GPs now to test ANY patient with bad coughs for coronavirus
GPs should now treat ANY flu-like illness requiring hospitalisation as a possible coronavirus case regardless of travel history – but NHS 111 STILL won’t consider you at-risk unless you’ve been abroad
- GPs told to test patients with severe ‘flu’ that needs to be hospitalised, PHE says
- Family doctors must isolate the patient without touching them and report case
- NHS England told all GP surgeries to keep one room free to quarantine people
GPs have been told to perform coronavirus tests on any patient with flu-like symptoms if they need to be admitted to hospital, regardless of travel history.
Public Health England has updated its guidance to say family doctors should disregard whether people have links abroad and treat them as a potential case.
It comes as the killer virus is increasingly spreading among Britons who have not left the country and one patient has died after catching it in Wolverhampton.
GPs are being urged to immediately isolate the patient without touching them, put on protective gear and report it to PHE and NHS 111.
NHS England has told all GP surgeries to keep one room free to quarantine suspected coronavirus patients.
The policy shift is at odds with the NHS 111 service, which is still wrongly telling people they cannot have the killer virus unless they’ve travelled abroad.
GPs have been told to perform coronavirus tests on any patient with flu-like symptoms if they need to be admitted to hospital. Pictured: A masked medic tends to a patient on the intensive care ward in Cremona, in northern Italy at the centre of Europe’s outbreak
MailOnline revealed yesterday the online service was failing to tell the public they needed to self-isolate for a fortnight if they had just come back from Italy, the worst hit EU country.
The site was only instructing people to stay at home if they had been in certain regions in the North, even though the Government advice was officially extended to all of Italy on Monday night.
And NHS 111 reassured people they don’t need a coronavirus test if they haven’t left the UK recently – despite the disease spreading rapidly between people in Britain.
A poll of more than 400 GPs found 67 per cent did not feel their surgery was prepared to deal with the escalating crisis.
More than half (53 per cent) said they had not been given proper guidance and information about the virus and how to deal with patients who may have it.
Just one in five said their practice had the equipment – including protective masks and clothes – needed to cope with an outbreak.
The poll was conducted by British medical site GP Online.
Respondents said they were worried a surge in cases could push their already-stretched practices over the edge, particularly if doctors and nurses have to stay at home and self-isolate.
The lack of awareness over the guidelines raised questions over whether the Government is really doing enough to contain the outbreak in the UK.
As of today, 382 patients have tested positive for coronavirus in Britain out of more than 26,000 tests. Six people have died.
The latest victim was a man in his early 80s who was being treated at Watford General Hospital in Hertfordshire.
An NHS England spokesman said the NHS 111 coronavirus website would be fixed ‘imminently’ to ensure the self-isolation advice should be issued to anyone returning from Italy.
A Number 10 spokesman said: ‘They are aware of the problem and that information is being urgently updated. Obviously, we have been setting out very clearly in public what the advice is in relation to Italy. But I am aware of the issue and it is being urgently resolved.’
A Department of Health spokesman said: ‘Our advice could not be clearer – anyone returning from Italy should self-isolate as a precaution, even if they have no symptoms.
‘We all have a part to play in combatting this virus and we urge members of the public to look out for each other, pull together and make the right decisions based on the latest advice.’
Dozens of ‘scared’ Britons who were turned away by the online service blasted it as ‘rigid’.
Sam Butler, from Fleet, Hampshire, who is in his 70s and suffers from heart and kidney problems, said: ‘I’m scared and angry. I’ve got the worst flu I’ve ever had (despite flu jab), and it’s unlike any flu I’ve had before.
‘It fits the description of COVID exactly, but NHS111 says it isn’t, because I haven’t been abroad.’
Doctors work at a hospital in Schiavonia in northern Italy with more than 9,000 coronavirus cases now confirmed in the country in the worst outbreak outside China and South Korea
Sam Freedman, a former senior policy adviser at the Department for Education, said: ‘Unfortunately I have a cough and a fever. Turns out I can’t get a test because I haven’t been to any affected countries or come into contact with a known case.
‘Even though I have been through an airport and to a concert. This seems a major flaw in the testing system to say the least. I am self-isolating for the time being. If I do have it it doesn’t seem to be a serious case. Not yet anyway.’
Kishan Rajdev, a doctor in Birmingham, said ‘rigid’ NHS 111 criteria were likely meaning thousands of cases were going unreported.
He said: ‘While the epidemiologists are doing a great job of contact tracing, we as HCPs [healthcare workers] need a way to refer patients for coronavirus testing as the rigid NHS 111 criteria are likely missing thousands of cases. How will you empower HCPs and crowd-source contact tracing?’
Britons who fear they may have the killer virus are being turned away when they try to access NHS 111 online unless they’ve been to high-risk countries like Italy or China
Fiona Rosser, from Scotland, claimed health bosses were in denial about how rampant the virus was in the UK.
She added: ‘There is misleading and conflicting information on the NHS 111 site. They are basically being told that unless they have been to one of the regions abroad or been in contact with a confirmed patient, it’s not coronavirus. They’re in denial about community spread.’
Nich Starling, from Merseyside, wrote: ‘Reading so many people on Twitter with symptoms of COVID-19 phoning NHS 111 and getting told ‘it’s not coronavirus because you’ve not been to China or Italy’. The government’s response is appalling. #Johnson is leaving people to die.’
Arvand Hassan, from London, said he was ‘fairly certain’ that a significant number of people who have undiagnosed coronavirus and took the NHS 111 questionairre were being told they are low risk and don’t need to be tested.
It comes as more people contracted the virus in the UK than in China for the first time – 46 people caught it in Britain compared to 45 in China.
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
Someone who is infected with the coronavirus can spread it with just a simple cough or a sneeze, scientists say.
More than 4,000 people with the virus are now confirmed to have died and more than 110,000 have been infected. Here’s what we know so far:
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.
By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.
By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.
By February 5, there were more than 24,000 cases and 492 deaths.
By February 11, this had risen to more than 43,000 cases and 1,000 deaths.
A change in the way cases are confirmed on February 13 – doctors decided to start using lung scans as a formal diagnosis, as well as laboratory tests – caused a spike in the number of cases, to more than 60,000 and to 1,369 deaths.
By February 25, around 80,000 people had been infected and some 2,700 had died. February 25 was the first day in the outbreak when fewer cases were diagnosed within China than in the rest of the world.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
There is now evidence that it can spread third hand – to someone from a person who caught it from another person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak is an epidemic, which is when a disease takes hold of one community such as a country or region.
Although it has spread to dozens of countries, the outbreak is not yet classed as a pandemic, which is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
The head of WHO’s global infectious hazard preparedness, Dr Sylvie Briand, said: ‘Currently we are not in a pandemic. We are at the phase where it is an epidemic with multiple foci, and we try to extinguish the transmission in each of these foci,’ the Guardian reported.
She said that most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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