Current Coronavirus (Covid-19 Situation) - An Update
23rd March 2020... You will be aware of the rapidly changing guidance and legislation being introduced to combat the threat from the Covid 19 virus that have been implemented over the last 7 to 10 days.
It is fair to say it has been a tumultuous period in all our lives, but particularly so for us healthcare professionals – the world is suddenly a different place!
We in the medical world have been trying recently to reflect on and digest all the emerging evidence and data emerging from areas of the world that have thus far been worst affected by the virus, particularly China and Italy.
To put it in perspective, this data would seem to suggest that the Covid 19 virus poses little risk to the vast majority of the UK population.
Most of you in the general population with limited likely virus exposure (particularly now social distancing measures are in place) are either unlikely to get it with appropriate isolation or to get it at some stage, and most likely have only a very mild illness and will completely recover without any need for medical input or intervention.
The Covid 19 virus is now likely to be circulating in the community among a lot of people at present, who may not show any symptoms and may merely be unwittingly acting as ‘super-spreaders’ to those around them. The only way we will ultimately overcome significant virus circulation is for enough people to have had the virus and recovered and/or by the development and manufacture of a vaccine. Then we will have ‘herd immunity.’
The only reason we don’t know the true numbers in the general population at the moment is that they may have already had the illness and recovered, are not ill enough (or don’t even feel ill at all) at present, or are currently infected and showing no symptoms yet.
None of these people will thus far have been tested for Covid 19, so the official figures are likely to vastly underestimate the true number of people with / who have had the virus.
This explains the need for social distancing, stopping the virus transmission and the requirement to ‘STAY AT HOME!’
However, particular sections of the population such as the elderly (whose immune systems are not as effective at fighting the virus), those with underlying respiratory or cardiac illnesses, diabetics and particularly those that are immunocompromised due to particular illnesses or drug therapy are seemingly more at risk of more severe illness due to Covid 19.
These individuals are those that are more likely to need hospitalisation and perhaps ultimately ventilatory support such as that offered in the Intensive Care Unit (ITU.)
The challenge for the NHS is to be able to offer enough ITU beds / ventilators and staff to man them should large numbers of patients with this issue arrive at hospital simultaneously.
There is also evidence that particular sections of the medical community are more at risk.
In China, the most deaths among medical staff have been amongst anaesthetists, ENT Surgeons and Ophthalmic Surgeons.
This is almost certainly due to the necessity to get close to the patients nose and mouth in order to carry out common interventions that are termed ‘aerosol producing procedures’ such as intubation (passing a tube into the lungs to allow artificial ventilation) as well as endoscopic examination of the nose and throat, and eye examination using a slit lamp. These interventions are more likely to expose the Dr to increased ‘viral load.’
It is with this in mind, learning from the terrible experience of our Chinese colleagues, and under national guidance from our governing body ENT-UK (see ‘links’ tab for their website) that we as a surgical speciality in ENT have decided to stop all such ‘aerosol producing procedures’ in all but the most essential clinical situations.
If they are required, it should be in a controlled environment and with appropriate Personal Protection Equipment (PPE) for the Dr and patient. From now on, and for the foreseeable future, this is going to be in an NHS facility where these issues are more commonplace and where these PPE measures will be in place.
We have also from now stopped performing all but the most essential ENT operations apart from life- saving cancer operations, although even these may have to be temporarily stopped if the situation deteriorates significantly.
The vast majority of the operations I carry out in my Private Practice fall into the ‘non life-saving’ category, and I therefore can’t see my private surgical practice coming back any time soon until the current crisis settles.
If you are waiting for an operation under my care as I write, I can only apologise and ask you to keep in touch with my secretarial colleagues at Dover Street Doctors to keep abreast of developments once the dust starts to settle and normal surgical activity recommences.
If you need further medication or advice pending your surgery, please let me know or book a telephone consultation as outlined below.
Thinking positively, the good news is that a large proportion of ENT issues can be resolved without the need for surgery. We are now carrying out all NHS outpatient consultations remotely by telephone, and this is a practice that I aim to reproduce in my Private Practice, but with the option of a video consultation by Skype if you should wish it.
Skype has the required data protection for this purpose providing my and your environment is safe and not overheard.
All the major Medical Insurance Companies such as BUPA, AXA and Aviva have published documents over the last week approving this move, and agreeing to reimburse insured patients for remote consultations – please check with your individual insurer if you have any queries though.
I am also happy to accept self-referrals from self-funding individuals.
I suspect as GP Practices and A/E Departments become more swamped with other more pressing issues during this unprecedented period there will be difficulties in accessing ENT advice and treatment, and I am happy to henceforth offer this service to you.
Whilst not being able to examine you is clearly not optimal, I have been surprised in my initial experience in the NHS how a telephone consultation is a very reasonable and satisfactory alternative, at least in the short term.
Listening to your story, asking appropriate questions and even being able to see and hear you by video often gives me a very good idea of what your issues are, and I can recommend appropriate treatment and / or investigation to at least tide you over until the situation reverts to normal and I would be able to see you face to face and examine you in detail.
Unfortunately there will a number of you who may / will need a ‘procedure’ such as fibreoptic endoscopy of the nose and throat, microsuction / cleaning of the ears or cautery of the nose due to nosebleeds at some stage. I would normally be able to sort out for you straight away and I can only apologise again that I will not be able to offer you this service during the current uncertainties, but will as soon as is possible reinstate this facility.
ENT procedures will, of course, be available through the NHS Emergency service at the William Harvey Hospital accessed through the normal channels via your GP, but I must emphasise only if urgently required.
I will be part of the team offering this service.
If you would like to book an appt with me via telephone or Skype, please contact my secretaries at Dover Street Doctors as per the ‘contact us’ portal on this website or click on the ‘book a private appointment online here’ tab to access the booking proforma and book online directly.
If you require a video consultation, you will need to supply an email address to my secretary via telephone or on the online booking form. My secretary will then book you a mutually convenient time for your appointment. You then need to download the Skype application on your smartphone, tablet or PC and I will send you an invite via your email address to join a conversation at your allotted appointment time.
I hope that this will continue to allow me to offer you the best ENT service possible during this period.
Sending my best wishes to you and your family in this challenging time.
(Consultant ENT Surgeon / Rhinologist and Nasal Plastic Surgeon)
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