Just As Well, The Women's Health Podcast - Talking Coronavirus: What A GP On The Frontline Wants You To Know

Episode Date: March 19, 2020

Regular listeners will know that we normally focus on helping you reach a health or wellness goal. But these aren’t normal times. The novel coronavirus, or Covid-19, is now a global pandemic, and in the UK, we’re facing what the Prime Minister has declared ‘the worst public health crisis for a generation’. Right now, all we - like you - want to know, is how to stay as physically and mentally well as possible, and how to minimise the risk of causing harm to others. So, that’s exactly what we’ll be aiming to find out over the next few episodes, where we’ll be putting your coronavirus questions to scientists, healthcare professionals and fitness experts - starting with Dr Chintal Patel. Dr Patel studied immunology at university before going on to qualify as a GP. Today, she practises in central London, putting her on the frontline of the Covid-19 response in the UK. In this episode, she reveals what life has been like for GPs these past few weeks, answers your questions and shares the practises she’s been using to keep herself and her family safe and well.  Join Women’s Health on Instagram: @womenshealthuk Join Roisín Dervish-O’Kane on Instagram: @roisin.dervishokane Join Dr Chintal Patel on Instagram: @drchintalskitchen Topics:  What is a coronavirus and why is this one posing such a threat? What does flattening the curve mean, and why it is so important?  What are the key symptoms of Covid-19, and how should you manage them? How should you talk to children about this pandemic?  Links and references: https://www.nhs.uk/conditions/coronavirus-covid-19/ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen https://www.cdc.gov/coronavirus/2019-ncov/index.html https://www.mindheart.co/descargables Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

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responsibly. When you support Movember, you're not just fundraising, you're showing up for the men you love. Your dad, your brother, your partner, your friends. It isn't just a men's issue. It's a human one. That's why Movember exists to change the face of men's health. From mental health and suicide prevention to prostate and testicular cancer research and early detection. Movember is tackling the biggest health issues facing men today. Join the movement and donate now at Movember.com. Hello everyone, you are listening to Going for Goal, the women's health podcast with me, Roshin Deversherkane. Regular listeners will know that we normally focus on how you can hit a health or wellness

goal. And you can listen back to previous episodes for advice on everything, from ethical eating to realistic weight loss and making your social life work for you. But these are not normal times. COVID-19 or coronavirus has become a global pandemic and we are facing what's being termed the biggest health crisis for a generation. Right now, all we, like you, want to know it's how to stay as physically and mentally well as possible and how we can minimise the risk of causing harm to others.

So that's exactly what we'll be aiming to find out over the next few episodes, where we'll be putting your questions about how coronavirus affects you to a range of healthcare professionals and fitness experts. Today is Dr Chintel Patel, an NHSGP practicing in central London. She is on the front line of the coronavirus response, and she comes to this conversation with a working understanding of the science of viruses and how they spread, having completed an undergraduate degree in immunology. Welcome, Chintel. Thank you for having me. Good to have you on. As I mentioned, as an NHS GP, you're on the front line of this response.

What are you seeing in clinic? So obviously these are really testing times for us in general practice. We're all working really, really hard. It's a very much all-hands-on-deck approach. and as GPs we're kind of trying to keep up to date with all the latest advice and guidelines that are coming out. We have moved in our practice towards a telephone triage system. So we are speaking to our patients rather than trying to bring them in, trying to decrease the amount of footfall into the practice. And a lot of our telephone conversations are obviously patients with symptoms who are concerned about themselves or their loved ones having symptoms of coronavirus or COVID-19,

the condition. Interesting. And let's just remind people up top what those symptoms are. So the main symptoms that we are concerned about and the main symptoms that you will see with the COVID-19 infection are a temperature, which would be a temperature of greater than 37.8 and a cough which has been persistent for the past four to six hours, so a new onset of a cough that's persistent. If you have either of these symptoms, it's really, really important that you stay at home, self-isolate yourself and call either your GP or maybe use some credible sources of information on the internet first. So the NHS website and the NHS 111 website are great credible sources of information and if you're concerned to call your GP. But do not go to your GP, go to a pharmacy,

or go to hospital. That's very important. Yeah. I should say upfront as well. So we are recording this on Monday the 16th of March. Advice may change by the time. is published. So as always, if you're confused about what to do, always head to the NHS website. Yes, definitely. We're trying to decrease the number of calls to 111 if possible. They're obviously very overburdened at the moment. So we would, if you have access to the internet, the NHS website and the NHS 111 website are constantly being updated. So you can find a whole lot of information there, first of all. And then if you don't have the information that you need there, then do call your GP who will direct you.

either towards 111 or be able to help with your symptoms or your concerns. And what is it like as a healthcare professional at the moment? How are you guys coping? I can definitely say that at the moment really testing times in general practice, things are moving and changing really quickly. We're learning to work in a very different environment. We're used to having face-to-face consultations, but we have had to drastically reduce that and try to limit the number of patients

that we have attending our surgery to prevent spills. bread. So a lot of our consultations are via telephone triage or video consultations. We're working together with other practices to try and come up with innovative ideas of trying to best cope with the increased demand that we're facing every day. There is this sense of this mounting anxiety and uncertainty. What's that like when you're dealing with a patient? I think that's probably the mainstay of most of our telephone calls, actually. It's really difficult to alleviate the anxiety when everything you see in the media on the news, the minute you switch on the TV is about coronavirus and this pandemic and how it's, you know, every, every stat is how

how many people are dying, how many people have been infected, how many people across the world have got complications. I think what we have to try and remind ourselves as well is that when it infects fit and healthy young people, the majority of people are then actually recovering, they are then having very mild symptoms, you know, similar to a common cold or a flu-like illness. And the majority of these people are feeling fine and able to, you know, self-isolate and then hopefully have built up an immune response to it. Okay. So as we say, people are, nervous, people are worried. What is different about COVID-19 that has got health professionals and the general public so concerned? So if we go back to the basics, coronavirus,

is part of a family of viruses and that encompasses everything from the common cold to more serious conditions such as the SARS epidemic in 2002. So COVID-19 is the illness that is associated with this current strain of coronavirus and what's new about this current strain

is that it hasn't been previously seen in humans until December last year. It's spread, obviously we don't know everything about how it spreads and the effects But what we do know is that it's thought to be droplet spread. And that means stuff that comes out of our nose and our mouths. So that means stuff that comes out of your nose and your mouth. And so it is spread by close contact.

And so you would hear a lot about kind of social isolation, self-isolating yourself. There are lots of terms flying around at the moment that we're hearing that it's quite difficult to actually understand what they mean. Can I run through some definitions with you first before we get in? to people's questions. So first, we've mentioned it already, but social distancing. It's based on the theory that given the virus is spread by contact, if you were to decrease the number of contacts. So if you, for example, cut the number of contacts in half, then you technically, theoretically will cut the possibilities for the virus to spread in half. So it would be things like temporary closure of public spaces, concerts, sporting events, which we already have, so large

gatherings, but then also reducing use of things like public transport, encouraging people to walk or cycle, perhaps encouraging people to work from home if it's possible, limiting contact with others, even avoiding visiting elderly or if you have relatives that aren't well. Personally, as a parent, you know, I have said my children won't visit their grandparents for a few weeks. It's so hard, isn't it? It's a real alteration. It is. But at the same time, you know, young children are vectors and carriers for this. And although they may not exhibit the symptoms, they may have very mild symptoms,

if they were to infect their elderly grandparents, their grandparents could have quite severe symptoms or complications. So it's really important we try and protect our elderly. And what about then about herd immunity? Yes, so this is another phrase that's banded about. And I think it's really important to understand herd immunity. We probably have to go back to the basics of understanding immunity. Yes.

Good place to start. Yeah. So if we think about if your body is faced with an infection, a fit and healthy person will generally fight off that infection. They will then build, hopefully, immunity to that infection and some kind of immunological memory to that infection. So that were they faced with that infection again in the future, they would be able to fight it off again in the future. So this is the basis of how vaccines work and why we vaccinate. And the thinking is that if enough of our population and the clever statisticians have come up with the value of around 50 to 70, around over 60% for this particular virus, if enough of the population were immune, this means that it would be harder for the virus to actually spread between people because the people that are immune would be actually acting as a kind of barrier to it spreading to the people that are not. So flattening the curve, that's another buzzword.

So the curve that we are talking about is that if we didn't take action, any kind of action, we would see a massive spike in the number of cases of coronavirus. Although the huge number of these would just be self-isolating, would recover very well. A lot of these would require further help from the NHS and hospitalisation with complications. So all the hospitals do have a threshold for how many patients they can. admit we have a limited number of ITU beds, we have limited capacity for NHS services. So what we don't want is that number to spike above our threshold. So flattening that curve and flattening that peak is basically trying to control the number of cases that we have over a period of time.

So we're trying to push the number of cases further towards this kind of spring and summer months, for example, where the NHS workload is less. We're trying to flatten the number of cases over a period of time so that the NHS is more able to cope with the numbers that it's seeing and we don't ever reach that threshold. This also gives us more time to research the virus, to come up with vaccinations and to come up with ways of treating it and treating the symptoms. Also, there is a possibility that if there's a seasonal element to the virus, like the common flu virus that we have, that it may be that by this towards the summer months it should hopefully be dying down. So the government is using kind of government scientists using lots and lots of complex mathematical models

so that we can really try and flatten that curve further. But the overall aim of it is to control the number of cases that we're seeing over a period of time so that we can cope. And thank you, by the way, for all that you do. I think everyone is realizing more than ever just how grateful we are to have such robust healthcare systems. It was amazing like even seeing in Spain when everyone was applauded. or their healthcare workers, I found it massively moving. So yeah, thank you.

So basically, so those are all big, statistic-based, zoomed out. That's what we are hearing about a lot. Now I want to zoom in and use your expertise as a GP to really answer our listeners questions about how this is affecting their life and what they can do within it. So one question that we had a lot when we put out a call was, is it safe to go to the gym? This is an interesting question.

We don't know if coronavirus is spread through sweat currently. Okay. Obviously, we should all be putting in kind of the normal hygiene measures that we should all be doing. So top of the list, full stop is the hand washing. So if you are going to the gym and if you choose to go to gym, making sure that you wash your hands, making sure that you wipe down. equipment, wash your hands after wiping down equipment. You know, all gyms have soap, sanitizers available. So making sure you're using that, if you're coughing or sneezing in the gym, so basic respiratory hygiene, make sure you cough into a tissue or sneeze into a tissue and

throw that tissue away and then wash your hands once again. Going back to hand washing, it's really important that people know how to hand wash properly, making sure that they are doing it for more than 20 seconds. Realising that actually soap and water is the best way to wash your hands, it washed the virus away. It doesn't have to be a hand gel. In fact, soap and open, and then just really following the current guidance, at the moment, gyms are open. If you can work out at home, it's great. And if you can work out in an open space and a garden, you know, with lots of fresh air, you're probably doing lots more for your health than going to the gym at this moment in time. That's true. In spring as well, it's lovely.

Yes, exactly, exactly. Okay, so then the next question, one that we had come up a lot was what to do if you live with someone or take care of someone with compromised immunity? So this is quite a tricky situation. So obviously somebody with compromised immunity would be more at risk. So if for any reason you have symptoms or suspect that you might have symptoms, you would need to self-isolate and you would need to contact your GP and we would try and arrange some other kind of care for the person that you're caring for. It's really, it's difficult.

I think every individual case would have to be seen. individually. It would depend on a number of factors, depending on why that person is immunocompromised, to the level that they are, and how much help that we can get in for them. Yeah. But certainly if you had symptoms, it would be no different. You should self-isolate. And also just taking your basic precautions, once again, for that person. So the basic hygiene, making sure your hand washing, making sure you're cleaning. Coronavirus can stay on work surfaces, for example. for up to 72 hours. So if you're sharing combined work spaces or kitchen space, making sure you're cleaning that really well. So is it possible to say if someone is living with, I don't know,

a housemate or someone that has a, could be like a chronic disease, something that impacts their immune system. Is it possible to self-isolate within the same home? So self-isolating within a home, it's not, I wouldn't say it's 100% easy, but it is possible and we are encouraging it. So the way they would do this would be, you know, with an aim to distance themselves at least two to three meters away from other people. So they would pick a room, which would be their room, make sure it has a window for ventilation, no visitors for that period of self-isolation. So any deliveries, food, medications, etc., to be left outside the room, to eat in the room, to have their own crockery, cutlery towels and not share, to just, you know, use that time to recuperate, to rest, to sleep, to try and recover. at home if there were shared spaces, things like bathrooms, if you have to share a bathroom, to try and have a rotor in place, to try and use the bathroom last after the people who are well

have used it and then clean it down really well afterwards. So there's lots of things that you could do to self-isolate within the home as well. That's really helpful and so important for like modern living when we're not just all of our own or set up as families. Yes, absolutely. Really good advice. Okay. And then we've had lots of people wanting to know about how the advice may differ for women who are pregnant.

If you have a confirmed COVID-19 infection, so you have been tested and it's confirmed, then that may pose a risk to the baby's growth. And so they have recommended an ultrasound scan 14 days after to check. And there could be an increased risk of premature birth if you became seriously unwell. So those are things to maybe consider. talking to your obstetrician or your GP about. Pregnant women will have very similar presentations, as I say, and we would manage them in the similar way. There has been one study in China looking at nine late-stage pregnancies,

and it was published in a reputable journal, The Lancet. And all of these babies, at the time of birth, they were all born by Caesarean section, but all of these babies were found, there was found to be no evidence of virus, in the mother's breast milk, cold milk or amniotic fluid. And of those that did develop COVID-19 symptoms, none of them had severe complications or required ITU admission.

So it is thought that mother-to-feetus transmission in utero doesn't seem to be happening, although it could happen at the time of delivery. The other thing is they also found that it wasn't present in breast milk. So I did have that question with a mother. concerned with her symptoms about breastfeeding. And so obviously breastfeeding does involve close contact, so really important to be making sure you're washing your hands and good hygiene during breastfeeding.

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who are really feeling the strain and the anxiety at the moment? I think it's really important to talk to somebody. So there is definitely lots and lots of advice online on cranes. sources once again, the NHS and the 111 website, I would recommend. But your GP would be very happy to discuss it with you. And I do think pregnancy is a case where it would be perfectly reasonable for you to book a telephone consultation with your GP if you had any kind of concerns or symptoms so that hopefully we can give you advice. You know, if you're anxious or worried, I would call your GP for a telephone consultation and we could discuss your

individual case. Okay. And then, as we've talked about mothers of young children. You're a mum yourself, right? Yes. What are some, do you have any any tips for how people can, I don't know, engage with their children about the coronavirus, basic tips for hygiene? Is there anything else we haven't covered? I think the main point is definitely to talk about it with your children and to discuss it and to help alleviate some of their concerns about it. I actually had a discussion with my children this weekend. I've been very open. We've discussed it from day one. And I asked them, what were they worried about with coronavirus? And I was really pleased with the answer, actually, because they said nothing, Mummy, because we're just going

to just have an infection, but we've got to be careful not to spread it to other people, especially their grandparents. And so actually, that is, you know, that's pretty much. That's a really important message. So as a family ourselves, we've decided to distance ourselves from grandparents because I do have frail parents. And it's really important because because, as I said before, children are vectors. They are carriers and they can spread the virus. I would, obviously, my children are older, so they're age 10 and 7, so they have a better understanding, but obviously explain appropriate to age.

And there are some really great resources out there actually that I can give you for link, for ways of explaining to younger children what the virus is and what it does. That's a great shout. I will make sure that we put those in the show notes. And then really to be mindful of how you show your reactions, how you are, how you show panic and anxiety, because children feed off this. So it's really, really important to remain calm, to explain to them calmly. Because how we, you know, by doing this, we're teaching them how to respond to stress and uncertainty. And they're feeding off us.

So if we can remain calm and how we approach it, they, you know, they will feed off that. And I think things like social isolation can be pretty scary if you're a child, you know, to have a loved one, to have a loved one, to have a a parent isolating them from you is quite hard. So that would have to be, you know, approach really sensitively. Yeah. And the more conversation and understanding around the entire thing would then contextualize that big change. Exactly. Okay. And then really teaching them importance. I mean, children are great at sharing everything, you know, cutlery, towels, toothbrushes, glasses, everything. And they get rewarded for sharing. Exactly. So kind of really teaching them the importance of hygiene at this moment in time, teaching them how to wash their hands.

You may have seen a lot of the NHS websites talking about singing happy birthday twice. It's roughly 20 seconds. So just teaching them quick and easy hacks and ways that they can practice hygiene, sneezing, catch it, kill it, bin it, using a tissue, throwing it away, washing their hands, not touching their faces, things like that. Great. What are also some just some like quickfire, common sense things that we can all be doing to reduce our lives? risk of infection. So I think once again, I'm going to repeat myself, but the main thing we can all be doing is looking after our hand hygiene. That is the commonest way it's going to spread, and that's the commonest way that we can really quickly and easily and efficiently reduce spread.

So hand washing consistently, so for myself, in between every patient I see when I go into my clinic, I will wash, I will wipe down my computer, keypad, the telephone, anything that I'm touching or holding, I will wipe my mobile phone. You know, parents, after changing nappies, after blowing their children's noses, anything that they're doing to make sure they're washing their hands before and after, every time you sneeze, blow your nose, touch your face to make sure you're washing hands before preparing meals, touching surfaces, things like that. And then really kind of think simple things looking after yourself. So keeping yourself hydrated, keeping your immune system boosted by good sleep, good rest, good diet, a healthy diet trying to. exercise if you can. And then if you had symptoms, obviously, things like paracetamol to reduce any fever, once again, keeping yourself really hydrated and well rested to try and help your body recover.

Are there any other ways? People really seem to want to know how they can cope with symptoms in if they end up getting them. So the main, main symptoms are a fever and a cough. So we would control the fever, as you said, with paracetamol. And the cough is usually a dry cough. So sometimes things like steam inhalations might help. But general advice, so it is generally a minor self-limiting illness. So it is really coping with the symptom relief. So keeping yourself really well hydrated, drinking lots of water, trying to rest and let the body recover, getting good sleep, you know, eating a good balanced diet, if possible. Just trying to, trying to limit the symptoms. And I guess it's letting yourself not be well. Because I think so often in our

culture we are so determined to push through, aren't we? And so I think it's a real shift in mindset that we think, okay, I'm not just going to power through on LEMSIP and Black Coffee. Holding my hand up is that sometimes the way that I deal with colds. I think it's really important to take, to kind of realize that actually this is my time to recover. So in a way, self-isolation gives you that opportunity to actually take that time out and think, I need to actually rest, I need to recover, I need to sleep, I need to, you know, think about my health and just letting myself recover. And lose the guilt because not only you doing this for yourself, but you are doing this for the health of the entire population. Absolutely. You need to totally lose guilt because you need to be not, you need to distance yourself from everybody. You know, it's really important that you take that time out.

Yeah, fantastic. And what can people do right now, I was saying before, how it's thrown into sharp relief just how important our health service is. What can people do to support the NHS and its workers right now? Because it's going to be a hard, this is going to be a rough few months, right? It is going to be a rough few months and it is going to go on for a period of time, as you say. It's a long period. And at the moment, we're not even at the peak. So this is going to get worse before it gets better.

and I think we have to be equipped for that and whilst practices are trying really hard to be equipped for that we are experiencing a huge volume of phone calls concerns and I think there is really really good advice credible advice on NHS websites and the NHS 111 website and the Public Health England website and the WHO websites and I think it's really important that people stick to those credible sources of information

before they contact their GP so they might find a lot of their questions are answered very quickly there. The other thing is to not go to the other sources of information. So I think it's interesting. You know, I find that my parents, for example, are sending

me lots of messages and forward messages that they've received through WhatsApp groups of lots of weird and wonderful cures for coronavirus and how they drink lemon water every morning. They'll be cured. I think it's, you've just got to be really careful and mindful of what's out there. And, you know, trying to

relieve some of that burden off the NHS in terms of phone calls and appointments would be really helpful. You know, credible sources like this podcast, for example, or other similar podcasts where you are, you know, you are spreading evidence-based information as opposed to... Lemon water. Lemon water fixing everything. Exactly. I think it's just really important. No offense to lemon water. Lemon water is lovely. Probably, it's probably not going to be the silver bullet in this situation. It's not great for your teeth either. True. Or it's always. To your store. But then that's just not so good for the back ones. Anyway, I digress. So the main thing then, as a GP, there's so much information. Even within this podcast, there's so much information generally going about there, as you say, from broadcast media, from WhatsApp groups. What's the one thing of everything we've spoken about today. What's the one thing that you really want people to take away? I think if we're going to control the spread of this virus, I think the self-isolation message and the hand-washing message are really.

really, really, really important. So if you think that you have symptoms, you must self-isolate because it is very easy for one person to infect hundreds and thousands of people exponentially once due to contact and interaction. And then hand washing to stop the spread. Yeah. So don't push through, play it safe and wash your hands so much that it might feel a little bit ridiculous. Yes. Yeah, Definitely. Because it's not meant to be normal because as you say, we're not doing things normally at the moment. No. And that's fine.

It's a period of time where unfortunately we are going to have to adapt and we are going to have to do things that we're not used to doing. Yeah. Okay. Well, thank you so much for coming on and sharing all your advice. That's been so helpful. Thank you for having me. And thank you, everyone, for listening. Even in the time we recorded this episode, the advice has changed.

While we are attempting to keep our content as up to date as possible, The situation surrounding the coronavirus pandemic continues to develop rapidly, so it's possible that some information and recommendations may have changed. For any concerns and the latest advice, visit the World Health Organisation. If you're in the UK, the NHS website can provide useful information and support, while any US listeners can contact the Centre for Disease Control and Prevention. The final thing to say is that if we do go on a break over the next few weeks, don't panic. As Going for Goal is a weekly show

There's a good chance that we may need to pause recording During disruption caused by the coronavirus Right, all that's left to say is take care everyone And I'll catch you soon Thank you.