COVID-19 Coronavirus Advisory

The early symptoms of COVID-19 consist of a fever, sore-throat, muscle ache, tiredness, and a persistent dry cough. In fact, these symptoms initially occur in many infections, but during the pandemic  of COVID-19, it is best to err on the side of safety and assume that these symptoms are due to the coronavirus. If you do feel unwell in this well, it is vitally important that you do not go to work.

As COVID-19 is very infectious, if you attend work, you run the risk of infecting your co-workers. Please stay at home, contact your line manager to tell them of your illness, and self-isolate for at least 14 days. At the end of this time, if you are completely better, you can inform your line manager who will likely allow you back to work.  

Whilst it is essential that employees who are unwell stay away from work, sometimes workers beginning to feel unwell whilst in the workplace, having felt entirely well beforehand. As this is the very earliest stage of the illness, symptoms are generally very mild, often consisting of a sore throat or a general feeling of being unwell. It is important that these feelings are not ignored, but that you inform your line manager, who will send you home to self-isolate for at least 14 days. Inform the line manager which parts of the building you have been to during the day, including which restrooms and kitchen areas.

This is because the office will want to perform heightened cleaning of those areas. In the very unlikely event that you become suddenly unwell at work; the emergency services will need to be contacted. If this should occur, it is more likely to be related to a heath matter unconnected to COVID-19.

If the person with whom you share a house has a flu-like illness, it is best to assume that they might have the coronavirus. Please phone your line manager, informing them of the situation, who will likely ask you to self-isolate at home. If you are able to homework, this should occur. Keeping yourself healthy at home is best done by minimising the contact that you have with your sick flatmate. Clearly, if they are deteriorating they may need the services of a doctor or an admission to a healthcare facility. If the flatmate has mild symptoms, it is important to protect yourself by washing your hands frequently, reducing the number of times that you touch your face.

As the coronavirus is spread by infected respiratory droplets resting on surfaces, it is easy to transfer viral particles from a table or door handle, for example, to your mouth or eyes. When cleaning, handling your flatmate’s cutlery, mugs, or plates on which they have eaten, it is especially important to clean your hands. You should self-isolate for 14 days. If you are entirely well afterwards you should phone your line manager to ask if you can return to work.

Although, the vast majority of people infected with the coronavirus has a relatively mild range of symptoms, this is not the case with those who are elderly or those who have some pre-existing diseases. Around 20% of those infected with COVID-19 will develop a severe form of the illness, requiring urgent care in hospital. These patient often require oxygen therapy and sometimes therapy in Intensive care, when they may be placed on a ventilator to help their lungs. People with severe lung diseases, such as cystic fibrosis and severe chronic lung disease, are at risk as are individuals with diabetes, cardiovascular conditions, and those who have cancer or are immunosuppressed.

These patients are particularly at risk and should follow the advice issued by each country, which may involve self-isolation for several weeks. This is also the case with those who are 70 or older, for whom special care should be taken. This will include a reduction in social contact, which at times may have to be a severe reduction, as directed by Governmental authorities.

If you have been in contact with someone suspected of being infected with the coronavirus, it is likely that you would be told to self-isolate for 14 days. This is because there would have been a risk of becoming infected with the virus, and 14 days should be waited to see if any symptoms developed. If 14 days have passed and you have remained entirely well, then you have not been infected with COVID-19.

In this instance, contact your line manager, informing them of your continued health – they will likely ask you to return to work. Hand hygiene and social distancing should continue to be practised, especially at work, because you are still at risk of catching the coronavirus.

Most people who have mild symptoms with COVID-19 get better after only a few days. Some people do develop more severe symptoms over time, however, that require admission to a healthcare facility. If your cough is getter worse, you feel increasingly weak, or have shortness of breath, it is important that you phone your healthcare provider. In this situation, discussing your case over the phone is important, as if you visited your doctor’s offices directly, infection to others might occur.

Your healthcare provider might suggest that you are reviewed immediately in hospital and arrange an ambulance. The healthcare professionals who tender to you will be dressed in personal protective equipment, such as masks and gowns, to reduce the risk of infection. This can be frightening but is perfectly routine. If in doubt, phone your healthcare provider for advice or reassurance.

The COVID-19 virus is usually spread by coughing and sneezing on to everyday surfaces, such as tables or handles, that are subsequently touched by those uninfected. Following these simple rules will ensure you are playing your own part in protecting against transmitting the virus:

• Wash your hands with soap and water regularly and especially after going to the toilet, ensuring they are completely dried.

• Avoid touching your eyes, nose and mouth – and face in general – unless you’ve washed your hands first.

• When sneezing, do so into the crux of your elbow or into a disposable tissue, as opposed to a handkerchief. If you catch your sneeze in your hands, wash your hands immediately afterwards.

• Avoid close contact with people who have any symptoms

• Clean and disinfect frequently used objects and surfaces

• Keep at least 2 metres (6 feet) from people at all times as this reduced the risk of transmission.

This process should take at least 20 seconds (the time it takes to sing happy birthday twice)

First, Get your hands wet then use enough soap to cover your hands.

Rub your hands together. Rub the back of one hand with the other and clean in between the fingers. Do the same with the other hand. Then, rub your hands together and clean in between your fingers. Rub your palms with the back of your fingers and then rub your thumbs using the other hand. Rinse your hands thoroughly and lastly: Dry your hands thoroughly.

Social distancing is a number of steps you can take to minimise the social interactions you have with others.  The idea is that this will help to reduce the transmission of COVID 19.

1. Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include a temperature, sore throat, feeling unwell and a continuous cough.
2. Avoid non-essential use of public transport when possible
3. Work from home, where possible.
4. Avoid large and small gatherings in public spaces,
5. Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
6. Use telephone or online services to contact your Doctor or other essential services
7. Keep at least 1 metre (6 feet) clear around you at all times.

Designate an area for home working and develop a daily routine that you can follow.

Break up long spells sitting in front of computer screens with regular small rest breaks (at least 5 minutes every hour) or with changes in activity. Avoid awkward, static postures by regularly changing position in your seat, regularly getting up and moving, or doing stretching exercises. Try avoiding eye fatigue by changing focus, or by blinking. Importantly, you should maintain regular contact with managers and co-workers, as this will reduce the risk of becoming isolated. Try phoning occasionally instead of only emailing. Recognise (and deal with) signs of stress.

Self-isolation means staying indoors and entirely avoiding contact with other people. You need to do this if you have symptoms of coronavirus or live with someone who has symptoms. This is to stop other people from getting it.

You need to self-isolate:

1. If you have symptoms of coronavirus, such as a fever, sore throat, malaise and a regular cough or live with a potential coronavirus patient.
2. Whilst awaiting a coronavirus test.
3. While you wait for the coronavirus test results
4. If you have had a positive test result for coronavirus

If you developed symptoms, please continue self-isolation until 14 days after symptoms have started. If you are a contact of a potential COVID-19 patient, also wait 14 days.

Do

Stay at home, in a room with the window open.

Keep away from others in your home as much as you can.

Check your symptoms - call a doctor if they get worse.

Phone your doctor if you need to - do not visit them.

Cover your coughs and sneezes using a tissue - clean your hands properly afterwards.

Wash your hands properly and often.

Use your own towel - do not share a towel with others.

Clean your room every day with a household cleaner or disinfectant.

Don't

Do not go to work, school, religious services, or public areas.

Do not share your things.

Do not use public transport or taxis.

Do not invite visitors to your home.

Keep away from older people, anyone with long-term medical conditions and pregnant women.

It's OK for friends, family or delivery drivers to drop off food or supplies. Make sure you're not in the same room as them, when they do.

The history of humankind is plagued with episodes of widespread infections, affecting civilisations with catastrophic numbers of sufferers. From biblical diseases causing skin eruptions, to the ‘Black Death’ of the 14th Century, populations have been regularly blighted - and this has continued up to modern times. From the feared Spanish Flu of 1918, killing 50 million people, to the recent global spread of the Zika virus, our world is still subject to diseases infecting all. The last decades have been especially affected by frequent epidemics.  Including SARS (the Severe Acute Respiratory Syndrome) and H1N1 (‘Swine Flu’), Ebola, MERS (the Middle East Respiratory Syndrome) and Zika, every few years another worrying virus hits the headlines. With the advent of easy global travel, diseases can start in one region of the world and hours later crop up in a country the other slide of the globe. This was certainly the case with SARS, that was rapidly spread from Hong Kong to Canada following one long-distance flight.

It’s interesting to compare the worldwide effect of Ebola with the present COVID-19 pandemic. Although a much more deadly disease, the recent outbreaks of Ebola have produced fewer fatalities than the ongoing outbreak of the coronavirus. This is partly to do with the ease that COVID-19 is spread to others, but also due to the fact that Ebola has occurred in countries with far poorer access to international travel. The excellent infrastructure in Wuhan, China, was an important factor in the rapid transmission of the virus to many parts of China, and then on to several countries in the region. Although there has been a sharp decline in international travel recently, it is expected that long-haul flights will rapidly resume following the successful control of the coronavirus. It’s important to note that as further novel viruses, as easy to transmit as COVID-19, emerge over the next few years, new epidemics will no doubt be rapidly seeded across the globe.

Novel viruses have been a constant companion to the human race. With repeated exposure to a virus, however, our immunity often increases, providing protection against subsequent infection. The first time that we catch a virus, we have no immunity to the new illness, so sometimes severe symptoms can occur. In fact, when a novel virus emerges - for example with COVID-19 - millions of individuals can potentially be infected, causing symptoms in many.

It is not just our immunity that determines whether a virus will flourish, however. The characteristics of the virus itself will dictate how easily transmissible it is. Some recent viruses, such as the bird flu H7N9, are very poorly spread from human to human, making an epidemic in humans extremely unlikely. Other infections, such as the recent MERS virus, can be transmitted from human to human, but when that occurs a milder disease results. This is not true for those with various chronic diseases, however, as they can still be severely affected. It’s important to know that the general health of the person infected is a factor in whether they experience a more severe form of an infection. This is true of many illnesses, but is also presently seen with COVID-19, which is particularly severe in those with diabetes, severe lung diseases, and individuals with compromised immune systems.

It’s not just biological factors that determine whether a pandemic will occur. If new infections start in countries that have few public health resources, then they are unlikely to be efficiently controlled or treated. Conversely, resource-poor countries may have limited access to international travel, and a population generally unable to afford expensive air-fares: both these factors can lead to the virus having a delayed transmission to regions further afield, reducing the risk of a pandemic.

In general, if an outbreak of a highly infectious new virus, rapidly emerges in a technologically advanced country, the disease can quickly establish itself in several centres, possibly leading to infections in many countries and causing a pandemic - as has been seen with COVID-19.

The mainstay of controlling pandemics is the isolation of those who are infected, preventing the further infection of others: the process of quarantine. This process involves several stages. The first is the early identification of a possible case. It has to be as early as possible to prevent further transmission should the case be confirmed. With outbreaks such as Ebola, which have often occurred in remote parts of countries with poor infrastructure, it can be imagined that there are often delays: delays travelling to the patient, getting permission for blood testing, sending the sample to the laboratory and delays receiving a positive result. Having received confirmation of a case, however, the patient can be quarantined in a treatment centre where they can receive care for the condition, and also reduce their risk of infecting others. Contact tracing can then also begin. This is where recent contacts of the now confirmed patient are also tested for the disease. As this group is the most likely to have become recently infected, if they all test negative, it suggests that no further transmission of the virus has occurred. In practice, some contacts often test positive, necessitating further contacts to be tested and quarantined as necessary.

In this way, infections are tracked and further transmission stemmed. When a disease has become widespread in a country, however, it may not be possible to track each patient and their contacts, as this could number 100,000’s of patients. This is the situation in several countries at present with COVID-19. Instead, a different strategy for controlling a country’s epidemic might be employed: instead of trying to eradicate an outbreak, the aim is to supress it. This is achieved by whole populations changing behaviour to make viral transmission much less likely. People are ordered not to attend large gatherings such as sporting events; restaurants and theatres are closed; and those able to work at home are told to do so. There are several reasons why suppressing an epidemic is advantageous. Firstly, by reducing the peak number of patients at any one time, healthcare resources are less stressed and have a greater chance of effectively treating the heightened number of those admitted. It is important to remember that when hospital services are over-burdened, even uninfected patients are affected as those with other severe diseases and trauma cannot be treated adequately.

There are two main hopes during the suppression phase of pandemic control. Firstly, that enough people will survive the infection and achieve immunity, that a subsequent wave of infection will be both slow to be established and also be reduced. Secondly, that the number of those severely infected will be lessened so that by the time an effective vaccine is developed, the number of fatalities will be as low as possible. With COVID-19, the development of a vaccine will be the factor that finally establishes control over the virus, delivering immunity to those at risk, and preventing further waves of infection from recurring in the future.

Fear is a common feature of many pandemics. From Ebola in Africa, to Zika or COVID-19, the potential to catch diseases during epidemics causes worry over the fate of loved ones, concern about the inevitable changes that are needed to control the disease, and often fear of foreigners or those in charge. In many outbreaks, episodes of violence are also frequently reported. This has sadly already been the case during the present COVID-19 epidemic.

Other examples include the recent Ebola outbreaks in Africa, which has been compounded by widespread community resistance to the efforts of the WHO and partners. As viruses were often poorly understood in rural communities, the explanation for the Ebola crisis was frequently disbelieved. The experience of the local population was to see masked and gowned healthcare officials taking away loved ones to treatment centres for a reason they did not understand – centres from which the loved ones often never returned. The fear engendered was of course amplified when those involved were children. In this context it is easy to see how fear can spill over to distrust and violence.

In addition to fear, isolation and depression can occur in communities controlling an epidemic. As efforts are made to reduce the effects of a pandemic, whole populations may well be needed to reduce social contact, which can lead to isolation. During the present COVID-19 outbreak, those at high risk of the severest forms of the disease are being asked to self-isolate for several weeks at a time. This includes those who have a history of certain chronic illnesses, but also individuals over the age of 70. For those isolated at home, rarely going out, and not socialising, this can be a testing time. Especially for those who have little family and few friends. Regular telephone contact, or by using face to face apps, can stave off depression and help self-isolating individuals improve their mental wellbeing.

For others, who share their living space with differing generations of relatives, this can also be a difficult time - for opposite reasons. As schools close, children must remain inside with their families for extended times, whilst trying not to mix with elderly relatives, and with parents often trying to work at home. In such crowded families, days of isolation can rapidly feel like months. It’s true to say that when social constraints are ordered during epidemics, each member of society must play their part.

Johns Hopkins Center for Systems Science and Engineering

WHO

• https://www.who.int/health-topics/coronavirus#tab=tab_1

European Centre for Disease prevention and control

• https://www.ecdc.europa.eu/en/novel-coronavirus-china

Nathnac

• https://travelhealthpro.org.uk/latest-news

CDC

• https://www.cdc.gov/coronavirus/2019-ncov/index.html