By and large, we have had very few reports of children getting affected or indeed infected by this virus. However, this does not mean that children cannot get infected. The commonest involvement for children is as asymptomatic carriers. This means that they have no symptoms but could transmit the virus from, say their teachers to their parents, or from their parents to their grandparents.

Similar to the cases in adults, the children that we see suffering severe symptoms with this infection and requiring hospitalisation are those that have pre-existing medical conditions. Again, as in adults, this does not mean that a relatively healthy child cannot be infected and suffer from symptoms.

Rather than receiving and forwarding messages on social apps like WhatsApp (and contributing to panic), we would prefer if you called the doctor and had a chat. This can also help you to disseminate more accurate information to your loved ones and friends.

Something worrying that has recently come up and prompted this is the following article:

Children and Covid-19

Again, if unsure, please speak to our doctor who can help clear things up for you and your children. Call us on ‭07568 369 455‬.

dental hygiene in lockdown

‘Lockdown’ your Dental Hygiene

This is not our area of expertise; however, as most dental surgeries are closed we are trying to manage the conditions that we feel comfortable doing with a telephone or video consultation.

We have attached below some advice on dental hygiene.

Brushing your teeth

Brush for at least 2 minutes, twice-a-day using a toothpaste that contains at least 1350ppm-1500ppm Fluoride. Children under 3 years should use a smear of toothpaste, whilst children aged 3-6 years should use a small pea-sized amount. It is important to brush last thing at night and at least on one other occasion in the day. After brushing, spit out the excess and remember not to rinse your mouth or use a mouthwash immediately after. (Activity idea: Brushing technique would be a great skill to pencil into your child’s learning schedule.)

Interdental brushing and flossing

To ensure your gums stay healthy, anyone over the age of 12 should use interdental brushes between their teeth daily. For really tight spaces try dental floss or tape. Lockdown is the perfect time to experiment with interdental brushes and floss so you can incorporate this into your daily routine. (TIP: if you’ve never used interdental brushes before try a small size first then work up to the largest size that fits in the space comfortably.)

Snacking

We have all been reaching for the snack drawer a little more than usual during this period. Aim to keep snacks between meals sugar-free, and keep an eye out for those hidden sugars particularly in ready-made meals and ‘healthy’ snacks. Try and keep the sugar in yours and your children’s diet as low as possible by reducing the amount of sugar you consume, and the frequency of how often you consume sugar during the day; Eat less sugar, and eat it less often. (Activity: As part of your child’s learning get them to identify healthy foods from a selection from your cupboards)

Braces

Your orthodontist will have given you instructions on how to care for your braces when you had them fitted. It is important to follow these instructions so that you get the best result for your smile from your braces. Brushing twice a day and limiting the sugar in your diet is very important. You can use an interdental brush between the teeth to keep the areas around your brace and in-between your teeth clean, as well as using other brushes recommended by your orthodontist.

Dentures

Ensure you remove your denture at night and clean it thoroughly using warm soapy water and a brush over a basin filled with water (in case you drop your denture: you don’t want it to hit a hard surface.) If you prefer you can soak your denture overnight in water with added denture cleaning solution, please use the solution that is correct for the type of denture you have.

Also, remember to be extra careful with your denture as it may be difficult to repair or replace the denture during this period.

As always, if you have any queries or concerns about your health or your child’s health then please do get in touch with our doctor.

Credit: Rodericks Dental Clinic, Marylebone

HRT and Coronavirus

HRT and Coronavirus

It is estimated that around 75% of menopausal women experience symptoms and that around 25% of these women experience severe symptoms that are having a negative effect on their lives, often affecting their family and work lives.

The menopause symptoms that affect women the most include:

  • low mood
  • anxiety
  • reduced self-esteem
  • poor memory and concentration
  • reduced libido
  • vaginal dryness

Managing women with symptoms of the menopause is a very rewarding aspect of clinical practice. There are now excellent guidelines available, both national and international, for healthcare professionals on the management of the menopause 1-3. However, these guidelines have not been read by many healthcare professionals which means that many women are being denied evidence-based treatment. All the guidelines support the notion that for the majority of women starting HRT when they are under 60 years old, the benefits of taking HRT usually outweigh any risks.

Please do contact us if you are worried about being in the menopause and wanting to start HRT (Hormone Replacement Therapy).

A new statement has been released from the British Menopause Society, along with RCOG, RCGP and FSRH, urging all doctors to avail HRT consultations via video or telephone. This is in addition to providing easy access to repeat prescriptions (which is a service that the Mayfair GP provides).

The societies mentioned above realise the importance of HRT and thus the aim is to ensure that menopausal women do not struggle to obtain their HRT prescription in these difficult times.

Please read the British Menopause Society statement below from the 25th of March 2020:

We recognise that many women are likely to experience difficulties in obtaining HRT supplies due to the current coronavirus situation. We also appreciate that continuing HRT intake is likely to help many women control their often difficult menopausal symptoms, which is particularly relevant given the additional stress some women may be under in view of the strains of the current situation on society.

Furthermore, General Practitioners’ surgeries have also been put under additional pressure, with consultations and advice prioritised to dealing with serious and potentially life-threatening medical issues.

Recognising the current constraints, we recommend that General Practitioners and healthcare providers consider advising women about menopause issues through telephone and virtual consultations where at all possible to reduce face to face engagement, and with easy access to repeat prescriptions of HRT supplies (especially to women who have been on HRT and have not been experiencing any problems with their intake). This will help to avoid the need for many women to visit their GP surgery to discuss these issues and assist with obtaining repeat prescriptions.

Haitham Hamoda, Chairman, BMS

Edward Morris, President, RCOG

Martin Marshall, Chair, RCGP

Asha Kasliwal, President, FSRH

Coronavirus and heart disease

Coronavirus and heart disease

We have seen it fit to share the below information from the British Heart Foundation. However, should you be unclear or feel you need to speak to someone in more detail, please call to speak to our doctor.

I have a heart or circulatory condition – am I at increased risk of coronavirus?

We know that this is a frightening time for lots of people, especially if you have an existing health problem. Most people with coronavirus (COVID-19) have mild symptoms and make a full recovery. Having a heart and circulatory condition probably doesn’t make you any more likely to catch coronavirus than anyone else. But if you have a heart condition it may mean that you could get more ill if you catch it, which is why it’s really important to protect yourself.

Anyone with a heart condition is considered high risk of more severe complications of COVID-19 coronavirus.

Should I still call 999 or go to hospital if I’m worried about my health?

Whether or not you have Coronavirus symptoms, it’s essential to dial 999 if you have symptoms that could be a heart attack or stroke, or if your heart symptoms get worse. We are hearing that fewer people are being seen in hospital with heart attacks in recent weeks, which suggests that people are not seeking help when they should do. Don’t delay because you think hospitals are too busy – the NHS still has systems in place to treat people for heart attacks. If you delay, you are more likely to suffer serious heart damage and more likely to need intensive care and to spend longer in hospital.

You should always dial 999 immediately if your chest pain is sudden, spreads to your arms, back, neck or jaw, and feels heavy or tight, or if you become short of breath or start to feel sick.

You should also dial 999 if you have signs of a stroke, such as your face drooping on one side, can’t hold both arms up, difficulty speaking. You should also dial 999 if you are having severe difficulty breathing (such as gasping for breath, choking, lips turning blue, or not being able to get words out.)

Am I in the “extremely vulnerable” group who need to stay at home for 12 weeks?

Some heart patients are considered at extremely high risk of severe illness from coronavirus. You are classed as extremely vulnerable (at highest risk) if:

  • you have had a transplant at any time, including a heart transplant
  • you are pregnant and have significant heart disease – defined by experts as any of the following: coronary heart disease (if you have symptoms), hypertrophic cardiomyopathy (if it affects your heart function), thickening of the heart muscle (left ventricular hypertrophy) caused by high blood pressure, pulmonary arterial hypertension, a narrowed or leaking heart valve if this is moderate or severe, heart failure that affects your left ventricular function, significant congenital heart disease

If you are in one of these groups, you should protect yourself by staying at home, and minimising contact with people you live with, for the next 12 weeks. This is called shielding. If this applies to you, you will be contacted directly by the NHS with further advice. If you think you fall into one of these categories but have not received a letter, email or text by now, you should discuss your concerns with our doctor.

I don’t fall into one of those groups: am I still at high risk from Coronavirus?

Even if you are not at highest risk, you may still be at particularly high risk because of your heart condition if:

  • You have heart disease and you’re over 70
  • You have heart disease and lung disease or chronic kidney disease
  • You have angina that restricts your daily life or means you have to use your GTN frequently
  • Heart failure, especially if it restricts your daily life or you’ve been admitted to hospital to treat your heart failure in the past year
  • Heart valve disease that is severe and associated with symptoms (such as if you regularly feel breathless, or you have symptoms from your heart valve problem despite medication, or if you are waiting for valve surgery). A heart murmur that does not cause you symptoms doesn’t put you at high risk
  • You’re recovering from recent open-heart surgery in the last three months (including heart bypass surgery)
    Cardiomyopathy (any type) if you have symptoms such as breathlessness, or it limits your daily life, or you’ve been told you have problems with your heart function
  • Congenital heart disease (any type) if you also have any of the following: lung disease, pulmonary hypertension, heart failure, you’re over 70, you are pregnant, or if you have complex congenital heart disease (such as Fontan, single ventricle or cyanosis)

Read our information about Coronavirus if you have congenital heart disease.

If you are in one of these groups, the advice is the same as for everyone in the UK (except for the extremely vulnerable, who have to be even more careful to protect themselves): stay at home apart from essential needs.

If you don’t fall into one of the groups above, having a heart condition or any of these issues means you are at high risk – again, you should stay at home, apart from essential needs:

  • Coronary heart disease, such as a past heart attack, stent, or bypass surgery (at any time)
  • Over 70 years old
  • High blood pressure (hypertension)
  • Pregnancy
  • Diabetes
  • Lung disease, including asthma
  • Chronic kidney disease
  • Stroke
  • Vascular dementia or small vessel disease in the brain
  • Body mass index of 40 or over (severely obese)
  • Smoking – because the act of smoking (putting your hand to your mouth) increases your risk of catching it, and because it damages your lung health. If you smoke, stop today

What information do you have for people with Brugada syndrome or Long QT syndrome?

If you have Brugada syndrome or Long QT syndrome and get coronavirus symptoms (especially a high temperature), you should call our doctor and tell them about your heart condition, and ideally let your cardiology team know. This is because you might need extra ECGs to monitor your heart, and your heart condition may affect what treatment for COVID-19 is right for you. It is important to try to bring your temperature down quickly by taking paracetamol, to avoid a very high temperature triggering a heart rhythm disturbance.

I have atrial fibrillation – am I at risk from coronavirus?

If you have atrial fibrillation, there isn’t enough information at the moment to tell whether it or other abnormal heart rhythm problems put you at higher risk from coronavirus. It seems likely if you have well-controlled atrial fibrillation, that your risk is lower than for the groups mentioned above.

I have a pacemaker – am I at risk from coronavirus?

If you have a pacemaker, whether or not this raises your risk from complications will depend on the reason why your pacemaker was implanted. There is no evidence that the virus itself infects pacemakers or ICDs, or that it causes endocarditis.

COVID-19 coronavirus is a new disease and we don’t know everything about who is most at risk of complications. Other heart patients may still be at particularly high risk or high risk. This list is based on the best information available from relevant experts. It’s possible that other conditions could put you at risk that we don’t know about yet, so it’s important that everyone works hard not to catch or spread coronavirus.

 

Credit: British Heart Foundation

dealing with Coronavirus

How to protect yourself from Coronavirus when you’re out and about

One of the most common questions we get asks in regard to Coronavirus and how to protect yourself: are you unwittingly bringing Coronavirus into your homes and how do you prevent this? In this article in the New York Times, infectious disease experts, aerosol scientists and microbiologists answer questions from readers about the risks of coming into contact with the virus when you leave your home to do essential shopping or receive a delivery.

READ MORE

If you want further advice on Coronavirus and how to protect yourself, call us on ‭07568 369 455.

using a face mask

Using masks in everyday life

We have been very encouraged by questions regarding putting on and using masks and gloves. We would like to address the use of masks first.

Please remember that out in the public, one need not wear hospital masks/N95 masks or even surgical masks. The masks that some of you have made at home have been brilliant. We have even come across inspiring and inventive videos of some of our patients fashioning masks from scarves!

We feel that we should first speak about masks rather than gloves. This is because from our chats with you and from the input we are receiving we found that most of you are so good with hand hygiene-washing and using hand sanitiser. This is far more powerful in itself than using gloves.

Some of you have also sent in pictures of your own wearing masks in public areas (and especially supermarkets). This has been great to see!

Thank you for being so responsible and protecting others. Remember we should all wear masks to protect each other – I will wear a mask to protect you and you wear a mask to protect me etc.

We have searched all over to find a video that is brief enough and clear enough on putting on and taking off masks. We did manage to find one (that is also not targeted to the medical professionals only).

In order for a mask to offer protection — rather than becoming a vehicle for COVID-19 germ-spreading — it must be handled, worn and stored properly. This step-by-step video on mask-wearing covers the how-tos and the do’s and don’ts of mask use, with tips from Sarasota Memorial nurse Jennifer Sorensen, RN (Registered Nurse in the USA).

The video addresses mask use in hospital but more importantly also in/by the general public.

As always, should you have any questions about your health or about what to do or how to behave (responsibly for your own health), please do get in touch with us to speak to the doctor.

Please watch the video below:

 

social distancing guidelines

Is six feet too close?

Social distancing guidelines recommend that people stay six feet apart in public, based on how far most large droplets from a cough or a sneeze travel. But that may not be enough, especially if your health is vulnerable or you’re in an enclosed space.

Smaller droplets called aerosols that could spread the virus might be carried farther by air currents. They’re produced not only when you sneeze or cough, but also when you simply breathe or talk.

(We created a 3-D simulation to show just what happens in the 20 minutes after an infected person coughs indoors. We also used augmented reality — accessible with the NYTimes iOS app on a newer iPhone or iPad — to show how the six-foot guideline could apply in real life.)

Image

All the more reason to wear a mask

Barriers of cloth or other materials can stop large particles from landing on your nose and mouth, while disrupting the trajectory of your own coughs and sneezes.

Worried about surfaces?

Most people catch the virus by inhaling droplets that an infected person has just breathed out, not by touching a surface where it may be lurking. So the usefulness of widespread public disinfecting remains up for debate.

 

New York Times

Heart failure advice during COVID-19

Heart failure advice during COVID-19

  • People living with heart failure are particularly vulnerable to COVID-19
  • Social distancing/isolation is advised by Public Health England for the over 70’s and those in the vulnerable group. If you have heart failure you are considered vulnerable
  • It is important to reduce the significant risk to you by minimising face to face interaction with hospitals, GPs and other health care professionals
  • Please take care of your general wellbeing by eating and drinking well, exercising as you would usually within your home and taking your prescribed medication
  • If you require any support or advice with regards to your management, please contact us

Green – monitor your symptoms

  • No changes in your breathing
  • No changes in leg swelling
  • Weight stable
  • You are as active as usual

Continue to weigh daily, take medications as prescribed

Amber – contact your heart failure nurse or GP for advice if symptoms persist

IT IS IMPORTANT TO SEEK HELP TO AVOID DETERIORATION AND POSSIBLE ADMISSION TO HOSPITAL WHERE RISK OF COVID-19 IS GREATER

  •  Breathing is more difficult than usual and worsens on lying down/wakes you in night
  • Legs increasingly swollen
  • Weight has increased 4lbs/2kg over 2-3 days
  • Your heart medication has been changed and your heart failure team are not aware

Continue to weigh daily, take prescribed medications, follow advice given from specialist team regards altering medications and ensure you have any requested blood tests

Red – contact your heart failure nurse/GP/111- dial 999 if you feel very unwell

  • New onset chest pain – not relieved by GTN
  • Persistent rapid heart racing/palpitation
  • Difficulty breathing whilst resting
  • Severe leg/abdominal swelling
  • You have had a blackout

 

Credit: Imperial College Healthcare 

The Mayfair GP in COVID Research and helping the NHS

In addition to our patients using us and hence taking additional stress away from an already overstretched 111 and other NHS services, we are contributing in other ways towards the fight against Coronavirus.

Our doctors are assisting the NHS in every capacity that they can on a daily basis.

They are also involved in research conducted by Oxford University and the NHS. This trial involves the use of the drug called Hydroxychloroquine in people aged 50 years and older with underlying health conditions and in those aged 65 years and older.

At the moment we really do not have enough information about whether any benefits from taking this drug outweigh any possible harms from the drug. We do not, therefore, know if this drug works for COVID-19. They are therefore looking to assist in a proper trial* so that we have the information we need to guide the provision of the best care for all.

*PRINCIPLE PIL v1 27-MAR-2020 REC No.20/SC/0158 IRAS No: 281958

diabetes and coronavirusDiabetes and Coronavirus

If you have coronavirus symptoms, however mild:

  • Do not go to a GP surgery, pharmacy or hospital. Call us for advice via a telephone appointment
  • If you live alone, stay at home for 7 days from when your symptoms started
  • If you live with someone who has a continuous cough or a high temperature, you should stay at home for 14 days from the day the first person got symptoms. If you then develop symptoms, you should stay at home for 7 days from the day your symptoms start, even if it means you’re at home for longer than 14 days
  • Follow the advice of our doctors or your diabetes team regarding your medication
  • If you routinely check your blood sugar at home you’ll probably need to do it more often
  • If you don’t check your blood sugar levels at home, be aware of the signs of a hyper (hyperglycaemia), which include passing more urine than normal (especially at night), being very thirsty, headaches, tiredness and lethargy. You should contact us if you have hyper symptoms
  • Stay hydrated – have plenty of unsweetened drinks and eat little and often

If you have type 1 diabetes, check your blood sugar at least every four hours, including during the night, and check your ketones. If your blood sugar level is high (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets) or if ketones are present, contact your diabetes team.

If you take a certain type of diabetes tablet called SGLT2i and become unwell, you should stop taking these. You need to check your ketones and your blood sugars (if you’ve been told to do this and have the kit), and speak to your healthcare team. The brand names of these tablets are Forxiga, Invokana and Jardiance. Taking these tablets when you’re not very well could increase your risk of developing diabetic ketoacidosis (DKA), so you need to know the symptoms to look out for.

Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you’re vomiting, or not able to keep fluids down, get medical help as soon as possible.

How Coronavirus can affect people with diabetes

Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people and those with other long-term conditions, such as cancer or chronic lung disease.

Everyone with diabetes, including those with type 1, type 2 and gestational, is at risk of developing a severe illness if they get Coronavirus, but the way it affects you can vary from person to person.

When you have diabetes, being ill can make your blood sugar go all over the place. Your body tries to fight the illness by releasing stored glucose (sugar) into your bloodstream to give you energy. But your body can’t produce insulin to cope with this, so your blood sugars rise.

Your body is working overtime to fight the illness, making it harder to manage your diabetes. This means you’re more at risk of having serious blood sugar highs and lows, as well as longer-term problems with your eyes, feet and other areas of your body.

For most people, Coronavirus is a mild illness, but some people develop a more serious form of the virus and could die.
It is important that people with diabetes follow the sick day rules should they become ill from any illness.

Advice from Dr Kaushal and Diabetes UK