#MSCOVID19 De-deployed

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This is a very good news post and worth a quiet celebration. 

As you can see from the study and figure below that Barts Health NHS Trust, where we work, was at the epicentre, of the epicentre of the UK’s COVID-19 pandemic. London has had the most COVID-19 cases in the UK and it looks as if the majority of cases where managed in our four COVID active hospitals. This graph shows just is how effective the London lockdown has been in flattening the peak of the epidemic. 

The bars show you the proportion of asymptomatic HCPs (healthcare professionals) who tested positive for SARS-CoV-2 on consecutive weeks from March 23, 2020: 

28 of 396 HCPs (7.1%) in week 1
14 of 284 HCPs (4.9%) in week 2
4 of 263 HCPs (1.5%) in week 3
4 of 267 HCPs (1.5%) in week 4
3 of 269 HCPs (1.1%) in week 5

Importantly of the 44 HCPs who tested positive for SARS-CoV-2, 12 (27%) had no symptoms in the week before or after positivity. Although I was not one of the HCPs in this survey there is a chance that I have been exposed to SARS-CoV-2, which is why I am volunteering to get myself tested next week to see if I have antibodies to the virus. Knowing I have been infected or not will clearly affect my behaviour. This is why it is so important for widespread antibody testing to happen ASAP. 

If you generalise these results to the wider HCP population, then so-called asymptomatic SARS-CoV-2 infection rates among HCWs tracked the general population infection curve in London. This suggests that the rate of asymptomatic infection among HCPs more likely reflects general community transmission rather than in-hospital exposure. 

So if you are one of our, Barts-MS, patients these results should be very reassuring and as the overall epidemic wanes asymptomatic infection among us, your MS team is likely to be low and we are unlikely to be a major source of virus transmission. This means you need not fear us when we resume face-2-face consultations. 

The other good news is that we now have so few new COVID-19 admissions at the Royal London Hospital that we have started closing down some of the extra medical wards that were created to deal with the surge. This means my services as a make-shift general physician are not required anymore and I have been de-deployed back to being a neurologist and MSologist. I hope this means that we will be able to resume our MS services, albeit with adaptations to make sure social distancing is maintained, very soon. 

Treibel et al. COVID-19: PCR Screening of Asymptomatic Health-Care Workers at London Hospital. Lancet. 2020 May 8;S0140-6736(20)31100-4. 

CoI: I work at the Royal London Hospital, which is one of five hospitals of Barts Health NHS Trust.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

12 comments

    • This is all good news, however I am hearing different views regarding antibody testing – are they accurate, how long will these antibodies remain in your system, can you be reinfected etc.
      Barts Team – I am wondering what your current views are whilst appreciating we are still learning about this virus?

      • Nobody knows how long the antibodies will remain effective in your system or about reinfection risk. Anti-CD20 treatment could reduce both effectiveness and duration of the antibody response, but nobody knows yet. They’ve done antibody tests here in Jersey and the results were shockingly unreliable (https://www.gov.je/SiteCollectionDocuments/Government%20and%20administration/R%20Prevalence%20of%20antibodies%202020508%20SJ.pdf). I asked my local neurologist about having an antibody test to inform the decision whether to delay my next Ocrelizumab infusion and have yet to receive a reply. You will acquire some immunity through contact or immunisation which reduces with time. It then becomes a matter of viral load whether you are re-infected. Looking after somebody with CoVID-19 using a nebuliser in an enclosed space would deliver a high viral load and and a high chance of bad infection while walking past somebody outside would be relatively safe and might even improve your resistance if you’ve already become immune.

  • Good to hear Prof G & I hope that you manage to have the test too. It’ll put your mind at rest to know and I hope all the back log of MS work isn’t too daunting!

    Let’s hope the winter, assuming things will go back to a bit of normality by then (with hygiene & social distancing awareness) that it doesn’t come back layered on top of the usual flu, pneumonia & viruses.

    Also, whilst in contact – do you think COVID-19 was around the UK in January/February and had already started its attack on people, resulting in hospitalisation & ultimately tragic circumstances?

    Good luck with everything and I wish you well,

    • More than likely – while not in the UK myself I have two friends in London (a couple) who had symptoms of mild Covid in late Feb and recently got positive anti body test (I think one of them had substantial exposure to someone who was later PCR-tested positive so wanted to know retroactively). So unless you believe they later got an asymptomatic case (or are both false positive….) January sounds more than likely for me.

      Meanwhile on the continent, I had much the same experience most of March (returning mild fever, weakness, sore throath but no cough) but given that ocrelizumab probably screws with the anti body test I was in no hurry getting tested seeing that I will have big blood work in June so probably ask if it can be done then…

  • Agreed widespread antibody testing is needed ASAP. Just as it is important to know the reduction in positivity rate the percentage of the population exposed is needed in order to assess current mitigation strategies. Can the exposure to the virus be slowed so that herd immunity is achieved and critical care wards are not overwhelmed? So far it seems to be working.

  • These are all good news, light, be it at the other side or even inside the tunnel.
    And true, the BBC helicopter is not here to film people clapping but nevertheless, this is an opportunity to thank you and all who exposed themselves while doing hard work, and remember those who were taken by Covid-19

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