COVID-19 information

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The majority of people with COVID-19 have uncomplicated or mild illness (81%), with non-specific symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise,muscle pain, sore throat, dyspnea, nasal congestion,or headache. Rarely, patients may also present with diarrhoea, nausea and vomiting. Loss of taste and smell has been reported early in the infection.A relatively small proportion of people, particularly but by no means exclusively in those aged >70 years,will develop severe illness requiring oxygen therapy (14%) and approximately 5% will require intensive care unit treatment. Time from the onset of the infection to hospitalisation can be up to ~13 days.Of those critically ill, most will require mechanical ventilation. The most common diagnosis in severe COVID-19 patients is severe pneumonia; this can progress to acute respiratory distress syndrome,and life-threatening multi-organ dysfunction and death. Mortality has been estimated at between 1 and 2% of those infected, the higher figure in men.

Current testing for COVID-19 (SARS-CoV-2) is rapidly evolving

Limitations and clinical interpretation As with all viral PCR assays, patients with very low viral loads are less likely to be detected. ‘Not detected’ results do not preclude infection with the SARS-CoV-2 virus and should not be the sole basis of a patient treatment/management or public health decision. Where there is a strong clinical suspicion of an early COVID-19 infection repeat sampling should be considered 24-48 hours later. Patients with COVID-19 symptoms in intensive care have been shown to no longer carry the virus in the upper respiratory tract. Viral detection tests should assist in the decision on when to discontinue additional precautions for hospitalised patients.
Results should be interpreted by a trained professional in conjunction with the patient’s history and clinical signs and symptoms, and epidemiological risk factors.

Molecular testing (PCR Swab) will identify people with the virus. Antibody testing can tell whether a person has been previously infected.

Most patients who recover from coronavirus have been found to produce antibodies, but it is not yet known if an individual with a positive result showing presence of IgG levels following being infected with SARS-CoV-2 will be protected, either fully or partially from future infection, or for how long protective immunity may last. Testing should be undertaken 14 days or more following exposure or onset of symptoms. 

The host immune system reacts to the infection by SARS-CoV-2 by producing antibodies from afew days to 2 weeks after the onset of symptoms. Specific IgG antibodies are produced in the later stages of infection to SARS-CoV-2, and are detectable after RNA(PCR Test) is no longer detectable.The persistence of IgG antibodies allows identification of people who have been infected by SARS-CoV-2. Test development relating to SARS-CoV-2 is rapidly evolving. Laboratory review of new assays as they become available may chnage guidance.

References

Department of Health (DoH), Coronavirus (COVID-19) Guidance: what you need to do. Available at: https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public. Updated daily.

The Lancet, Covid-19 Resource Centre. Available at: https://www.thelancet.com/coronavirus-19/dgcid=kr_pop-up_tlcoronavirus20.

National Institute for Health and Care Excellence (NICE), NICE Guideline (NG) 159. COVID-19 rapid guideline: critical care.
March 2020. Available at: https://www.nice.org.uk/covid-19.

Fauci, AS et al, Editorial – Covid-19 – Navigating the unchartered. NEJM 2020; 382:1268-1269

WHO: Coronavirus disease (COVID-19) Pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
WHO: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected.

13 March 2020. https://www.who.int/publications-detail/clinical-management-of-severe-ac...
novel-coronavirus-(ncov)-infection-is-suspected.

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