As the first case of coronavirus on the island of Ireland has been confirmed, RTÉ's Morning Ireland asked a panel of experts to answer your questions on Covid-19.
Associate Professor and Head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland. He is also a consultant in infectious diseases at Beaumont Hospital, Dublin.
Dr Sarah Doyle
Consultant in Public Health Medicine at the Health Service Executive
Dr Ray Walley
GP and former president of the IMO
Keep your questions coming, email: firstname.lastname@example.org as there are more podcasts to come.
Question: Do you have to go to hospital to be treated for Covid-19, or can you be treated at home?
Ray Walley: No. On the basis that she [patient in NI infected with coronavirus while on a trip to northern Italy] had come from a skiing holiday, she's likely to be fit and healthy. There’s a 20% infection rate of people. The majority of them – 80% - have mild symptoms. So in the majority of those cases they’re going to be fit and well and be able to be treated at home and be self-isolated. There’s a lot of advice in regard to that on the HSE’s website (www.hse.ie). And again, when you’re dealing with that, try to maintain your own good immune system – so eating well and drinking well, making sure you’re taking paracetamol and ibuprofen, getting guidance from the public health people, getting guidance from your general practitioner. There’s no specific anti-viral treatment for coronavirus but the greater majority of people will not need any specific treatment.
Question: At what point would a patient need to go to hospital and what would happen to them then?
Ray Walley: I’m presuming they will be monitored by the public health people under their general practitioner, and clinically you’ll be deciding on the basis of assessing them – the same way you’d assess any other patient. So an assessment obviously would be first of all listening to the patient on the basis of their symptoms. If they’re symptomatically stable, and they’re not exhibiting any other problems, you will be certainly containing them at home.
Question: Say you’re the GP, would you be going to see them?
Ray Walley: Possibly. Again, what you’d end up doing is liaising with the public health doctors because there may be public health involvement there. So you’d be seeking guidance on the basis of – are we dealing with this for the first time but we don’t see it being any different than any other virus that we’ve dealt with before. The greater majority of people will not be referred to hospital; the greater majority of people will be kept at home and dealt with at home.
Question: And when somebody does have to go to hospital – if they become ill to the point that it can’t be treated at home anymore – what happens then?
Sarah Doyle: Just to say that we’re at the early stages of managing this disease in Ireland so we’re at a containment phase and for the early cases in the Republic of Ireland we will be aiming to manage patients in hospital with full infection-protection-control precautions.
Question: What does that mean?
Sarah Doyle: What that means is that they will be admitted to an isolation room and they will be managed with – what are called- droplet precautions. It means wearing a mask, wearing goggles, gloves and a gown. All healthcare professionals would be very well-versed in the use of these precautions.
Question: What treatment would they receive?
Sarah Doyle: They will receive support of treatment. There’s no specific treatment for novel coronavirus but obviously there are many supportive treatments that can be given while the patient uses their own immunological system to fight it.
Samuel McConkey: The Chinese have published data form 45,000 cases of coronavirus that have happened over there so we’ll have some idea of what will likely happen. The vast majority of the sick people – 80% - are just mild symptoms. But 20% get sick. That sickness is respiratory – it’s lung failure, it’s requiring oxygen. So it will be manifested by pulsometry; the sats monitors go low (the little red light that tells you how much oxygen is in your blood). If the oxygen is even a little bit low, then you’d be given oxygen by nasal prongs. If that’s not adequate, then they’re a thing called venturi masks that can give 24, 28, 30% oxygen. Then, there’s non-rebreather masks. We can escalate that more with non-invasive ventilation when there’s a rather tight mask and it actually helps people to breathe. If the person is still struggling to breathe, then we have a very good technology in Ireland to put in a cuffed endotracheal tube and have a machine blow oxygen into the lungs. Many people in Ireland are having this at any one time during an operation and in intensive cares all over Ireland for other conditions. So this is not some new technology. We can support people through respiratory failure very very well.
Question: That level of intensive intervention, when there’s a failure of the lungs, in China has proven to be a problem as there have been more and more cases. Frankly, they’re running out of equipment to do that. Is there a danger that could happen here?
Samuel McConkey: Yes. Certainly we have a fixed capacity to do respiratory ventilation and intensive care in Ireland. There are things that we could do to expand that – for example, probably in the face of extensive coronavirus infections, a lot of elective surgery would actually stop. Noone’s gonna want to go to hospital to have your hip done electively when you can wait a few months in the middle of this coronavirus outbreak. So the ventilators in the operating rooms could be used to supplement our ability to ventilate people who need it for coronavirus. Similarly, private hospitals might be asked to help.
Sarah Doyle: Again, to say – we’re at the very early stages and there’s still no circulating virus in Ireland at the moment but we anticipate that that might happen. But that’s why a really important part of our strategy is containment and delay so to identify cases very early and to prevent onward transmission, to identify contacts so we don’t have sustained transmission. Part of the reason for that is to minimise impact but obviously to also minimise the impact on the health service so that we can manage capacity.
Question: Let’s go back to the containment phase – a number of people have asked if schools are putting in hygiene education around the coronavirus? How are crèches and primary, secondary schools managing it at the moment?
Sarah Doyle: We’ve had contacts regionally with our schools and third level institutions but also with the Department of Education. Most parents would have received messages from the Department of Education already advising them on the risks from novel coronavirus, and to go to HSE.ie for advice. The advice in terms of prevention is the same at this passé as it will be through all the phases – washing your hands is a really serious and important prevention measure. And everybody needs to wash their hands. I’d also appeal to people – particularly as we are likely to move to another phase – is you need to stay at home to protect others, particularly those who are vulnerable.
Sam McConkey, Associate Professor and Head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland
I’d like to reassure the listeners that the data coming from China is showing that people of school age, under-10 and under-20, very rarely get this infection and I believe there have been no deaths in China from their numbers of 45,000 cases in children under 10.
Question: Could you reiterate that again because often with any virus or indeed ay contagious illness, we’re told that the most vulnerable are people who are very young and very old. That’s not the case here, is it?
Sam McConkey: From the very large data set from China it appears that the mortality rate among people under 20 is very low. This is not the illness that we should fear for our children.
Question: People are asking whether they should avoid using cash if they can – to use contactless payments – and should they be using gloves when they’re on public transport? People are wondering what sort of precautions they can take when they go about their everyday life?
Ray Walley:The most important thing here is hand hygiene, repeatedly washing your hands when they’re dirty. Washing your hands after the toilet. Washing your hands during the preparation of food, before and after. And then – cough etiquette. If you’re coughing, [make sure you are] coughing into your elbow or use single-use tissues. So if you maintain all of that hand-hygiene, or cough etiquette, you can use paper money but you basically wash your hands.
Question: All this talk is scaring me because I suffer from OCD and anxiety and depression. It’s beginning to affect my mood and my sleep.
Ray Walley: What I’d emphasise to those people is that the best person to deal with them is their own general practitioner. [It’s also important] that they keep to their routine, making sure that they get a good night sleep, eat well and drink well, and exercise. [Make sure] you’re talking to friends and practising all the things we’re doing within reason. Obviously, hand hygiene, cough etiquette, and dealing with your specific GP who knows you best.
Question: Should people who receive communion via their mouth defer to receiving in the hand this season?
Sarah Doyle: This one also comes back to washing your hands. If everybody is washing their hands, and the priest is washing his hands, receiving communion by hand is OK.
Question: A lot of people are asking about hand sanitisers which you can frequently buy in chemists and supermarkets but good luck trying to find them at the moment. Do you need to have an alcohol-based wash to thoroughly wash your hands at the moment?
Sarah Doyle: No, you can just use water and soap.
Question: Can you make up your own type of sanitiser?
Sarah Doyle: In theory, that’s possible. Isopropyl alcohol is the active ingredient but I think that in practice that might be difficult.
Question: Masks are impossible to find at the moment...
Samuel McConkey: I wouldn’t recommend the general public walking down O’Connell Street to be wearing a mask. It’s not the sensible thing to be doing. Masks are a technical tool for healthcare workers and for people who are either suspected to have coronavirus or else who do have coronavirus.
Question: What to do if you get the virus? People are asking if fluids and paracetamol help?
Ray Walley: If they contact their GP in regards to this, we’ll make sure that they satisfy the criteria and we’ll be engaging with the public health people who’ll engage with them. And if they are tested positive, they will be directed to a hospital and then it’ll be mean managing that clinical situation. So as with any other illness, it’s important that you are well-hydrated and eating well. It’s important that you take antipyretics. And if you are clinically with that diagnosis in the hospital setting, then you’ll be supported in regards to how you’d be managed.
Question: as this is a new virus, and we have no natural immunity, am I right in thinking if you’re in contact with an infected person, you will automatically be infected?
Ray Walley: The infection rate appears to be about 20% which means that 80% of people will not be infected. Generally, you need to be 15 minutes in the vicinity of a person within 1-2 m.
Question: Correctly if I’m wrong but I heard some statistics that say for every one person that has a virus, they would infect two more?
Sarah Doyle: Those are the estimates that are being made that for each person – what we call the reproductive value – is two people. Now, obviously that is very dependent on who your contacts are and how sociable you, the kind of places you’ve been and the things that you’ve done; whether you’ve washed your hands ad whether you’ve self-isolated. But that’s the evidence from the early phases of this outbreak in China.
Question: We have a question from a lady who’s on a chemotherapy. What can she do to protect herself?
Sarah Doyle: So again, to come back to this - washing hands is absolutely key for this lady but also to ask people who are ill not to visit and to avoid people who are unwell.
Question: I take immune-suppressing medications. Am I more susceptible to the disease?
Sarah Doyle: Yes, probably. And the same advice would apply to that lady.
Question: Is there a value to taking the flu vaccine in relation to coronavirus?
Sarah Doyle: No, there’s no value in taking it but a considerable number of people who’ll be dealing with their GP, will be coming in with an influenza, and some of those people will not have had the flu vaccine even though they had been strongly advised.
Question: Is the virus transmissible from or to dogs, cats, birds?
Sarah Doyle: We’ve no evidence that that is the case.
Question: So even if you’re self-isolating, you can do that with your dogs?
Sarah Doyle: Yes.
Ray Walley: The one I’d like to throw in is cigarette smoking. We don’t know from the data in China how smoking history affects [susceptibility to coronavirus]. We have data about other coronaviruses. So, when we did the smoking ban here 10 or so years ago, the rate of respiratory infections, many of which are coronaviruses actually dropped dramatically in workers in restaurants, hotels and bars after the smoking ban. So without having solid data from China, I would be very surprised if it’s not cigarette smoking over many years that has an impact. There’s people with chronic lung disease that are dying from this. So I would put out an anti-smoking message quite strongly.
Question: How did Covid-19 start, and how is it different from previously known coronaviruses?
Samuel McConkey: The Chinese were able to detect it very early and sequenced it very early for the rest of us to look at. The genetic sequence of this new SARS-2 virus is about 90% the same as the bat coronavirus that was sequenced about 7 years ago. And is about maybe 83% the same as the SARS one. So this is clearly related to SARS. It’s almost like the first cousin, oir the sibling, of the bat coronavirus and of SARS 1. So it may have gone from bats to another animal and then to human. Bats now in China are actually hibernating so there’s not much contact between people and bats so it may have actually spread from the bats to another vector.
Question: How is flying still possible when sharing a common area surely presents a risk?
Sarah Doyle: In Ireland, we don’t have sustained community transmission – and on flights in and out of Ireland. So we’re not advising any restrictions on people flying at the moment.
Question: Why haven’t we blocked countries with huge outbreaks from coming into Ireland? Saudi Arabia has blocked all flights from coming into the country.
Samuel McConkey:I think we have to look at the economic impact of that. So In Ireland, 32 million people came though Dublin Airport last year. If we actively close the Dublin Airport, and other airports, that [will have] an absolutely devastating impact on our economy. In Ireland which is an open economy, [the drop in the GDP due to border closure] would be even higher [than 50%]. We will all be vastly poorer and then we’ll have no resources to buy the masks, buy the oxygen and look after people. Choosing poverty is not a good solution to this problem.
Question: Is it inevitable that if someone on a public transport has [Covid-19] then the rest of the passengers will get it?
Ray Walley: The context is that we don’t have any confirmed cases in the Republic of Ireland. Basically cough etiquette and hygiene has to be practiced. Coughing correctly into your elbows and using single-use tissues. And washing your hands after the toilet, as well as before, during and after food preparation.
In regards to the travel – your GP is not the person that you’d ring in regards to travel. The Department of Foreign Affairs - who provide up to date data – is the people that you ring. What we want to ensure is that the phone lines to general practitioners are only for clinical cases which have to be dealt with.
Question: Why cancel the Italy-Ireland match but not close the border?
The Irish-Italian match was a very particular situation where you have people coming from Northern Italy with an area that we know had sustained community transmission so I think it was a very reasonable thing to do to cancel that match.
Question: Would we not want to stop the ministers for visiting other counties for St Patrick’s Day?
Ray Walley: I think we should keep as much business as usual. They definitely shouldn’t go to Wuhan, but if they want to go to Brazil, Washington or New York to celebrate our culture abroad, I think that’s really important that they celebrate Irishness with the rest of the world.
Question: Do people need to seek help if they have cough, fever, and shortness of breath, or just one of these? Is it true that only 60-70% alcohol hand gels would kill coronavirus?
Ray Walley: Simple standard washing techniques – washing for about 20 seconds which is the length of time it takes to sing Happy Birthday twice, I guess – is good enough.
About the symptoms – just one is enough [to seek help] but again [providing that] you’re satisfying the algorithm of the countries you’ve gone to, or you’ve been in a facility that has dealt with Covid-19, or you’ve been in the vicinity of someone who’s been diagnosed with Covid-19.