mental health issues such as anxiety or depression, the extra uncertainty may also lead to increased mental health symptoms. You can go to ‘Open Mind Let’s Talk’ (search via Google). The website is: http://www.iaptportal.co.uk/leicsself.html, or speak to Mind on 0300 1231393, or the Samaritans on 116 123. You can also go to your GP, or your psychiatric nurse if you have one.

40. My family have not left the house since lockdown – they are grocery shopping, and cleaning everything. What do we do if we develop symptoms?
The risk of developing coronavirus in this circumstance is very low. In theory, you could still contract it if you do not take appropriate precautions with mail. Remember, the virus is invisible – and can be spread by contaminated surfaces. However, it cannot creep underneath your door! If you develop symptoms, test yourself just like everybody else – you just never know.

41. I read a paper that said that some who develop a mild form of the virus only develop IgA antibodies, so they can be re-infected. Those with severe illness get IgG antibodies. Is this true?
The science behind testing and anti-body development in the body is very complex. The body produces different type of antibodies which include IgA, IgM and IgG. Certain antibodies are present during the active infection state, whilst some antibodies can persist after the infection has resolved. It is not yet known whether certain antibodies confer immunity for long term protection, and this is currently an intense area of research interest internationally.

42. Can cats transfer Covid?
There is not enough evidence for us to categorically answer ‘yes’ or ‘no’. The truth is that it is highly unlikely that a cat will transmit infection, but it is not impossible for a cat to be whilst unaffected by the coronavirus, to act as a medium for transmission.

43. My sister lost all her smell and taste during a Coronavirus infection in March. Do you have any advice?
If the symptoms started with the onset of coronavirus, it could be that the cells lining some of the lining of the nose which sense smell could be damaged temporarily. In these circumstances we would normally expect the cells to heal. If she has persistent problems, we would advise a medical review to assess for other causes. This may include a physical examination of the ear, nose and throat, and a referral to the ENT specialist. This is also an area of intense research – we do not yet fully know the long term complications of Coronavirus infection.

44. How did the virus start?
The evidence suggests it started in China after it developed mutations to allow it to move from an animal to a human.

45. Why aren’t you encouraging BAME groups to take high doses of Vitamin D? Isolation reduces our exposure to sunlight therefore reducing our immunity.
Lots of people have low Vitamin D. BAME people are at higher risk of Covid. The current studies suggest a ‘correlation’ which is different to ‘causation’. It is only an association. The evidence is not substantial enough to allow changes to the Vitamin D public health guideline. Here is a NHS reference to Vitamin D which discusses how you can get Vitamin D from sunlight. https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from- sunlight/

46. My wife is pregnant. Is she high risk?
There’s no evidence that pregnant women are more likely to get seriously ill from coronavirus. But pregnant women have been included in the list of people at moderate risk as a precaution. This is because pregnant women can sometimes be more at risk from viruses like the flu. https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher- risk/pregnancy-and-coronavirus/