Written by Dr Robin Warshafsky, General Practitioner and adviser to Dr Morton’s – the medical helpline

As we embark on 2021 today, my goodness, what a time we are all coping with! The third wave of the COVID-19 pandemic in full flow, and our personal and National resources stretched to the max. And now in the middle of winter when chest infections and other illnesses become more common anyway.

“Chest infection” is not a precise medical term,and it is widely used when someone simply has a nasty cough and is bringing up phlegm. Chest infections can be caused by viruses, bacteria or (in very rare cases) fungi, and can affect any part of your lungs. If an infection involves the small air sacs (alveoli), where oxygen passes from the air into the blood vessels and carbon dioxide goes in the opposite direction, this is called ‘pneumonia’. Viral pneumonia is commonest, but bacterial pneumonia is quite common and due to the seriousness of this condition antibiotics will be needed; sometimes intravenously, in other words in hospital and through a drip into a vein. Extra oxygen will also be needed.

Everyone’s anxiety levels are greatly elevated at the moment due to the chest and whole body infection with the coronavirus, COVID-19. Originating in China, this virus has now spread across the world, such that the WHO declared the situation to be a Public Health Emergency of International Concern (PHEIC) in the same way as they did for the Ebola, Zika and swine flu outbreaks. Interestingly any new human influenza outbreak is automatically a PHEIC so no declaration is needed. On March 11 2020 the COVID-19 outbreak was declared a pandemic. On 30 March 2020 the UK went into ‘lockdown’ to try to prevent further spread and protect NHS resources from being overwhelmed. Since then there have been further lockdown measures both in the UK and around the world. A rapidly spreading new variant has forced the UK to take drastic action over the Christmas period to stem the rate of spread. At the time of updating this article there have been hundreds of thousands of cases of COVID-19 infection confirmed in the UK with over 70 thousand deaths. The elderly and people with other health issues have been the most vulnerable and there has also been a disproportionate number of deaths in people from black, Asian and other minority ethnic groups. This has rightly prompted a deep look into why this might be and action taken to protect vulnerable groups.

Clearly this is a call to be sensible and abide by the government regulations with regard to wearing of face masks and staying at home except when entirely necessary. Simple precautions like coughing into a tissue and binning it carefully together with scrupulous hand hygiene; social distancing and wearing masks on public transport and in shops is mandatory. There is, however, absolutely no need to panic.

How do you tell if you have pneumonia rather than a milder upper respiratory tract infection like acute bronchitis?

Sometimes it can be hard to tell whether a patient has pneumonia or an upper respiratory tract infection like acute bronchitis. The gold standard method to tell the difference is to have a chest x-ray, however, it is not always convenient and, although the radiation dose from an x-ray is small, taking x-rays unnecessarily should be avoided. Most of the time doctors rely on the patient’s symptoms and history when determining which disease they have, and therefore what is the best treatment.

Currently people who are unwell are being advised to ring NHS 111 to be told where (if needed) they should attend for viral swabs to be taken. Many people are ringing Dr Morton’s for advice which is fine, but if our doctors feel that there is a possibility of COVID infection the next step will be to ring NHS 111 as they have been asked to coordinate where in any particluar location patients are sent for testing or indeed admission to hospital. Please ring us if you are worried.

Pneumonia will usually be associated with a fever above 38.5°C. Patients with pneumonia have air sacs that are full of fluid. Therefore, it is difficult for gas exchange between the blood and the air to occur. This may lead to patients feeling out of breath, and consequentially they may breathe faster and have a high heart rate. Measurement of ‘oxygen saturation’ of the blood has proved a very useful test when deciding if a patient with COVID chest infection needs admission to hospital. A pulse oximeter can be boughtly inexpensively and is easy to use. There may also be a sharp pain in the chest with breathing in. It can be anywhere, but usually occurs only on one side. It is caused by the infection in the lung causing inflammation of the smooth lining of the surface of the lung, which then irritates the corresponding smooth lining of the inside of the chest cavity. This is called pleurisy.

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When the doctor examines the chest, he or she might find signs that are highly suggestive of pneumonia. These include hearing “crackles” in the area of the lung where the infection is, and dullness when the chest is tapped with the fingers instead of a hollow sound. The lack of resonance indicates a buildup of fluid and inflammatory products in the normally very aerated lung tissue. There may also be changes in the way your voice feels and sounds when your chest is examined with hands and stethoscope.

What treatment can I expect for pneumonia?

How can I stop myself from getting a chest infection?

There are measures you can take to help reduce your risk of developing chest infections, and to stop them spreading to others. Pneumonia usually develops after you get a viral infection, so taking steps to reduce your chances of getting sick will cut your risk of developing this disease. Sensible precautions include:

• good hygiene – although chest infections aren’t generally as contagious as other common infections such as flu, you can catch them from others when they cough and sneeze. Avoid close contact with unwell people.
• stop smoking – if you smoke, one of the best things you can do to prevent a chest infection is to stop. Smoking damages your lungs and weakens your defences against infection.
• alcohol and diet – excessive and prolonged alcohol misuse can weaken your lungs’ natural defences against infections and make you more vulnerable to chest infections. If you drink alcohol, do not exceed the recommended daily limits (three to four units a day for men and two to three units a day for women). Eating a healthy balanced diet can help strengthen the immune system, making you less vulnerable to developing chest infections.
• vaccinations – if you are at an increased risk of chest infections, your GP will recommend being vaccinated against flu and pneumococcal infections (a bacterium that can cause pneumonia). These vaccinations should help reduce your chances of getting chest infections in the future. It is with huge excitement that vaccines are now available to protect against COVID-19. It is little short of a miracle that the scientists and laboratories who have worked so hard, have developed and tested these vaccines in under a year, and brought them to market. Their safety and efficacy have been rigorously tested by the regulatory body in the UK, and we strongly recommend that you have a vaccination just as soon as you are offered it. It is a two part vaccine with some debate currently about the timing of the second dose.

Flu and pneumococcal vaccinations are usually recommended for:

• babies and young children
• pregnant women (flu jab only)
• people aged 65 and over
• people with long-term health conditions or weakened immune systems

So, don’t panic; wash your hands, and remain socially distanced. Life will start again as soon as the numbers of cases is falling and immunity kicks in with sufficient numbers of vaccinated people.