Gerry Gajadharsingh writes:

The recent UK government announcement regarding Spain and the need for people travelling/returning from holidays to Spain needing to quarantine for 14-days, with only 6 hours’ notice given, has caused chaos.

As someone who was caught up in the recent events, it focused my mind on finding a solution, to try and avoid missing 14 days from work after a few days holiday In Marbella, Andalucía and then Gibraltar on a boat! Let’s see if the UK government helps us find a pragmatic solution, soon, there is enormous pressure on them from various sources, including LHR, various airlines, travel industry and prominent politicians.

Please have a look at my most recent blog for further information

By the way the risk of catching SARS-CoV-2 is currently higher in certain parts of the UK, Blackburn & Darwen 85.9 per 100,000 (27.7.20), Oldham 54.3 per 100,000 (27.7.20) and Leicester at 53.2 per 100,000 (27.7.20), Andalucía is 11 per 100,000 (25.7.20). It seems the rise in cases in the UK and Europe, after lockdown restrictions were lifted, is being driven by younger people, if that is the case the majority maybe asymptomatic or having mild/moderate symptoms, as yet there is no dramatic rise in rates of hospitalisations or deaths.

So, what did I do?

I had a SARS-CoV-2 PCR antigen SWAB test on the day I arrived back into the UK from Gibraltar, I self-isolated. The result was negative and I had a repeat test 5 days later, why 5 days later? Because the average incubation of SARS-CoV-2 is 5 days. Two negative tests mean that there is an 88% probability that I do not have the virus (according to recent research by the London School of Hygiene and Tropical Medicine) or at 7 days gives 94%.. Never mind that mask wearing is compulsory in Spain inside and outside, the social distancing is exemplary in Marbella, the hotels have really got their PPE and social distancing sorted out, we avoided crowded places and Marbella has minimal cases. Gibraltar is not on the quarantine list, but because I had arrived in Malaga and spent a couple of days in Marbella, I would be required to quarantine, from the date that I left Spain. However, I am possibly exempt from the 14-day quarantine, as a UK registered health care practitioner seeing urgent patients, and could, under UK government rules, have returned to seeing patients, but I avoided seeing patients for the week I returned, to keep them safe, and until I had 2 negative results.

We have completed 157 Sars-CoV-2 antibody serology (blood) tests and found a positive result in 12.7% of patients. Whilst this means that those positive patients have definitely had the novel coronavirus and produced antibodies, we suspect that others may well have had the virus but not produced antibodies, probably because their immune systems produced an adequate T cell response (the innate immune system) and was able to kick out the virus before the immune system activated the acquired immune system antibody response, it may be that I am one of these people, but who knows. I have previously blogged about this

Just to remind you, the only way to have an antibody test at the moment, is via an appointment with me to have a venous sample taken, TDL are yet to confirm when they will allow us to restart the popular home sample blood capillary (finger prick) collections (and then sent to the TDL lab to be analysed). They are still awaiting approval from PHE/MHRA.

It seems that we are all going to have to learn to live with the novel coronavirus for the foreseeable future and possibly future as yet unknown viruses.  Individuals, businesses and the UK government need to come up with pragmatic solutions balancing our health needs (protecting those at high risk of COVID 19 complications) and the needs of the wider economy, given that 80% of the population will get no or mild/moderate symptoms.  It is evident that blanket bans on countries, such as Spain (and soon to be added other European countries) forcing people into 14-day quarantines, is highly problematic, because of probable non-compliance from those  who are forced to quarantine but who may try to avoid it, because of the need to earn an income or other reasons. There needs to be a nuanced approach.

So, whilst we wait for the government to get their act together, what can we do now to keep ourselves safe and others around us?

SARS-CoV-2 PCR antigen SWAB test.

As described above this can be done on the day of arrival from abroad and a repeat test 5 days later.

  • I suspect that at least one of the tests will be required to be validated by an ID check (passport or driving licence), which may become mandatory. This can be done by booking an appointment with me at The Health Equation to take the SWAB sample. The TDL result and a certificate confirming ID, provided by The Health Equation, will be emailed to those patients.
  • If it is not convenient to come into the practice a self-sample collection kit can be couriered to you, full instructions on how to take the sample are provided with each kit and a Royal Mail 24 hr tracked postage paid envelope back to TDL is provided (London based patients can of course drop the sample directly to TDL or arrange their own courier to aim to get a result ASAP).
  • In both instances TDL will report the result usually within 48 hours of RECEIVING the sample, but this timing is not guaranteed.

Situations where an antigen test might be helpful:

  • Patients returning from abroad, from both UK quarantine exempt and non-exempt countries, such as recently added Spain.
  • Patients needing to travel to countries which require a confirmed negative antigen result (these are currently, Dubai, Austria, Barbados, China, Seychelles, Hawaii, Alaska, Iceland, Czech Republic, the list is growing weekly, the time requirements vary but many suggest testing up to 72 hours before travelling, please check with the relevant country website)
  • Companies wishing to bring staff back to work
  • Family members wishing to visit self-isolating relatives
  • Healthcare workers, clinicians and other staff, who are coming into close contact with patients.
  • Other higher risk occupations where regular close contact with people is necessary.
  • Patients presenting with symptoms of COVID 19, including cough, fever loss of smell/taste, fatigue and headache. However, we are asking patients not to attend the practice if they suspect they have current symptoms of COVID 19, they can request a home collection sample kit from us or see if they can get a testing appointment via the NHS.
  • Occasionally I may request an antigen test on a patient who presents with symptoms where COVID 19 is a possibility, as part of differential diagnosis.

The cost of the COVID 19 tests (correct at August 2020)

  1. SARS-CoV-2 IgG ANTIBODY clinic sample (serology) blood test and ID certification, including a phlebotomy/sample taking appointment at The Health Equation £130 and includes an ID check and certification from The Health Equation.
  2. SARS-CoV-2 IgG ANTIBODY home sample capillary (finger prick) blood test, including next day courier of the kit to your home and postage paid Royal Mail 24 tracked return to the TDL lab £95. THIS TEST IS CURRENTLY UNAVAILABLE.
  3. SARS-CoV-2 PCR ANTIGEN SWAB clinic sample test and ID certification, including a sample taking appointment at The Health Equation £195 and includes an ID check and certification from The Health Equation.
  4. SARS-CoV-2 PCR ANTIGEN SWAB home sample collection test including next day courier of the kit to your home and postage paid Royal Mail 24 tracked return to the TDL lab £165.
  5. Urgent samples. It can also be arranged for a TDL medical courier to bike urgent sample collection kits to a person, wait for the sample and then returned to TDL ASAP, this is an extra charge and quoted separately, depending on which part of the UK you live.