The coronavirus (COVID-19) outbreak is a rapidly developing situation in the UK. At Harefield Hospital we have taken steps to reduce non-emergency clinic appointments for patients who are well and will offer telephone appointments as an alternative option for patients who require medical advice.
We are receiving an increased number of calls from patients and will attempt to answer some of the common questions below.
Last updated 5th January 2021.
What can I do to keep myself safe?
Am I at increased risk?
What should I do if I feel unwell?
Is there a treatment for COVID-19?
What about the COVID-19 vaccine?
What should I do if I think I have been in contact with someone with COVID-19?
Should I self-isolate or work from home?
What should I do if I have a holiday planned?
Should I send my child back to school?
Will I still be able to access my medicines / do I need to stockpile?
How you can help
According to Public Health England (PHE) guidance all cardiothoracic transplant patients are “extremely vulnerable persons”
Please ensure you have registered as a vulnerable individual at: www.gov.uk/coronavirus-extremely-vulnerable.
From Monday 4th January, new restrictions have been implemented based on the significant increase of new coronavirus cases. Extremely vulnerable population have been asked again to remain in self-isolation, which is what we have been calling “shielding”.
Updated information can be found here.
At Harefield we have again taken steps to reduce unnecessary clinic appointments for patients who are well, and we will offer telephone appointments as an alternative. We are still arranging face to face appointments for patients who need specific investigations, urgent medical advice or need to be seen following a telephone consultation.
As your transplant team, we encouraged you to stay at home as much as possible except for limited purposes. You should not attend work, school, college or university, and you should limit the time you spend outside the home. You should only go out for medical appointments, exercise or if it is essential.
If you need support to work from home, do not hesitate to contact us and we will prepare a letter you can show to your employer. Even if you cannot work from home, you should not travel to work.
We consider exercise – especially outdoors – to be very important in maintaining the health of your transplanted heart and/or lung, as well as your overall physical and mental wellbeing. You can continue to exercise alone, with one other person or with your household or support bubble. This should be limited to once per day, and you should not travel outside your local area.
Some advice on how to exercise safely outdoors:
- Locate open spaces in your area. Choose the one that is likely to be less busy. For example - an open field near your house may be better than your local park.
- Try to exercise or go outdoors at times of the day when it is quieter (this may be early in the morning or late in the evening).
- Always maintain social distancing when you exercise (two metres apart)
- Follow stringent hand hygiene and don’t share your belonging such as a towels, cups or water bottles with others.
Patients and their families who have undergone transplant should follow national guidance as below in order to help prevent spread of the virus:
- Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel.
- Wash your hands often with soap and water. Use a sanitiser gel if soap and water are not available.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid close contact with people who are unwell.
- Social distancing measures such as avoiding face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel are likely to reduce your risk of acquiring COVID-19 as well as reducing risk of ongoing transmission.
You should share this advice with friends and family. You can access latest updates from the NHS website: https://www.nhs.uk/conditions/coronavirus-covid-19/
There is limited data on the relative risk of COVID-19 in patients who have had a cardiothoracic transplant. Patients with chronic heart or lung disease are known to be at increased risk of developing severe illness. It seems reasonable to believe that all patients who have had a transplant will be at increased risk of severe infection especially if they have established graft damage that has occurred since transplant. Patients requiring oxygen or non-invasive ventilation will most likely be at highest risk.
We cannot stress enough how important it is that the data is interpreted with a lot of caution for several reasons:
- Testing was not as readily available in the beginning of the COVID-19 outbreak in the UK so patients with no or very mild symptoms will not have been tested. This means that the risk may have been lower if these asymptomatic/mildly symptomatic patients had been included. In fact, a recent large epidemiological study done in the UK suggests that the risk of a patient with an organ transplant may be up to 4 times higher than the risk the same person would have had if they hadn’t had a transplant.
- These numbers are still very small, and the degree of uncertainty is huge.
Finally, there is no evidence that wearing a face mask will protect patients from catching COVID-19, however there is growing evidence that if people with symptoms (e.g cough) wear a mask this protects others from catching the virus. Do wear a mask if you have symptoms and encourage others to wear a mask. Please note that in the UK you are currently required to wear a mask when using public transport, a hospital or enclosed public spaces were social distancing cannot be followed.
All patients coming to our hospitals must wear a face covering while in our buildings. This does not have to be a medical/surgical mask, it can be made of cloth and be as simple as a scarf that ties behind the head while allowing you to breathe comfortably. If you do not bring a face mask/cover with you, you will be given one on arrival by a staff member at the hospital entrance. See government guidance on how to make a face covering.
It is extremely important that you do not go directly to your transplant centre unless specifically advised to do so by a member of the transplant team.
The symptoms of COVID-19 are the same as many other problems in patients who have had a transplant which makes it difficult to decide the best course of action. You should monitor your symptoms closely, i.e. if you have had a lung transplant increased vigilance with spirometry is highly desirable. If you have had a cardiac transplant, you should contact us in case you develop new symptoms as shortness of breath, cough, etc. If you develop fever, cough or difficulty breathing you should call the transplant team on 01895 823737. If you are well (i.e. with no drop in spirometry) it is likely we will ask you to call NHS 111 for access to local COVID-19 testing. If you are unwell you may be asked to attend the transplant unit. If you are advised to come to the hospital, please stay in your car and call the on-call transplant doctor/nurse in charge to advise them that you have arrived. Please do not come inside the hospital before you have spoken to a member of the team. If there is clinical concern based on your history, a member of staff will come to meet you with protective clothing for you to wear and will direct you to the most appropriate place immediately.
Please continue to follow advice regarding social distancing and handwashing stringently when onsite.
Please remember that health issues unrelated to COVID-19 needing treatment can arise at any time and you may feel anxious about asking for medical help. We are now offering virtual consultations for all our transplant patients. We are able to assess and help you remotely. If needed, we will arrange a clinic consultation which can be carried out safely. Please get in touch with the transplant team with any concerns.
There are many clinical trials currently ongoing including different agents such as azithromycin, remdesivir, tocilizumab, convalescent plasma amongst other. Dexamethasone (type of steroid) has proven to reduce mortality in severe disease. As a transplant team we are following the scientific developments very closely and we are also participating in a number of clinical trials.
As your transplant team we advise you to receive the COVID-19 vaccine. COVID-19 immunisation is encouraged by NHS-Blood & Transplant and the International Society for Heart and Lung transplantation, in patients with advanced heart or lung disease and Pulmonary Vascular Disease, or in those awaiting or following heart or lung transplantation, when a vaccine is locally available.
You may NOT be suitable for the vaccine in the following cases. Please get in touch with us to discuss if:
- You have had a heart/lung transplant within the last six months
- If you have had significant increase in your immunosuppression recently such as ECP, TLI, Immunoabsorption, Rituximab or RATG
- If you have had severe allergic reactions in the past.
Two different vaccines have been approved in the UK: the first one was the mRNA based vaccine (Pfizer/BioNTech) and more recently the Oxford vaccine (Astra Zeneca). Both have proved to be effective in clinical trials and we are recommending patients to receive either of the vaccines that they are offered.
For further information, please visit: COVID-19 Vaccination advice for Heart and Lung Transplant Recipients. | Royal Brompton & Harefield NHS Foundation Trust (rbht.nhs.uk)
If you have been in contact with someone who has a confirmed case of COVID-19, you should self-isolate for 10 days, and let your clinical team know so that they can monitor you closely. If you start having symptoms call 111 and let your transplant team know.
Please see section what can I do to keep myself safe.
National guidance currently advises against all non-essential travel. As a transplant patient you should be currently in self-isolation and therefore any form of travel is not advised.
For more information, please visit: https://www.gov.uk/guidance/travel-advice-novel-coronavirus
We are working closely with our NHS partners e.g. Healthcare at Home, to make sure we continue to have enough supplies of medicines for our patients. If you are currently receiving medicines such as anti-rejection medication from Healthcare at Home, this will continue. However, at this time, we are unable to enrol any new patients. The main change people may experience is that drivers may not ask for signature and may stay a safe distance away from patients by setting parcels down and then walking away and watching for recipient to pick them up. No medicines will be left unattended.
As usual, make sure you have enough ‘buffer stock’ by keeping at least two to four weeks’ worth of your medicines at all times (as advised by your clinical team), and requesting repeat prescriptions or homecare deliveries well in advance of this supply running out. That will give your pharmacy or homecare provider enough time to deal with any shortages should they arise.
It’s important to note that this is standard practice for our patients and not new advice.
If you are experiencing any difficulty getting hold of a supply of your medicines, or if you have any concerns about their availability, please let the pharmacy team know as soon as possible, please contact the team at Harefield Hospital: email@example.com