By Dr. Vidal Crescencio III
This is the NEW NORMAL. It is HERE. It is a REAL!
(EDITOR’S NOTE: Dr. Vidal Crescencio III earned his Doctor of Medicine degree from the Cebu Institute of Medicine. He completed his undergraduate studies at Silliman University, earning the degree, Bachelor of Science in Biology. Dr. Cresencio practiced Anesthesia and General Medicine in the Philippines from 1986 to 1998. He served as the first company doctor of Alturas Supermarket Corporation and held the position for three (3) years. He also has a diploma in Computer Programming from the Computer Learning Center in San Francisco. California. In addition to all these, he earned another diploma in Interior Design from the New York Institute of Art and Design in New York City, New York. He has a license in Phlebotomy from Kaiser Permanente School of Allied Sciences in Richmond, California. Currently, he is a resident physician at the Ramiro Community Hospital in Tagbilaran City.)
The new normal is here, COVID-19 is locally made now or shall I also say can be outsourced, too. But it is here and it is a real!!
After Bohol enjoyed the status of COVID-Free community for more than two months, the reality has already set in, though late but it did come. Let us not forget that the period when Boholanos were able to enjoy a negative Corona case was due to the fact that the provincial government was very fast and decisive in proclaiming a lockdown prohibiting the entrance of people from other places: native Boholanos coming home, or new visitors, or tourists traveling in. Because of that hasty decision of proclaiming a full quarantine for the province, most Boholanos were able to relish a time of peace and hope that the dreaded disease may never come here, ever.
But, for all beginnings there are always endings and sad to say the new beginning had happened, the phase where we will all be counting the “positives”. This is now the period where everybody will be suspicious of everybody. In the last preceding months, news came out about positive results on Patient X and Patient Y; but all those were false alarms because those positive tests were for antibody detection and not the identification of antigens, the collective name for viruses and bacteria, in this case the SARS-CoV-2 (or COVID-19), that invade the human internal system causing infection.
So, what are we going to do now? Many will ask? My answer is move on, zero case or not, life goes on and must go on. This is now, this is reality. Always remember that in real time, there are no rewinds and pause buttons, only play and forward. So what we have now, let it play and look ahead. Will it be worse in front of us? We will never know. So what would it be: ECQ, GCQ or QQQ? Whatever acronym the authorities would put as a label on the current situation, it doesn’t matter anymore. It is because aside from a large part of the population who are naturally born hard-headed, stubborn. Insistent on not following preventive guidelines and protocols, the authorities or groups assigned to do the task of managing the pandemic problems also committed a lot of lapses from the start.
- First and foremost they should have invested more money in procuring test kits that yield more accurate results and more specific for the Beta Corona viruses. I have been beating the drum on this idea in my FB posts from the earlier stage of this health problem. This particular test that they were using earlier does not tell you if a person has COVID-19. It will only tell you that there was an infection happening earlier which could be either viral or bacterial. They used Rapid Test which detects antibodies and which presence in human blood means an infectious process had already occurred and may have been fully consummated already. Furthermore, the individual who was tested with antibodies present in the blood may not be infectious anymore since most or all viruses had broken through barriers of resistance, went into the blood stream triggering the mass production of immunoglobulins commonly called antibodies. The presence of IgM, which is the first of the antibodies produced during and infectious process or the IgG which is the last ones produced, signifies the end of the active infection cycle. Their presence signals that at least an infectious process had occurred 7 to 28 days prior. Rapid Antibody Test is mainly used for screening and monitoring purposes, to monitor or screen possible antibody-rich-plasma donors to patients who are inflicted with the disease and are immunologically compromised making his or her body unable to react fully to the invading antigen and cannot produce its own antibodies. The process of testing that they should have followed from the start is the one that the more industrialized countries utilized. Obtain swab specimen from nasopharyngeal and oropharyngeal areas and send for RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) Test, the test to “DIAGNOSE” COVID-19, although not very strain specific but CORONA Specific. If this test yields a positive result it means the person is harboring the culprit organism and is still contagious or infectious at this stage even without signs and symptoms. Studies showed that the contagious stage is when the virus is still in the naso-oropharyngeal areas which can be spread from person to person through droplets, via the saliva or nasal discharges. Once they break the barriers of human body’s defenses, the infectious cycle commences.
- Second lapse in their management. If the province was able to procure machines that will process swab specimens, now why were they not able to do that during the early days of the pandemic. It should have been easier to send specimens for processing and faster turnaround of results thus having convenience in the decision on what level of precautionary measures will be done.
- Another mishap and/or oversight committed was that the authorities should have started the LSI and Oplan Exodus much earlier, shortening the time of exposure of these unfortunate kababayans who were stranded from everywhere. The LSIs (locally stranded individuals) should have been “entertained” first because these were the groups most probably more cash-strapped compared to the OFWs. And besides that, those coming home from abroad were much better screened than the denizens. If these were planned and done in the early phase of this public emergency, the length of so much angst and apprehension could have been shortened and we could have already been on the downside of the peak at this time. We should not be faulting the influx of the LSIs and OFWs as the cause of this upward census of the “positives”. Let us just accept the fact that our enemy is invisible through our naked eyes and nobody chooses to get infected or plans to infect somebody. This is just part of the natural course of any epidemic.
There are now 18 recorded individuals with positive PCR Test result in Bohol. What happened? What went wrong? The increase happened within a period of a little over a month. This rise can be attributed to the period after the implementation of the Oplan Exodus and LSI programs. Are we going to blame the provincial government for this? I don’t know, but personally, I say, probably not? First of all these Boholanos have the right to come home and they should be granted the privilege to come back sooner than later. It is because during dire times like this one, it is always comforting and healing when you are beside your loved ones, much so, when you unfortunately contracted the disease. In doing so, however, any local (provincial) government should do in its power the best way possible to bring them all home safe for all parties affected, all Boholanos. I am not well versed on how the expatriation was done but they should have strictly followed a safe and thorough process. First, “expats” should be tested using PCR and quarantined for 14 days in the locale where they came from before letting them travel back home.
1. Those who are “symptomatic positive” must be treated and (retested after therapy again with PCR if feasible and affordable) tested for Rapid Antibody to document whether the individual’s immune response is working right with the presence of immunoglobulins (antibodies) in their circulatory (blood) system.
2. Those who are “asymptomatic positive” should complete a 14-day quarantine and tested for Rapid Test after the quarantine period with the same purpose which is to document whether or not the individual’s immune response is working right with the presence of immunoglobulins.
3. Those negative ones should be allowed to go back home sooner and quarantined immediately for 14 days as soon as they arrived here then tested for Rapid Antibody to check if any immunoglobulins were formed.
If all 3 groups were having positive results for Rapid Antibody test, they are now okay and safe to mingle with the general population. Only those with positive results for PCR, symptomatic or not are considered contagious and are not safe for release to the community.
There is no blaming now because one way or another, these people who are now tested positive, will eventually go home when all travel forms are opened ultimately. At least under this program if someone is positive for the diagnostic test which is the PCR swab, they can be monitored constantly, properly isolated, promptly treated and the contact tracing is much easier plotted and pursued.
What the authorities can do now is to strictly impose their established protocols and be fully followed through not just in the suburbs but also in the rural areas.
Three things I would suggest to be continued and fully and strictly implemented with penalties (500.00 per violations) if violated: These are more practical and essential.
1. Wear mask all the time if you are out mingling with the public (may not require it if you are driving your own vehicle with members of your family inside)
2. Social distancing at least 6 feet or less if with barriers in between like inside public transportation (exempt the back riders in a motobike if both belongs to the same family, couples, siblings, lovers) Habalhabal and other passenger picking bikes should not be included in the exclusion
3. Wear your quarantine pass all the time. Do not put it inside a bag, purse or pocket. Hang it around the neck all the time if you are outside your house. It is your tag seen from a distance that you are allowed to roam that day. I wear it all the time and it is not fair if others don’t hang it.
Continue to implement rulings on the public transportation and the weekly schedule of who can come out of their homes, who can, which day.
With regards to washing of your hands with soap and water and splashing them with alcohol as often as very often, I think this protocol is absurd and unnecessary and should be optional. According to recent findings Coronavirus 2019 cannot be fomite borne (unless you touch a contaminated surface or object and touch immediately your eyes, nose or mouth). It cannot be blood borne, airborne, food borne or sexually transmitted (except with kissing). Aside that, too much washing with soap and alcohol can irritate your skin, it can also kill millions of beneficial bacteria that are naturally friendly and useful to our body.
There was an idea about herd immunity. This can be done but in our current situation, the absence of an effective vaccine will endanger the general population. If the Philippines cannot even afford to test those who are not LSIs, OFWs and the unknown asymptomatic ones, how much more the power to accommodate hundreds of active cases at once.
There are not enough hospitals beds, oxygen machines, ventilators and efficient isolation wards in case the situation becomes pandemic in scope. How about the financial capability of the government to procure enough stocks of Hydrochloroquine, Azithromycin, Zinc Sulfate and Dexamethasone for the therapy regimen? The Philippine health system is, I believe, not capable of coping with an overwhelming scenario of COVID-19 overdose. According to some studies, at least 70% of the population must be immune to the disease or has the appropriate antibodies to fight against an invading antigen/virus to achieve a safe herd immunity process and the only way to get a 30% vulnerable population is by mass vaccination.
Finally, I have read somewhere that out of the 18 cases recorded as having positive PCR tests, 1 died, 10 are active and 7 have recovered. My question is “are these 10 classified as active and 7 classified as recovered having signs and symptoms? If they were asymptomatic as what most reports claimed they are, then there was no recovery that happened and there was no active infectious process occurring. If they were declared asymptomatic then just classify them as is. Label the case as recovered when the person had signs and symptoms, treated and got cured or recovered. Call them active only if they are infirmed because of fever, cough, colds and sore throat, the syndrome of possible Coronavirus infection. And now that the disease is locally transmitted and the Gallares Memorial Hospital has been designated as “COVID-19 only” admitting hospital, why won’t we just send all patients that present with respiratory problems or Influenza Like Infections, with or without fever as a possible COVID-19 case and refer immediately there. Take note that 80% of cases according to the data collected around the world were mild and asymptomatic, only 15% needs oxygenation and 5% needs ventilation. The last two comprising 20% of cases are the MARI and SARI but let us not forget that the bulk of the virus’ occurrence is found in the mild and asymptomatic cases. This is the portion where possibly the majority of population can catch the source, this is where testing should start and this is where success of controlling the spreading further can be curtailed and achieved without a doubt.