Lifting Lockdown

LIFTING LOCKDOWN Tips from a GP A practical and inclusive guide to moving forward safely in the COVID-19 pandemic DR FARHANA RAHMAN LIFTING LOCKDOWN Tips from a GP DR FARHANA RAHMAN Dr Farhana Rahman is a London-based GP. She writes at www.happywisewell.com Design by Ed Blunt www.edbluntdesign.co.uk Note: This guide is intended to be a reference and does not replace government guidelines. It contains principles and advice that must be taken in the context of latest official government recommendations, so please stay up to date with these as they are rapidly changing. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this document. Any views or opinions expressed in this document represent the views of the author and do not represent those of the people, institutions, organisations or employer that the author is associated with, unless explicitly stated. Any views or opinions are not partisan to or intended to malign any religion, ethnic group, organisation or individual. All data and guidelines correct as of June 2020. Copyright © 2020 Farhana Rahman. GMC registration: 7021329 CONTENTS Acknowledgements . IV Forewords �� V Executive Summary . VII Key Points . XI Introduction ��XVIII Part I: Easing lockdown does not mean ‘back to normal’ . 1 Avoiding infection . 2 Curbing Infection . .12 The impact of COVID-19 on BAME communities . 16 The Case of Belly Mujinga. 24 Back to work ��26 Part II: COVID-19 Toolkit . 32 How to prepare . 33 If you get COVID-19 . 37 A. Managing symptoms . .37 B. Monitoring symptoms . .39 C. Packing a hospital bag �� 40 D. Managing in an emergency �� 40 E. Post COVID-19 Syndrome . .41 Health beyond COVID-19 . 43 A. Children �� 44 B. Pregnancy . 45 C. Contraception �� 46 D. Mental health . .47 E. LGBTQI health needs in the pandemic �� 48 F. Domestic abuse . 49 G. GP services �� 50 H. Hospital services �� 50 I. In a medical emergency �� 50 J. Bereavement �� 50 K. Wellbeing in the pandemic . .52 References . 58 ACKNOWLEDGEMENTS For Sumiyya, Osman and all those who have lost loved ones to the COVID-19 pandemic. May their souls rest in eternal peace. With support from: Bangladeshi Doctors British International Black Medical Doctors’ Association in the UK Society Doctors Association Society UK African & Caribbean C ACDental AssociationA UK African and Caribbean Ask Doc Melanin Medics Muslim Doctors Dental Association UK Association With thanks to: • Professor Dame Donna Kinnair and Dr Bob Gill for their invaluable support in writing forewords for this endeavour. • Dr Hina J Shahid for her contributions to the COVID-19 Toolkit • The Team: Dr Mursheda Chowdhury, Dr Farzana Rahman and Jane Rahman for their help, advice and encouragement throughout. • My mother, Faozia Rahman for the endless childcare that made this possible and for reminding everybody that Bangladeshi women are superheroes, not statistics. • And a huge thank you to Ed Blunt: talented musician, visionary artist and faithful ally in the pursuit of a fairer and more equal society. Thank you for donating your time and expertise to this project, even when it seemed like the references would get the better of us. IV FOREWORDS By Dr Bob Gill and Professor Dame Donna Kinnair The Coronavirus pandemic has had a profoundly disruptive impact on the nation with an enormous human and economic toll. People are worried and confused about the future and learning to live with the infection still present in our communities. Lifting Lockdown provides a comprehensive, clear and practical guide to reducing the risk of coronavirus on individuals, their families and the wider society, drawing on best evidence from a wide variety of sources. This well-structured and easy to read booklet provides useful information and pragmatic advice to help people safely navigate the ongoing uncertainties ahead. Dr Bob Gill GP and NHS campaigner This publication, Lifting Lockdown, is a guide to coming out of lockdown safely for vulnerable groups within our communities by Dr Farhana Rahman, a London-based General Practitioner. It has come at the right moment in time as the restrictions imposed since March begin to be eased. The resource aims to provide balanced, culturally informed advice on returning to the ‘new normal’ safely that is sensitive and reflects people’s lived experiences. It is important for communities to see leaders in health and wellbeing like Dr Rahman who is BAME herself taking responsibility for advising local populations and wider communities in alternative ways as face to face contact with our health care practitioners continue to be restricted. V Lifting Lockdown: Tips from a GP The COVID-19 pandemic has transformed the way in which we have all lived our lives and it has been a challenge for us all no matter what our circumstances are. What started as a three week lock down has extended to 14 weeks and the impact on the physical and emotional health on individuals is now being recognised. A particular component of the emerging evidence has been the clear link to ethnicity, with those in BAME groups being disproportionately affected by this virus and hence it is right that we are placing emphasis on how these individuals safely come out of lockdown, taking advantage of the learning we have to date. At the start of the pandemic little was known about the virus. As the pandemic has progressed, we have more information and data to guide decision making and thus keep people safe. As lockdown restrictions are lifted, resources that provide clear and accurate information for our most vulnerable groups and people from all ethnicities in maintaining their safety while returning to their lives are to be welcomed. This well written, easy to understand guide contains much of the latest practical information that will help patients and their families support themselves to stay alert to the corona virus risk and stay safe. Professor Dame Donna Kinnair DBE Chief Executive & General Secretary Royal College of Nursing VI EXECUTIVE SUMMARY The aim of this document is to provide a comprehensive guide to coming out of lockdown safely. It offers insights and suggestions that draw upon relevant data and professional expertise to form a framework that can be used in conjunction with official government recommendations. With the presence of Coronavirus forecast to be with us for the foreseeable future, this guide acknowledges the risks faced by vulnerable groups and offers balanced, nuanced advice that is sensitive to how people actually live as we find our way together in establishing the ‘new normal’. Whilst the spread of Coronavirus is decreasing, the infection itself has not gone away and its capacity to cause harm through sickness and death remains unchanged. Vulnerable groups including Black, Asian and Minority Ethnic (BAME) communities have been the worst hit by the virus and there is little to suggest this disparity will change as lockdown is lifted. At the same time, the harms of lockdown have been far-reaching and now outweigh the benefits to society. Therefore, acknowledging Coronavirus risk, being aware it’s not evenly spread and having a system to manage this in our day-to-day lives will allow us to ‘stay alert, control the virus and save lives’ as we move forward together. This system can be divided into two parts: Avoiding Infection and Curbing Infection. VII Lifting Lockdown: Tips from a GP Avoiding Infection asks everyone to consider: A) risk of harm from Coronavirus and B) risk of spreading/catching Coronavirus in relation to their interactions. When assessing the risk of harm from Coronavirus, each person can think of their individual risk, the risk to those close to them and the risk to society. A ten-point checklist has been devised for this purpose using the Public Health England (PHE) Disparity Review findings and existing PHE guidance. The checklist is a reminder of the groups who have been found to have worse outcomes from infection. If a person finds that much of the checklist applies to them, they are at increased risk of harm from Coronavirus – they should take extra care when interacting with others (as detailed in part B), seek prompt medical attention if concerned about symptoms

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