‘I’ll be more scared of tuberculosis and measles than COVID-19’
This online interview was conducted in the early days of the new coronavirus outbreak so what appears in text as COVID-19 was actually originally nCoV in e-mail exchanges between Dr. Maria Rhona M. Gatpandan-Bergantin and INQUIRER.net.
Dr. Bergantin is a specialist in infectious diseases who has a master’s degree in Science. While she holds clinic and teaches at the University of Sto. Tomas, she is in this discussion about COVID-19 as a member of the Philippine Society for Microbiology and Infectious Diseases.
Dr. Bergantin’s discussion of COVID-19 offers some insights from the perspective of a Filipino private health professional and could be useful in providing a calm narration of how to respond to the disease.
INQUIRER.net: It is now widely known that there is no cure or vaccine yet for COVID-19 but since there are existing vaccines against pneumonia, will these or can these provide protection for those who had the vaccines or those who planned to have them against COVID-19, particularly if its end result is pneumonia? I ask the question on the basis of information that pneumonia is one of the most likely result of the new coronavirus .
DR. RHONA M. GATPANDAN-BERGANTIN: Setting things straight, when we talk about infectious pneumonia, which is the inflammation of the lungs brought about by infectious agents, commonly bacteria or virus (as there are also some parasites, fungus and even non-infectious causes of pneumonia), we speak of various pathogens which can gain entry into the lungs.
Among the more common bacteria are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Bacterial pneumonia is not limited to these organisms as there are a lot of other bacteria which can cause the infection.
Among the viruses, we have a number of organisms which attach and invade the respiratory tree, including rhinoviruses, parainfluenza, influenza and coronaviruses. Again, like the bacteria, there are a lot more of other viruses which cause pneumonia.
Now going back to the vaccines, for the common causes of bacterial pneumonia, we have pneumococcal (streptococcal) and Haemophilus influenzae vaccines which are recommended for children. In selected population of adults, pneumococcal vaccines are given but the Haemophilus is not part of the current recommendations. Among the viruses, influenza virus vaccine is recommended for both children and adult.
Can having either the bacterial vaccine or viral vaccine or both, be protective against COVID-19? The answer is a resounding NO, because there are no vaccines yet against coronaviruses, whether the old coronaviruses nor the new ones.
But, if you have vaccines against streptococcus, haemophilus and influenza and you get these bacteria and virus in your lungs while you are also infected with COVID-19, to some extent, you are protected from developing the streptococcal, haemophilus or influenza pneumonia which may cause co-infection or complicate the coronavirus infection.
Also to set things straight with regards to the nature of these organisms, it doesn’t mean that once they enter a person’s body, that person will automatically have pneumonia. If the person’s immune system is quite robust, the body can get rid of these organisms quite fast in such a way that there are people who may not have any symptoms, some may have mild disease which can manifest as cough or colds or even sore-throat, muscle and joint pains without lung involvement, while some really develop pneumonia.
Q: Aware that several vaccine types against pneumonia are being compared on the basis of prices, I would like to ask if there’s such a thing as money worth spending in terms of vaccine effectivity?
DR. BERGANTIN: To elaborate as we focus on streptococcus pneumoniae or pneumococcus–there are more than 100 strains of these bacteria and the PCV13 offers protection against 13 strains of pneumococcus.
To note, there is another form of pneumococcal vaccine which we call pneumococcal polysaccharide vaccine which offers protection against 10 additional strains of streptococcus, but by present studies, the protection that this type of vaccine (PPSV) renders is not as lasting and not as robust as that of the PCV-13.
Again, the pneumococcal vaccine is not protective against nCoV but should streptococcus be acquired by the person infected with nCoV, somehow the vaccine can reduce the risk of having the pneumococcal pneumonia complicating the nCoV.
In our practice, we stick to the adage that an ounce of prevention is a lot better than a pound of cure.
Basically, people may consider vaccines costly, but if one looks into the effects of an illness, like pneumonia in a person’s physical, mental, emotional and economic well-being, there is no point of comparison.
A person will feel unwell, suffer physically then eventually will not be able to work (loss of productivity), and will spend on treatment (hoping there won’t be additional complications). Likewise, being ill can cause depression and even anxiety, lack of self-worth, uncertainty in the recovery.
As for medications, we have generic medications which are as potent as the innovator medicines basically because they have to undergo testing prior to licensing, thus it does not always mean that if the cost is less, the commodity is of inferior value.
Q: Just how scary is COVID-19? I’ve read about the swiftness with which it is transmitted but also read about the lower chance of death from the new virus compared to SARS or MERS-COV. Reports about continuing deaths as a result of the new virus are adding to the fears, but is it really something that we should shiver in fear about?
DR. BERGANTIN: I will be more scared of tuberculosis and measles than COVID-19. These diseases are more easily transmitted and can really cause bad infection. Not that I am saying that COVID-19 is not bad. We do not want any bad bugs in our body – they are not part of our normal well-being.
I think the scare that we have goes with the fact that we are fighting with a newcomer which we are quite unfamiliar with, hence we are not prepared – no vaccines, no drugs whatsoever to immediately fight the virus. It is like going to combat without knowing whom you are battling with, hence, steps and strategies are quite unsure.
However we have to remember that like any other infection, we have to rely on our good old immune system to work well to fight off the virus. God has so designed our body that any infectious agent trying to enter our body will trigger the immune system to work well to fight off and eventually control the invading agent.
We are also scared because the numbers we get to see flashed in front of us focus more on the death rather than those who recover. Based on the data from the WHO, more than 80 percent of those who had nCoV had mild illness, above 10 percent are said to have severe illness while around 3 percent became critically ill. But we have to understand that patients also recover even if they have been critically ill.
But again, this does not mean that we have to put our guard down. We still need to control the spread of the virus and prevent ourselves and others from getting ill.
Q: The Philippine government has just declared plans to prevent the entry of Filipinos in Hubei province, where the epicenter of COVID-19, Wuhan City, is located if they tested positive for the new virus. Without sounding like I’m trying to provoke a criticism of the government from you, I would like to ask you from an expert’s point of view what could be the logic of preventing the homecoming of citizens infected with COVID-19? What message does it relay?
DR. BERGANTIN: This process I believe is practiced elsewhere in the world and not exclusive to our country. This is an expected scenario when we are dealing with infectious diseases of public health importance.
If people are asked to be quarantined, whether in a designated facility or home-quarantine, this is simply a means to prevent them from getting near other people who can be infected with the virus. They have to isolate themselves until the body has gotten rid of the virus.
If one will think that they are being stigmatised simply because they are infected, I think he or she should also look at the isolation in the aspect of protecting their loved ones from getting the infection. Even if we have the right to join our families and other members of the society, we also have the responsibility to protect them from being infected.
Q: Do you think the country has enough capability to handle an epidemic like the scale we are witnessing now in Wuhan in particular and China in general? If there’s lack of technology, or latest equipment, how can we make up for that if the availability of latest tech or medical gadgets is yet years away but an emergency like COVID-19 is already knocking on our doors?
DR. BERGANTIN: We have to acknowledge that we are not as equipped as the first world countries in terms of the latest technological and medical gadgets, but our health care workers/medical professionals are quite resilient and resourceful when in comes to dealing with infectious emergencies.
Since the outbreak has begun, our medical teams have been tirelessly devoting their time in taking care of those who were and are possibly infected, even to the extent of going on long hours of duty.
The medical professionals have been pro-active in communicating with the government agencies to share their expertise and help in mitigating the spread of the virus. Likewise the medical professionals keep themselves updated with the scientific knowhow regarding the nature of the virus, the clinical presentations and the course of illness.
The healthcare workers rely on these published articles simply because the ones who authored these publications are the ones who first-handedly experienced the novelty of the coronavirus from Wuhan.
Some of the health care workers volunteer their time to educate the public to reduce the panic brought about by this newcomer. What we lack in technology, we compensate with lots of compassion. This compassion propels the health care workers to do beyond what is expected of them.
Of course, we also have our slips at times, simply because we are dealing with the unknown, unfamiliar processes and walking through unchartered territories. But the medical professionals learn fast.
Q: Media advertisements by the DOH seem to focus on hygiene as a preventive measure against COVID-19. I noticed that these ads didn’t focus on wearing of masks, although there was an advice about covering one’s sneeze or cough. What could still be added to these precautionary pieces of advice?
DR. BERGANTIN: The DOH advisory is similar to the WHO advisory which emphasizes on hygiene, most especially hand washing, as viruses and bacteria can also easily get transmitted through dirty hands and dirty environment.
Only those who have the sniffles, those who are coughing, those with sore throat, with or without fever are advised to don on their mask, simply because they are the ones who readily transmit the bug.
The WHO emphasizes on avoiding spitting in the public, which I think isn’t just about sanitation but about proper etiquette as well.
There is also the advice of avoiding consumption of raw meats, even bushmeat, exotic delicacies. People are quite fond of bragging about the uniqueness of the food we place in our mouths, but we really have to be mindful of the kind of food we eat, their origins, how these food items are prepared and cooked. Bugs can be sleeping in these commodities and we unknowingly expose ourselves to these bugs by consuming these types of food.
Personally, my advise has nothing to do with hygiene and use of mask, but I wold like to borrow the Brits’ familiar pre-WWII tagline – “keep calm and carry on”! We need to have the presence of mind to be able to deal with the outbreak. We need not lose our equanimity over this newcomer.
Q: Aside from saying there’s no need to panic, what else can we tell people who are anxious to spend all their money to buy as many masks, alcohol or sanitizers as they can get their hands on which only results in shortage of supply?
DR. BERGANTIN: I think it will be quite difficult to tell the public not to panic simply because we are being shown “panic-inducing” scenes in televisions and the internet.
What our experts and the media ought to do is to refocus the presentation of the illness and highlight on the non-scary and non-panic-inducing aspects of the COVID-19. Like the number of those who get well and fully recover.
As an educator and a healthcare worker, I give talks about the coronavirus, comparing it with the previous illnesses which has besieged us and how we managed to survive.
By talking about the truth and calmly talking about the illness, the panic is remarkably reduced.
Q: Are reports correct about the new corona virus being more virulent in cold climates?
DR. BERGANTIN: The accuracy of this report needs to be seen as the days go by, as the scientists uncover the truth about the virus whether it can really survive more in the cold than in humid or hot weather.
Even if there are studies which looked into the nature of other coronaviruses such as SARS and MERS, we simply cannot generalise.
What will matter is that we take precautions and observe proper hygiene.
Q: What do you think is the virus’ behavior that should be a focus in terms of early detection or timely alert?
DR. BERGANTIN: There are so many factors here to be considered as each virus is unique – its habitat, host, mode of transmission, how virulent it is, how pathogenic it is, how long does it survive inside and outside the human body and if ever, its natural host, with which molecules in our body is it more prone to attach to, how does our immune system react to the virus… and a lot, lot more
The nature of the virus regarding this various aspect needs to be known so that with each step, potential solutions may be offered.
Q: Can you describe your reaction the first time you heard news or reports about this new virus?
DR. BERGANTIN: I thought : “God, I hope this is not such a bad bug … and please guide us as we deal with this newbie in the days to come. Help us to think and act rationally, trusting in Your will” and funny as it may seem, I kept calm and carried on.
Q: In terms of impact on personal finances, how do you think would the virus affect health care provision in terms of income classes? Would it have an income discriminatory impact like the poor having higher chances of contracting the virus for lack of access to primary health care than those who could afford it?
DR. BERGANTIN: Like any other illnesses, not limited to infection, those who are less-equipped financially may suffer more compared to those who have access to the more ideal health care.
This is the sad truth about our current health care system. We are not privileged to have our diagnostics and medications given free of charge. We pay for our medical expenses from our own pockets.
Much as our government is trying to reach an ideal set up where the health care system will be delivered equally amongst those who are blessed and not-so-blessed financially, this is still a very long journey.
Often in out textbooks, crowding is mentioned as a culprit for faster transfer of bugs… hence I think living in smaller, poorly-ventilated spaces, with less water supply and lacking good sanitation makes the impoverished more susceptible to acquire the bug, not necessarily because they lack the access to primary health care.
Q: Are you satisfied with the amount of information that is coming in about the virus? Are these pieces of information enough to guide your own response to infected patients or choice of preventive measures?
DR. BERGANTIN: Nope, but, much as most of us healthcare workers are wishing that new and vital information regarding the novel coronavirus reach us rapidly, we can only wait for the information and results coming from the learned ones who are directly dealing with and working with the virus and the patients.
During the initial days of the outbreak, I believe most of us relied on our past experiences and information based on the previous coronavirus infections, such as SARS and MERS.
The information that we have at present are so fleeting and so dynamic as newer things are uncovered and discovered about this new scourge. And we thank those scientists and healthcare workers who tirelessly toil to give the public a glimpse of truths about the COVID-19.
(Interview conducted by Tony S. Bergonia)
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