- People in the UK have been told to stay at home in an effort to combat the spread of the COVID-19 virus.
- Those who develop symptoms - a new continuous cough and/or high temperature – must self-isolate for seven days.
- It is important that managers and staff keep as up-to-date as possible about the latest official guidance. The outbreak has escalated rapidly so check often for updates.
Coronaviruses are micro-organisms that cause serious infectious diseases. Previous outbreaks have included Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
COVID-19 is a new strain of coronavirus which first appeared in the Wuhan region of China at the end of 2019. The virus proved highly infectious and rapidly spread to other countries through infected travellers.
In January 2020 the World Health Organisation declared a global emergency and early in March they defined the disease outbreak as a pandemic.
The virus spreads from person to person in droplets from the nose or mouth of an infected person. These are spread when the person coughs or exhales. Others become infected when they breathe in the droplets or touch contaminated surfaces and then touch their eyes, nose or mouth. Incubation is between 2 to 14 days.
It is known that some people may be infected but remain symptom free. However, it is not known if they can pass the virus on to others.
Symptoms and treatment
Symptoms of COVID-19 include fever, tiredness, and persistent dry cough. Other symptoms such as aches and pains, nasal congestion, runny nose, sore throat and diarrhoea are also reported.
Most infected people will have fairly mild symptoms with no significant infection in the lungs. Most people with mild symptoms will recover at home with no treatment needed. They should drink plenty of water and take paracetamol to lower fever.
However, some will have severe symptoms causing serious shortness of breath, low blood oxygen or other lung problems. A minority will suffer critical respiratory failure and pneumonia. People who are critically ill require hospital treatment. Many will need to be placed on a ventilator.
The exact mortality rate of COVID-19 is as yet unknown. However, the virus has caused thousands of deaths around the world. It is particularly dangerous for older people over 70 and for people with weakened immune systems or long-term conditions, including diabetes, cancer and chronic lung disease.
There is no vaccine currently available and the virus does not respond to known anti-viral medication.
How can people protect themselves?
Public Health England (PHE) state that people can protect themselves from catching COVID-19 by regularly washing hands with soap and water for at least 20 seconds. They are advised to use 60% alcohol hand sanitiser gel if soap and water are not available. PHE also recommend that people cover their mouth and nose with a tissue or with their sleeve when coughing or sneezing. They should not use their hand. Used tissues should be disposed of straight away and frequently touched objects and surfaces cleaned and disinfected. Lastly, they should avoid close contact with people who are unwell and should not touch their eyes, nose or mouth if their hands are not clean.
As well as handwashing and respiratory hygiene, key government strategy is to prevent people from passing the virus on to each other. This is accomplished by ‘locking down’ the country and asking people to ‘self-isolate’ and observe ‘social distancing’ rules.
The following ‘self-isolation’ rules must be followed:
- those who live alone and have symptoms of new continuous cough and/or high temperature - however mild - should ‘self-isolate’ by staying at home for 7 days from the symptoms start
- those who live with others should self-isolate as a household for 14 days from the day the first person in the house became ill.
People self-isolating must stay-at-home. They must not have visitors and should arrange for friends or family to shop for them. They should use the internet and NHS111 online for information and call NHS111 if without internet access or if symptoms worsen. People are asked to avoid going directly to a GP, a pharmacy or a hospital. For a medical emergency they should dial 999.
People do not need to call NHS111 to go into self-isolation.
Social-distancing and lockdown
In addition to self-isolation many countries, including the UK, have introduced mandatory ‘social distancing’ as well as restrictions on people’s movements.
On the 23 March the Prime Minister announced a ‘lockdown’ where the majority of the population are required to stay at home. They should only go outside if:
- shopping for necessities, such as food and medicine, as infrequently as possible
- to do one form of exercise a day, such as running, alone or with household members
- for medical or care needs, for example to help a vulnerable person
- travelling to and from work, but only if the work cannot be done from home.
Meeting friends, shopping for anything beyond essentials, and gathering in crowds or groups of more than two people are banned.
Every citizen must comply. The restrictions are designed to protect the NHS. They will be enforced by the police and may lead to fines for non-compliance.
To support the lockdown people are being asked to work at home, wherever possible, and to only travel for essential reasons. They should not have visitors, including friends and family. Sporting events have been cancelled and pubs, restaurants, bars, cafes, libraries, outdoor gyms and playgrounds, places of worship and leisure centres have been ordered to close. Most schools and nurseries have also closed with the exception of a reduced network of schools to look after children of ‘key workers’ such as doctors, nurses and paramedics who cannot be looked after at home, and certain vulnerable children. Shops that sell essentials such as food remain open.
A business operating in contravention of the Health Protection (Coronavirus, Business Closures) Regulations 2020 is committing an offence.
Social distancing means that when people do go out, or when they go to work, they should avoid any unnecessary social contact. They must stay at least 2 metres (about 3 steps) away from anybody outside their immediate household and should stay away from people who are unwell.
Because they are more at risk, vulnerable people such as those aged 70 and over are being strongly advised to stay at home. Even visits from family members must be avoided.
The intention of the lockdown and social distancing policy is to suppress the transmission of the disease and slow it down so that NHS critical care capacity can be protected for the sick. It is hoped that this will be enough to ensure that hospitals can avoid being over-whelmed with the strain of so many sick people all at once.
People are advised to keep in touch using the phone, internet, and social media.
The lockdown rules will be kept under review. In time the transmission rate of the virus will be suppressed far enough for the lockdown requirements to be gradually relaxed.
Guidance on social distancing for everyone in the UK can be found at www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
Shielding’ high-risk individuals
Arrangements have been introduced to ‘shield’ people considered as especially high-risk.
‘High-risk’ individuals are identified as those who:
- have had an organ transplant
- are having certain types of cancer treatment
- have blood or bone marrow cancer, such as leukaemia
- have a severe lung condition, such as cystic fibrosis or severe asthma
- have a condition that makes them much more likely to get infections
- are taking medicine that weakens their immune system
- are pregnant and have a serious heart condition.
People in these categories have been written to by the NHS advising them not to leave their home for a period of at least 12 weeks from receipt of the letter. They are urged to avoid close contact with other people in their home, not to go out for shopping, not to visit friends or family, and not to attend any gatherings. Other people living with high-risk individuals are not required to adopt these protective shielding measures for themselves. However, they should be stringent in following guidance on social distancing.
Some high-risk individuals will already be supported by their families, in a care home or by an agency such as a domiciliary care provider. However, others may find the restrictions difficult. Local authorities are therefore coordinating care packages to ensure that shielded individuals have the support they need, such as supplying essential medicines, food or supplies.
Details of the scheme are set out in Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19, published by Public Health England (PHE).
People can register for high-risk support at www.gov.uk/coronavirus-extremely-vulnerable
A test is available for determining whether somebody has the virus. However, due to a shortage of test kits in the UK these have largely been employed on symptomatic people in hospital. They are not routinely done on people who self-isolate themselves at home. Plans are in place to roll out the testing for NHS workers.
It is hoped that additional antibody tests will become increasingly available. These will be able to show whether someone recently had coronavirus, even if they had no symptoms.
More widespread testing is seen as key to tackling coronavirus.
The National Institute for Health and Care Excellence (NICE) have published the first of a series of ‘rapid guidelines’ to help UK doctors and nurses know the best course of treatment for patients amid the coronavirus pandemic. The guidelines cover patients in critical care, those having kidney dialysis and people being treated for cancer.
Further guidelines are expected in the coming weeks on symptom management, radiotherapy patients and those with rheumatoid arthritis.
It is important that managers and staff keep as up-to-date as possible about the latest official guidance. The outbreak has escalated rapidly so check often for updates.
The further information contains links to the latest guidance. Information should be passed on to staff and patients as required.
- The NHS111 online service https://111.nhs.uk/service/COVID-19/
- Number of coronavirus (COVID-19) cases and risk in the UK: The latest number of coronavirus (COVID-19) cases and risk level in the UK, Department of Health and Social Care and Public Health England www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public#information-about-the-virus
- NHS advice on symptoms and treatment www.nhs.uk/conditions/coronavirus-covid-19/
- COVID-19: guidance for households with possible coronavirus infection: Stay at home guidance for households with possible coronavirus (COVID-19) infection, Public Health England www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-people-with-confirmed-or-possible-coronavirus-covid-19-infection
- Travel advice www.gov.uk/guidance/travel-advice-novel-coronavirus
- Coronavirus action plan, Department of Health and Social Care www.gov.uk/government/publications/coronavirus-action-plan/coronavirus-action-plan-a-guide-to-what-you-can-expect-across-the-uk
- Information from the National Institute for Health and Care Excellence (NICE) www.nice.org.uk/covid-19
- NHS guidance for primary care, NHS: https://www.england.nhs.uk/coronavirus/primary-care/
- Isolation advice for people with possible COVID-19 infection, Department of Health and Social Care and Public Health England: https://www.gov.uk/government/news/new-guidance-for-households-with-possible-covid-19-infection
- COVID-19 guidance for infection prevention and control in healthcare settings, Public Health England: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
- Decontamination in primary care dental practices guidance HTM 01-05, Department of Health and Social Care: https://www.gov.uk/government/publications/decontamination-in-primary-care-dental-practices
- CQC update: Routine inspections are suspended to coronavirus outbreak, CQC https://www.cqc.org.uk/news/stories/routine-inspections-suspended-response-coronavirus-outbreak
Use the following item in the Toolkit to put the ideas in the article into practice:
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.