As part of the University of Brighton's podcast series, Dr Chi Eziefula from BSMS answered a series of Coronavirus questions in a COVID-19 Q&A special.
Dr Chi is Senior Lecturer in Infection at BSMS and an Honorary Consultant in Infectious Diseases and Microbiology at Brighton and Sussex University Hospitals NHS Trust.
Listen to the podcast below or see a full transcript on this page.
So you're in your practice at the moment, what is morale generally like?
Yes, I am in practice as a doctor. We had some time to prepare for this, which has helped us work better. So I think that's actually quite high morale currently in the hospital. Staff are supporting each other and we're putting sort of learning systems in place. And I think that teamwork and that necessitiy to really step up is keeping morale up at the moment. So we're in a positive space.
That's good to hear. Before we fire away, can you give us a brief outline of your background, what you've done in the past and your specialism?
Sure. So I'm a clinical academic, so I work as a doctor, a consultant job doctor in the hospital, and I also do research as an academic and mainly in tropical medicine, in malaria and global public health. So malaria ologist and I focus on epidemiology as well in clinical trials studying drugs and how they work in people.
So we threw out to students and staff for their questions on the Coronavirus. We'll try and get through as many as possible around half an hour or so. First question is from Hannah, a history, literature and culture students-She asks, When is the virus likely to peak in the UK based on what we know at the moment?
At the moment, we are in lockdown. And the aim of that lockdown is to actually delay the peak slightly and to make it lower. So the flattening the curve. And there's some really nice data from a paper from the team at Imperial College and the lead authors, Neil Ferguson, which shows what that delaying tactic might look like and it shows that if we were to lock down and do social distancing and quarantining of people who are symptomatic and whole family quarantine, when people are symptomatic and shut down the schools and stop people going to work and increased working from home, then that should delay the actual peak time. At the moment, we're probably expecting the peak would be May, June, with the measures that we've got in place at the moment.
This is an anonymous question. Do you think this is more of a personal view, I guess? Do you think the lockdown restrictions will get stricter?
It is difficult to deal with that uncertainty of not knowing how long lockdown will last. It's worth thinking about why we need to lock down at all with this virus and there are three main reasons for that. The fact is that it can be transmitted asymptomatically. So when people are out and about feeling well, we know that just before symptoms start, people are actually infectious. So the lockdown is to really reduce the chance of that. Another reason is because it is very infectious. It's got a high reproductive rate. So one person can transmit the virus to more than two people currently and probably more like four people. So it's very infectious. So lockdown should help. And also, thirdly, it has a long incubation period so you can get infected but it can take a while to actually get infectious and to get symptoms. So the lockdown is important for doing that. But whether the current measure is strict enough- What we're doing now, we don't quite yet know because we're only a week or so into the lockdown. It looks like it is beginning to start to reduce that infectiousness. So for each new case, we think we might be getting the curve, might be might be beginning to flatten, but we might be getting fewer new cases. So that might mean it's strict enough. But the real reason for that lockdown is to stop the NHS from getting overwhelmed so that the proof in the pudding is if the restrictions are strict enough, if the NHS doesn't get overwhelmed. So we have to predict whether that is the case or not. I think at the moment we've never taken such drastic measures and there are no potentially negative implications from being in lockdown on people's health and physical and mental health and also risks of people who are vulnerable and obviously risks to the economy. So personally, I'm hoping that we don't need to get stricter in order to protect people from the negative impacts of even more strict lockdown. In terms of the duration, I think we are in for quite a long series of long duration of this lock down and a long series of lockdowns.
Yeah, I think it comes down to the next question, actually, which is from Lucy, who asks that once the social distancing rules are eased, are we likely to have a second peak or even more than one?
I'm afraid so, yes. Because what lockdown does is it stops people who haven't been infected. It stops those people from getting in contact with people who are infected, hopefully. But the problem is that means that those people don't get immunity. So lockdown doesn't help us get what, the so-called herd immunity. So as soon as lockdown is lifted, then people who haven't been exposed to the virus can get exposed, meaning that there can be many more cases. And that's what the models are predicting. And we really need to look at China now, because China has just done excellently with mitigating the outbreak there now is starting to relax restrictions in Wuhan, which was the epicentre. But that needs to be done really carefully because you can get another peak when you relax the restrictions. And that peak could even be bigger than the peak that they've already had. If it's not done properly.
All right. So we're in for the long haul on this one as we keep being told as well in these daily briefings that we're seeing from number 10, and Mark asks how much difference will testing make to beating the virus? And can you screen an entire population with the antibody test?
Testing is really, really important. And good question about whether we can screen the whole whole population. It's crucial to test enables us to know who's got the virus and whether the interventions that we're using are actually working at all. And it also helps us to predict where we are and to know where we are on the curve and to predict what's going to be happening next. So at the moment we just got this PCR test and that tests, whether people actually have the virus now. So it looks for the RNA, which is the genetic material of the virus and sees whether it's in a persons, nose or throat when they're swapped. And what's going to be more helpful is to know whether people have had the infection. So how many how many people in the population have had it? And that will be through antibody tests. So what we want to know from the antibody tests is who's had it, but also what is their level of immunity or what has their immune response been to to the virus? And that will let us know whether people are getting immunity. So there would be less transmission in the community. And there are several antibody tests already now in the pipeline, which is really encouraging. It's easier to test antibody tests than it is to test the PCR test that we have at the moment. It's should be a little cheaper and more easy to access more sort of widely. I don't think we can test the entire population. That's logistically huge, so it cost and logistics. It's a it's a big undertaking. But what we would do is we would hopefully roll out testing of large groups in the population so we can have an idea and then use that for modelling to see who's infected. So different countries are testing to different extents. Some countries are testing really avidly and rolling out larger number of tests in some countries like the UK, it may be lower than other countries. And Iceland in particular is testing a large proportion of the population. The advantage of testing is also that we get to know how the virus is behaving. So we get to what's really important is to know the denominator. So when we compare the number of cases or the number of deaths, we know what that compares to the number of either negatives or the number of people who've had the virus but been asymptomatic so that they wouldn't have to test normally because they haven't had symptoms. So in a country like Iceland with really high testing rates can show us how deadly the virus actually is more reliably than if large proportion of the population are not being tested. So in Iceland, we're getting data out that suggests that the case fatality rate, the number of deaths per cases is probably a lot lower than in the numbers that we're getting from other countries who are only testing people who have symptoms.
A question from Nina. Nina asks, is it true the virus is also airborne?
This virus is mostly droplets spread. So droplet it means that it's spread through wet droplets that we spread out into the air, spray into the air when we cough or sneeze or we talk. And also we can we can wipe those droplets on our hands and cross-contaminate things we touch. And so droplet spread, doesn't stay in the air for very long and it's mostly spread by close contact. But airborne infections are more of a concern because they can hang in the air for longer. So you need different interventions to protect from airborne infections. So this is mainly not an airborne infection, but in certain circumstances it can stay in the air for longer. And that's when people produce aerosols. So that's when a large amount of air is blown out through the respiratory tract, through the airway, and then smaller droplets can stay in the air for longer and they can float in the air. But that's mostly in situations in hospital. So when someone's having a tube put down to be ventilated, that's an example of an aerosol generating procedure. So in most situations, in normal life or out and about, people aren't producing aerosols.
So with that in mind, I mean there's lots of conflicting advice about face masks, obviously. But I mean, if it's not airborne, is there much needs to wear a mask especially when you're out in the open, or is it mainly a good thing to protect yourself from touching your face?
Okay, great question. Really, really important. So facemasks mostly should be used to protect others from ourselves if we have the infection. So that's too because they catch the droplets and it stops us being able to project the droplets out to other people so the intervention of face masks is all about protecting others. They're not very good at protecting us from getting the infection from somebody else. So wearing a face mask is not as effective if you walk around to stop you getting the virus. It's all about stopping you from transmitting the virus to other people. Remembering that you can transmit it without symptoms as well. And the face masks are about protecting the vulnerable. At the moment, we're not advising widespread use. I suppose there may be a scenario in some countries have used it when they think that a large proportion of the population probably do have the virus in those countries. We saw in China earlier on, people were encouraged to wear a face mask when they went out and about. And if we were to relax social distancing. It may be that more people be encouraged to wear face masks if they think they've got symptoms to stop them spreading to other people. Again, not to protect themselves, but to protect other people. So but at the moment, we're not advising that. And it's really important to know that wearing a face mask isn't about protecting yourself from getting the virus.
This one is anonymous. If you have symptoms and you believe you may have the virus, but it's not serious enough to go to hospital. What would the home remedies be?
Okay. Good question. Home remedies. So there aren't at the moment we don't have any home or hospital proven treatments for for covid 19. But what makes sense is to just boost your immune system so that if you guess it, you might be in a better position and might be more able to fight it off. And so what I would really recommend in that situation is eat good quality food, a variety of vegetables and fruits and sleep is really good for the immune system. It boosts the immune system and exercise, which also boosts the immune system. So try to support your your immune system and then also try not to do things which waste your body's immune response. So for example, dont smoke and dont take in toxins. That kind of waste your body's detoxing capacity. So rather than taking supplements or home remedies, I'd advise people to do those really basic things eat well, sleep well and exercise and also dont buy drugs online. I dont encourage that. It could be fake drugs. They may not be approved and regulated. And also self dosing can be dangerous because drugs interact. If you see a headline about a certain drug that might work, it may not actually been tested for Covid 19. When drugs are tested and are effective, they'll be available on the NHS.
Quite a few people would have asked a variation of this question, but Julie asks if you contract Corona virus acutely. Is there any long term damage to your lungs?
Ok, so definitely not for the vast majority of people, so most people who get covid 19 will either not know they had it because they will be asymptomatic or they'll have a mild illness and then they will recover. Obviously, we're hearing a lot of really alarming coverage in the news about severe cases, but many people are contracting the infection and are recovering. And in those situations, we don't expect there to be any long term effect on the lungs. But in cases that are severe, severe enough to be on life support and need ventilating. We are seeing that in that severe stage of the disease that lungs get damaged enough to get scarred. And so a process called fibrosis happens. And we haven't got long term data yet. We don't yet know whether because the virus has only been around for a couple of months now. So we haven't got that long term data to say whether there will be Long-Term Damage. But what I'd predict is that people who have had really severe cases, there may be some indeed some long-Term damage.
Photography student Amber asks, is it true the more you're exposed to the virus, the more severe it is?
Well, actually, lots of viruses work a bit like that. That all the higher dose that you get if a virus and the more likely- A that you get infected and B, that you could get more severe disease. So that's why social distancing is important to not get as close to the virus or getting a high dose. That's also why, unfortunately, health care workers are probably contracting the infection because they're closer to people who do have the disease and a higher risk of a high dose. If you think about something like chickenpox, if you get the first child in a household, will get a milder form of chickenpox. And often the second child who gets the high more severe case because they are in close contact with the case, someone that the other child's coughing on them and and contaminating them. So the more you're exposed, the more severe the infection could be. In terms of the more frequency of exposure, if that's what the question is about, hopefully of a second exposure, if you've already been exposed to the virus and had it, then the second exposure, you shouldn't really get it. You should have some immunity.
This one is an anonymous question, the question is why do you conditions such as diabetes increase vulnerability?
Okay, great. Yeah, a very important question. So the conditions that make you more vulnerable to takeover? So first of all, some of those conditions make people's immune system work less well. So something like in diabetes, for example, there is slightly less strong immune system or blood cancers or people who are on immune suppressive drugs or have certain auto immune conditions. So in those situations, the immune system's not working very well in the first place. So if an infection comes along, the immune system is not in a very good state or a strong enough state to fight off that infection. So the infection can be more severe. The other issue is that even without the lower immune system, there's some other conditions. The vital organs in the body aren't functioning well. So in order to survive the infection, the heart of the lungs need to be strong, the vital organs may be less well able to fight off the infection. For example, diabetes can affect the heart and can affect the kidneys and be in less of a position to fight off disease. Then thirdly, the immune system itself the response to infection can make the underlying disease worse. So if you've got heart disease and you get infection, then the response then in fact the inflammation caused by the infection can cause more damage, this could put you at a higher risk of getting a heart attack because of inflammation caused by an infection. And then there's another condition. Hypertension is very specific to Covid 19 high blood pressure puts you at risk of more severe disease. It's very clear from Covid 19 and that's because the virus uses the ace 2 receptors to get into cells. And that's that's up regulated when you have high blood pressure, the virus can get into cells more easily and it can also cause more severe disease.
Omar asks - and again, this is another popular one is the vaccine a solution? And when it's ready how long would that realistically take to distribute?
So I hope so. I hope a vaccine will be a solution. Because it's early on, we dont know how strong people's immune response is going to be to this virus. So hopefully when you get infected. You can get a strong immune response. That means your immune to getting it again. And that's what we'd want a vaccine to trigger really effective immunity. Something like influenza mutates it's an unstable virus and it mutates. So even though we have a vaccine, we have to create a new vaccine for the next wave of the outbreak. And so we don't know how stable this novel Coronavirus is going to be, whether it will mutate and whether a putative vaccine will be effective in the long term. And then we also need to know whether a vaccine would work in different groups, so we know that responses to vaccines vary between sex and also age. So some vaccines work better for children, but they don't work as well for adults and vice versa. So I really hope a vaccine will work. I think it's important in the meantime that we also have drugs that reduce severity of disease. And now there are a lot coming in the pipeline. A lot of clinical studies in the pipeline to assess drugs. But also, when a vaccine is available, we already have vaccine candidates. So the virus was sequenced in January. Really quickly. Really impressive. We know all of the components of the of the virus. Now on a molecular level, and that means the very quick work was done to work out what parts of the virus we could target to make a vaccine. But to actually get a vaccine out that works in a population, it's very much more than just developing a vaccine candidate. It needs to be tested first on small groups and on larger groups of people then in these different groups of people. And we need to know whether it works. And we also need to know whether it's safe. And that will takes a long, long time. And it's probably going to be at least 12 to 18 months minimum, possibly two years before we have that safely approved vaccine.
I suspect then everyone wants at the same time, of course?
Yes that’s the difficulty.
And this another one on vaccines. Another anonymous one. If a country if finds a vaccine will they share that immediately or only look after themselves first?
It's crucial. Yeah, really, really crucial questions. I think at the moment there's a lot of competition between countries to be the first to identify either drugs or vaccine. But there's also really impressively a lot of cooperation. And I think the whole nature of this pandemic, is that our world is very interlinked. And that response in one area predicts the outcome in another area of the world. So we're all dependent on each other. And I think that's a really huge message that's coming out with this pandemic. Already, large bodies like the W.H.O. and vaccine agencies are predicting that we're going to need mechanisms to roll out a vaccine if it works at scale and to ensure that regions or countries that may usually be left out of access to Vaccines are included because we depend on it logically, but we all depend on an effective vaccine being rolled out globally so that there's no more resurgence.
Yeah. Alex asks, Why are we seeing a mix of younger people dying now from the virus? We were told at the start it was more dangerous for older and vulnerable people.
Yeah, it's very disturbing to hear about these tragic cases. And at any age and also we're hearing about some younger cases recently. It's important to get perspective on the range of cases we've seen across the whole world. And definitely still the majority of cases of deaths are in older people. And we've had no deaths in under under elevens or under 12 year olds and that seems to be borne out very clearly on the large numbers of large amounts of data we've had across the world. So it definitely still is the case that older people are more at risk. I don't know the details of the individual cases of the younger children who have died sadly and they didn't have obvious risk factors for severe disease. But it is important to know about the individual cases and why what may have what may have led to a more severe presentation in those cases?
Gemma asks, Are you scared at the moment to work in clinical practice during this pandemic?
Well, I can't be complacent. My job is about is to treat people who have proven- whose tests are positive for covid-19. And we've seen lots of deaths in health care, a number of deaths in health care workers across the world. And we're seeing health care workers already in our care in the UK who have severe disease and are on life support on ICU. So I don't have any complacency at all. And yet it's important that we're focused and that we have the right protective gear and and really good systems in place in how we work.
That leads into the next question actually from Sam. Sam asks, Are you seeing enough PPE in hospitals when you're working there?
There was definitely- there was a shortage. And we've tried to adapt by changing how we use PPE. And we're still I think we're still learning about what optimal PPE is, PPE, personal protective equipment. And yet there are several such things. The supply lines have been limited, but there's definitely lots of programs and lots of process at the moment to try to secure those supply lines, but it is something that makes me anxious. Definitely.
What do you think about the campaigns, the crowdfunders things like masks for NHS heroes. It's raised nearly one and a half million pounds at the moment is fronted by celebrities such as James McAvoy. That that sort of thing could be quite crucial, couldn't it, to get into get into the hospitals?
So if the masks are a homemade that they're not the kind of mask that will be used in the hospital. But the high quality mask that can protect healthcare workers are needed. Then there's two aspects of funding potentially. Well, there's a lot of funding which is being divert national funding, government funding is being diverted to this, but it's actually also the supply lines and actually getting hold of the masks and getting them manufactured. Of course, I think it's fantastic the huge support and motivation that the general public is showing. So fantastic.
Just a few more. This one is from Anna- new guidance from the British Medical Association says health workers may need to make grave decisions should hospitals come overwhelmed with Covid 19 patients prioritizing healthier patients to save lives at the expense of another potentially. And she asks, how can it come to that? And what are your views?
This is it's very difficult. This is not what anyone has gone into medicine to do, to be in this sort of situation where you might be treating patients, where the resources are so limited that you need to make decisions about who should have access to those resources and might need to make decisions about protecting the population as a whole rather than your individual patient. That's really the opposite way round to how we practice medicine. And yes, you're right. The GMC has released advice about how to think about those ethics and we're not at that stage yet. In the UK. But all of us are aware. I think it's really challenging. The issue is the resources. So if we had and have enough high dependency resources and ventilators and critical care support, then we won't be having to make such horrendous decisions. So so, yeah, I think it's all about the response. It's all about readiness. Obviously, it's about flattening the curve so that we don't get overwhelmed. And social distancing is crucial for that. But it's also about readying ourselves for what is now inevitable, inevitable epidemic wave, which is on its way.
Your final question is from Olli. He says the symptoms for coronavirus are common at this time of year. How can we know it's not just a cold?
Well, actually, for most people, we can't know, I'm afraid because we're not testing everybody and Corona virus does have some similarity with cold, but it's but typically it does not cause a runny nose, a sniffly runny nose. And in most people, it also doesn't cause a sore throat, but it does cause a cough or shortness of breath and fever. So people with those symptoms could be caused by a myriad of other infections. A, we're not testing for those other infections. So we're not testing people for the common cold. We're not even testing for influenza widely. And B, we're not testing people when they have symptoms unless they're on well enough to need to come into hospital. So even if you have symptoms and you're not sure what it is, it's still important. If you fit the criteria for coronavirus, which is fever, shortness of breath or cough to consider that it could be and probably as coronavirus and to isolate for seven days and for the whole household to isolate for 14 days after your symptoms start. And that's important as well, because even if it isn't Corona virus, if it's just a just a common cold, but you have Corona virus as well, asymptomatically then because you've got a cold, you're more likely to transmit it. And lots of people will probably have asymptomatic coronavirus. So if you have a common cold and you also happen to have coronavirus, that's why it's more important to isolate. Because when you have a cold, you project droplets more readily. So. So it's the same action. Basically, whether or not it's corona virus, it's still important to isolate.
I think that's about all we have time for. Plenty of invaluable information, straight facts, a bit of myth busting, that's really very useful in general. Any any final advice for the people listening?
I think, yes, try to find some really good sources of information, because at the moment most people are at home and are online a lot and there's a lot of information that can either provoke fear and can also be misinformation. So to look at some, there is some really good Web sites by academic institutions, universities and also the government and W.H.O. and try to go to trusted resources for information and get information hot off the press in that way rather than social media. That may not be as reliable. Secondly, definitely well-being is very important right now. And so to reach and find your personal resources and try to reach yourself and try not to let fear take over. And I think we can all respond best in that way. And thirdly, just aim to do what you can to keep yourself well. So to focus on boosting your immune system with keeping yourself healthy, with good, good diet, exercise and sleep. Focus on the sleep.
Great. Thank you for coming on. I'll speak for many, I'm sure when I say everyone is so thankful for the work people like yourselves, your colleagues and all the NHS is doing. Thank you once again.