GPs are using COOKING APRONS to see suspected coronavirus patients ‘because they don’t have the correct protective equipment’
- GP Faye Kirkland said doctors are suffering a shortage of appropriate equipment
- NHS England has reassured GPs that hundreds of protective kits are on the way
- Doctors also report they haven’t been given clear guidance on seeing patients
- People who believe they have symptoms say they have been ignored by NHS 111
GPs are using cooking aprons to see coronavirus patients because they don’t have the correct protective equipment, it has been claimed.
NHS England has reassured GPs that protective kits, including aprons, gloves and face masks, will be issued to every practice.
But Faye Kirkland, a GP and reporter, told the BBC’s Radio 4 Today programme that some doctors are having to resort to cooking aprons.
Today Public Health England said GPs will need to perform coronavirus tests on any patient with flu-like symptoms if they need to be admitted to hospital, regardless of travel history.
It follows doctors reporting that they haven’t been given clear guidance on how to manage the coronavirus outbreak, which has affected almost 400 people in the UK, by NHS England.
The chairman of the Royal College of General Practitioners (RCGP) slammed the Government for failing to focus enough attention on doctors.
He said general practices will feel the pressure of COVID-19 – the disease caused by the coronavirus – in a ‘significant way’.
GPs are using cooking aprons to see coronavirus patients because they don’t have the correct protective equipment, it has been claimed. They are supposed to use disposable plastic aprons which prevent the spread of germs
Disposable plastic aprons should be worn when dealing with suspected coronavirus patients because close contact can lead to clothing becoming contaminated with germs. Single-use aprons reduce the risk of contaminating other people (stock of a correct apron)
Britons with symptoms of the killer virus are being turned away when they contact NHS 111 unless they’ve been to high-risk countries. It has sparked fears hundreds of infections are being missed and the true toll could be far higher than the 382 currently reported
Dr Kirkland said she has been contacted by a ‘number of GPs concerned about the current guidance’.
She said: ‘There is an increasing concern about those who have symptoms such as a fever or a cough but haven’t been away or haven’t had a known contact.
‘Patients are calling 111, but they’ll go through a whole set of questions.
‘And if they don’t think they are at risk or don’t fit the tightly-defined criteria for a swab then often those calls are passed to the GP and they might come and see the GP.
‘I’ve heard of GPs trying to see those patients at the end of a list so they can be seen together, seeing patients and trying to use catering aprons to protect themselves because they haven’t got the correct equipment.’
Disposable plastic aprons should be worn when dealing with suspected coronavirus patients because close contact can lead to clothing becoming contaminated with germs.
Single-use aprons reduce the risk of contaminating other people. Therefore, a standard cloth cooking apron does not offer the same protection because it is re-usable.
Without correct equipment, including face masks and protective eyewear, doctors are vulnerable themselves to catching the life-threatening infection if they interact with a coronavirus patient.
Dr Kirkland said personal protective equipment (PPE) was not being shared among surgeries, leaving some in desperate need.
There is hope deliveries from NHS England will come in the next few days.
NHS England said it informed all GP surgeries in England that ‘hundreds’ of protective kits would be sent out from this week.
An initial stock for each practice will include 400 aprons, 300 pairs of examination gloves and 300 face masks. Larger surgeries will receive repeat deliveries to ensure they have sufficient amounts.
Speaking in the House of Commons, public health and primary care minister Jo Churchill said: ‘We have over two thirds of PPE now rolled out into GP surgeries with the rest arriving imminently.’
The general advice for people who believe they have symptoms of the killer infection is to stay isolated indoors and call NHS 111.
If a patient with flu-like symptoms which are severe enough for hospitalisation comes to the surgery, family doctors should disregard whether people have links abroad and treat them as a potential case.
GPs are being urged to immediately isolate the patient without touching them, put on protective gear and report it to PHE and NHS 111.
According to Dr Kirkland, the RCGPs said members are experiencing some confusion about how to correctly deal with concerned patients who call for appointments.
They are unsure on which patients they should be talking to on the phone, and which patients they should be bringing in for assessment.
Sam Butler, from Fleet, Hampshire, who is in his 70s and suffers from heart and kidney problems, was refused a test because he hasn’t been abroad
Dozens of ‘scared’ Britons who were turned away by the online service blasted it as ‘rigid’. They said thousands of cases were going unreported due to the NHS 111 questionnaire
GPS ASK FOR PAPERWORK TO BE CANCELLED
Ministers have backed GPs requests for paperwork to be dropped in order to free up time as they expect a surge of appointments – despite the public being urged not to visit their practice if they have symptoms.
In a monthly health questions sessions held in the House of Commons, Shadow Health Secretary Jon Ashworth urged the Government to suspend the need for appraisals and other requirements.
Health Minister Jo Churchill said talks are ongoing to make changes while also keeping patients safe.
She said: ‘I’m currently having those discussions to make sure that we can lift, within the bounds of making sure patients stay safe, all appropriate bureaucracy.’
It comes after a poll by GPonline found almost half of the 402 respondents think paperwork [The Quality and Outcomes Framework, QOF], should be halted to cope with increasing work pressure amid coronavirus in the UK.
A letter from Nikita Kanani, medical director for primary care, advised that practices replace face-to-face appointments with phone or video consultations to mitigate the risk of infected patients turning up to a surgery.
Health Secretary Matt Hancock said GP and outpatient appointments will be held digitally where possible ‘with immediate effect’.
But Dr Kirkland said: ‘For the vast majority of patients – they can be spoken to on the phone. But there are circumstances whereby the patients will need to be examined.’
The British Medical Association has said routine health checks by GPs may need to be halted to ‘focus on the sickest patients’.
Richard Vautrey, chairman of the BMA GPs committee, told the BBC cases of COVID-19 are anticipated to ‘rise rapidly’ in the coming weeks.
This could leave those needing routine health checks, such as to check blood pressure or diabetic control, waiting in limbo.
He said: ‘It does mean that some patients may have to wait longer than normal to see their GP. ‘It’s likely to continue for at least a few weeks, if not months. And it’s quite possible that there will be more than one wave of infection.’
It comes after three-quarters of 402 GPs surveyed by GPonline said routine appointments should be suspended in the event of a widespread coronavirus outbreak.
One in five thought this should happen now, in the survey published on Monday.
Meanwhile, the chairman of the Royal College of General Practitioners (RCGP) criticised the Government for being ‘insufficiently focused’ on GP surgeries amid the outbreak.
Professor Martin Marshall told Londonwide LMCs conference on Tuesday he had been inundated with emails from GPs concerned about a lack of information.
‘Overall it feels like the Government are doing a reasonable job, but it does feel that they are more focused on hospitals and much more focused on NHS 111 and insufficiently focused on general practice,’ he said.
‘General practice is going to start feeling the pressure probably in quite a significant way.’
He told delegates in London that a widespread COVID-19 outbreak could be ‘the biggest issue the NHS has ever seen’.
MailOnline yesterday revealed suspected coronavirus patients within the UK were not being tested unless they’ve travelled abroad – despite the disease spreading rapidly between people in the UK.
Britons with symptoms of the killer virus are being turned away when they contact NHS 111 unless they’ve been to high-risk countries.
It has sparked confusion among the public who believe they have caught coronavirus in some way, possibly from a close contact who has not been diagnosed but has the virus.
It also raised fears hundreds of infections are being missed and the true toll could be far higher than the 382 currently reported by the Government.
An NHS spokesman said: ‘In the first of a series of regular updates the NHS wrote to every single GP practice in England on Thursday pointing them to all the latest advice and guidance for GPs and practice staff, and informing them that hundreds of protective kits, experts at Public Health England recommended, would be sent to them from this week.
‘The NHS is continuing to work with the Royal College of GPs, the BMA and local NHS organisations to ensure that family doctors and their teams are supported as the health service works to tackle coronavirus.’
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
Someone who is infected with the coronavirus can spread it with just a simple cough or a sneeze, scientists say.
More than 4,000 people with the virus are now confirmed to have died and more than 110,000 have been infected. Here’s what we know so far:
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.
By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.
By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.
By February 5, there were more than 24,000 cases and 492 deaths.
By February 11, this had risen to more than 43,000 cases and 1,000 deaths.
A change in the way cases are confirmed on February 13 – doctors decided to start using lung scans as a formal diagnosis, as well as laboratory tests – caused a spike in the number of cases, to more than 60,000 and to 1,369 deaths.
By February 25, around 80,000 people had been infected and some 2,700 had died. February 25 was the first day in the outbreak when fewer cases were diagnosed within China than in the rest of the world.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
There is now evidence that it can spread third hand – to someone from a person who caught it from another person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak is an epidemic, which is when a disease takes hold of one community such as a country or region.
Although it has spread to dozens of countries, the outbreak is not yet classed as a pandemic, which is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
The head of WHO’s global infectious hazard preparedness, Dr Sylvie Briand, said: ‘Currently we are not in a pandemic. We are at the phase where it is an epidemic with multiple foci, and we try to extinguish the transmission in each of these foci,’ the Guardian reported.
She said that most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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