front page

Covid-19: Survival of the fittest

March 28, 2020

The more intelligent would rule the less intelligent, or those who were less fit (Victorian England, 1820–1914) Covid-19 outbreak has spread throughout the world.  It reminds us of Darwin’s theory. Survival of the fittest. Corona virus has made the world public panic. Every nation gets suddenly terrorized. The people in any country should keep themselves at home. They have to apply social distancing. The family at home must lockdown. It causes chaoes everywhere. In micro-level—among the families—we can see the affluent families and the poor ones. They have different conditions in reacting to Covid-19. Let us imagine the real situation between the two different economic conditions of the families. And, also in macro-level—among the nations throughout the globe. They have different panorama in tackling the problem and surviving. There is no more beautiful panorama around the world but mentally blurring and dark scenery of the environment. People get mentally stressed. As if Covid-19 both made all the same. No! It makes us all people different in reacting and feeling. For the poor, in micro-level--it is different. When going out, we get scared. When still keeping at home, we get tired. Tired of thinking about how to get a meager meal every day. How to keep the family served with them enough food. Unfortunately, when looking at the fluent families— while keeping themselves at home—they always look to enjoy life. The affluent families can enjoy the beautiful scenery behind their houses. They can enjoy the green and peaceful home yard. On the contrary, the ordinary, and very specifically the poor family, they cannot do it. They have to pursue a meager meal, selling things: food or anything as street vendors, working hard to be public transport drivers, Gojeck as well.  What happens when they lockdown and stay at home? Noone can imagine in such a chaos, panic with Covid-19. For poor families, it is either to die or to live. The alternative is balanced: either A or B. A refers to save themselves by keeping at home. They must stay at home, doing nothing and getting nothing. No, it is the same as when going out. Therefore, they may choose B, to go out. They have to work, for finding a meager meal for their families. That is in  family lives with the different conditions of economic background. On a much wider scale, we can see globally among the nations throughout the globe. Which one is the more intelligent among the people in any country? Which one is the more intelligent among the nations around the globe? They are the winners. They are the quick survivors. They are—of course—the fittest. Technology and the advancement of science dominates. Those that are supported by high technology and superb medical infrastructures quickly flat their Covid-19 outbreak peak. They could detect quickly. They could treat their environment and the victims quickly. And, that is the evidence of looking at the scary Covid-19. In that situation, we can see who will be the winners in the world. Survival of the fittest. Though Darwin’s theory was along time ago introduced, today, it is in practice. It is in reality. Survival of the fittest. The more intelligent, they will control the less intelligent. However, all can be the same when humanity is uphold right. Otherwise, the world will be dominated—if not occupied-- by the most intelligent— and that is the fittest. We will vanish. **** Editor's Note: Dr. Djuwari is the director of language laboratory at STIE Perbanas Surabaya, the editor of some research journals in the Philippines and Indonesia. He is also a journalist in some newspapers in Indonesia; the president of International Association of Scholarly Publishers, Editors, and Reviewers (IASPER).

READ MORE
Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations

March 28, 2020

Scientific brief 27 March 2020 - According to current evidence, COVID-19 virus is transmitted between people through respiratory droplets and contact routes. Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g.  coughing or sneezing,) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets (which are generally considered to be > 5-10 μm in diameter). Droplet transmission may also occur through fomites in the immediate environment around the infected person.7 Therefore, transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g. stethoscope or thermometer). Airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which are generally considered to be particles < 5μm in diameter, and which result from the evaporation of larger droplets or exist within dust particles. They may remain in the air for long periods of time and be transmitted to others over distances greater than 1 m. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed (i.e. endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation). In analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported. There is some evidence that COVID-19 infection may lead to intestinal infection and be present in faeces. However, to date only one study has cultured the COVID-19 virus from a single stool specimen. There have been no reports of faecal−oral transmission of the COVID-19 virus to date. Implications of recent findings of detection of COVID-19 virus from air sampling To date, some scientific publications provide initial evidence on whether the COVID-19 virus can be detected in the air and thus, potentially involve airborne transmission. These initial findings need to be interpreted carefully. A recent publication in the New England Journal of Medicine has evaluated virus persistence of the COVID-19 virus. In this experimental study, aerosols were generated using a three-jet Collison nebulizer and fed into a Goldberg drum under controlled laboratory conditions. This is a high-powered machine that does not reflect normal human cough conditions. Further, the finding of COVID-19 virus in aerosol particles up to 3 hours does not reflect a clinical setting in which aerosol-generating procedures are performed—that is, this was an experimentally induced aerosol-generating procedure. There are reports from settings where symptomatic COVID-19 patients have been admitted and in which no COVID-19 RNA was detected in air samples. In addition, it is important to note that the detection of RNA in environmental samples based on PCR-based assays is not indicative of viable virus that could be transmissible. Conclusions Based on the available evidence, including the recent publications mentioned above, WHO continues to recommend droplet and contact precautions for those people caring for COVID-19 patients and contact and airborne precautions for circumstances and settings in which aerosol generating procedures are performed. These recommendations are consistent with other national and international guidelines, including those developed by the European Society of Intensive Care Medicine and Society of Critical Care Medicine and those currently used in Australia, Canada, and United Kingdom. At the same time, other countries and organizations, including the US Centers for Diseases Control and Prevention and the European Centre for Disease Prevention and Control, recommend airborne precautions for any situation involving the care of COVID-19 patients, and consider the use of medical masks as an acceptable option in case of shortages of respirators (N95, FFP2 or FFP3). Current WHO recommendations emphasize the importance of rational and appropriate use of all PPE, not only masks, which requires correct and rigorous behavior from health care workers, particularly in doffing procedures and hand hygiene practices. WHO also recommends staff training on these recommendations, as well as the adequate procurement and availability of the necessary PPE and other supplies and facilities. Finally, WHO continues to emphasize the utmost importance of frequent hand hygiene, respiratory etiquette, and environmental cleaning and disinfection, as well as the importance of maintaining physical distances and avoidance of close, unprotected contact with people with fever or respiratory symptoms. References Liu J, Liao X, Qian S et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis 2020 doi.org/10.3201/eid2606.200239 Chan J, Yuan S, Kok K et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020 doi: 10.1016/S0140-6736(20)30154-9 Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; doi:10.1056/NEJMoa2001316. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M,et al. Active monitoring of persons exposed to patients with confirmed COVID-19 — United States, January–February 2020. MMWR Morb Mortal Wkly Rep. 2020 doi : 10.15585/mmwr.mm6909e1external icon World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020 [Internet]. Geneva: World Health Organization; 2020 Available from: https://www.who.int/docs/default- source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020 Mar 4 [Epub ahead of print]. Zhang Y, Chen C, Zhu S et al. [Isolation of 2019-nCoV from a stool specimen of a laboratory-confirmed case of the coronavirus disease 2019 (COVID-19)]. China CDC Weekly. 2020;2(8):123–4. (In Chinese) van Doremalen N, Morris D, Bushmaker T et al. Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1. New Engl J Med 2020 doi: 10.1056/NEJMc2004973 Cheng V, Wong S-C, Chen J, Yip C, Chuang V, Tsang O, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020 Mar 5 [Epub ahead of print]. Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020 WHO Infection Prevention and Control Guidance for COVID-19 available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine DOI: 10.1007/s00134-020-06022-5 https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19 Interim guidelines for the clinical management of COVID-19 in adults Australasian Society for Infectious Diseases Limited (ASID)  https://www.asid.net.au/documents/item/1873 Coronavirus disease (COVID-19): For health professionals. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals.html Guidance on infection prevention and control for COVID-19 https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html Infection prevention and control for COVID-19 in healthcare settings https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-covid-19-healthcare-settings Infection Prevention and Control (IPC) for Novel Coronavirus (COVID-19) Course. https://openwho.org/courses/COVID-19-IPC-EN

READ MORE
Address uneven distribution of health workers in PH—PIDS study

March 28, 2020

A STUDY of state think tank Philippine Institute for Development Studies (PIDS) found that Filipino healthcare professionals are more likely to work in areas where earnings are potentially high and near communities where they were trained. According to PIDS Senior Research Fellow Michael Abrigo and former PIDS Research Associate Danica Ortiz, authors of the study “Who Are the Health Workers and Where Are They? Revealed Preferences in Location Decision among Health Care Professionals in the Philippines”, the supply of healthcare workers such as nurses, physicians, and midwives are highly uneven in terms of their geographic distribution in the country.   The authors noted that the composite density of physicians, professional nurses, and professional midwives in the Philippines reached 40.8 per 10,000 population in 2015.   This was above the thresholds recommended by the World Health Organization (WHO) in 2006 and the International Labour Organization (ILO) in 2011. The WHO proposed “a density of 23 skilled health care workers, comprising of physicians, nurses and midwives, per 10,000 population”, while the ILO suggested “a density of 34 physicians, nurses and midwives per 10,000 population”.   Subsequently, WHO updated its threshold to 45 skilled healthcare workers per 10,000 population in 2016 while ILO updated it to 41 per 10,000 population in 2014.   While these international metrics suggest that there is a sufficient supply of healthcare workers in the Philippines, Abrigo and Ortiz argued that this is not the case based on the country’s disaggregated data on health human resource (HHR) density.   “Less than 25 percent of cities and municipalities have HHR density above the 41 physicians, nurses and midwives per 10,000 population recommended by the WHO [in 2016]. This leaves as much as three-quarters of cities and municipalities in the country with potentially insufficient number of HHRs to provide healthcare services,” they explained.   The authors also found that these cadres of healthcare professionals are more likely to work in cities and municipalities that have greater access to amenities like hospitals and clinics. However, they are less likely to work in areas with high levels of ethnic concentration.    The continuing maldistribution of healthcare workers can aggravate the country’s problem on limited access to healthcare services.   To address this issue, the authors highlighted some policy considerations in designing programs that will attract and retain healthcare workers especially in underserved areas.   One is to boost household incomes through local economic development, which is “essential in ensuring the economic viability of any professional practice, particularly in health care”. The role of the private sector should also be strengthened in providing healthcare services to the people. “Supporting private healthcare practices through the country’s social health insurance system or a similar voucher scheme may provide greater incentives for healthcare workers to practice in underserved areas,” the authors said. They also proposed for the reassessment of common- and deep-rooted beliefs on healthcare professional practice. However, they pointed out that “although altruistic motives among healthcare practitioners to serve in rural areas may be important in recruiting HHR for rural practice, it may not necessarily be the most sustainable.”     The authors also suggested using technology as an alternative mode of service delivery, particularly in conducting remote medical consultations and diagnosis, and in record management.   Lastly, they recommended the “certification of some primary healthcare skills that may be done by other cadres of healthcare professionals, instead of relying on the limited supply of physicians.” They cited as an example nurses in the United States, Canada, and the United Kingdom who are certified to assess patients’ needs, interpret diagnostic and laboratory tests, prescribe medication, and formulate treatment plans. This strategy may also be explored in the Philippines, the authors said.

READ MORE
Health exec: No Covid-19 positive patients in barangays Nazareth, Patag

March 28, 2020

CAGAYAN de Oro City--A health official has belied reports that there are Covid-19 positive patients from barangays Nazareth and Patag. "Walay taga-Nazareth ug Patag nga nagpositibo sa coronavirus disease 2019 (Covid-19)," said Dr. Rachel Dilla, assistant city health officer, during the special session of the City Council held last Wednesday. Dilla clarified that there is only one Covid-19 positive patient in Cagayan de Oro City. "Kini mao kadtong nabalita nga 71 anyos nga lalaki nga naggikan sa numbered barangays sa syudad ug adunay travel history gikan sa San Juan City, Metro Manila." The health official said the city government of Cagayan de Oro was even grateful to the Covid-19 positive patient for the cooperation and for following the needed protocol to prevent the spread of the dreaded disease. According to the Power, a daily newsletter of the City Council, the Covid-19 positive patient opted to return to the Northern Mindanao Medical Center (NMMC). The patient is now undergoing quarantine, the report said. It said the Covid-19 Response Team has already conducted disinfection at the patient's residence. On one hand, Dilla said that the City Health Office (CHO) and the  Department of Health (DOH) have already conducted the contact tracing. For his part, Councilor Ian Mark Nacaya urged residents not to immediately believe in what they read in the social media, especially if the information did not come from reliable sources. Health exec: No Covid-19 positive patients in barangays Nazareth, Patag CAGAYAN de Oro City--A health official has belied reports that there are Covid-19 positive patients from barangays Nazareth and Patag. "Walay taga-Nazareth ug Patag nga nagpositibo sa coronavirus disease 2019 (Covid-19)," said Dr. Rachel Dilla, assistant city health officer, during the special session of the City Council held last Wednesday. Dilla clarified that there is only one Covid-19 positive patient in Cagayan de Oro City. "Kini mao kadtong nabalita nga 71 anyos nga lalaki nga naggikan sa numbered barangays sa syudad ug adunay travel history gikan sa San Juan City, Metro Manila." The health official said the city government of Cagayan de Oro was even grateful to the Covid-19 positive patient for the cooperation and for following the needed protocol to prevent the spread of the dreaded disease. According to the Power, a daily newsletter of the City Council, the Covid-19 positive patient opted to return to the Northern Mindanao Medical Center (NMMC). The patient is now undergoing quarantine, the report said. It said the Covid-19 Response Team has already conducted disinfection at the patient's residence. On one hand, Dilla said that the City Health Office (CHO) and the  Department of Health (DOH) have already conducted the contact tracing. For his part, Councilor Ian Mark Nacaya urged residents not to immediately believe in what they read in the social media, especially if the information did not come from reliable sources.

READ MORE
World leaders hold emergency virtual summit thru video call to address covid-19 crisis 

March 27, 2020

VIRTUAL MEETING OF WORLD LEADERS VS CORONAVIRUS DISEASE DUBAI (MDN International News)  — A top-ranking official of the United Nations has challenged leaders of the 20 major industrialized countries of the world Thursday (March 28) that "the world is at war with a virus - and not winning it," even as countries implemented stringent measures to contain the deadly coronavirus disease. (covid-19)    The G20-member nations are made up of 19 countries and the European Union. The 19 countries are Argentina, Australia, Brazil, Canada, China, Germany, France, India, Indonesia, Italy, Japan, Mexico, the Russian Federation, Saudi Arabia, South Africa, South Korea, Turkey, the UK and the US. Government leaders around the world issued quarantine and lockdown measures to seal their borders and prevent the entry of the dreaded virus, but still the efforts proved futile as covid-19 continued to sneaked in unnoticed and only caught leaders by surprise when persons under investigations began to rise in numbers in their respective countries. The unusual video meeting of the members of G20 need to produce positive outputs purposely to flatten the curb of corona's onslaught as the world's economy really dwindled and shutter businesses in the process. US AND CHINA VIDEO CALL. US President Donald Trump is set to do a video call with China's Prime Minister Xi Jen Ping to discuss matters about coronavirus disease. During the online video conference, the world leaders have identified that the deadly coronavirus has successfully disturbed the world's business and economy which now starting to create massive poverty among nations, closed government and private buildings, crippled government and private operations and shockingly resulted to the deaths of over 20,000 patients from around the world. Now the G20 has vowed to help one another in response to criticism they were failures in containing the deadly spread of the virus, jointly injecting over $4.8 trillion into the global economy, as a way to counteract the financial and social impacts of the pandemic. As G20's final virtual summit's statement, G20 has committed to make the World Health Organization's (WHOs) mandate even more stronger and strengthened.  U.N. Secretary-General Antonio Guterres urged G20 leaders to adopt a war-time plan to tackle the pandemic.  “The unprecedented COVID-19 pandemic is a powerful reminder of our interconnectedness and vulnerabilities,” the group said. “The virus respects no borders.” “It took the world three months to reach 100,000 confirmed cases of infection,” he said. “The next 100,000 happened in just 12 days. The third took four days. The fourth, just one and a half.” Guterres said: “This is exponential growth and only the tip of the iceberg,” adding that countries must be able to combine systematic testing, tracing, quarantining and treatment, as well as coordinate an exit strategy to keep it suppressed until a vaccine becomes available. Meanwhile, a total of 250 million pounds ($302 million) will be provided by the United Kingdom (UK) as additional funding to the group developing vaccines to effectively contain the onslaught of coronavirus disease.  

READ MORE
Nast Health Sciences Division Statement: Scientific Research and Development as drivers to win the race against COVID19

March 27, 2020

The current CoViD19 problem caused by the SARS CoV2 virus has raised and continue to raise issues on how programs and strategies can better control and prevent the escalation of the problem. With the recent declarations of the World Health Organization that COVID 19 is already a global pandemic and the implementation of community quarantine and subsequently extended community quarantine initially involving the National Capital Region and eventually the whole of Luzon, we expect greater urgency for countries to implement programs and strategies to stem and arrest this epidemic.      Almost all of these countries, and the Philippines is no exception, have proposed novel and sometimes radical measures as possible solutions. Almost all of them, however, are not based on scientific studies but largely on expert opinion and what we think worked and did not work during the SARS problem in 2003 and the pandemic influenza global pandemic in 2009.     Being caught in the midst of this ongoing epidemic and the consequent rapid rush of research institutions, both in the private and the public sector to find the magic cure for this disease, whether it be a drug or a vaccine to prevent transmission and infection of the virus, the research community should galvanize and unify efforts to spearhead researches that will address current health issues brought about by the CoViD 19 problem.     Dealing with and confronting this problem will require a whole of government-led approach with involvement and engagement of the private sector and the general public. Networking and collaboration among and within these different groups will be the key.      Researches, in particular, will be critical in the fight against the CoViD 19 recognizing that this is a new disease with a potentially different behavior, progression and effect on the health of individuals, the community and the nation as compared to the other emerging pathogens     We, at the National Academy of Science and Technology, fully support the current research initiatives of the government and the Department of Science and Technology.      In the face of limited resources and paucity of knowledge concerning the virus and the disease it causes, researches are being developed and implemented in collaboration with various research groups both here and abroad to address various aspects of the CoViD19 problem. In the light of all these, we propose that the following researches be done or enhanced to identify and implement the most effective measures to address problem of CoViD 19 in the following areas:     1) In the area of epidemiology, modelling studies , which are mostly mathematical, may help us better understand how the epidemic will evolve.      Input of health data into these disease models, as the epidemic progresses, will be very important to provide government planners scientific projections on how this epidemic will progress. The data generated will be very helpful in forward planning by concerned government agencies to anticipate, prepare and dampen the effects of this epidemic on different aspects of national life, including the economy.     2) In the area of diagnostics, whereas current tests are focused on the detection of the virus in affected patients, tests determining the presence of antibodies mounted by the human hosts should also be developed.      These antibody-based assays will help determine the patients who were truly infected, whether symptomatic or asymptomatic. It may catch the cases missed by the tests for detecting infection as these tests may have been done too early or too late in the disease.      The tests to detect antibodies will determine the true burden of disease and as well as provide added information on the infectiousness, transmission dynamics and progression of the disease. These tests may also be used for predicting chances for development of complications as well as mortality, especially if the antibodies are proven to be neutralizing antibodies.     3) In the area of therapy, the country should participate in clinical trials that would have already been initiated by other countries to help us better understand patient responses to this therapy and determine whether different genetic backgrounds, cultures and environment may affect patient response.      Moreover, participation in these multi-country studies can facilitate its availability in our country when the results become significant.     4) In the area of prevention and the development of vaccines, knowing more about the virus, its genetic makeup and how fast it mutates or changes will accelerate its development.      Characterizing the molecular and genetic structure as isolated from patients in the Philippines can be contributed to the international database that will serve as references for vaccine development. This will ensure that the vaccines developed can induce protection against all of the circulating SarsCoV2 viruses isolated from patients anywhere else in the world. 5) In the area of host factors, genetic biomarkers may be identified that may either predispose or make people less susceptible to the infection. They may also be used to determine risk for severity of disease and complications.     In all of these initiatives, sharing of information within and among scientists, researchers and institutions both here and abroad will help us build on each others’ strengths and accelerate the race for finding the solutions and the answers to many of our questions.     Ultimately, winning the battle would depend on how much and how good we understand our adversary- the Covid19 and the virus that causes it.      To many, the virus is like an unknown enemy that works silently easing its way among and through susceptible populations, evading detection and prevention. The experiences of many countries, whether good or bad, will serve as valuable learnings for all of us.      For one thing is certain, this epidemic will not be the only ones we will be confronting in the years to come. It has been established by scientists that in the area of zoonotic diseases that start from animal hosts before reaching humans, only half of viruses have been identified. Scientific research and development remain our most effective weapon to confront them and the SARS CoV2.

READ MORE

Subscribe Now!

Receive email updates from Mindanao Daily News.