ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020

March 9, 2020

Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

The ME Association information and guidance about the coronavirus that was originally issued in early February and updated again last week, will continue being updated and issued on a weekly basis.

This is to take account of the rapidly changing situation here in the UK and the fact that while the situation in China appears to have stabilised, coronavirus infection has now spread to many other countries.

The UK Situation
There are currently (March 8th figure) nearly 300 confirmed cases here in the UK with two fatalities and it looks as though we will shortly have a full-scale epidemic of this infection.

The numbers are steady rising and will probably start to increase more significantly over the coming days/weeks – at which point government restrictions on what people can and cannot do will probably be brought in.

However, at the moment, the risk of someone with ME/CFS coming into contact with someone who has coronavirus is still extremely low. 

Viral infections are a very common factor in causing symptom exacerbation and relapse of ME/CFS – sometimes severe and prolonged.

So, everyone with ME/CFS should be taking simple self-help measures that reduce the risk of both spreading infections and catching infections from other people – these are listed below.

For people with ME/CFS who are not housebound, considering how to reduce your social mobility now needs to be considered.

This information is based on what we know, and do not currently know, in the current situation.

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The Coronavirus – Covid-19

It appears that this is a virus that has spread from animals (possibly bats or pangolins) to the human population in the Wuhan region of China – where the main focus of infection originated. 

Significant numbers of cases are now being increasingly reported in countries like Iran, Japan, South Korea and Singapore – where people from China have visited. 

Cases are also being reported throughout the UK and in most other parts of Europe, Italy in particular – normally linked to foreign travel, or contact with someone who has been abroad.

The virus is spread from person to person by tiny viral-containing droplets – which arrive in the air through coughing, sneezing and just breathing.  So, coughs and sneezes really do spread diseases!

The time between contracting the infection and developing symptoms appears to range from a few days to about 2 weeks – during which time an infected person will be passing on the virus even though they may not have any symptoms.

This was why people returning from China and some other countries, and those who are at high risk of having the infection for other reasons, are now being placed in self-isolation/quarantine for 14 days.

There is no drug treatment available for this infection and although rapid progress is being made in developing a vaccine this will require proper testing for efficacy and safety – so it won't be available in the foreseeable future.


Cheap face masks may help to stop spreading infections but are of no real value in stopping you catching one as the viral particles are minute…

As with most viral infections, there is a range of severity if someone picks up the infection. Most healthy people – probably around 80% – will experience cold or flu like symptoms, or no symptoms at all, and recover.

Most people have a cluster of flu-like or cold symptoms.  Fever and malaise are common initial symptoms whereas cold-like sniffles appear less common. 

In a minority of cases the infection then passes to the lungs where it can cause a dry (unproductive) cough and, if more severe, shortness of breath.

This can then pass into a more serious infection involving the lungs, which can quickly progress to pneumonia and even prove fatal.

At the moment the mortality rate in higher risk groups (see below) is around 1 to 3 in every 100 people who are taken ill – which makes it worse than flu, where the mortality rate is closer to 1 in every 1000.

Who is most at risk?

Most of those who develop a more serious or fatal infection are elderly (i.e. over the age of 70) and are less able to mount a good immune defence or have a long-term health condition – especially one that causes immune system depression.

Children and young people, whose immune systems are much better at mounting a good defence against new infections, are generally coping well and not developing serious complications.

As ME/CFS involves immune system activation, rather than immune system deficiency, there is a theoretical reason to indicate that having ME/CFS may not place someone at being at increased risk of developing a severe infection.

But how people with ME/CFS will react to the actual virus remains uncertain – so it is best to err on the side of caution.

Viral infections are a very common factor in causing symptom exacerbation and relapse of ME/CFS – sometimes severe and prolonged. If you do catch this infection, as with any infection, the aftereffects are likely to be more serious.

This is why taking steps to avoid catching coronavirus, or any other flu-like virus at this time of year, are very important.

Prevention of spread:  Respiratory and hand hygiene

At the moment the view from the virologists is that every person who contracts coronavirus is then passing it on to another 4 or 5 people – so it’s a fairly infectious/contagious virus when it comes to person to person spread.

As with flu viruses at this time of year, there are a number of simple practical precautions that will significantly reduce the chance of picking up this infection, and these should be adopted by everyone.  

Washing your hands thoroughly and limiting social contact remains the best preventative advice to help reduce the risk of infection with coronavirus.
  • Infection containing droplets from coughs and sneezes from an infected person stay in the air for a short time and then land on surfaces where they can remain infective for several hours, possibly even longer, and in this case possibly up to 72 hours.
  • The first step involves avoiding (where possible) crowded places – such as public transport – where people are coughing and sneezing. The general rule of thumb is to aim to keep 3 metres or more away from other people – if you can!
  • The second involves washing your hands when you have been in contact with a surface that lots of other people have been touching. In particular are things like public toilets, cash machines, keyboards, handrails, door handles, trays that are used for security checks in buildings and airports, and also shaking hands!
  • Thorough hand washing with soap and warm water for 30 seconds after contact with potentially infected surfaces is the best thing to do – if facilities are available. Alcohol containing antiseptic/sterilising wipes are very useful if you are out and about. Alcohol dissolves the lipid/fatty coat around the virus and helps to inactivate it. The alcohol content of these wipes content should be 62% or more.
  • There has been a big demand for antiseptic wipes and gels, and they are becoming difficult to find. The best time to shop appears to be first thing in the morning. Please note that antibacterial wipes and gels are not going to be effective.
  • Do not touch your face, mouth or eyes if your hands are not clean!
  • Cheap face masks may help to stop spreading infections but are of no real value in stopping you catching one as the viral particles are minute and can only be kept out of the mouth, nose and eyes (which are another route for infection) by the sort of masks used by health workers.  More expensive ones, if they have Dept of Health approval, will have some effect.
  • People who are housebound should ask visitors with any sort of infective symptoms to stay away. Healthy visitors should be asked to thoroughly wash their hands and possibly wear disposable gloves – especially if the visit involves close personal contact for nursing or social care purposes.
  • Finally, if you have any sort of infection keep away from other people and sneeze into a tissue or handkerchief.

How to wash your hands:

Social mobility

For people with ME/CFS who are not housebound, considering how to reduce social mobility now needs to be considered, especially if you are elderly or have another health condition that create a significant risk – e.g. heart or lung disease.

The advice on social mobility is likely to change as the number of cases rises and the government also issues further advice or restrictions on social mobility.

Being out and about in contact with people and with surfaces that may be contaminated with the virus is the most likely way of picking up the infection – so changes in what you do away from home do now need to be carefully considered.

To what extent this is put into practice has be a personal decision based on individual circumstances, but this could involve restricting out of home activities to essential things like shopping (although you could consider home-deliveries), medical appointments and avoiding unnecessary meetings and social events.

If you are still in work you will need to find out what will happen regarding your financial situation if you go off sick, or self-isolate, or decide to stay at home – see the link to helpful guidance from ACAS below.

The advice on social mobility is likely to change as the number of cases rises and the government also issues further advice or restrictions on social mobility. Large public events and crowded pubic transport are obviously a significant source of infection and are best avoided unless you really have to go.

Foreign travel

The situation here is changing quite rapidly as new cases appear in countries outside China. The Foreign Office is providing regular updates on the situation regarding non-essential to travel to countries where cases are occurring.

If anyone with ME/CFS is going to be travelling abroad, especially if going to or passing through somewhere like Italy, Singapore, Thailand or Hong Kong, you need to check on current guidance – as you may find that you are going to have to put yourself in self-imposed quarantine for 14 days on either arrival at the destination or on return to the UK.

Unfortunately, airports, aeroplanes and cruise ships are also fairly high-risk places for picking up infections.  Serious thought should be given to planning trips to far off places at the moment.

More information

If you think there is any possibility that you may have this infection phone the NHS 111 helpline. Self-isolate and do not go to your GP surgery or hospital.

UK Government and Department of Health updated information, especially in relation to foreign travel: Information for the public on the outbreak of coronavirus, including the current situation in the UK and information about the virus and its symptoms.

Important note:

This information is intended to be used as general guidance on coronavirus infection in relation to ME/CFS.  If you require individual guidance or advice please consult your GP, who can take this information into consideration.

Image credits: 123RF/maridav/KaterynaKon/JozefPolc   

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