MEA Website Survey: Why are we talking about protection against winter viral infections, including coronavirus/covid-19? | 03 March 2020

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

Viral infections are a very common factor in causing symptom exacerbation and relapse in ME/CFS – sometimes severe and prolonged. It’s sensible to be taking simple self-help measures that reduce the risk of both spreading infections and catching infections from other people.

An added problem this year is the coronavirus infection, Covid-19, which is why we issued some specific advice on this infection, and how to reduce the risk of contracting it, back in February.

This ME Association advice has now been updated to take account of the fact that while the situation is China appears to have stabilised, coronavirus infection has now spread to many other countries, including the UK.

There are currently 36 confirmed cases here in the UK, however, the number is steadily rising and could start to increase significantly – at which point government restrictions on what people can and cannot do will be brought in.

At the moment the risk of coming into contact with someone who has been infected with coronavirus is still extremely low, but we will be continually updating the MEA website information as the situation changes.

The Coronavirus – Covid-19

It appears that this particular virus 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.

Not surprisingly, significant numbers of cases are now being increasingly reported in countries like Iran, Japan, South Korea and Singapore – where people from China have visited.

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

The virus is spread from person to person by tiny viral droplets – which arrive in the air through coughing and sneezing.  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.

And this is which is why people returning from China and some other countries, or are at high risk for other reasons, are now being placed in isolation/quarantine for 14 days.

Symptoms

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

They will experience a cluster of flu-like or cold symptoms. Fever and malaise are common initial symptoms whereas cold-like sniffles appear less common.

In some cases, the infection then passes to the lungs where it can cause a dry (unproductive) cough and, if more severe, shortness of breath. A minority develop a much more serious infection involving the lungs, which can quickly progress to pneumonia and even prove fatal.

At the moment the mortality rate appears to be 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.

Most of those who develop a more serious or fatal infection are elderly (i.e. over the age of 60), have a long-term health condition, or are unable to mount a good immune defence.

As ME/CFS involves immune system activation, rather than immune system deficiency, there are some theoretical reasons to indicate that having ME/CFS does not place someone at being at increased risk of catching this virus. But if you do, as with any infection, the effects are likely to be more serious.

Taking steps to avoid catching coronavirus, or any other flu-like virus at this time of year, are very important. At the moment the view from the virologists is that every person who contracts the virus 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.

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.

Prevention of spread: Respiratory and hand hygiene

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:

• 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.
• 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.
• BBC Video: Dr Adele McCormick from the University of Westminster demonstrates how germs spread and what the best methods are to avoid catching a virus including how to wash your hands properly.
• Finally, if you have any sort of infection keep away from other people and sneeze into a tissue or handkerchief.

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 passing through somewhere like 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, so 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.

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