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COVID-19 for the confused:

A London Doctor with front-line hospital experience discusses dealing with COVID and steps you can take to protect yourself

I’m Dr. John Ndikum I’m currently working as a frontline professional in the National Health Service.

Now I’ve been inundated with questions from friends and family members just really many people are confused so they’ve reached out to me with a view to clarifying and gaining a better understanding of what to do during this time. So in this short piece, I’m going to go through a few points, going to go through the WHO guidelines and discuss them and guidelines around dealing with COVID in different countries, just generally. I’m gonna discuss being careful during this time as efforts to ease lock down the now underway. I’m gonna discuss the possibility of a second wave, discuss the vaccine or the upcoming vaccine and obviously discuss the reality of the situation.

So tons of guidelines. There’s been a lot of confusion because we have WHO guidelines which are still evolving and different countries are doing different things. Why is this happening, why is there no best practice. The truth of the matter is that was still trying to understand the virus itself and we best practices based on emerging evidence and unfortunately this virus is spreading so rapidly so fast having such a devastating impact at such a rapid pace that guidelines are forced to shift accordingly which makes it very very confusing. So I’d say the evidence so far is much better than the evidence that existed four weeks ago, so I’d say be guided by WHO guidelines and obviously be guided by whatever your particular government the guidelines in your particular government are providing. I know that in many countries things have been confusing for many people, and more recently the Prime Minister provided guidelines for easing lockdown which have confused appears to have confused many members of the general population.

I would say that the core message is about being careful during COVID-19 so it really boils down to doing what you need to do. I know that some people will have to work, some people will have to go shopping, but precautions must be taken, which means wearing masks number one, when you go shopping, wearing masks when you go on public transport absolutely necessary I can’t obviously tell you where you can secure those masks but those masks will be available if you reach out for them. The research that has emerged is telling us that actually any piece of clothing should be sufficient to reduce the output of the virus by up to 90%. So while FFP3 masks are the best they reduce the output of the virus or at least the transfer of the virus by around 98% their use with frontline workers but as you get going about your day to day life, a basic surgical mask this is probably about two layers thick, so you can have two of these, should suffice. Ok questions are under bring up well some people say don’t double up. The fact of the matter is that the data tells us that the more layers that you have well not too many but if you have up to four layers the criss-crossing that occurs in each layer is sufficient to reduce transfer of the virus up to 90%. So two of these are ideal for when you go shopping or on public transport.

If you can I would get an oxygen saturation probe you can find these on eBay for around, I bought mine for around 16 pounds, let’s see if I can find it here. And this is particularly useful for high-risk members of the public. It’s just measuring the oxygen level. I should come up soon… so my saturation of the 98% or air, my heart rate is 72 look it’s now 70, it’s 72 yeah there we go. I have no underlying conditions, so I’ll be aiming for a saturation of above 94 or ideally above 97%. An oxygen saturation probe can be very particularly useful for people who are high-risk because what we’re seeing is that certain people’s lungs can be impacted long before they feel something. It’s been described in the media as the happy hypoxic so obviously they’re not going to be happy but they’re happy because they’re not aware that anything is wrong. And for the high risk people having this just doing the morning can give you several hours head start. So if you’ve got COPD be aiming for saturations between 88 to 93 percent, and if you don’t have an underlying lung condition you’d be aiming for saturations of above 94 percent, because your lungs might start to be affected around 6:00 a.m., and you won’t actually feel it until around 2:00 p.m. So if you at 9:00 a.m., you’ve monitored your oxygen and seen that something’s wrong that will give you several hours during which you can actually, so several hours head start during which you can actually contact health services. Okay? And those are available and they can be very useful.

And the next thing to talk about is I’ve already touched on people who are high-risk but those who are high-risk I would say should continue taking the precautions that they’ve been taking. So I know that it’s very tough for many people during this time and they you have to see family members but again so if your doubt if you’re if you feel that you must if you feel that you must then obviously no one can force you to not do that but you must take appropriate precautions. The ideal would be to sit out, you know just talk you know someone some people have a car they sit outside and they just communicate with a mobile phone but they can see each other, that would be the ideal. If you absolutely must, I mean as a clinician I would say continue if you’re high-risk, one of the high-risk members of the public, continue to take the precautions which means continue to take the lockdown precautions but I know how to say I understand that for some people being isolated being lonely can be psychologically devastating, then ideally, meet only outside. You don’t want to be staying inside where the virus can actually circulate, and where one of these or two. Okay?

Now as for a second wave we’ve seen that South Korea and Germany been very successful in containing the virus and now that they’re easing lockdown we’ve seen the emergence of a second wave. And while there haven’t been an increased number of deaths have certainly been an increased number of COVID cases the deaths might or might not occur, but the fact that it is such a dramatic increase in the number of cases tells us that it’s likely that we will also have a second wave, which is why I’m kind of insisting, no not kind of, this is why I am insisting that people continue to be safe continue to be careful, because the results or the the consequences of a second wave won’t be felt for another couple of weeks and if you are high-risk you might not be affected now, but you may very well be affected in a couple of weeks, if we do have a second wave. So just continue to be cautious until we we can actually understand what might happen what might or might not happen should a second wave occur.

As for a vaccine I know that several pharmaceutical companies are working very very hard to know if he’s working with GSK, Gilead as well as you know working on a vaccine, it’s recently come out that Roche has been given the contract for supplying highly effective antibody tests so I have no doubt that our scientists are working very very hard in those efforts. I personally have no doubt that we will develop a vaccine. Pharmaceutical industry and the science industries have some of the brightest minds in the world, so I have no doubt that it’s just a question of when. But what we do know, what has recently come out is that from the from scientists that if a vaccine does come out there’s no guarantee that it will work. I think another way to put is that there’s no guarantee that will work for every single person, which means that obviously all the people who the vaccine won’t work on it’ll be still be capable of spreading you know, COVID-19. That’s the same for every vaccine, it’s same for flu vaccines as well. But yet we understand whether the virus is mutating, there might be various there might be variants of the virus which might require different vaccines. So while a vaccine is in fact needed and it will be groundbreaking and transformation transformational, will have a transformational impact in tackling this virus, we can’t hedge all of our bets on a single vaccine and we must continue to keep safe until we know what the data is telling us.

Now I’m just gonna finish off by talking about the reality of the situation, and really a practical aspect of it. I know what my advice is as a clinician I know what I want people to be doing which is to continue being cautious, for people who are high-risk to continue staying at home and to avoid visiting family members who are who are high-risk but understand that you know the practicalities of the situation can be different and people are affected by it being at home. Some people will have to work some people’s furlough time would have been over some companies might not be able to continue and furloughing them if they stay at home, in which case I would advise people as I advised a friend yesterday to have gentle talks to try and negotiate things with them, with with your employers if you’re concerned about your health health and welfare then obviously you can speak your employees about making necessary adjustments about maybe adjusting time that you can you know if it’s possible for you to work from home. But there’s no general advice I think that can be given on this. This will be on a case-by-case basis and I implore you to gently approach your employer and see what can be worked out.

A friend reached out to me about sending children to school. One of their family members could possibly have a condition, it’s currently being worked up to try and determine whether they have an underlying condition. So this particular family member going to school might actually impact everyone in the family, and my advice to her was listen I can’t give general advice here but I what I would say is that people when you approach them in a in an in a thoughtful way generally quite sensible so for parents who are concerned or if you’re a parent and you happen to be high-risk and you’re worried that sending your kids to school, they could very well bring back home COVID-19, I would say have a gentle talk with with teachers, reassure them that you’ll be able to follow the curriculum at home you will guide the children if that is indeed possible and again this will happen on a case-by-case basis, but you know your concerns if you approach the teacher or the school in the right way generally will be heard, and I hope I can only hope that they will try and work with you to find a mutually satisfactory solution.

As for people with illnesses another friend reached out to me and raised her concern that a family member is ill has been asked to go to clinic but she’s had underlying lung condition and she’s worried about that. Again in this kind of situation doctors are very understanding if you if you tell them look yes I know I’m ill I know I need to come in but I’m very concerned because I had this underlying condition. They can do phone and clinics video clinics if you’ve got a skin condition they could you could send over pictures and doctors are generally very understanding. What happens sometimes is that I find the general public can expect us sometimes to know things so almost have psychic powers and be telepathic, and you know what while we do know a lot I do hope that you feel that you can turn to us and and and raise your concerns with us because a lot of the time we make decisions on what you tell us, so please if there’s something that we you think we should know that might help guide our decision-making to make you know to to address your concerns in a more satisfactory fashion then please please do raise those things because I know that my colleagues in the National Health Service are working very hard to give the best to our patients, and if you give us that information and you tell us that you’re worried or you’re concerned we absolutely will hear you and we’ll try and make any adjustments that we can.

And obviously it’s under socialising I see that a lot of people are going out socialising and I suppose completely flouting the rules of the previous law lock down, which is understandable, given the recent message about easing lock down. I would I would implore I hope that the general public can continue to be careful. Again I know that a lot of my friends are extroverts and staying at home is taking a tremendous psychological toll on them, and I’ll say to these people if you absolutely must go out, there’s no way you can stay in… wear one of these okay? And just just please be careful.

Let’s all remember that being safe isn’t just about us you know because I for example am not worried too much about my own health, I’ve got robust health, but I know that if I do have the virus there at any point and I have had it before, then me not wearing this, means that I could transmit it to anyone who’s vulnerable, so when I go to the supermarket I wear this not just for me but for other people. So I suppose the message is just let, keep staying safe keep watching the evolving guidelines as best practice begins to emerge and obviously taking the reality of the situation the practicalities of life into account doesn’t preclude being safe being careful or wearing one of these. I hope this has been useful and please let’s all let’s try our very best for each other okay? Have a great day, thank you.

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