As South Africa gears up for the next easing of restrictions, moving from Level 4 to Level 3 lockdown, there are many factors to take into account.
Numerous well-researched blogs and articles have been written by prominent and respected local and international colleagues dealing with situations where there is a greater risk of exposure to the virus, especially if you or one of your loved ones is Asthmatic.
Firstly, staying at home saves lives by “flattening the curve” and allowing for an improvement in healthcare system-readiness, but does not kill the virus. As we ease restrictions, infections will increase. We must therefore continue practising known methods of reducing the spread of the virus.
We are very probably in this for the long haul. The exponential behaviour of this virus is clear and until we have herd immunity (usually about 2/3 of the population, which means about 19 million people in South Africa) or a vaccine is developed (optimistically 12 months), people will continue to get infected.
We know most people who contract the virus will have mild symptoms and certain groups will be at higher risk for more serious and possibly fatal outcomes. These include, but are not limited to: the elderly, immunocompromised and those with certain chronic medical conditions, including ASTHMA.
Here are a few points about the management of Asthma during the COVID-19 pandemic:
1. If you have asthma you are probably on inhaled medication including corticosteroids. DO NOT STOP your treatment. Continue taking your inhaler as prescribed and if you have a seasonal exacerbation, or you are not well enough controlled, you might increase as per your doctor’s advice.
2. In acute attacks, it is still recommended to use oral corticosteroids as we have before, or increasing certain fixed inhaled medications.
3. NEBULISERS: There is clear evidence that the use of nebulisers increases the risk of disseminating COVID-19. If you have or suspect you have COVID-19 and are at home, please keep in mind that the virus may persist in droplets in the air for 1-2 hours. Research has shown that using a metered-dose inhaler (“puffer”) of a bronchodilator via a spacer device is as effective in the emergency situation as a nebuliser. (Spacers should not be shared and if they must be shared they should be well-sterilised between uses). If however, you decide to use a nebuliser, it should be in a location that minimizes exposure to non-infected people. This location could be outside, on the veranda or in the garage – i.e.: wherever air is not recirculated into the home.
4. Asthmatics with allergic rhinitis (hayfever) should continue using their nasal corticosteroids. The use of methylcellulose intranasal powder (a local example is Nexa®) has been shown to significantly decrease both allergens and viruses penetrating the nasal tissues. While not specifically tested against COVID-19, it has been tested against other viruses.
5. If in doubt contact your doctor or local casualty.
6. Ginasthma.org is a good Asthma resource for patient and professionals alike, and these guidelines are drawn from their recent updates during COVID-19.
Dr Gilbert is still seeing and reviewing asthmatic patients in the rooms (having spoken on the telephone if there is a suspicion of a COVID-19 infection).
In conclusion, as we all try to navigate these unchartered territories, where the landscape and goalposts constantly morph and are changed, please be safe and remember:
- Sanitise – wash your hands often
- Wear a mask in public or around those that are infected
- Social distance for your own sake and your family’s, and out of respect for those vulnerable to the virus
- If you think you have COVID-19 infection please contact your doctor or local casualty department.
Please feel free to contact Dr Gilbert’s rooms via email should you wish to have a look at any of the references used for this post.