What to tell immunocompromised patients about Coronavirus

19th February 2020

Let’s start with guidance for NHS Clinicians

As of last week, people from 25 countries were known to be affected by the novel coronavirus, COVID-19. In the UK, 9 cases had been diagnosed to date.

The current guidance from Public Health England (PHE) states that it is possible that COVID-19 may cause mild to moderate illness, in addition to pneumonia or severe acute respiratory infection, so patients could potentially present to primary care.

The main advice from PHE to healthcare professionals’ states:

  • to identify potential cases as soon as possible
  • prevent potential transmission of infection to other patients and staff
  • avoid physical contact, including physical examination, and exposure to respiratory secretions
  • isolate the patient, obtain specialist advice and determine if the patient is at risk of COVID-19.

Currently, COVID-19 is most likely to be seen in travelers who have recently returned from China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan or Thailand. Therefore, an accurate travel history is an important part of identifying potential risk.

For GPs, the principle is to avoid additional pressures on primary care, ambulance services and hospitals, including emergency departments.

Several actions have already been taken to prevent patients with suspected COVID-19 being inappropriately directed to their GP. A process is in place for NHS 111 whereby, when a patient calls asking for more information about the virus, they will hear a pre-recorded message. At this point, if the patient has concerns, they will be put through to a PHE helpline for guidance. If the patient is unwell or recently visited affected areas, they will be triaged to an NHS clinician. Furthermore, hospitals across the country have been asked to put in place an NHS 111 pod; a facility (close to the entrance, outside A&E) with a direct line to NHS 111. Patients who suspect they have symptoms of the virus are directed to the pod and will be put through to NHS 111 where they will discuss their symptoms with a clinician and be provided with further instructions. Hospitals have also been asked to identify a separate space where testing can take place. Moreover, a home diagnostic swab testing service is expected to be rolled out very soon.


What to tell your immunosuppressed patients

Despite the above guidance, if a patient presents to you as their GP with potential symptoms of this novel virus, you still need to know how to act. The UK Chief Medical Officers have raised the risk to the public from low to moderate. However, it is important to emphasise to your patients that the risk to individuals remains low. Nevertheless, because it is a new illness, we do not know exactly how coronavirus spreads from person to person. Yet, similar viruses spread in cough droplets. Therefore, encourage your patients to help stop germs spreading by covering their mouth and nose when coughing or sneezing, washing hands regularly and avoiding contact with people who are unwell.

The main symptoms of COVID-19 are a cough, a high temperature and shortness of breath.

If your patient is thought to have the virus, they may be asked to isolate themselves. A safe quarantine period of 14 days is recommended based on the incubation period of the virus. Please note, individuals who have travelled from Wuhan or Hubei Province in China are supposed to isolate themselves for 14 days even if they are experiencing no symptoms. Otherwise, individuals who have travelled from the other countries mentioned should isolate only if they have symptoms.

This strain of coronavirus (COVID-19) is now thought to be moderately contagious (although less so than influenza). However, it behaves very similarly to other infectious viruses by targeting mainly the elderly and/or immunocompromised portions of the population. For the vast majority of the population, contracting the coronavirus infection will lead to flu-like symptoms and the majority of patients will survive, very similar to the majority of people who get the flu. However, like with the flu it is highly likely that people with immune systems that are suppressed are at a particularly high risk for severe disease and complications. The importance of seeking early medical attention is also likely to apply.

Due to the new nature of the virus the only advice available at this point for GPs regarding your immunosuppressed patients is to emphasise the importance of following NHS guidelines:

  • cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • put used tissues in the bin straight away
  • wash your hands with soap and water often – use hand sanitiser gel if soap and water are not available
  • try to avoid close contact with people who are unwell
  • do not touch your eyes, nose or mouth if your hands are not clean.

It is important to reassure your patients that individual risk of contracting the virus remains low. However, it is equally important to ensure your immunosuppressed patients are aware of their increased risk, compared to the general population, of contracting any infection and their ability to fight off the infection without medical intervention. Yet, by following the NHS guidance above they are limiting their risk of contracting the virus as much as possible.

Make sure your patients know to call 111 if they have any concerns regarding the coronavirus.


Resources

https://www.gov.uk/government/publications/wn-cov-guidance-for-primary-care/wn-cov-interim-guidance-for-primary-care

https://www.ecdc.europa.eu/en/factsheet-health-professionals-coronaviruses

https://www.healio.com/infectious-disease/influenza/news/print/infectious-disease-news/%7Bb655da60-154b-4c81-bb89-84fc63c8026c%7D/preventing-and-treating-flu-in-immunocompromised-patients-2019-2020-update

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.mdmag.com/medical-news/the-fear-of-the-corona-virus-and-the-reality-of-the-flu

https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/coronavirus-disease-2019