20th March 2020

COVID-19 Advice from Scottish Government

We now have more specific advice to share with you from the Scottish Government in relation to the risk categories and guidance/policies to be followed for each group.
6th April 2020

COVID-19 – Advice for people with chronic liver disease

The latest advice received from Scottish Government is detailed below.

This can also be downloaded in pdf format from this link

 

 

Healthcare Quality and Improvement Directorate

Planning and Quality Division

Date: 2 April 2020

Coronavirus (COVID-19) – Important advice for people with chronic liver disease

This leaflet provides you and your family with information about how Coronavirus (COVID-19) might affect you if you have chronic liver disease.

The most common symptoms of COVID-19 are a new continuous cough and/or a fever/high temperature (37.8C or greater).

A new continuous cough is where you:

  • have a new cough that’s lasted for an hour
  • have had 3 or more episodes of coughing in 24 hours
  • are coughing more than usual

A high temperature is feeling hot to the touch on your chest or back (you don’t need to measure your temperature). You may feel warm, cold or shivery.

Some people will have more serious symptoms, including pneumonia or difficulty breathing, which might require admission to hospital.

Your safety is our priority and we aim to minimise disruption to hospital services where possible. The NHS will continue to provide vital cancer treatments, and emergency and urgent care for all patients. With that in mind we have listed some important information below. This advice includes answers to questions you may have and details on services that can offer advice and support.

Some groups of people are considered to be at extremely high risk of severe illness with COVID-19. If you are in this group you will receive a letter from NHS Scotland or be contacted by your doctor. If you are in this group you should follow shielding measures: https://www.nhsinform.scot/illnesses-and- conditions/infections-and-poisoning/coronavirus-covid-19/coronavirus-covid- 19-shielding.


What should I know about Coronavirus/COVID-19 and chronic liver disease?

Some people with chronic liver disease have a higher risk of becoming ill if they have Coronavirus/COVID-19 because their immune system is weakened. This is the case in people with cirrhosis (scarring of the liver) and people on immunosuppressant medication. If either of these apply to you, you will be contacted directly by the NHS with advice that you should stay at home at all times and avoid all face-to-face contact until told otherwise. It is possible this advice will change as more information is available and, if so, you will be contacted again.

The British Liver Trust also has useful information for people with liver disease: https://britishlivertrust.org.uk/coronavirus-covid-19-health-advice-for-people-with- liver-disease-and-liver-transplant-patients/

Advice for people that have had a liver transplant is available at https://www.organdonationscotland.org/news-events/coronavirus-covid-19-advice- for-transplant-recipients

 

Where can I call for support?

If you have concerns about your condition or your treatment you should contact your liver specialist team.

The NHS Inform Scotland website has up-to-date information and answers to frequently asked questions.

https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19

For general information and any concerns about Coronavirus / COVID-19 you can call 0800 028 2816 (COVID-19 helpline).

For other non-emergency health concerns, your first point of contact should still be your GP or 111. They are likely to assess you over the telephone or via video link rather than in person to reduce the risk of infection from Coronavirus / COVID-19.

The British Liver Trust also has information on its website about Coronavirus / COVID-19.

https://britishlivertrust.org.uk/

Further information is available at:

https://britishlivertrust.org.uk/coronavirus-covid-19-health-advice-for-people-with- liver-disease-and-liver-transplant-patients/


What is the risk to me if I have chronic liver disease?

People receiving immune-suppression therapies, which put them at higher risk of severe illness from Coronavirus/COVID-19 will receive a letter from NHS Scotland outlining more specific advice to keep themselves safe.

The following provides practical guidance on whether you might be in the high risk group or not. The risk to an individual will also take account of other factors such as age and other health conditions.

1) High Risk: If you are either on immunosuppressants or you have severe scarring (cirrhosis). You are likely to be in this group if you usually see your liver specialist about once a year or more (and usually you would have been offered a flu jab).

2) Normal Risk: If you have a liver condition but no or very little inflammation and no or very little scarring and you are not on immunosuppressant medication and you are younger than 60 years old. You are likely to be in this group if you usually see your liver specialist less than once a year.

If your condition falls within the highest risk group you should not wait for the NHS Scotland letter and should protect yourself immediately by following the shielding measures set out on the NHS Inform website. https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19/coronavirus-covid-19-shielding.

Identification of people at the highest risk is ongoing, informed by centrally held data and with input from GPs and hospital clinicians. If you have questions about this please contact your hospital liver specialist team and not your GP.

 

I am part of the group who are identified as at higher risk of illness and got a letter from the NHS. Is there something I need to do differently to reduce the risk of Coronavirus?

The safest course of action is for you to stay at home at all times and avoid all face- to-face contact for at least twelve weeks, except from carers and healthcare workers who you must see as part of your medical care. The rest of your household should support you to stay safe and closely follow guidance on social distancing, reducing their contact inside and outside the home. This will help protect you by stopping you from coming into contact with the virus.

Things you or the person you care for should be doing and not doing to stay safe.

  • DO STRICTLY AVOID contact with anyone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature (above 37.8 °C) and/or a new and continuous cough. You might want to have a thermometer at home to check your temperature if you are worried that you may have a
  • DON’T leave your
  • DON’T attend any gatherings. This includes gatherings of friends and families in private spaces e.g. family homes, weddings and religious
  • DON’T go out for shopping, leisure or travel. When arranging food or medication deliveries, these should be left at the door to minimise
  • DO keep in touch using remote technology such as phone, internet, and social media.
  • DO use telephone or online services to contact your GP (for non-coronavirus issues) or other essential

DO regularly wash your hands with soap and water for 20 seconds. Ask carers or support workers who visit your home to do the

  • minimise the time you spend with others in shared spaces (kitchen, bathroom and sitting areas) and keep any shared spaces well ventilated
  • aim to keep 2 metres away from others and encourage them to sleep in a different bed where possible
  • use separate towels and, if possible, use a separate bathroom from the rest of the household, or clean the bathroom with cleaning products after every use
  • avoid using the kitchen when others are present, take your meals back to your room to eat where possible, and ensure all kitchenware is cleaned thoroughly using a dishwasher at the 60 degrees setting if possible, otherwise in very warm soapy water

If the rest of your household are able to follow this guidance to help keep you safe, there is no need for them to wear any special medical clothing or equipment. Aim to keep 2 metres away from others and encourage them to sleep in a different bed where possible

 

I did not receive a letter from the NHS, but I am currently being treated for chronic liver disease, do I need to do anything differently to reduce the risk of Coronavirus?

If you have not received a letter from NHS Scotland but using this guidance because you believe your condition or circumstance falls within the highest risk group you should protect yourself immediately by following the shielding measures set out on the NHS Inform website.

https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19/coronavirus-covid-19-shielding.

If you have not received a letter and do not believe you are in the highest risk group, you do not need to follow shielding measures. If you meet the criteria set out in this guidance for normal risk, then there are no special or different precautions you should take compared to someone without your condition and you should follow social distancing measures: https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19/coronavirus-covid-19-general-advice.

If you are not following shielding measures and develop symptoms of Coronavirus/Covid-19 your household should follow the instructions to self-isolate: https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19/coronavirus-covid-19-guidance-for-households-with- possible-coronavirus-infection.

 

Will my treatment change?

Your treatment plan is individual to you. You should not change your medication unless told to by your GP or liver specialist. This is also true if you are being treated with immunosuppressants.

 

Should I still go to hospital appointments?

If you are receiving treatment for a chronic liver condition, it is important that you take extra care of your overall wellbeing, and attending hospital appointments is part of this.

Your clinical team will try to minimise the time you spend in hospital departments, for example arranging telephone or Near Me video consultations and offering blood tests at a different NHS site. Make sure your care provider has your up-to-date contact details.

Your liver specialist or one of their team may contact you to change your appointment. If you have not been contacted, please assume the appointment is to go ahead as arranged.

If you have symptoms of possible Coronavirus/COVID-19 infection then do not come to the hospital. Instead you should check your symptoms against the information on NHS Inform https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19 and call 111 to seek further advice.

Please tell the call handler about your liver condition. Please also inform your liver specialist team.

Being visited by friends or relatives in hospital, or someone going with you to appointments is now restricted unless essential. The following visits are deemed essential:

  • a person receiving end-of-life care
  • to support someone with a mental health issue such as dementia, a learning
  • disability or autism where not being present would cause the patient to be distressed
  • to accompany a child in hospital

If relatives or friends need to visit you, it is vital that they wash their hands for at least 20 seconds on arrival and often after that.

If hospital admission is likely please remember to pack your mobile phone and phone charger so you can keep in touch with relatives and friends.

 

Will the symptoms be different because I have chronic liver disease and what should I look out for?

The symptoms of Coronavirus/COVID-19 will be the same as the general population.

NHS Inform Scotland provides up to date advice about Coronavirus/COVID-19 https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19.

People with liver disease also often have other mental health or medical problems. Alcohol problems, diabetes and being overweight are all common in people with liver disease. You should follow all the advice for the general population, which includes looking after your mental and physical health and especially your liver. With social distancing and isolation there is a risk of drinking more alcohol than is healthy for you (or even taking illicit drugs, which is also very risky). Alcohol puts your liver and your health at risk. Reduce your alcohol consumption if you do drink (in most cases reducing over 8 days is safe). If you drink more than 15 units per day or suffer withdrawal symptoms then please see national guidance available https://www.shaap.org.uk/publications.html#latest. If you are currently not drinking alcohol then please continue to stay off it.

Your body is likely more sensitive to alcohol than that of other people and therefore you should not drink alcohol at all. Alcohol can worsen any liver disease by causing inflammation in your liver. Hopefully with the help of your liver specialist team your condition will be very stable until the situation is settled and the healthcare system is back to normal.

 

Who should I contact if I become unwell or develop side effects while on my current medicines?

If you have chest pain, significant bleeding or you need immediate medical attention call 999.

If you have symptoms of Coronavirus/ COVID-19 while you are on your therapy, or for any side effects of drug treatment, call 111. They will ask a series of questions and will give advice or arrange for you to have a medical review at your nearest hospital.

If you have Autoimmune Hepatitis you will be on medication, which influences your ability to fight infections (immunosuppressants: prednisolone, azathioprine budesonide or others). Your pharmacist will be able to help you if you are not sure what your medication is for. You should continue with your medication for your liver unless you are told to by your GP or by your liver specialist team. The risk of reducing or stopping the medication would be higher than any possible benefit in virtually all cases. If you are on immunosuppressant medication you are in the high risk group and you should follow the instruction to stay at home and self-isolate very strictly.

If you think you may have Coronavirus/COVID-19, developed a new continuous cough and/or a fever/high temperature do not go to your GP, pharmacy or hospital.

You should phone 111 if:

  • your symptoms worsen,
  • breathlessness develops or worsens,
  • your symptoms haven’t improved in 7 days Tell the call handler about your liver

If you have a medical emergency, phone 999 and tell them if you have Coronavirus/COVID-19 symptoms.

 

What should I do to collect my routine medications?

You should ask family, friends and neighbours to support you and use online services. If this isn’t possible, then the public sector, business, charities, and the general public are gearing up to help those advised to stay at home. It’s important to speak to others and ask them to help you to make arrangements for:

  • food
  • medicines
  • essential services and supplies
  • looking after your physical health, mental health and wellbeing

If you receive support from health and social care organisations, such as care support through your local authority, this will continue as normal.

Your health or social care provider will be asked to take additional precautions to make sure that you’re protected.

 

What should I do if I am a carer for someone with chronic liver disease?

Coronavirus/COVID-19 can have serious effects on anyone who has a long-term health condition or a weakened immune system, including some people with chronic liver disease.

If you’re caring for someone who’s vulnerable, there are some simple steps that you can take to protect them. You should follow advice on good hygiene, such as:

  • Wash your hands on arrival and often - use soap and water for at least 20 seconds or use hand sanitiser
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands
  • Don’t visit if you’re unwell and make alternative arrangements for their care
  • Provide them information on who they should call if they feel unwell (their GP phone number and 111) and how to use NHS inform
  • Access advice on creating a contingency plan from Carers UK
  • Find out about different sources of support that could be used
  • Look after your own well-being and physical health

 

As we are being asked to stay at home for a prolonged period, how can I maintain a positive mental health?

We understand that the situation you may be facing at the moment, due to Coronavirus/COVID-19 and your health condition can increase anxiety.

There are simple things you can do that may help, to stay mentally and physically active during this time, such as:

  • Exercise regularly - look for ideas of exercises you can do at home
  • Spend time doing things you enjoy – this might include reading, cooking, other indoor hobbies or listening to/watching favourite radio or TV programmes
  • Eat healthy, well-balanced meals
  • Drink enough water
  • Try to avoid smoking, alcohol and drugs
  • Keep your windows open to let in fresh air
  • Arrange a space to sit with a nice view, if possible
  • Get some natural sunlight if you can or sit on your front step, staying more than 2 metres away from others

Support in dealing with anxiety around impacts of Coronavirus can also be found at: https://breathingspace.scot/
https://www.samh.org.uk/ https://www.supportinmindscotland.org.uk/

Tips on how to cope if you are worried about Coronavirus and in isolation can be found at:

https://learn.nes.nhs.scot/28084/coronavirus-covid-19/psychosocial-support-and- wellbeing/tips-on-how-to-cope-if-you-are-worried-about-coronavirus-and-in-isolation

NHS Inform has further resources to help your mental wellbeing: https://www.nhsinform.scot/illnesses-and-conditions/infections-and- poisoning/coronavirus-covid-19

 

Are my carers, and/ or friends and family still allowed to visit my home?

You should let your regular visitors know that you are reducing social contacts and they shouldn’t visit you during this time, unless they are providing essential care for you.

Essential care includes things like help with washing, dressing, or preparing meals.

If you receive regular health or social care from an organisation, either through your local authority or paid for by yourself, inform your care providers that you are reducing social contacts and agree a plan for continuing your care.

If you receive essential care from friends or family members, these carers can continue to visit. Carers will be provided with gloves and facemasks to reduce the risk of passing on infection.

It’s also a good idea to speak to your carers about what happens if one of them becomes unwell. If you need help with care but you’re not sure who to contact, your local council should be able to help you.

If you need help with care but you’re not sure who to contact please visit https://careinfoscotland.scot/topics/how-to-get-care-services