Coronavirus/COVID-19: RCSEd information
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We, the Royal College of Surgeons of Edinburgh (RCSEd), are fully signed up to The Department of Health and Social Care’s coronavirus (COVIS-19) action plan published on 10 March 2020: https://www.gov.uk/government/publications/coronavirus-action-plan/coronavirus-action-plan-a-guide-to-what-you-can-expect-across-the-uk
We are working closely with the Chief Medical Officers of England and Scotland, with medical bodies and with the Government to ensure that our members, fellows, surgical and dental colleagues across the country are informed with the latest advice on COVID-19. We participate in daily briefing calls, and are helping disseminate best practice advice to our community of practitioners both medical and dental in all of our seven Faculties.
There has been much in the press regarding the coronavirus outbreak and its spread on a global scale. The official name for the coronavirus implicated in the current illness is COVID-19. Much work is ongoing for COVID-19 at the present time. The UK Government will continue to monitor the number of cases and together with the Chief Medical Officer for England, Professor Chris Whitty, have issued an action plan. There are four phases identified to the UK action plan:
- Containment
This means providing care for all infected people with COVID-19 and identifying the contacts that they have made in the previous 21 days. - Delay
This involves making decisions on what actions to take to attempt to reduce the pace of spread. This would allow more time to plan management and also move the peak of the outbreak into later spring or summer with less strain on hospital services. - Mitigate
This implies the limitation of damage to patients if the virus does spread widely. - Research
Constant assessment of the manner and size of the spread to inform the other three phases of the response.
On 11 March, the World Health Organisation (https://www.who.int/) confirmed that the coronavirus could now be characterised as a pandemic.
On 12 March 2020, the Prime Minister & First Minister of Scotland stated that we are now in the 'Delay' phase of the action plan and updated the guidance accordingly. The Delay Phase aims to increase efforts to slow the spread of the illness and, where necessary, employ "social distancing" tactics to try to prevent accelerated transmission.
There are many websites that provide information about coronavirus and in particular advice for holiday makers as well as advice for the general public on how to minimise the chance of infection and of spreading infection.
Government advice for Professionals
Government Advice for the Public
There are also many websites, including the BBC, which provide information regarding the symptoms and the early management of patients who are suffering from coronavirus infection. Such symptoms include:
- Fever, fatigue and dry cough in the early stage of illness. Nevertheless, many patients will not progress to more severe illness. The WHO reports that 25% of coronavirus confirmed cases are severe.
- Dyspnoea or breathlessness is said to be common in patients who are hospitalised. Older patients with underlying health conditions are more likely to progress to the severe form of the infection.
- A variety of abnormalities may be expected on chest x-rays including bilateral lung infiltrates similar to those found in viral pneumonias.
Conferences and Exams abroad
The RCSEd have already cancelled a number of educational courses and examinations in Asia. The College continues to monitor very carefully the modelling from the WHO and, of course, from UK Government regarding the length of time it will take to reach a peak of infections as well as the number likely to be infected. Educational events and examinations in low risk countries have continued but will be under careful scrutiny over the coming week. The risks of holding health care conferences and examinations and educational courses are two-fold. One is the potential spread of the infection in large gatherings and the second is the potential for self-isolation of all healthcare professionals if there were to be an incident case of coronavirus infection at the meeting. The latter would exclude a large number of healthcare professionals from the work place at a time that the NHS could ill afford.
There are a number of countries that have a higher risk of coronavirus. These countries include Cambodia, China, Hong Kong, Iran, Northern Italy, Japan, Laos, Macau, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Tenerife, Thailand and Vietnam. There is clear advice on the websites of Public Health England (PHE) and Health Protection Scotland (HPS) about self-isolation and the initial management of coronavirus infection. In England and Wales, Hospital Trusts, and in Scotland, NHS Boards, are ensuring that all healthcare professionals have access to guidance on the early management of coronavirus infection. The UK Government has talked about calling in retired doctors and, indeed, healthcare professionals to help deal with the coronavirus outbreak.
Updates from the CMOs
There are at present twice weekly updates from both the CMOs of England and Scotland with representatives from all Royal Colleges including the Royal College of Surgeons of Edinburgh. All four surgical Colleges will continue to discuss coordinated plans and will follow the latest CMO updates.
We are very mindful of the need for the Medical community to be available to support all aspects of containing and controlling this virus. Our President and senior team are meeting daily to discuss the impact on our events, education and examinations which are held all across the world. We will review them on the basis of current need and priority while being mindful of the demand on clinicians’ time and ability to travel. We will keep all of our members and fellows informed of our decisions.
On 12 March the UK's Chief Medical Officers issued the following message and letter supporting doctors during the COVID-19 epidemic:
"As COVID-19 puts pressure on services doctors will have to work differently for their patients. The UK CMOs, medical director NHS, Royal Colleges and GMC are clear that in emergencies doctors must be supported to work in new and unfamiliar ways. This letter is for all doctors."
Summary
In summary, it appears that the situation in China has improved but there is increasing concern regarding other areas of the world. The incubation period is thought to be up to 14 days but the illness does appear to prevail over a longer period of time than seasonal influenza. It is important to note that the virus remains on hard surfaces for up to 3 days and, for all practical reasons, the virus will have cleared by then. The mortality rate for coronavirus is still estimated to be around 2% when compared to the Chinese SARS outbreak in 2002 which was 10%. It is important to note that the virus is more serious to the vulnerable, elderly, infirm and those with other significant illnesses than it is to healthy adults and children.
The College will continue to receive regular updates from all Public Health bodies and will keep this website updated. We will continue to follow the advice of the Government and the CMOs of each nation in everything we do and in how we support our Members and Fellows.
Professor S Michael Griffin OBE PRCSEd
