By Antonio Moya, MD, MPH and Nico Cabrera, MD
FILIPINOS globally are struggling to make sense of the flood of information coming from social media and news outlets regarding the novel coronavirus disease (named COVID-19) caused by the virus “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).”
Unfortunately, racism and irrational fear against people of Asian descent have not only descended upon our mga kapwa Pinoy, but ironically, some of us have also propagated xenophobia against our fellow Asian sisters and brother in talking about this disease.
As Filipino physicians who treat patients of all ethnicities and backgrounds, both in the Philippines and the U.S., we have one simple message: the racism and ignorance need to stop now. We must empower ourselves to take simple, effective precautions to mitigate the spread of this virus, its resultant disease, and the social biases that come with fear-mongering #iamnotavirus #nosoyunvirus #jenesuispasunvirus
Our main message to our patients and the global Filipino community is this: do not panic. Now is not the time to let feelings of panic and anxiety cloud our judgment. When we simplify the clutter of information out there, breathe calmly, and think positively, we affirm our ability to not only stop the spread of COVID-19, but also the myths that have, no pun intended, gone viral.
There is a calm way to respond to COVID-19 that gives this important issue its due attention. This involves gathering accurate information about the virus through trusted health professionals from agencies like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
COVID-19: Where things stand
On Jan. 30, 2020, the WHO declared the COVID-19 outbreak a public health emergency of international concern. As of Friday, March 6, there have been 101,587 confirmed cases globally with 2,931 deaths in mainland China and 14 deaths in the United States, according to researchers at John Hopkins University. The CDC reported that there have been over 250 cases detected and tested in 20 states in the U.S, according to the New York Times. In the Philippines, the Department of Health website reported five confirmed cases as of Friday and 537 persons whose testing was negative.
This roughly amounts to 1 case for every 7 million people in the U.S. and one case for every 35 million people in the Philippines. In contrast, the CDC estimates that between October 1, 2019, and February 22, 2020, about 35 to 45 million people in the U.S. have fallen ill with influenza and 18 to 46 thousand have died.
As of March 4, Los Angeles County has also declared a public health emergency in order to execute more efficient management of government resources to stopping COVID-19.
Signs and symptoms of COVID-19
In the largest study of patients hospitalized with a diagnosis of COVID-19 in China reported by Guan, et al., in the New England Journal of Medicine, Feb. 28th, almost 9 out of 10 experienced fever while almost 7 out of 10 had a cough. Symptoms like body or joint aches and pains, sore throat, difficulty breathing and headache were less common and diarrhea was very infrequent. It is likely that many patients who have been infected with this virus do not experience any symptoms, much like other infectious diseases like the seasonal flu.
Diagnosis, treatment, and prognosis of COVID-19
The test to diagnose COVID-19 is a polymerase chain reaction (PCR) test, which picks up fragments of the DNA of the virus. This test is run on several different samples such as swabs from deep inside the nose and from the back of the throat. The best sample is fluid from deep in the lung. It can be collected by having the patient cough up phlegm or, if the patient is sick enough, using a tube inserted down the air pipe to collect fluid.
Facilities will vary with respect to their readiness to care for patients suspected of COVID-19. Emergency rooms are more likely to have rooms equipped to accommodate patients in a manner that minimizes the risk of transmission to others. Primary care or urgent care clinics are unlikely to be similarly equipped.
There is no specific treatment for COVID-19 like in many viral respiratory illnesses. The best treatment we can offer as medical professionals is supportive care—close monitoring and interventions that support breathing and oxygen delivery, blood pressure and circulation as well as other organ functions—while giving the body time to heal. Some medical centers have tried certain antiviral drugs against MERS, SARS and HIV, but it is not yet clear if these treatments have any benefit. Development of a vaccine is currently underway however one will likely not be available for at least another year to a year and a half (past March 2021), thus prevention is key!
We are in the middle of the outbreak and are still learning much about COVID-19. In the study from China above, the number of patients who die among the total number of patients diagnosed is at 1.4% or fewer than two deaths out of every 100 cases. Many experts feel that 1.4% is an overestimate given that it has been difficult to determine by symptoms alone who is actually infected with the virus. In contrast, for SARS in 2002, this fatality rate was close to 10 out of every 100 and for MERS in 2012, it was just under 40 out of every 100.
Here are the top 10 essential tips to share among our fellow Filipinos globally:
1. Wash your hands mindfully with water and soap, for a duration of at least 20 seconds (think of singing the “Happy Birthday” song) or use hand sanitizer to disinfect hands. Stick with reputable hand sanitizers with 70% alcohol content. Do not create your own hand sanitizer!
2. Only wear a surgical mask if you are coughing and sick. Wearing a mask is not recommended for healthy people and should be reserved for medical professionals only, especially due to shortages of supplies. If wearing a mask, replace after 24 hours of use as effectivity is lost with repeated use. Avoid the use of cloth masks as these can dampen and are ineffective.
3. Do not touch your face, mouth, or eyes with unwashed hands. Do not apply disinfectant alcohol to your face directly as this can damage one’s eyes.
4. Please DO NOT cough into your hands! If possible, cover your mouth and nose with a tissue when you cough or sneeze and put tissue into the trash. Avoid use of a cloth handkerchief. If you don’t have a tissue, cough or sneeze into your upper sleeve and elbow, not your hands. Worst of all, do not spit on the floor or at home to prevent the spread of diseases.
5. Avoid being within one meter (about three feet) from someone who is coughing. Avoid touching contaminated public objects that can be homes for viruses. The virus can stay on a surface for hours at a time.
6. Look to official local government websites, such as the CDC, for the latest recommendation on travel. One of the most important things is that if you are taking medications daily, making sure that you have at least a 14 days supply of those medications in case of a possible 14-day quarantine
7. Do not spread false news about COVID-19. It is crucially important to verify the news you obtain. Sensationalist headlines only stir up panic.
8. If you start to develop cold-like symptoms, do not go to work and be mindful of not spreading your sickness. If you are sick, it is more reasonable to wear a mask. Avoid coughing on objects or on others. Journal your symptoms if need be in order to track the progression of your sickness. Talk to your primary care physician to determine if you should be tested for COVID-19 if you have a high suspicion of the disease.
9. Common myths regarding things, such as eating more garlic, ginger, over-hydrating, smoking more, avoiding Chinese food, using sun or heat to “kill” the virus, and even drinking alcohol to disinfect your stomach are harmful and have no place in our community. There are no home remedies for COVID-19 but to stay adequately hydrated and seek medical care only if one is having severe symptoms such as shortness of breath or unabating fever.
10. Lastly, Do not panic! As the director of the WHO has stated, “The greatest enemy we face is not the virus. It’s the stigma that turns us against each other.”
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Dr. Antonio Moya is a board-certified neurologist and public health practitioner in the Filipino American community of Los Angeles County. He received his medical and research training at UCSF, New York Presbyterian Weill Cornell Medical College/ Memorial Sloan Kettering Cancer Center, UCLA, and his public health training at the Harvard T.H. Chan School of Public Health.
Dr. Nico Cabrera is a board-certified internal medicine specialist and an infectious disease fellow in the immunocompromised track of the University of Texas Health Science Center at Houston jointly with the University of Texas MD Anderson Cancer Center. He received his medical education at the University of the Philippines College of Medicine and residency training at the John H. Stroger Jr. Hospital of Cook County in Chicago.