Covid-19: advice for iSGS patients

This is the official medical advice for patients with airway stenosis as of Thursday 28 May 2020.

GENERAL GUIDELINES FOR EVERYONE

  • Avoid touching your eyes, nose, mouth or stoma area (for those with a tracheotomy) as much as possible. It may take practice, touching the face is often done inadvertently.
  • Wash your hands regularly through the day with soap and water for around 20 seconds or use alcohol-based hand gel.
  • Stop shaking hands or kissing as a greeting
  • Keep a distance of around 2 metres (6 feet) from others
  • Use a face mask in situations where you cannot guarantee you will be 2 metres (6 feet) from another person (eg in small shops, public transport)
  • Cover coughs and sneezes with a tissue or your elbow.
  • Avoid all non essential travel
  • If you can access the flu vaccine, ensure you are vaccinated now
  • Advice on cleaning to remove Covid-19 can be found here:

IF YOU HAVE BEEN TOLD YOU ARE HIGH RISK, HAVE A HIGH RISK CONDTION (EG HEART DISEASE, DIABETES, HYPERTENSION, LIVER OR KIDNEY DISEASE HAVE A BMI OF 30 OR MORE (OBESE CATEGORY)), ALREADY HAVE BREATHING ISSUES, ARE RECEIVING IMMUNE SUPPRESANT MEDICATION/TREATMENT, OR ARE AN ISGS PATIENT OVER 60 YEARS OF AGE

Breathing issues include: 

  • Your airway is closing up and breathing is already a challenge 
  • You have regular mucus plugs and issues clearing your airway
  • You have a tracheostomy
  • Your airway closes rapidly with infections

First and foremost, you should self-isolate and plan to do so for the foreseeable future. This means minimising any contact with people outside of your household, staying home unless leaving for medical treatment. Ensure you and fellow household members follow the general guidelines above.

• Stay at home at all times and avoid any face-to-face contact with others for at least three months
• Get food, medicines and other essential items delivered, and have the person delivering them leave them at the door. You can ask friends and neighbours to help with this, or use delivery services. If you need to, you can register for extra services from Government, or try a local mutual aid network.
• Use phone or online services to contact your GP or other services if needed.
• Inside your home, minimise all non-essential contact with other people you live with.
• People who provide essential support for you, such as healthcare or support with your daily needs or social care, can still come to your home. But if they have symptoms of COVID-19, they should not come. All people coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there.You should make a plan for how your care needs will be met if your carer becomes ill.
• If you get symptoms of COVID-19, which means a fever or a new continuous cough, call your doctor immediately. Do not wait for your symptoms to get worse. Organise to get tested as soon as possible.
• If someone else lives with you, they do not have to follow the shielding guidance. They should follow the social distancing guidance very closely and do what they can to support you with shielding.

If your doctor is operating and you need dilation surgery or steroid injections, the recommendation is to proceed with the procedure as soon as possible.

You should be able to get advice via telephone from your airway specialist should you need it. You should assume it will be some time before you can have a dilation or surgery in hospital. 

Make sure you have access to your emergency medicine kit as detailed in the Rough Guide (especially oral steroids, antibiotics).

Contact your airway specialist by phone or email to find out the protocol should things get worse for you.

It is recommended you work at home where possible.

Follow the advice in the Rough Guide for dealing with mucus and inflammation:

IF YOU ARE IN A HIGH RISK JOB

If you work as a frontline worker likely to come into contact with people with Covid-19 (eg nursing, intensive care, dental or other medical work)

Talk to your airway surgeon about providing you a letter for your employer suggesting particular recommendations for safety measures to maintain your health. This is especially recommended if you also fall into a high risk category (see above).

A PDF of an example letter can be downloaded here:

As always, follow advice in the Rough Guide.

IF YOU HAVE NO ISSUES AT PRESENT

Your airway is open/ breathing is not too bad

Ensure you and your household strictly follow the general advice above. Work from home if possible and minimise contact with people outside of your household. If working from home is not possible, talk to your employer about providing you a safe place away from colleagues to work. Avoid any time indoors with people other than your household members.

Make sure you have access to your emergency medicine kit as detailed in the Rough Guide (especially oral steroids, antibiotics).

Non essential visits to pharmacies, hospitals or doctors should be avoided, as these will be hubs of the virus. It is likely your doctor will have cancelled all routine checkups – you should be able to request a remote appointment (eg by video or telephone).

It is recommended you delay any non urgent visits for up to 3 months. If your airway health changes, talk to your airway surgery by telephone.

IF YOU HAVE CAUGHT THE VIRUS OR HAVE SYMPTOMS

Do not panic!

Remember that not all people who catch the virus will get seriously ill. Contact your airway specialist and GP/primary health care provider by phone to ensure they are involved in any treatment you receive.  

Warnings against the use of ibuprofen have now been revoked. You can use these and other pain killers to treat your fever and other symptoms.

For the majority of patients, the advice is to self isolate for at least a 7 days after your symptoms first appear. Your whole household should also isolate for 14 days.

At the very first signs of shortness of breath, contact a doctor immediately and go to emergency.

Not everyone will experience shortness of breath.

If you experience shortness of breath that is different to normal, prepare a single bag in case you need to go to hospital. This should include your emergency contact, any recent details about the status of your airway stenosis, your doctor’s contact details, a list of the medications you take (including dose and frequency), any information on your planned care appointments and things you would need for an overnight stay (snacks, pyjamas, toothbrush, medication and so on). If you have an advanced care plan, please include that.

Patients who have very serious issues with breathing and pneumonia are often treated with intubation. This is not advised for iSGS patients – a laryngeal mask is likely first port of call, and if your symptoms worsen, a temporary tracheotomy at the area of stenosis is likely. The medical team dealing with you will need to know about your existing airway disease.

Decisions will be made at the time with the information available, tailored to your individual situation and with the expertise on hand. Since the start of the virus doctors have now started using CPAP machines instead of ventilators in many cases.

Intubation is only for the extremely sick, and will be required only if everything else has failed. Only 50% of extremely sick patients are intubated.

Follow the advice in the Rough Guide for dealing with mucus and inflammation. 

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Thanks to otolaryngologists Mr Guri Sandhu, Mr Martin Birchall, Mr Chad Al Yaghchi, Dr Hannah Burns, Dr Alexander Gelbard, Dr Alexander Hillel & Dr Thomas Schweiger for their help in preparing this document. Updates are adapted from the World Health Organisation.