People living with chronic illness, including ME/CFS, may be concerned about how COVID-19 might affect them differently to the general population. ME/CFS Australia has therefore provided the following information.
The Department of Health (Australia) has published some information on the novel coronavirus.
Disclaimer: Information contained in this article was accurate as at 6 March 2020; it should not be used for individual medical advice. Readers must seek their own medical advice as required.
Table of Contents
- 1 COVID-19 Summary for people with chronic illness
- 1.1 TL;DR Highlights
- 1.2 Key terms and why this matters
- 1.3 Why it’s a little different for chronic patients
- 1.4 Don’t panic, take preventative action
- 1.5 Key national actions
- 1.6 What next?
- 1.7 PS Extra information on epidemics and data sources
- 1.8 References
COVID-19 Summary for people with chronic illness
© 6 March 2020 by S. Jade Barclay, MPH, MBA, MCAP* and Dr John Whiting F.R.A.C.P. (Aust.), MB, BA, B.Ch, BAO (Trinity College Dublin)**
*Epidemiologist and Health Science Writer, The University of Sydney, The Delphi Institute
**Physician, Internal Medicine and Infectious Disease Specialist
Countries and communities are working together to know the signs and stop the spread of COVID-19 (and hopefully find credible, trustworthy information). Patients living with chronic pre-existing conditions and their loved ones have a few additional things to consider.
The COVID-19 disease and the virus that causes it have been making headlines this year. The words “outbreak” and “pandemic” have been used appropriately and inappropriately, and have led to some myths and toilet paper panic. The World Health Organisation (WHO), epidemiologists, and the Chinese response to the virus have all been key to establishing good data and good practice, and the rest of the world can learn from their experience.
Many of the media messages have tried to reduce alarm by indicating that it is only a danger to the elderly or chronically ill – but these messages are not reassuring if you are a member of either of those groups. Messages that increase distress or panic in the media also increase cortisol, immune, and inflammatory responses in the body, which are particularly unhelpful in a situation like this. This paper focuses on the key issues for chronically ill and immunocompromised patients, why this matters, what to focus on, how to manage, and what’s next.
- Why this matters for chronic patients: inflammatory complications and ACE inhibitors.
- Don’t panic. Know the signs and take preventative action.
- Know the signs: Fever, dry cough, sore throat, shortness of breath. Not a runny nose, and not the common cold.
- Stop the spread: wash hands, cover your cough, gloves vs masks, self-isolation, contact doctor, social distancing (6 foot rule).
- Manage pre-existing conditions: review medications with your doctor, manage inflammation, hypertension and heart conditions, calm mast cell activation with antihistamines where possible.
- Key national actions: find it early, trace close contacts, reduce the spread.
- PS: Extra info on epidemics and data sources.
Key terms and why this matters
- All coronaviruses are named for their crown-like shape (coronam = crown in Latin), and they are usually carried by animals and shift to humans. While several other coronaviruses have been found in humans for many years, this one was reported to be present in humans for the first time on the 31st December 2019. The fact that it is new means that we are learning about its transmission, mortality rate, and how to treat it for the first time. Most countries have an emergency response plan prepared for an influenza pandemic, and this is being deployed and adapted as we gather new information.
- This global learning curve requires a coordinated global research, health, travel, and government response. All 29,902 jumbled letters of the whole genome of the COVID-19 virus was submitted for publication on the 5th January 2020, a full month before the disease had even been given an official name. While travel has been restricted, research restrictions have been lifted as hundreds of other open publications appear, enabling global collaboration and a rapid global response from the science and medical community. This was made possible by an unprecedented move by all the major research journals, who have agreed that posting data openly online would not jeopardise future publication.
- There are currently two known strains of the virus: the original S strain and the mutated L strain, which is more virulent and infectious. Both these strains have been found in China, and we do not yet know which strain is more prevalent in other countries.
- Pandemic is a word that mostly goes undefined when used by the media or health authorities. An epidemic is an infectious disease that has had an outbreak in one country. A pandemic is an infectious disease that has spread to multiple countries. The initial COVID-19 outbreak started in China and was reported to the WHO on 31st December 2019. The WHO named the disease and the virus on 11th February 2020.
- There are two notable stages of the spread of a pandemic: First there’s the spread to other countries, and then there’s the spread within each country. Air travel restrictions have been imposed in several countries to slow the first kind of spread as much as possible. The first case outside of China was reported on 20th January 2020. As of today, there have been cases reported in 85 countries, and air travel restrictions have been imposed on travel to, from, and within the most affected countries, including Italy, Iran, Korea, and China.
- The spread within each country is generally via person-to-person local transmission. Each day WHO reports which countries have imported cases only, and which countries have cases that arise from local transmission. This is where it is important to stop the spread within countries, and where individual and government preventative action can make a big difference. According to the WHO epidemiologists that have been actively learning from the Chinese response, the biggest opportunity to slow the spread of the disease in other countries is by using community awareness rather than waiting for cases to show up in the health system. This starts with the public knowing the signs, and knowing what to do to slow the spread.
Why it’s a little different for chronic patients
- People living with pre-existing conditions are more vulnerable to most infections, and this is no different. The current recommendation is that people with pneumonia or flu-like symptoms should get tested for COVID-19. Learning from the information and experience in China to date (where over 80% of cases have been located so far), the WHO has found that most critical cases there involved an inflammatory process in their lungs. They are not yet certain of the mechanism. They do know that the highest rate is in people with hypertension and cardiovascular disease. Diabetes is a little bit lower than those two, and cancer is lower again.
- The infection mechanism for the COVID-19 virus involves close contact. While touching contaminated items can also transfer the virus, transmission has been most commonly found with health workers or family members, and situations where small children or people with illnesses require close daily care. So if you are a carer/healthworker or you have a carer/healthworker, then extra precautions should be taken if either one of you starts to show signs of fever, dry cough, sore throat or shortness of breath.
- ACE inhibitor medications for hypertension and heart disease increase the ACE2 receptor for the virus in the lungs, which may potentially be an additional risk factor. If you’re using these medications, contact your doctor as soon as possible to have them review your medications and options.
- The recommendation for two weeks of self-isolation may be easier for people with chronic conditions to manage, as they are often more accustomed than the working well to spending extended periods of time at home. Workplaces and health services are being asked to make teleworking and telehealth services more widely available to reduce the spread of the virus in workplaces and doctors offices. This short-term measure may make everyday life easier for chronic patients in the long term, as the flexibility of teleworking and telehealth services have been needed by these groups for many decades, and will hopefully remain available after the pandemic subsides.
Don’t panic, take preventative action
One of the biggest causes of panic is misinformation. Get information from credible sources, like the World Health Organisation or the local and national government health departments.
Know the signs
The four key signs to be aware of are:
- Dry cough
- Sore throat
- Shortness of breath
If you notice these symptoms in yourself or others, self-isolate (stay home) for 14 days, and contact your doctor’s office to request a telehealth consult over the phone. Anybody you have had close contact with in the last 14 days should be notified as well.
Note that a runny nose and the common cold are not known symptoms of COVID-19. If your fever is mild and the temperature seems to be below normal, please check it against what is normal for you. People who track their temperature daily have noticed that their temperature fluctuates during the day, during the month, or if taken orally or rectally. One person’s whole temperature range may be lower than that of other people. It is helpful to know what your normal temperature range is so you can know when you have a fever that is more than two or three degrees higher than your normal range.
Stop the spread
Masks or gloves?
- If you are ill or infected: Masks, self-isolation and washing your hands can help to prevent you from infecting others.
- If you are not ill or infected: Gloves, social distancing, and washing your hands can help prevent you from getting infected. It’s also helpful to use alcohol wipes to wipe down communal use objects, such as the mouse and keyboard in shared computer labs, door handles, or elevator buttons to prevent transmission from shared items or surfaces.
The five key actions to stop the spread of the disease:
- Wash your hands: and avoid shaking hands or touching your face. Scrub your hands with soap and water all over and between fingers for 20 seconds. Air dry or paper towel dry.
- Cover your cough: with a tissue (and dispose of it immediately in a bin with a lid), or cough into your elbow. And avoid touching your face, especially your mouth, nose or eyes.
- Self-isolation: If you have the signs, stay home from work or school for 14 days. Working or studying from home is being supported by many employers and universities at this time. Self-isolation for 14 days is also advised for anyone who has been in close contact with someone who develops COVID-19, or if you have recently returned from travelling to one of the countries with known outbreaks, like Italy, China, Iran, Korea. This list is updated daily in the WHO situation reports and by national government announcements.
- Contact your doctor: Ideally via phone. It is important to let the health services know your symptoms and to get tested as soon as you can. To prevent infecting others, contact your doctor via phone. Some health services are also making it possible to get tests and prescriptions sent to your home.
- Social distancing: This means to maintain 3-6 feet space between yourself and other people when in crowds, and especially maintain that distance from anyone who coughs. Avoid shaking hands or high fives.
Manage pre-existing conditions
- Manage inflammatory conditions: If you have any mast cell activation condition, gastrointestinal inflammation, or autonomic dysregulation with inflammation flares, talk to your doctor, pharmacist or allergist about inflammation management. Your doctor or pharmacist can do a MedsCheck and help you stay ahead of baseline inflammation, and develop a flare plan, with preventative use of antihistamines and mast cell inhibitors. Don’t wait for a flare.
- Review ACE inhibitors with your doctor: Some ACE inhibitor medications for hypertension and heart disease can increase the ACE2 receptors in the lungs. Review your management plan with your doctor to assess potential risks and options.
- Stay up to date on medications: Manage all conditions and medications, and make sure you have enough of your daily and as-needed prescriptions. Unless you’re in a professionally supported tapering program, this is not a time to taper off.
- Eat well, stay hydrated: Keep up good nutrition and hydration.
Extra things for chronic or immunocompromised patients to consider:
- Get ahead on your prescriptions: There’s no need to stockpile a year of medication in advance, but it could help to have about four months of your medications on hand. Some medications may have restricted supply in some countries soon, so be prepared.
- Don’t share towels or tea towels: Damp towels can be a breeding ground for all kinds of viruses and bacteria, so it’s best not to share and wash all towels twice a week if possible.
- Don’t share cutlery: Don’t drink from other people’s cups. Don’t use personal cutlery to remove food from a shared serving bowl or plate. Ideally, use your own utensils when eating out, and wash your hands before and after meals.
- Clean everything: If you or a loved one is infected, clean everything that they touch with hot soapy water, and ensure that masks are worn during the self-isolation period.
Key national actions
The WHO has indicated three important national actions:
- Find cases early: Individuals and communities can help by knowing the signs to look for, and by contacting the doctor if you suspect infection.
- Trace close contacts: It is only close contacts who have been infected by local transmission so far. If you are experiencing signs yourself, you should notify the doctor and any friends, family or health workers that have had close contact in the last 14 days.
- Reduce the spread: Early detection and self-isolation can help reduce the spread. Also, social distancing and avoiding crowds can be helpful. Some organisations have chosen to postpone large social gatherings at this time to help with prevention efforts.
Keep calm and go about your life. Keep your hands clean. Connect with your favourite people (via phone if you’re self-isolating for a little while).
PS Extra information on epidemics and data sources
- Try to get information from good sources. The best sources in this case have been the WHO daily situation reports, local and national government health departments (who are following the WHO guidelines) and epidemiologists, like Bruce Aylward, who deeply understand the nuances of these situations, what is helpful, and how to work with them at a global, national and individual level.
- Many posts online have been found comparing “death rates” and “death counts” of this versus other diseases or pandemics. This is unhelpful and incomplete, and offers little more than clickbait. These rates cannot be meaningfully compared or understood if they are separated from the specific era within which each specific virus exists. An infectious disease a hundred years ago was not dealing with the speed of air travel that is normal today, nor was it managed with the speed of research or emergency response, or the global collaboration and information sharing that has enabled such a rapid and coordinated response. We also didn’t have this kind of speed of global response or collaborative research available as recently as the SARS outbreak in 2012, let alone an outbreak in 1918.
- From an epidemiological perspective, we can’t make accurate claims about mortality rates, transmission rates, or other predictive models about the speed with which the virus moves through a population until the end of the epidemic. Everything else is a speculative guess until the initial epidemic is complete. This is why we’re learning from the countries that had early outbreaks, both in terms of their emergency response procedures, and the data about the symptoms, seriousness of the cases, and speed and spread of the infection. All this data can help other countries to be better informed and prepared.
McNeil, D.(2020). Inside China’s All-Out War on the Coronavirus – Interview with Bruce Aylward. The New York Times. https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html
World Health Organisation. (2020). Advice for public. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
World Health Organisation. (2020). Novel Coronavirus (2019-nCoV) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Page last updated 7 March 2020