Last updated 25th January 2022.
What can I do to keep myself safe?
Am I at increased risk?
What should I do if I feel unwell?
Is there a treatment for COVID-19?
What about the COVID-19 vaccine?
What should I do if I think I have been in contact with someone with COVID-19?
Should I send my child to school?
How can I socialise safely?
Should I self-isolate or work from home?
What should I do if I have a holiday planned?
Will I still be able to access my medicines / do I need to stockpile?
How you can help
What can I do to keep myself safe?
Please follow national guidance on what you can do to keep yourself safe. The guidance changes regularly, so it is important to keep updated. According to the UK Health Security Agency (UKHSA) guidance, all cardiothoracic transplant patients are clinically extremely vulnerable.
The shielding programme ended in England on 15 September 2021, which means that people who were previously considered clinically extremely vulnerable are now not being advised to shield. There is specific guidance for people whose immune system means they are at higher risk of serious illness if they become infected with COVID-19, which can be found here.
At Harefield we have taken steps to reduce face-to-face appointments for patients who are well, so you may be asked to attend a telephone or video appointment instead. We are still arranging face-to-face appointments for patients who need specific investigations, urgent medical advice or need to be seen following a virtual consultation. The decision to increase the number of face-to-face appointments will be reviewed on an ongoing basis, as the threat level of COVID-19 changes.
Transplant patients and people in their household should continue to practice good hand and respiratory hygiene:
- Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel.
- Wash your hands often with soap and water. Use a sanitiser gel if soap and water are not available.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid close contact with people who are unwell.
- Keep indoor areas well ventilated with fresh air, especially shared living areas.
Am I at increased risk?
There is increasing data on the risk of COVID-19 in patients who have had a cardiothoracic transplant. People who are immunocompromised following a transplant are known to be at increased risk of developing severe illness, according to data collected by NHS Blood and Transplant (NHSBT).
The latest NHSBT report on COVID-19 in cardiothoracic transplant recipients published in October 2021 shows that 10.8% of lung transplant recipients and 9% of heart transplant recipients in the UK tested positive for COVID-19 since the beginning of the pandemic, with mortality rates higher in lung transplant patients, which indicates the impact respiratory viruses - in this case COVID-19 - can have on lung transplant recipients. The full report can be found here.
While this data may be concerning, it is important to note that the patients captured in the data had not yet received a primary third dose and booster vaccination, while some patients had not been vaccinated at all. New treatments have also been added to our arsenal since the publication of this report, such as monoclonal antibodies and molnupiravir which we are hopeful will affect the mortality of cardiothoracic lung transplant patients. Please see section below for more information.
It seems reasonable to believe that all patients who have had a transplant will be at increased risk of severe infection especially if they have established graft damage that has occurred since transplant or another risk factor (age, ethnicity, obesity, co-morbidity such as kidney dysfunction).
Growing evidence suggests that wearing a face covering can reduce the spread of COVID-19. All patients coming to our hospitals must wear a face covering while in our buildings. If you do not bring a face covering with you, you will be given one on arrival by a staff member at the hospital entrance. Further information on this can be found here.
What should I do if I feel unwell?
You should not go directly to your transplant centre unless specifically advised to do so by a member of the transplant team, but call the transplant team on 01895 823737.
The symptoms of COVID-19 can be like other problems experienced by patients who have had a transplant. You should monitor your symptoms closely, for example if you have had a lung transplant increased vigilance with spirometry is strongly advised.
If you have had a heart transplant, you should contact us in case you develop new symptoms as shortness of breath, cough, etc.
Whether you have symptoms, or you have no symptoms but have got a positive lateral flow test result, it is important you arrange local COVID-19 testing as a matter of urgency. You must self-isolate if you test positive. If you develop serious symptoms such as difficulty breathing, or your oxygen levels drop below 90%, call 999 immediately, and tell the operator that you are a transplant patient and have COVID-19. If you are relatively well and are able to remain at home, there are treatments available (see the next section).
Please remember that health issues unrelated to COVID-19 needing treatment can arise at any time and you may feel anxious about asking for medical help. We are now offering virtual consultations for all our transplant patients, which allows us to assess and help patients remotely. If needed, we will arrange a clinic consultation which can be carried out safely. Please continue to follow advice regarding social distancing and handwashing stringently when on site.
Please get in touch with the transplant team if you have any concerns: 01895 823 737.
Is there a treatment for COVID-19?
There are many clinical trials under way to explore different agents, and the treatments available are increasing as a result. As a transplant team, we are following the scientific developments very closely and we are also participating in a number of clinical trials. There are some treatments available for hospitalised patients only, however, new Covid-19 treatments for the highest risk non-hospitalised patients are now available on the NHS. These have been shown to reduce hospitalisation, and include intravenous neutralising monoclonal antibodies and oral antivirals.
Important information about new treatments for coronavirus should have been sent to you recently by the NHS. Treatment information can be found here. Please read this information carefully and keep a PCR kit at home. As your healthcare team we fully support the use of these medications if they are offered to you. Please get in touch with us if you have any queries or concerns.
What about the COVID-19 vaccine?
As your transplant team, we strongly advise that all patients receive the COVID-19 vaccine. Currently, this means three primary doses and a booster (three months after your third vaccine). Further boosters may be advised in the future. Further information on third primary dose vaccination can be found here. COVID-19 immunisation is encouraged by NHS-Blood & Transplant and the International Society for Heart and Lung transplantation, in patients with advanced heart or lung disease and pulmonary vascular disease, or in those awaiting or following heart or lung transplantation, when a vaccine is locally available.
Vaccines offer protection if you catch the virus, with the aim being to prevent or reduce the severity of illness. Side effects from the COVID-19 vaccine are rare.
You may not be suitable for the vaccine immediately in the following cases. Please get in touch with us to discuss if:
- You have had a heart/lung transplant within the last six months
- You have had a significant increase in your immunosuppression recently such as ECP, TLI, Immunoabsorption, Rituximab or RATG
- You have previously had severe allergic reactions to vaccines.
It is important to note that vaccines alone are not as effective in heart and lung transplant patients. We recommend that you continue to follow national guidance relating to hand hygiene, face masks and social distancing to keep yourself safe, even after vaccination.
For further information about COVID-19 vaccines, please visit: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/
If you would like to find out more about your COVID-19 antibody levels, and help us to better understand how we can support you, then please consider joining the MELODY study, which is specifically designed for solid organ transplant recipients.
What should I do if I think I have been in contact with someone with COVID-19?
Government guidance for contacts of people with confirmed COVID-19 can be found here. Please let your clinical team know so they can monitor you closely. If you start having symptoms, please undertake a PCR immediately and let your transplant team know.
Show I send my child to school?
Children and young people should attend education settings unless their clinician has advised otherwise. When rates of COVID-19 are high in the community, this can be an anxious time for vulnerable people, and your transplant team are happy to discuss ways in which they can support those who are vulnerable with minimal disruption to children’s education.
How can I socialise safely?
No social setting can guarantee that infection will not be transmitted. It is also important to remember that vaccines do not fully protect against infection transmission, and our vulnerable patients do not respond to the vaccines as well as the general population. You can reduce the risk by undertaking a few simple steps beforehand:
- Ensure everyone in the group is vaccinated fully (if possible) at least 14 days beforehand
- Individuals should undertake a lateral flow in the morning prior to gathering
- Wear a face mask
- Limit the number of people at the gathering
- Ensure adequate and continuous ventilation during the gathering - for example, keep a window open in an enclosed space.
Should I self-isolate or work from home?
The government is no longer asking people to work from home if they can. However, if you need support to be able to work from home, do not hesitate to contact us and we will prepare a letter you can show to your employer.
What should I do if I have a holiday planned?
Government guidance on travelling abroad can be found here.
Will I still be able to access my medicines/do I need to stockpile?
We are working closely with our NHS partners e.g. Healthcare at Home, to make sure we continue to have enough supplies of medicines for our patients. If you are currently receiving medicines such as anti-rejection medication from Healthcare at Home, this will continue. The main change people may experience is that drivers may not ask for signature and may stay a safe distance away from patients by setting parcels down and then walking away and watching for recipient to pick them up. No medicines will be left unattended.
How you can help
As usual, make sure you have enough ‘buffer stock’ by keeping at least two to four weeks’ worth of your medicines at all times (as advised by your clinical team), and requesting repeat prescriptions or homecare deliveries well in advance of this supply running out. That will give your pharmacy or homecare provider enough time to deal with any shortages should they arise.
It’s important to note that this is standard practice for our patients and not new advice.
If you are experiencing any difficulty getting hold of a supply of your medicines, or if you have any concerns about their availability, please let the pharmacy team know as soon as possible, please contact the team at Harefield Hospital: transplantpharmacy@rbht.nhs.uk
Further information about coronavirus is available on the NHS website and gov.uk/coronavirus.