Everyone has an opinion- Was it created in a lab, was it a bat, is it a storm in a teacup, is a second wave coming, how serious can it really be….
There is endless speculation and theorising, we all have suffered from information overload and many people are heartily fed up talking about it and the impact it has had on all our lives.
It is undoubtedly out there. Broadly speaking it catches people unaware and is unpredictable in its impact on different sectors of society. Here at Club de Mar Medical we are asked daily, again and again, so I want to summarise and recap the most salient points for you.
Let´s tackle transmission first – you can catch COVID-19 anytime, including in airports and busy bars. Wherever you catch it, then it can take up to 14 days to incubate. You maybe incubating and then develop the disease it is possible to never show symptoms, you are then asymptomatic. Whilst you are asymptomatic you are also infectious to others. Anyone you infect may have a much worse experience of the illness than you.
It can of course take less time for symptoms to show and when they do as we all know some people have mild symptoms and others have more serious and very grave (no pun intended) symptoms. At the outset it seemed as though older people and people with pre-existing conditions were most susceptible. Many younger people with pre-existing conditions, most noticeably people with diabetes and heart conditions have also been affected. There are also many cases of younger and healthy people being stricken to varying degrees – the lesson to be learned is that everybody needs to remain vigilant and responsible in their behaviour.
A few comments to the quarantine period – 14 days of incubation has been the standard length of suggested quarantine periods worldwide. Across the board these regulations are lifting. It doesn´t negate the fact that they remain eminently sensible.
If you are preparing for example, for an event or a charter or a boss trip then confining crew for 14 days prior to guests or owners coming on board is sensible. It protects the crew from being the people who pass it on. This is especially relevant if your owners or guests are older, have pre-existing conditions or have general health frailties.
Testing is also “A frequently asked question” so let´s clarify:
The Polymerise Chain Reaction (PCR) Test; this is the nasal swab and or the throat swab. Neither are pleasant and people have usually reported varying degrees of pain and discomfort for these depending upon personal sensitivity. These are testing for RNA (the molecule that carries the viral genetic information ) in the nasal cavity and throat area. These tests are used to establish that the virus is present but doesn´t indicate if you are infected.
Testing if you have been out or travelled the day before could lead to a false negative and you can still test positive days later.
These test results are not immediate.
Blood (Serology) tests, you can be tested for past and current infection by giving blood and it can be sent off to a laboratory for testing. These are 2 separate tests, one for current and one for past infection. Results take up to 4 days. These results will give levels of infection, if present, in your blood. These tests are testing for antibodies, the immediate IgM can take up to 5 days to appear.
Testing if you have been out or travelled the day before could lead to a false negative and you can still test positive days later.
Rapid (blood) tests, these are a past and present test for infection done by finger prick test and are now widely available. They are very different in price depending on the supplier. They are designed to give a small blood sample which is dropped into a cartridge with 2 drops of a buffer solution. They give a control line to confirm there is enough blood and buffer to get a reading then a line for current infection and or a line for past infection. The results take generally 10 minutes or so.
Testing if you have been out or travelled the day before could lead to a false negative and you can still test positive days later.
The subject of accuracy of all the above-mentioned tests has also been widely speculated upon. Unless you are undoubtedly positive and have an established infection there is margin for error and inaccuracy in all the tests. The rapid tests are said to be around 85-90% accurate.
In order to protect crew and reassure guests it is arguably better to have say 85% accuracy rather than no testing at all; to be able to evidence that a protocol is in place and protective measures have been considered. This is especially so if you end up in part of the world where no or limited testing is available.
How will mutations manifest themselves, is something else doctors are often asked. All viruses mutate and change and to use an easy example, take the common flu where vaccinations vary from region to region and hemisphere to hemisphere because the flu variations are regionally particular. COVID-19 has already mutated numerous times and the range of symptoms has been truly diverse. We started out thinking it was a respiratory infection and now there are reports worldwide of cardiac implications, gut abnormalities, bleeding and clotting problems to name but a few. Several countries have even set up centres to deal with the range of symptoms that people who have “recovered” are (still) dealing with.
How immunity works. Past infections of any disease leave antibodies in the infected person. These antibodies provide future immunity. The science on COVID-19 is rapidly developing however, there is no definitive information on how long antibodies remain in the body and what immunity that provides for preventing a re-infection. Most recent thinking from some quarters is that the antibodies start to degrade only weeks or months after infection has occurred.
The world is crying out for a vaccination so we can resume “normal life again”. There are numerous teams working on a vaccination around the world, it must be safely developed then there are production challenges, distribution mountains to climb and then the pressure for medical staff around the world to administer the vaccine to a vast amount of people in a timely fashion. It must not be forgotten that for a vaccine to be successful a good proportion of society must also take up the vaccine, that is thought to be over 70%.
Is there going to be a second wave? The medical modelling undoubtedly says yes. We all like things to be familiar and this virus has been so unsettling in so many incalculable ways that there can be no greater wish than for this medical modelling to be wrong.
The second wave may not look like the first wave with the absolute confinements and stoppages to many areas of the working population and schools and so on. Possibly degrees of travel will continue, economies must be supported as much as possible, schools will open, and efforts will be made to “get back to normal”. It is estimated that a second wave in whatever guise, will last many many months.
Social distancing, the wearing of masks and other preventative measures are likely here for some considerable time to come. The previous volume of air travel will take a long time to be regained. We are going to see pockets of outbreaks in specific areas of group gatherings (ie work, churches, social clubs) which will then affect specific villages, towns, cities and regions. Again, this will carry on for months and months to come. These localised outbreaks will affect society in different ways again and pose greater challenges for governments to impose and enforce. There will be a raft of different rules, restrictions, quarantine periods and lockdowns put in place, and these will vary from country to country and region to region. Frustrating though this may be, it is inevitable as we become accustomed to the threat and implications of this new disease.
The societal impact of COVID-19 is in no way to be underestimated; we are all aware that levels of hardship for people have increased. There is more suicide, more domestic violence, more addiction, anxiety, depression, isolation and loneliness, financial stress and poorer mental health. Levels of communication between some groups of people were high as the virus started to spread amongst us and that too became exhausting for many. It cannot, however, be expressed enough that people need support- from family, from friends, from the communities they live in and from doctors, therapists, and counsellors. Please do reach out – there is support there and the professionals are doing their best to help.
We have to work, we all want and have to live our lives, so please look after yourselves and others. Be vigilant and try to think about the health consequences for you, and for others, of your actions and activities. Please take this as an advocation for consideration and common sense.
Let’s be careful out there!
British Medical Services Mallorca
Club de Mar Medical
+34 971 703 391
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