Friday 7 August 2020
Please note advice about COVID-19 changes rapidly and you should check the latest Government advice here: England (https://www.gov.uk/coronavirus), Scotland (https://www.gov.scot/coronavirus-covid-19/), Wales (https://gov.wales/coronavirus) & Northern Ireland (https://www.nidirect.gov.uk/articles/coronavirus-covid-19-overview-and-advice).
If you have symptoms of COVID-19 please follow the advice on these websites or if you are very unwell call 999 or attend your local Emergency Department.
Coronaviruses (CoV) are a large family of viruses: 7 strains can infect humans, typically causing mild illness (1 in 6 cases of the common cold are caused by coronaviruses) and more rarely serious illness.
COVID-19 is caused by a strain of coronavirus called SARS-CoV-2 that first appeared in humans at the end of 2019. SARS-CoV-2 spreads from person-to-person, through droplets in the air from coughing, sneezing and through contact with contaminated surfaces. The rate of clearance of the SARS-CoV-2 from enclosed spaces depends on how well the space is ventilated; the virus can survive for up to 3 days on plastic surfaces.
We do not yet know if, or to what degree, people who have had it might be immune to future infection.
At the time of writing there have been more than 18 million COVID-19 cases and almost 700,000 deaths globally. Up to date figures can be found on the ECDC website (https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases). Figures on testing, confirmed cases and deaths in Wales, Scotland, Northern Ireland and England can be found here: https://www.gov.uk/coronavirus.
There are lots of symptoms associated with COVID-19 but the commonest are: a high temperature, a new, continuous cough and a loss of, or change to, your sense of smell or taste. For the latest advice about what to do if you have symptoms check https://www.gov.uk/coronavirus, https://www.gov.scot/coronavirus-covid-19/, https://gov.wales/coronavirus and https://www.nidirect.gov.uk/articles/coronavirus-covid-19-overview-and-advice.
Overall about 80% of people with COVID-19 are thought to have a mild illness, though it is hard to interpret figures as this depends on who gets tested. It’s still not entirely clear how many people have no symptoms (also called ‘asymptomatic’) as much of the testing has been in people who are unwell. However, a study in the UK testing 120,000 people in May, found most had no symptoms at the time of testing positive. How many went on to get symptoms eventually is not clear and this is an issue with a lot of the reports describing asymptomatic COVID-19. However, people without symptoms can still pass the virus on, (which is one of the reasons we are advised to wear a mask in many public areas,) but likely less than people who are actually unwell, which is why it’s important to isolate and get tested if you do have symptoms.
The risk of needing to be admitted to hospital with COVID-19 depends on general health and age; data from China showed about 1 in 5 over 80s need to go into hospital compared to 1 in 100 under 30s. Once in hospital, data from the UK shows about 1 in 6 people need to go to Intensive Care, and just over 1 in 3 of those die (https://isaric.tghn.org/covid-19-clinical-research-resources/).
People most at risk of serious illness and death are the elderly and those with long-term medical conditions, such as cardiovascular disease, chronic lung disease, obesity and diabetes. Men are at a greater risk than women and the rate and severity of COVID-19 have been higher in the Black, Asian and minority ethnic (BAME) populations. Data from the UK, from more than 17 million adults, calculated for several different factors the extra risk of death shows:
60% higher for men than women, about 50% higher for Black and South Asian than White people, higher for older people (60-69 year olds almost 2.5 times more likely to die than 50-59 years olds, much lower risk for under 40s) and higher for very obese people. People with well-controlled diabetes had a 30% higher risk of death, which rose to 95% if poorly controlled and the biggest single risk factor for death was a recent haematological malignancy (leukaemia, lymphoma & myeloma) with an almost 3-fold higher risk of death (https://www.nature.com/articles/s41586-020-2521-4_reference.pdf?referringSource=articleShare).
If you are worried about any medical conditions or treatments that may increase your risk of COVID-19, please speak to your GP.
This UK study described above was unable to analyse the impact of HIV, but another analysis, presented at the BHIVA Spring Conference showed people hospitalised with COVID-19 had a 63% higher risk of death than people without HIV, but was unable to take ART status, viral load and CD4 into account (Geretti AM et al. BHIVA Spring Conference, 3rd July 2020).
BHIVA, through its statements in partnership with the Terrence Higgins Trust, and with the European AIDS Clinical Society, continues to advise that people not on ART or with a CD4 less than 200 may be at higher risk, and that people with a CD4 less than 50 should shield where shielding programmes are recommended. At the time of writing, shielding has been lifted in the UK, but if or where it may be reintroduced either nationally, or on a local basis, we advise following Government guidance and speaking to your HIV clinic or GP if you are not sure.
If you are admitted to hospital we have some guidance available here: https://www.bhiva.org/BHIVA-statement-on-considerations-for-critical-care-for-people-with-HIV-during-COVID-19
There has been a lot of misinformation about COVID-19 treatment. Many of the trials are poorly designed and many press and social media reports have been inaccurate and misleading.
In the UK, the RECOVERY trial tested a range of potential treatments for COVID-19, including drugs already approved to treat other conditions in almost 12,000 patients from 176 NHS hospitals. Results so far have shown that two drugs which had been widely used to treat hospitalised COVID-19 patients globally, hydroxychloroquine and the HIV drug lopinavir-ritonavir, do not improve survival, whilst one drug that was not widely recommended before the trial, dexamethasone, can save lives. Dexamethasone, a steroid used in a wide range of conditions to reduce inflammation and dampen the immune system, reduced deaths by one-third in patients on ventilators and by one fifth in other patients receiving oxygen. There was no benefit among those patients who did not require respiratory support to breathe.
There is evidence that the antiviral drug remdesivir shortens recovery time and reduces need for ventilation in people with COVID-19 and it is approved for elected patients in the UK. At the moment there is no clear evidence that the risk of death is reduced but there are many more studies in the pipeline.
There are no coronavirus vaccines yet but there are many in development or being studied in clinical trials. Current UK vaccine trials do not include people with HIV but we hope that future studies will and we will ensure we publicise these.
There is more helpful advice here: https://www.nhs.uk/conditions/coronavirus-covid-19/
We advise looking after your general health through good diet and exercise, and avoiding excess alcohol. If you do have to self-isolate or quarantine, you can find exercise suggestions online at https://www.nhs.uk/livewell. You should ensure you have had the relevant vaccinations including the annual flu vaccine.
Stopping smoking will definitely help, as will stopping vaping (although this is still preferable to smoking – see https://www.nhs.uk/smokefree for advice.)
There is no strong evidence that being on HIV medication will stop you getting COVID-19. A study in Spain concluded tenofovir-disoproxil fumarate (the older version of tenofovir that we use to treat and prevent HIV) may be protective, but this may be driven by other factors. Laboratory tests are conflicting as to whether tenofovir is active against SARS-CoV-2. As above, the RECOVERY Trial showed no benefit of lopinavir/ritonavir. Other HIV drugs are being studied but there is no evidence yet that any are effective. Our advice is:
You should continue taking recommended treatment at the same dose: do NOT increase the number of tablets you take. This will not help you if you get COVID-19 neither will it protect you from getting it. It could in fact be harmful to exceed the normal dose.
Ensure you have 30 days’ supply of medication.
Do not share your HIV medicine: with anyone who has COVID-19 or who is worried about getting it.
There is no problem with supplies of HIV medications. There is no shortage of HIV medication and your clinic will arrange for your medication to be delivered to you if you cannot collect it. Most clinics are still using telephone or digital consultations for most patients but can arrange face-to-face consultations if necessary. Most clinics suspended routine blood and urine tests at the peak of COVID-19 but are gradually reintroducing them. If it is more convenient, and you prefer to avoid travel, your clinician may be able to arrange for your bloods to be taken at your GP surgery.
People who have recently been diagnosed with HIV should talk to their HIV clinic about any worries they may have about their immune system. Your clinic will get you on treatment as soon as possible and will choose a drug combination that suits you best, including your ability to attend for tests after starting therapy.
It is understandable to be anxious or low at a time like this, and the uncertainty and isolation of COVID-19 has affected us all in different ways. There are several resources to help and we list some of them here:
A summary of NHS advice, including situations when you should call 999 is available here: https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/dealing-with-a-mental-health-crisis-or-emergency/
Reports of domestic abuse have increased during COVID-19. Your clinic may ask you about this during telephone consultations but if you are not able to answer then there are other places you can go for advice and support.
There’s advice about spotting the signs of domestic abuse and a long list of places to seek help on the NHS website here: https://www.nhs.uk/live-well/healthy-body/getting-help-for-domestic-violence/. Some of the sites, like Refuge, have a button on the screen to shut the site down immediately if someone is near: https://www.nationaldahelpline.org.uk/. Finally, Silent Solution is an initiative where you can call 999 from a mobile phone but if you are unable to speak you can press 55 and be put through to the police: https://policeconduct.gov.uk/sites/default/files/Documents/research-learning/Silent_solution_poster.pdf.