One of my biggest concerns around the current Covid-19 pandemic is that all of the normal things that make people sick haven’t gone away. This concerns me because whilst Covid-19 is on the minds of healthcare staff they may inadvertently delay considering all of the other clinical problems that will continue to be going on in the background. Patients will still be coming in with appendicitis, UTIs, heart attacks and strokes; in fact ANY acute medical or surgical problem that happens in a normal day in the NHS.

There seems to be huge amount of confusion about what tests are available for Covid-19. It doesn’t help that politicians and the media keep using the wrong terms and don’t understand what the different tests tell us. The squabbles seem to surround the numbers delivered rather than correct testing!
 
There are 3 main tests that are currently being discussed:

1. Polymerase Chain Reaction (PCR) commonly referred to as a “molecular test”
2. Antigen (Ag)
3. Antibody (IgM and IgG)

 
In order to understand the value of these tests it is important to understand the basic structure of a virus.
 
The structure of a virus

Everyone I see around the hospital asks me how the Microbiology department and the Microbiologists are coping. They are concerned that WE are flooded with work… and yes we are busy… BUT we are not frontline staff dealing with acutely sick patients or GPs in primary care struggling to deal with Covid-19 whilst juggling all of their other patients!
 
I am especially in awe of how my primary care colleagues are dealing with Covid-19.
 
Primary care must be unbelievably hard right now. Not only are GPs still having to manage their normal case loads of chronic illnesses but they are also the first line of contact for many people who have been infected with SARS Coronavirus 2 (SARS Cov2). AND they are doing this remotely using telephone and videoconferencing!!! The Editor Chief in Charge (aka my wife) will tell you just how useless I would be at that… I don’t even own a smartphone; in fact I can barely use the TV remote control!

I don’t want to be accused of jumping on the Covid-19 bandwagon but I’m getting asked a lot of questions both from inside and outside of the hospital, so I thought I’d try and answer some of them for you (I think from now on I’m going to tell people I’m a florist rather than a Microbiologist… it’ll be more tranquil). The answers are based on my clinical experience within the hospital setting, evidence I have been able to find as well as National guidance in the UK.
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Hold onto you seats, here we go…!

“We have a patient with an odd infection of the face and neck and want to know what antibiotics to start” said the ENT Doctor.
 
“What do you mean by odd?” asked the Microbiologist vaguely, distracted by all of the requests for coronavirus testing that where sitting in the laboratory.
 
“Well the patient has bilateral swelling of her face and neck and difficulty swallowing, and it’s a bit odd to be bilateral”.
 
The Microbiologist perked up and started to pay more attention.
 
“What does she do? Has she injured herself recently? Does she have pain on opening her mouth? What’s her vaccination history?” he asked.
 
“Errrr. She’s retired. We haven’t asked about injuries. She can’t open her mouth. She’s 77 years old so we haven’t asked about vaccines” answered the ENT Doctor.
 
“Okay. Go and ask her the questions. More specifically is she a keen gardener? Has she had any injuries, however minor, which might have been contaminated with soil or manure? When did she last have a tetanus immunisation? I’ll stay on the phone while you ask. This sounds like it might be tetanus”.
 
There was a pause, then the sound of the phone being put down on the desk, whilst the ENT Doctor went off to get some answers…
 
The Microbiologist tapped his desk nervously, “see, see not all patients are presenting with Covid-19, and I do wonder how many “ordinary” illnesses are being overlooked amongst the Covid-19 shenanigans…”
 
The ENT Doctor returned to the phone and asked … “are you still talking to me?”
 
“Oh umm, no I’m just ranting a little to myself” replied the Microbiologist.

Yes, you may have noticed we’ve got more Covid-19 cases in the UK today than yesterday. But wait… this isn’t surprising; it’s the natural history of a respiratory viral infection. I think it’s probably worth a quick “keep calm and carry on” update…
 
So we are now in the “slow it down phase”
We (us with our fingers on the don’t panic buttons) always knew we couldn’t contain Covid-19, and that we would enter the “slow down the spread”, whilst trying to prevent the most vulnerable people from acquiring it, phase sooner rather than later. Those that appear most vulnerable to this infection include those of older age (over 80 years), diabetics, those with chronic lung diseases (especially smokers) and the immunosuppressed.

​Sack the Microbiologists and just employ computer geeks! Whoa! Hold on!! Where did that come from I hear you say…?
 
A headline caught my eye last week… well other than the normal coronavirus shenanigans anyway; “A powerful antibiotic that kills some of the most dangerous drug-resistant bacteria in the world has been discovered using artificial intelligence”.
 
Ignoring the sensationalised headlines I dug out the research paper, published in Cell last week, and had a look at what was going on, obviously it was a quiet day on the coronavirus front!

​What have we learned so far about Covid-19?

1. It spreads pretty well; each person infected and not isolated tends to infect another 2-3 people which can lead to an exponential growth in number of cases (currently over 80,000)
2. The incubation period is an average of about 5-6 days
3. The mortality outside of China is <1% (if you discount Iran which heavily skews the data with 15 deaths from only 95 cases)
4. If you put 3000 people in a closed environment with Covid-19 (Diamond Princess cruise ship) 695 people (23%) will get Covid-19
5. The World is putting a huge amount of effort into isolating areas with Covid-19 including Hubei province and yesterday Northern Italy

“We have a lady with puerperal fever. She’s 2 days post-delivery and pretty unwell. Critical Care are reviewing her now and we’d like some advice about the best antibiotics to give her” said the Obstetrics Registrar.
 
Excellent thought the Microbiologist; they’re being proactive about a serious problem.
 
“If she’s not allergic to anything then IV Benzylpeniciilin and Clindamycin. Have you looked for retained products and done a DNC?” asked the Microbiologist.
 
“She’s really unwell, we don’t really want to take her to theatre. We might damage the uterus” replied the Registrar.
 
“She’s unlikely to improve if you don’t,” said the Microbiologist sympathetically. “You need to remove as much infected material as you can. I know it sounds brutal but it’s really important”.
 
“Okay,” said the Registrar sounding doubtful, “my Consultant is with the patient at the moment so I’ll go and tell them what you have advised. Thanks for your help.”
 
The Microbiologist put down the phone and put down his pen. Time to visit the obstetric ward and see what is going on…

Happy Valentine's Day! The Love Virus is in the air...
“Chinese media are showing hardworking hero stories, it's Jeong Jae Pung’s wedding anniversary … ‘come home soon’ his sign says [according to the BBC reporter] … his wife is a nurse looking after virus patients and contact with the outside world is forbidden…” (BBC News at 10, 13/02/2020)

So what’s wrong with this picture?
The nurse is on a mobile phone wearing her PPE outside of the hospital, according to the UK’s guidelines it should be removed inside the patient’s room and why is she using her mobile phone?!

This breaches Infection Control policy in so many ways; leading to contamination of the hospital and the wider environment and also exposes this person and their family to the virus. She might as well not bother wearing the PPE at all.

This picture is so crazy it deserves a caption competition, no prizes, just the kudos for being the wittiest reader of the bug blog!
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Add your caption below or on Facebook :-)