June 19, 2020

Challenges of Sickle Cell Carriers In this Covid19 Pandemic.

World Sickle Cell Day 2020

As we know, COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a newly identified pathogen that has not previously been seen in humans. It’s highly contagious and has a different strain with its own characteristics.

Individuals of any age with blood disorders such as sickle cell disease may be at an increased risk of developing serious COVID-19 symptoms. These individuals should follow these guidelines

Here is an overview of the types of guidance and who they apply to:

For everyone: Staying alert and safe (social distancing) – this includes anyone with sickle cell trait (sickle cell carriers)

For all patients with a sickle cell disorder (e.g. HbSS, HbS Beta thalassaemia, HbSC, HbSD, HbSO): Shielding

Guidelines for People With Sickle Cell Trait

The most recent Government advice is that the most important thing we can do is to stay alert, control the virus, and in doing so, save lives. This should be done through:

People and employers should stay safe in public spaces and workplaces by following “COVID-19 secure” guidelines. This should enable more people to go back to work, where they cannot work from home, and encourage more vulnerable children and the children of critical workers to go to school or childcare as already permitted.

You should stay alert when you leave home: washing your hands regularly, maintaining social distancing, and ensuring you do not gather in groups of more than two, except with members of your household or for other specific exceptions set out in law.

You must continue to stay home except for a limited set of reasons but – in line with scientific advice – can take part in more outdoor activities

Family members and caregivers of people with sickle cell disease should take appropriate precautions and extra care to avoid bringing COVID-19 home. They should constantly monitor patients.

They should wear gloves when coming in contact with blood or body fluids of patients with a COVID-19 infection and thoroughly wash clothes and highly-touched surfaces such as counters, doorknobs, bathroom fixtures, and toilets.

If family members and caregivers show symptoms of COVID-19 themselves, they should avoid coming in contact with the patient until the self-isolation period is complete.

Specialists in Italy and England have described an increase in cases of an paediatric inflammatory multisystem syndrome (similar to Kawasaki disease) following the beginning of the pandemic with COVID-19*. This is a very rare syndrome characterised by a high temperature, rash and swollen glands. The treatment includes the use of high dose steroids and the outcome is usually good.

However, this treatment could be detrimental in children who have sickle cell disorder. It is important therefore that a distinction is made between a sickle cell episode and this very rare disease. There can be confusion as symptoms overlap. It is important that you talk to your specialist paediatrician or haematologist if you are concerned about new symptoms occurring weeks after a Covid infection to ensure the right diagnosis is reached.

If you are mildly unwell with a cough or fever below 37.8 oC you should manage your illness at home and not go to your GP or A&E. If you are worried about your symptoms you should call your hospital care team for advice.

If you suspected you have any symptoms of COVID-19 (high temperature and/or new and continuous cough) please contact your centre of care to ensure that you receive the appropriate specialist advice on the need for further assessment.

Due to the impact other infections can have on people living with sickle cell (including pneumonia and acute chest syndrome) anyone with a sickle cell disorder who has a worsening cough, difficulty in breathing or fever above 38 oC should urgently contact their centre of care or in an emergency. Mention you are worried about coronavirus but also that you have sickle cell disorder. They will then instruct you further.

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