As the COVID-19 situation continues to evolve, we as podiatrists, along with other key workers in healthcare face the daily challenges that go with our chosen role. Very often we work in a relatively isolated style compared to others in the healthcare family. So, without colleagues to interact with and consult with on a daily basis it can sometimes be difficult to stay up to date on current knowledge of the CV-19 virus situation. That’s one reason why the Institutes ‘CV-19 toolbox’ pages on our website are kept up to date, please have a look at them.
As the CV-19 situation evolves, in some ways knowledge becomes easier to get as more evidence develops, and yet in other ways becomes harder due to information overload, Therefore, what I will try to do in today’s letter will be to include some information about getting back to basics using our current understanding, bearing in mind that I, like you, am a podiatrist, not an immunologist, geneticist or similar.
Q. What is COVID-19?
A. One of a group of viruses that appear to have a ‘crown like’ (corona) structure of surrounding spikes viewed under electron microscopy. They frequently attack the respiratory system but it should be borne in mind that they seem to have an affinity for binding to cell receptor proteins (think of a cell receptor – usually a protein – as a keyhole on the cell with the virus as a key) – such as Angiotensin Converting Enzyme (ACE, an important regulator of blood pressure) and ACE occurs throughout the body. So multiple pathologies can follow ranging from hypertension, through to multiple organ failure. The term Coronavirus covers a very wide range of viruses including some that cause the common cold. Belonging to the specific subset Orthocoronaviridae; COVID-19 is not the first of the Coronavirus group to cause really serious problems; its relatives caused Severe Acute Respiratory Syndrome (SARS) in 2002 – 2003 and Middle East Respiratory Syndrome (MERS) in 2012.
Q. I keep hearing about its high infection rate. How does it compare to other Coronaviruses?
A.The most recent information I could source is from; Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. Which gives an R-zero (see below) rate for SARS of 1.4 – 5.5, MERS of <1 and COVID-19 of 2.2 – 2.6. BUT please bear in mind these are figures developed on 16th February 2020, predominantly from China, and also are not adjusted in any way for genetic characteristics or other confounding variables in different population groups etc. There are very possibly newer studies out there already, or at least they will be being developed, somewhere.
Q. So how does it compare to Influenza?
A. Depends what you compare it to, seasonal ‘flu or the recognised pandemics of 1918, 1957, 1968 or 2009. Using the R-zero (called R naught in USA) value method, which basically is the average number of people who will catch a disease from one infected person, then the 2.2 – 2.6 R-zero quoted above compares to an estimated 1.8 R-zero of the 1918 flu pandemic which is often quoted as killing 18 million – buts let’s remember reports on the 1918 are estimated, probably based on incomplete records and the indisputable fact that medicine in those days was far different to today, so it could have been much higher than that.
Q. Statistics are all very interesting but what should I do for my patients, should I close my clinic?
A.This will seem like a total evasion but in short – it’s up to you. It is not a legal requirement (at the moment – but this may change very soon) and certainly, the IOCP cannot do a case by case risk analysis on your practice and patients to give you a specific direction. But you certainly should do a case by case risk analysis, if still treating people. In my own case I have clinics at one primary care health centre and two private hospitals, plus popping out to see the odd patient I have had for possibly a quarter of a century, who is housebound now and just wants a little basic care, and often more of a chat over tea and biscuits. The health centre is closed to visitors from last Friday and there are no elective cases being accepted at the hospitals, so they would accept dire emergency cases only and I would be dressed up like the urban spaceman if I performed any procedures. Home visits? at the moment I cannot justify them but that is my personal decision. Just please bear in mind that if you still choose to home visit you may well have to justify the visit (not least to your own conscience) if it turns out you are personally infected but pre-symptomatic and end up essentially providing the vector of infection that resulted in the patient dying of CV-19. In the case of you having your own clinic there are a different set of justifications that may be needed. Personally I suggest the safest course, not least for you as well as your patients, is to stop non-emergency contacts entirely. If you must have contact then take every possible precaution, as an absolute minimum adopting the basic advice given in my newsletter of 24th March.
Q. I want to help out the NHS, but as I am a registered Health Professional I want to offer something beyond delivering food parcels, but I have never worked for the NHS.
A. This is a point I personally raised with the UK Department of Health leaders several days ago when I noted they were only referring to ‘returning to the NHS’ on their website. I’m pleased to report that the HCPC now has a useful link on its website under the heading : Some of our registrants have been in touch saying they are now in a position to help the NHS and want to know how to offer support. The NHS is co-ordinating the workforce response across the UK and has developed a survey for qualified and experienced health and care professionals who wish to help : https://www.hcpc-uk.org/registrants/updates/2020/able-to-offer-support/ Also, please check out the rest of the HCPC website there is lots of useful additional guidance there.
Also, we are planning some ‘remote CPD’ sessions via the Zoom app for registered members. We plan the first one to be on the subject of ‘Medicines and the Podiatrist’ which is a far more interesting subject than you may have perhaps believed (okay, as an independent prescriber I would say that, especially as I’m doing it – but it’s true) For the first one we can only accept up to 50 attendees but as we develop them we will look at having more and we can of course repeat them as demand requires. They are free as a member benefit and you can receive an electronic CPD certificate of attendance. If you are interested please email to email@example.com with ‘medicines CPD’ in the subject line and give your name, membership number and email in the message body. I am also delighted to tell you that we are additionally going to be offering a much wider range of online CPD in other formats as well, watch this space!
In conclusion, I sincerely hope you and yours remain healthy and that we can look back on this time in several weeks, knowing that we have throughout it taken the very best decisions as individuals, family members and professional practitioners that we possibly can. With our staff all working from home now it goes without saying that we can no longer give you instant responses at the end of a head office telephone (we are looking at alternatives however) but we are contactable via firstname.lastname@example.org where Julie and Jill will triage messages to ensure they get to the right person to be dealt with as promptly as we can.
My warmest regards, Martin
Martin Harvey FPodM PGC BSc Podiatrist Independent Prescriber
Chair of Executive Council