miércoles, 18 de marzo de 2020

Who should stay at home due to coronavirus?

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By Dr. Liji Thomas, MDMar 17 2020

COVID-19 is a spreading viral illness, mostly mild but fatal in the sick and elderly. At present, it has affected almost 200,000 people, with nearly 8,000 deaths worldwide. Governments around the world are formulating and executing new guidelines to control the spread of the virus. In the latest guidelines, pregnant women join the list of individuals who must stay away from all social contact for 12 weeks to limit the spread of the virus and deaths due to the illness.

Image Credit: Deliris / Shutterstock

Symptomatic patients

According to the UK's NHS guidelines, people with symptomatic illness and other vulnerable groups should stay at home, including:

Those with a fever
People who are repeatedly coughing with a new-onset cough

Such people are advised not to go to a GP surgery, hospital, or pharmacy. They do not need to inform the UK coronavirus helpline that they are self-isolating themselves, nor do they have to undergo coronavirus testing.

The period of self-isolation is seven days for the person with symptoms and 14 days for the household or family, which lived with symptomatic patients, beginning from the first symptom in the first patient.

On the other hand, if the individual lives with another person who is at high risk, the other person should be helped to live elsewhere for 14 days. If this is not possible, the two should stay as far apart as possible as much of the time as is feasible. According to UK Prime Minister Boris Johnson, the new recommendations for symptomatic patients spell "the difference between individual isolation and household isolation."

If at any time during the quarantine period the individual feels it is impossible to manage the symptoms at home, gets sicker, or remains symptomatic at the end of 7 days, they should call the coronavirus helpline if they cannot get help online.

High-risk groups

In addition, certain high-risk groups are identified for self-isolation for at least 12 weeks:

People over 70 years
People with weakened immunity
People with chronic heart or kidney disease
Pregnant women

The government is advising these people to stay at home altogether, including work and not going out to eat. They may go out only for exercise, and even then, they should avoid all contact with others. Referring to these recommendations, Public Health England's chief medical officer Chris Whitty says, "It may in retrospect find that was overkill, but we'd rather be more cautionary now rather than the other way." He describes these restrictions for the 'at risk' groups as "absolutely critical."

In addition, the government is also asking all people in the UK to stay at home unless it is essential to go out and to stop all social contact with others.

Social distancing

According to a new epidemiological model shared with the US from Great Britain, up to 2.2 million people in the US might be infected and die. The report, which was not released in a peer-reviewed journal but was authored by 30 scientists on behalf of Imperial College's coronavirus response team, simulated the role of public health measures aimed at reducing contact.

To avoid this, a drastic and comprehensive set of recommendations has been introduced in the US and the UK, including curbing all gatherings for work, school and social reasons until a vaccine is available – which is to say, for at least 18 months. Though these steps carry enormous social and economic costs, not to mention health impacts, they represent "the only viable strategy" currently, according to British researchers.

The reason is that mitigation policies – isolating infected patients, quarantining their contacts, and isolating vulnerable people from general society, could at most only reduce the projected number of deaths by half – still leaving over 1 million deaths. The only way out is to adopt radical social distancing.

In the US, gatherings of over ten people are banned, and Americans are advised to stay at home unless it is essential to travel. Some towns have already locked down.

American epidemiological expert and task force leader Deborah Birx says, "What had the biggest impact in the model is social distancing, small groups, not going in public in large groups. The most important thing was if one person in the household became infected, the whole household self-quarantined for 14 days. Because that stops 100 percent of the transmission outside of the household."

The leader of the 30-member strong UK group that released the model, Neil Ferguson, says indefinite isolation measures will be necessary until a vaccine is released. The scientists write, "The effectiveness of any one intervention in isolation is likely to be limited, requiring multiple interventions to be combined with having a substantial impact on transmission." Moreover, the stringent restrictions will continue for quite some time, they warn.

Why pregnant women?

At present, there is little evidence that pregnant women are more likely to have a more severe form of the illness, and the virus doesn't seem to be passed to the baby. However, the most prominent feature of expert knowledge in this area is its scantiness.

Professionals feel that pregnant women may become severely sick with COVID-19 more easily because of the immunosuppressive effect of pregnancy coupled with the rapid growth of the fetus and the uterus, which compresses the lungs in some areas, increasing the chances of infection.

Viral infections in pregnancy often affect the fetus, leading to miscarriages, congenital disabilities, growth restriction, and stillbirth. It is difficult to say how many of these complications are due to the infection itself because of the relatively small number of pregnant women infected and the high rate of spontaneous miscarriage.

While some professional bodies advise separating the mother and baby after birth to prevent perinatal transmission, the UK Royal College of Paediatrics and Child Health and the Royal College of Obstetricians and Gynecologists jointly say they prefer to keep them together to achieve bonding and the benefits of breastfeeding.

Since the virus has not been found to pass into breastmilk and thence to the baby, from the limited data available, new mothers are simply advised by these UK bodies to observe handwashing and wear a mask while feeding the baby. It is also suggested that such babies will also receive antibodies against the virus from breastmilk, making them the actual earliest vaccine recipients in the world.

However, pregnant women should be monitored even after they recover, preferably with an ultrasound every 2-4 weeks, and should stay away from public functions where they are at risk.

Conclusion

Summing up the goal of the new recommendations, Johnson says, "Many people, including millions of fit and active people over 70, may feel that there is something excessive about these measures, but I have to say that I believe they are overwhelmingly worth it to slow the spread of the disease, reduce the peak, to save life, minimize suffering and give our NHS the chance to cope".

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