DR ELLIE CANNON: So what is the plan for over-70s?

Ask DR ELLIE CANNON: So what is the plan for over-70s – and when can I stop shielding?

• Here’s how to help people impacted by Covid-19

Q: I am in my 70s, and perfectly healthy but guidance on social distancing for people like me seems to change endlessly. What exactly do I need to know now that things seem to be improving?

A: There are really two confirmed facts that are worth understanding which underpin all this changing guidance.

Firstly, whatever data you scrutinise, the risk of getting severe Covid-19 increases with age. This is the same for many illnesses, from flu to cancer, but it is a clear risk.

Secondly, despite the age-related risk, the majority of cases at any age will always be mild to moderate: even in the over-80 category, more than 80 per cent of those who get Covid-19 will get it mildly.

Dr Ellie advises one reader: ‘No matter what easing of lockdown occurs from today – if any – social distancing and hand-washing remain vital for the over-70s as we must reduce the risks from being in close contact with family and friends as much as possible. Even if it starts to feel that the lockdown is easing, these risks will remain and can’t be ignored’

However, no matter what easing of lockdown occurs from today – if any – social distancing and hand-washing remain vital for the over-70s as we must reduce the risks from being in close contact with family and friends as much as possible.

Even if it starts to feel that the lockdown is easing, these risks will remain and can’t be ignored.

Q: I have a pre-existing health condition which means that I’ve been told to ‘shield’. Will I have to continue with this, even when the lockdown ends? I’m going slightly mad already.

A: Isolation, of course, has a massive impact on mental health, and this has to be weighed up against the benefit of avoiding the virus.

Data newly published from 17 million patients’ records in the UK does confirm that the groups who have been told to shield are at greater risk from severe illness and hospitalisation.

Another reader with a pre-exisiting medical condition says she is going slightly mad in lockdown

So while it has been a traumatic and painful period for more than a million people who are shielded, it was the right decision.

And as lockdown eases, it is likely that changes will be very slow and that those who are shielding will be asked to do so for the full 12 weeks from the start of lockdown.

Easing of shielding will be gradual and until we know the transmission rate of the virus in the community it will not be safe to allow the most vulnerable in our communities to be put at risk.

Q: I feel utterly miserable, and exhausted, even though I’m not doing much. I really can’t see the point of going on if things are going to stay like this. What’s the point of being alive if you can’t actually live your life?

A: Sadly, I’m hearing this kind of thing more and more. It is depressing, being confined.

Some psychologists have even described what some people are experiencing as a sort of grief: for the life we want to be living, for what we have lost and for what we feel we could continue to lose in the future.

This is worsened by the uncertainty: will I or someone I care about get ill, will they die, and on a much bigger level, when will this end?

If lockdown is affecting your state of mind, ensure you are sleeping and exercising daily, as well as talking to at least one supportive friend each day, if that’s possible.

And remember that GPs at your local surgery WILL be available to consult by phone or video on mental health if you are feeling low and hopeless. There are excellent resources they can refer you to online for therapy at this time.

Q: Am I allowed to look after my grandchild when my daughter goes back to work?

A: The guidance around children is evolving but at this stage babysitting grandchildren would still not be advised.

The medical data very clearly shows that children have, in the main, been unaffected by the virus and most likely do not spread it on to grandparents.

But we still cannot be sure. While in Switzerland hugging grandchildren under ten is now allowed, in other countries the experts disagree as we just don’t have the full data yet.

Dr Ellie advises a grandparent against babysitting her grandchildren to reduce the risk of spreading or contracting Covid-19

A day of babysitting is very different to a quick hug, allowing repeated opportunities for the virus to spread.

Risks could be reduced by plenty of proper hand-washing, keeping apart as much as practically possible and even wearing face coverings.

The official advice is, I believe, that you may babysit – but only if it is absolutely necessary.

Q: How can people still be dying if everyone’s been in lockdown for so long? Will it really be safe to let us all out?

A: I know it’s a worry that the ‘stay at home’ rules might be eased when hundreds of people are still dying, but it’s important to understand how public health officials have come to this decision.

It relates to how fast the virus is spreading.

More from Dr Ellie Cannon for The Mail on Sunday…

Shortly before the lockdown, Chief Medical Officer Chris Whitty suggested that, although diagnosed Covid-19 numbers were at about 1,500, there could be tens of thousands more – many with mild or no symptoms.

When we were all freely going about our daily lives, it was estimated that on average one person with the virus was infecting three others every three days.

Each of these newly infected people would then infect three others themselves, and so on.

The number of others each person infects, on average, is used to calculate what we call the transmission rate, or R value.

When we have an R 3 – as could have been the case judging by how quickly numbers of cases in the UK and other countries shot up – you see what’s called exponential growth of infection, with the total number of cases doubling or tripling every three days.

It takes roughly five days for symptoms to appear, and deaths occur on average 25 days after infection.

This is why the peak of deaths – and new diagnoses – happened about three weeks after the start of the lockdown, and then began to decline.

With people not mixing, the transmission chains are broken.

Six weeks in, scientists now think the R value has dropped below 1, meaning that not every person with the virus is passing it on.

This means new case numbers will keep going down – and our risk of coming into contact with the virus reduces.

If you can keep transmission rates as low as this, eventually you could see Covid-19 dying out. Hundreds of people are still dying because of that 25-day time lapse after infection. But new infections are falling, and so deaths will keep falling.

How can we keep transmission rates low and make it safer to go out? Through a combination of continued social distancing, hand-washing, and mask-wearing – so asymptomatic carriers of the virus are less likely to spread it unknowingly – and isolating, testing, and contact-tracing anyone with symptoms will be key.

Q: I’ve heard that the R number – the rate of transmission – has increased over the past few days. Is that true and what does it mean?

A: The rate of transmission will waiver. It is likely to be higher in some places such as hospitals or some cities, and lower in others.

It is not only influenced by the natural properties of the virus but also the measures we take and the immunity we have.

It remains between 0.6 and 0.9 in the UK currently, but that will be an average. The risk of getting coronavirus in some places, such as hospitals or very busy, crowded places, will be higher.

Ultimately, the best of way to keep transmission rates very low would be a vaccination: the virus simply couldn’t be transferred to vaccinated people, stopping it in its tracks.

Until then we have to rely on the crude interventions of isolation and social distancing.

Q: The Government will make us all download a tracing app to stop the spread of Covid-19, but I don’t have access to the internet, let alone a smartphone. What will the options be for people like me?

A: The app will be optional so no one will be made to download it. And it’ll be only one aspect of the ‘test, track and trace’ system which is being set up. Much of the legwork, including tracking down people who’ve been in close contact with a newly diagnosed patient, will be done by old-fashioned phone call.

This is a well-established system we use in public health to monitor any disease outbreak. For example if you get food poisoning in a restaurant, public-health teams track back to find other customers to monitor for outbreaks.

It is a sensible approach: the countries that have avoided huge numbers and death tolls have used such systems from the first few cases.  

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