UK shielding paused – but normality remains far away

And so we make it to the end of the first week since shielding in the UK was paused. For most of us with blood cancer we remain cautious. As someone said on one of the forum’s: “I don’t think many of us will be going clubbing just yet!”

The numbers of cases in the UK until quite recently were going down. This means that the risk of anyone we meet having the coronavirus and being able to infect us is much lower than it was at the height of this first wave of the epidemic.

According to the ONS survey, an estimated 28,300 people in the community in England had COVID-19 between 27 July and 2 August 2020 (0.05% of the community population). (source: Analysis | Data.) This figure will vary a bit from region to region of course. But it means on average every individual you meet has a 1 in 2000 chance of carrying COVID19 at the time you meet them in England. If you meet someone who has COVID19 at 6 feet outside for a few mintuites even without a mask one estimate I read somewhere was that you’d have perhaps up to a 1% of catching it from that person. So perhaps each one to one meeting at six feet gives something like a 1 in 200,000 chance of catching it. This is of course a very rough estimate but you get the point. And if you are that 1 in 200,000 person it is of course no comfort that you have been very unlucky!

But at the moment here in the UK cases may be edging up and there is national concern we may be just two weeks behind Spain who are back to real exponential growth.

It is up to us to keep ourselves safe. We cannot rely on others to move out of our way or follow the guidelines.

It is worth saying that the situation in the USA and some other countries is that some areas are really only just entering their first proper wave of the virus and so may warrant a more cautious approach than I will outline below.

The UK shielding program is paused but those who have been labeled as “extremely clinically vulnerable” to getting severe complications from coronavirus have been urged to remain careful and take extra precautions.

The BBC Interviewed Nora Grant, one of the trustees of CLL Support about how the lock down easing is affecting those who have been shielding.

Nora’s viewpoint mirrors many I have spoken to. We want to begin to do a few more things, but we also want to remain safe. Everyone has a different view of the situation and will make their own judgements. But how do we do a risk assessment and work our what we are comfortable doing and what we are not?

I think it’s worth saying a couple of things first of all about the risk of serious complications if we do catch the disease. Clearly a combination of a reduced background risk (in areas where that is true) and us continuing to take some social distancing measures will reduce the overall risk by preventing us from catching the disease. But it is worth ensuring that we do not forget this disease does still pose a risk to us if we somehow catch it . I explain this in more detail in my previous post on the data.

• Some people with blood cancer will get mild or even asymptomatic disease and easily recover. 
• Some people with blood cancer will get more severe disease, report it to their blood cancer doctors and in this group maybe 30-40% will sadly die. 

There is a lot of confusion about precisely which patients do better and which worse. Some data suggests a higher risk for those in watch and wait early in the diagnosis than those in treatment which seems counter-intuitive. BUT what is often missed is that the reason for that data might be those people are likely to be more careless about catching the disease and so if they catch it they might have been exposed to a higher dose of virus initially. The so called virus load you are exposed to may make a difference.

Unfortunately we can’t be confident that whatever stage of our illness we are at that we will definitely survive if we catch COVID. Most blood cancer medications do further suppress our immunity, which in the early stages of an infection might make us worse. But in the later stages it is possible the same drugs might help stop the over reaction. But we do not know for sure in an individual patient if on balance a medication will be helping or harming our response. We need our immune Systems to regulate well. Ours do not. Not least because from very early on many patients with some types of blood cancer become impaired at making new types of antibodies for diseases we have not yet seen. 

So the short answer is to take as many steps as we possibly can to avoid catching this dissease. And if you are in a high incidence area especially that would mean not going out of your house for any reason except medical appointments and perhaps a socially distanced walk or meet up where this happens outside and more than 6 feet (2m) apart. At times we in the UK we were officially advised not even to do that! Definitely no shopping and know going inside bars or restaurants.

Here in the UK we have not seen a spike in cases following relaxing the rules about outdoor meetings, and even when huge numbers of people have gathered on streets, in parks, and on beaches this doesn’t seem to have reliably sparked major outbreaks. It seems that we are more safe outside than perhaps we first thought. It seems you are quite unlikely to catch the disease if you are breathing fresh air. You do not want to be breathing air which has come from someone else, and which is contaminated with air droplets. Small aerosol droplets can hang in the air indoors a long time and be recirculated and spread via air conditioning. We are seeing this confirmed by super spreader events.

How to avoid catching COVID19

• Be very wary of catching COVID19. Imagine every person you meet has it and every surface you touch is contaminated. 
• Follow social distancing and hygiene advice (hand washing, 6m apart, wear a surgical mask or respirator). See the official UK advice.
• Remain alert even outdoors and keep your distance and limit yourself to small meetings. There is still a small risk of transmission
• Avoid indoor enviroments where possible as this poses a higher risk. Use high quality masks (possibly with the addition of a face shield which should not be used alone). Online shopping is still best.
• Do not enter poorly ventilated or crowded rooms. Sit near open windows or doors and away from other people.
• Dry your hands with an unused clean towels or paper, do not use hot air driers. Public toilets pose a risk of transmission so use a mask, and ideally a facility that has not recently been used.
• If you have to get in a car with someone you don’t live with, then try to only go with one other person. The passenger should ideally sit in the back on the opposite side to the driver. Both can wear a quality mask (ensure that the non-vulnerable is not using one with a valve). If you can, then open the windows. The longer the journey, the greater the risk. Wash your hands after touching anything. I have done a car ride with someone to take me to hospital and was fine.

Fresh air is a vital defence

Think of yourself having a certain amount of “social contact capital” to invest. It is vital to our mental health to begin to do things that make us feel happy, normal, and connected to real life. For some that may even include returning to a work environment. In any situation we are planing to enter, however, it makes sense to reduce the amount of risk we are taking.

Eating outdoors will pose a lower risk than eating indoors, so leaves us with spare “capital” to spend in other ways at other times during the week and just as importantly may make us feel more comfortable.

As we tentatively begin to do more things we may find ourselves feeling nervous at times. This is normal. It may also sometimes not feel rational. But by gradually taking small steps that we are comfortable with and which make sense, we will gradually improve our confidence levels. We must not become complacent, however.

Personally this week I have continued my social distance walks early in the mornings in remote areas. I have actually also eaten at an outdoor cafe and restaurant. It was great to feel a bit more normal. Using a mask as I walked past the other tables helped me feel safer. And the second time was easier than the first.

The phrase “stay alert” which initially seemed unhelpful now feels like a good reminder. The epidemic is far from over as recent events in Scotland demonstrate quite clearly.

The Aberdeen Outbreak

One hundred and twenty Scottish people walked into a bar in Aberdeen. It sounds like the beginning of a politically incorrect joke. Unfortunately it is rather the beginning of a localised outbreak.

The background is that Scotland was doing really well at suppressing the epidemic. And indeed Nicola Sturgeon was able to point out that there had been no deaths for seventeen days, and it seemed that Scotland was doing a lot better than England at getting the epidemic out of control.

We are told that one person who attended the pub on the 26 July was feeling unwell. By the 1st August 13 people had tested positive for COVID19 from that evening’s night out. By the 7th August this figure had risen to 76. The city is now on lockdown amidst concern the spread from this night will get out of control.

Be hopeful but careful

In summary, we must remain vigilant because patients with blood cancer are still at high risk of getting serious complications if we do catch the disease. Outdoors is much safer than indoors.

But if one of us is unfortunate enough to actually catch COVID19, we should also remember that even in the highest risk group the majority of people will recover, even if they have to be admitted to hospital.

Keep safe. But begin to enjoy life again.