No one likes uncertainty. But, here we are, about to be hit by a pandemic – and the truth is, to some extent, it’s impossible to say what will happen. Of course, there is a lot we do know. We have knowledge gained from previous outbreaks, and from the already astounding international response to this one.
But Covid-19 is a new virus – one we are still learning about. And the situation is evolving by the hour.
There will be many more cases in the coming days and weeks. Up to eight in ten of us may contract Covid-19, according to some projections. Despite this, I genuinely believe this is not a cause for panic.
At present, as you’ll no doubt have heard, most people who get this disease will experience only mild symptoms, which include a cough, sore throat, fever and aches. They won’t even need to see a health professional, and will be able to manage at home, just as they would with flu or a cold.
Bizarre choice: A woman travelling on a London Tube train wears a large plastic container over her head. At present, as you’ll no doubt have heard, most people who get coronavirus will experience only mild symptoms, which include a cough, sore throat, fever and aches, says Dr Ellie Cannon
… and another passenger is covered by a blanket. With Covid-19, we are seeing a pattern. In terms of the number of cases, severity of illness and deaths, there is what we call ‘a shift to the right’. This is a reference to the fact that, when looked at on a graph, the most and worst cases all seem to happen in the older age groups. Specifically, it is beyond the age of 50 that the risks mount
However, some people will be worse affected – those over the age of 50 and those with other health conditions will have heard they are at higher risk. So, understandably, if you’re in these groups, you may be concerned.
Last week, the first British deaths caused by Covid-19 were reported: a woman, in her 70s and a man in his 80s. Both were already unwell.
But as England’s brilliant Chief Medical Officer Chris Whitty, who is an expert in tracking outbreaks of illness, told MPs last week, if you’re middle-aged and contract Covid-19, you’re not necessarily ‘a goner’.
The vast majority will recover. And be assured: for the five per cent expected to suffer severely, our healthcare system is excellent. Planning committees advising the Government are headed by some of the world’s leading medical and science experts. We are well prepared.
Of course you, the public, have a huge role to play too. It is vital to stay informed by listening to trusted sources of information – Public Health England (gov.uk) is providing up-to-date advice. With this in mind, I’ve tried to answer some questions that have most concerned my older patients.
I’m in my 60s and fit and healthy. Am I really more at risk?
The short answer is, yes – but still, as I’ve said, this isn’t a reason to panic.
With Covid-19, we are seeing a pattern. In terms of the number of cases, severity of illness and deaths, there is what we call ‘a shift to the right’. This is a reference to the fact that, when looked at on a graph, the most and worst cases all seem to happen in the older age groups.
Specifically, it is beyond the age of 50 that the risks mount.
Just two per cent of infections are in people under 20. This could be because they get such mild symptoms that the cases aren’t picked up, or it could be that young people generally don’t catch the virus, for reasons not yet fully understood.
The reason older people suffer more is because they are more likely to have other health conditions, and this will undoubtedly affect how well the immune system can cope with an infection such as Covid-19. (File photo of people in central London this week)
There’s a similar pattern with other infections, such as seasonal flu.
The reason older people suffer more is because they are more likely to have other health conditions, and this will undoubtedly affect how well the immune system can cope with an infection such as Covid-19.
According to the evidence, even older people who are in good health are at a slightly higher risk.
We know the respiratory system becomes generally less resilient as we age. However, the vast majority of people, even in the older age groups, recover from Covid-19.
I have diabetes and I’m over 60. My elderly mother has a number of health problems. I’m desperately worried. Could this virus make us very ill… or worse?
I understand your concern. You may have read that about one per cent of those in their 50s, and almost 15 per cent of those aged 80 who contracted the virus, have died. People with high blood pressure, heart disease and diabetes seem to suffer more.
But even in these cases, most patients will be able to manage their symptoms at home.
Of course, if you know you’re at higher risk, then being cautious in order to avoid infection is wise.
But it’s important to note that what we know about Covid-19 is based on data from the thousands of cases in China. In my opinion, we can only extrapolate a certain amount – outcomes, including death rates could be different in the UK.
We are not China. Our healthcare systems and the general health of the population are not the same.
So it’s reasonable to think that age-related mortality may be lower in the UK, where we have better access to medical care, less air pollution and fewer smokers.
Should middle-aged or older people be self-isolating now?
I can understand why people, especially the elderly or those in more vulnerable groups, think self-isolating at this early stage may be a good idea.
But it’s worth considering that this outbreak could last many months. Projections suggest that 95 per cent of infections will happen over the next nine weeks. And 50 per cent will be within the next three weeks. That’s a long time to lock yourself away.
It might be manageable for some. But for many, it could be frustrating, inconvenient or simply impractical for work.
Not everyone has access to online grocery delivery services, or has a network of people who will check in on them and bring food. And it could impact on things such as daily exercise, or being able to make it to medical appointments, which might end up being worse for overall health.
At present, the advice is to limit the chances of spreading infection by practising good hand hygiene. This is particularly important when coming into contact with older or more vulnerable people
This is why there is no official advice for healthy people to self-isolate at present. If Covid-19 begins to spread widely, Public Health England has said it might ask anyone with symptoms that might indicate they have the virus to call NHS 111 – and they’ll be advised to stay at home and avoid contact with people for up to 14 days.
It’s unlikely they’ll even be tested for Covid-19.
If spread is rapid, whole households may be asked to self- quarantine, including those who don’t have symptoms. It’s vital that this is done properly. No popping to the corner shop or having friends over.
And that’s why it’s best to save these extreme measures for when it’s deemed medically necessary.
At present, the advice is to limit the chances of spreading infection by practising good hand hygiene.
This is particularly important when coming into contact with older or more vulnerable people.
Can’t get hand sanitiser? You don’t need it
There has been a run on hand sanitiser gel. Chemists and supermarket shelves have been stripped bare. So do you need to worry if you can’t purchase any?
Do you need to visit 20 different shops to find a bottle, or pay extortionate amounts on auction site eBay?
No, no, no.
Just wash your hands. Soap and water does the best job.
There has been a run on hand sanitiser gel. Chemists and supermarket shelves have been stripped bare (including this branch of Tesco in Altrincham, Cheshire). So do you need to worry if you can’t purchase any? No
Pharmacies are generally filled with sick people – and visiting several just for a bottle of hand sanitiser will simply expose you to more infection.
I’ve also seen online guides to making your own. Please don’t.
Getting the balance of alcohol and gel exactly correct is struggle for even the most experienced pharmacists.
Your home brew will probably end up too weak to work, or too strong. The latter could damage the skin on your hands, increasing your risk of infection.
Just wash your hands instead.
Will getting this illness affect my blood pressure medication?
There is no reason it should. It is unusual for illness to have an effect on medication.
One notable exception is in type 1 diabetes – illness can affect blood sugar, so patients may need to adjust their insulin medication accordingly. However we type 2 diabetics don’t have the same problem. There is no indication that Covid-19 would affect the way blood pressure tablets work.
My grandchildren are due to stay. Is it still safe to have them over?
It is absolutely fine – people under 20 are the least likely group to have Covid-19. Separation, loneliness and missing out important contact can be hugely damaging to health and wellbeing.
As I’ve said, it is best to save these extreme measures for when we need them. It is possible that a child – or anyone else, for that matter – could be carrying the virus without any symptoms. So there is no harm in following the usual hand-washing advice while spending time with them.
Should I stop going to work or going swimming, avoid taking communion, or stop getting the bus?
This is what we call social distancing – and the Government isn’t enforcing this yet. I emphasise yet, as the situation may change. In the future, more people may be ordered to work from home and schools could be closed. People may also be asked to limit social activity – big events such as football matches may be cancelled – or avoid non-essential travel.
Some organisations are choosing to make changes now.
Some churches and synagogues have advised congregations not to shake hands or share communion cups. Some are even live-streaming services online, so people who need to self-isolate can still join in.
On an individual level, many people may make their own social distancing choices. Again, it’s important, if you’re considering making a change to your routine, to think about the impact it’ll have on your life, as this outbreak will go on for many months.
You catch Covid-19 much like other colds and flu. People who are ill cough and splutter in public places, covering surfaces in tiny droplets of moisture that contain the virus. The microbes can live there for days, unless the surface is cleaned properly.
During that time, if we touch the surface, the virus is transmitted on to our hands. Then, if we touch the eyes, nose or mouth, the virus gets into the body, and we’re infected. That’s why hand-washing with soap and water or sanitiser gel is the most crucial thing.
Do it thoroughly, for 20 seconds, at regular points during the day.
Should we stop shaking hands?
This would be another kind of social distancing. It’s a personal choice. The Prime Minister says he doesn’t mind shaking hands – but, personally, I’m avoiding it. It’s no big deal to me, and probably mitigates my risk ever so slightly, so why not?
Are there medicines, or anything else, I should stock up on?
The main symptoms seem to be a cough, a high temperature and other flu-like things such as a sore throat and aches and pains.
As I’ve mentioned, according to Chinese data, one in five patients may be ill enough to need medical intervention. For the rest, the best medication will be ibuprofen and paracetamol, as this controls fever and pain.
According to Chinese data, one in five patients may be ill enough to need medical intervention. (Above, a man has his temperature checked in Shanghai in February)
People have been panic-buying toilet rolls – I’m not sure why. There is unlikely ever to be a shortage, unless, of course, people keep panic-buying.
Health Secretary Matt Hancock has promised people will still be able to get the supplies they need, even if they have to self-isolate.
I have a hip operation coming up. Should I cancel?
No. There is no reason to. Chris Whitty has indicated that NHS hospitals may have to make changes to cope with an influx of patients suffering from severe Covid-19 infections, and that could, theoretically, mean routine operations are postponed. But it’ll be the decision of the NHS trusts, not the patient.
Better your hip operation is done now in case there are closures.
Will taking Vitamin C, or anything else, help?
There is an ongoing trial in China looking at whether intravenous Vitamin C helps patients in hospital with Covid-19 – but so far there is no proof that it does, and the results of the study won’t be available until September.
There isn’t any evidence that taking supplements has any effect on this disease. Our natural immunity comes from being healthy – and we can achieve that by eating well, exercising and sleeping well.
If you’re someone who won’t eat fruit and veg, it may be worth taking a vitamin supplement with zinc, Vitamins C and D, and iron – but even this is certainly no guarantee of protection.
Not smoking is a surefire way to reduce the risk of all respiratory infections, so now would be a great time to quit.
Will a pneumonia jab protect me?
The pneumonia vaccine protects against a bacterial infection called pneumococcal pneumonia. It is recommended for babies and all people over 65, as well as those with health problems such as lung disease. However, it will not stop anyone getting coronavirus or pneumonia.
As part of the action plan for this virus, the Chief Medical Officer has urged anyone due to receive any vaccine to have it as soon as possible.
This will protect individuals from any health problems that could make them more vulnerable to Covid-19. Importantly, it will reduce the pressure on medical services by reducing vaccine-preventable illnesses.
I have a Mediterranean cruise booked later this month – should I cancel?
Large numbers of people in close quarters on cruise ships are more prone to infectious diseases such as Covid-19.
Do you have a question for Dr Ellie?
Email [email protected] or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT.
Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.
So far, five cruise ships, including Diamond Princess in Japan, and now Grand Princess in San Francisco, have been quarantined after news about possible infections emerged.
On the Diamond Princess, more than 600 people out of 3,000 caught Covid-19 – and some got it while they were quarantined aboard.
Some viruses, like the vomiting bug norovirus have been known to spread like wildfire on board cruise ships, despite the best efforts of these companies.
There is no official advice to avoid cruises, so it would have to be a personal decision.
However, if you’re going to spend the whole holiday simply worrying about getting ill – or being quarantined – it wouldn’t be much fun.
Could younger people with conditions such as asthma or diabetes be equally at high risk?
Having asthma or diabetes does weaken the immune system and makes people more prone to the serious effects of Covid-19, such as pneumonia. So their risk would be higher than for other young people, who seem unlikely, on the whole, to get infected.
It is impossible to absolutely quantify this risk, as we just don’t have the data yet.
Keeping asthma and diabetes as well controlled as possible with regular medication is a sensible precautionary measure. And be up to date with all vaccines – the last thing you want is to get flu when hospitals may be struggling to deal with a surge in Covid-19 patients.
Should I be cleaning my house more often, and what should I be using on surfaces?
All coronaviruses, including the one that causes Covid-19, live on surfaces at normal room temperature for anything from a few hours to nine days.
Cleaning gets rid of the virus straight away, so reducing the risk of picking it up. How often we should clean depends on how frequently people visit.
Using water and detergents should kill the virus quickly, and the World Health Organisation recommends this to prevent spread.