Coronavirus disease 2019, otherwise known as COVID-19, has been a hot topic for the start of 2020. How worried should we be? Are we currently living the opening chapters of a dystopian novel, or is this mainstream media hype? At the time of writing, Public Health England (PHE) reported 71,329 cases of COVID-19 and 1775 deaths worldwide.1 But how do these numbers compare to those for influenza?
The World Health Organization estimates that worldwide, influenza epidemics result in about 3–5 million cases of severe illness and about 290,000–650,000 respiratory deaths per year.2 And this is despite efforts to limit spread through seasonal influenza vaccinations and public health campaigns reminding us that ‘coughs and sneezes spread diseases’ and to ‘please wash your hands’.
If mortality rates of COVID-19 are broadly comparable with seasonal influenza (around 2%), what is all the fuss about? Perhaps what is concerning is the global spread of the virus. How much of this is down to the virulence, and how much is a reflection of globalisation and social trends? Now that global travel is so much the norm, would it be possible to control a pandemic outbreak, should one arise? Do our advances in healthcare match our advances in global travel—if the 1918 pandemic influenza outbreak happened now, what would be the impact? There are so many questions, not all of which can be answered here and now, but one that we can answer is ‘what is the role of primary care in COVID-19?’
Dr Toni Hazell discusses PHE’s interim guidance for primary care on COVID-19. The main principles focus on identifying potential cases as soon as possible, preventing potential transmission of infection, avoiding direct physical contact, isolating suspected cases, and informing the health protection team. It is worth noting that the information in this article is correct as of 11 February 2020—for further advice refer to PHE’s interim guidance for primary care, which is being updated on a regular basis.
Moving on to a different type of infection: urinary tract infection (UTI) in adults is the topic of our top tips article. Dr Sonya Jey draws on recommendations from the NICE/PHE guidelines, as well as the European Association of Urology guidelines, including tips on recognising the different categories of UTI, diagnosing and treating UTIs, and managing suspected pyelonephritis. The article also includes useful tables for antibiotic choice, dosage, and course length in different population groups.
This issue also includes two Key learning points articles on recent NICE guidelines:
- Dr David Spraggett outlines five key learning points for primary care from the 2019 NICE guideline on cannabis-based medicinal products. Although prescribing should only be initiated by a specialist with particular expertise in the condition being treated, GPs can issue prescriptions for cannabis-based medicinal products under the direction of a doctor on the Specialist Register. GPs will need to be suitably informed about cannabis-based medicines so they can offer appropriate advice to patients querying their use, and be involved in decisions about whether or not they are prescribed
- Dr Ivan Benett identifies five key learning points from the recently updated NICE guideline on acute kidney injury (AKI). The updated recommendations in focus on new evidence relating to the use of iodine-based contrast media in investigations. The article also revisits other recommendations that are relevant to primary care, including identifying, assessing, preventing, and managing AKI, and knowing when to refer to secondary care.
This issue also includes a copy of our reflective template. This is designed to support revalidation, and provides framework for your notes about your thoughts and how you plan to change your practice after reading one of the articles in the issue.
Lastly, Sue Hope shares her View from the ground as a community midwife—a role that may not always be immediately considered part of the GP practice team, but she’s hoping to change the minds’ of any doubters.
- Public Health England. COVID-19: epidemiology, virology and clinical features www.gov.uk/government/publications/wuhan-novel-coronavirus-background-information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features (accessed 18 February 2020).
- World Health Organization. Influenza (seasonal). www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) (accessed 18 February 2020).