Too early to say Chinese tourists didnt help spread the virus in PH – DOH

MANILA, Philippines — While an analysis of the circulating strains of the coronavirus in the Philippines showed that their makeup differed from that contracted by the three Chinese tourists who visited the country early this year, the Department of Health (DOH) stressed on Wednesday that it was still too early to conclude that they did not help spread the infection that has already sickened more than 200,000 Filipinos.

Based on the gene sequencing done by the Research Institute for Tropical Medicine (RITM) on selected samples from COVID-19 cases in January, March and June, five lineages of the SARS-CoV-2 virus that causes the severe respiratory disease were found in the country. These are lineages A, B, B.1, B.1.1 and B.6.

A and B were the original strains from China, while B.1 and B.1.1 were associated with the outbreaks in Italy and other European countries, the RITM said. B.6, on the other hand, was detected in Australia, India, Singapore, the United Kingdom and North America.

Sequencing on the country’s first confirmed case—a 38-year-old Chinese woman—showed that the sample belonged to lineage A, while those of the second confirmed case—the woman’s partner—and the third—another Chinese tourist—belonged to lineage B.

All three are from Wuhan in China’s central Hubei province, the original epicenter of the outbreak.

Almost all sequences of the samples collected in Metro Manila, Ilocos Sur, Rizal and Laguna in March were of lineage B.6, which includes samples from the first two reported cases of local transmission.

Meanwhile, samples collected in Metro Manila and Laguna in June were of lineage B.1 and B.1.1, respectively. The RITM said these patients did not travel outside the country.

“The local transmission of different lineages and strains may have been imported from multiple introductions of different lineages into the country. While it is also possible that the virus may have accumulated mutations through transmission within the country, the relatively slow mutation rate of SARS-CoV-2 may not drive the circulation of very varied lineages in the country,” the RITM said in a statement.

“It is more likely that these lineages were imported from other countries,” it added.

Limited coverage

Health Undersecretary Maria Rosario Vergeire, however, urged caution in interpreting the RITM’s findings, especially because the study covered a small proportion of the population in a specific area.

Vergeire noted that because of the study’s limited scope, it was still too early to draw an accurate conclusion, particularly on how the infection might have spread.

“Although [the] RITM initially showed the gene sequence of the three Chinese tourists were different from the rest of the population that they have studied, again let us try to be cautious in interpreting. We need more details, we need more data,” Vergeire told reporters in her regular online briefing.

“We need to further study so that we can accurately say that the Chinese [tourists] weren’t the ones who spread [the virus] and that we had other sources of our infection,” she added.

After recording three COVID-19 cases in late January to early February, the Philippines had a three-week lull in new cases. But concerns were raised that the confirmed cases might have unknowingly infected others, especially because the government was unable to locate the 643 people they could have come in contact with.

Local transmission was declared in early March after the fifth confirmed case, who had no known contact with a positive patient nor had traveled outside the country, was recorded.

Cases top 200,000 mark

On Wednesday, the Philippines breached the 200,000 mark in the total number of COVID-19 cases as the Department of Health (DOH) reported an additional 5,277 additional infections. The new cases brought the national tally to 202,361.

Of the new cases submitted by 95 of the 109 accredited laboratories, 4,350 got sick between Aug. 13 and 26, while 680 fell ill between Aug. 1 and 12.

Metro Manila accounted for most of the new cases at 3,157, followed by Laguna (403), Negros Occidental (304), Rizal (237) and Cavite (228).

The DOH reported 99 more deaths, raising the death toll to 3,137, and 1,131 more recoveries, bringing the total number of COVID-19 survivors to 133,460 and leaving the country with 65,764 active cases, of which 91.6 percent are mild, 6.3 percent asymptomatic, 0.9 percent severe, and 1.3 percent critical.

Of the newly reported deaths, 77 died this month, 18 in July, three in June and one in May. Sixty-one of the fatalities were from Metro Manila, 14 from Calabarzon, 12 from Central Luzon, six from Central Visayas, two from Western Visayas, and one each from Cagayan Valley, Northern Mindanao and the Cordillera Administrative Region. The locality of one of the fatalities was unspecified.

Off-label drugs

The DOH also reminded doctors that they should first secure regulatory approval before giving off-label drugs to their patients following reports that a medicine for parasitic infections is being used as treatment for COVID-19.

Vergeire stressed that the Food and Drug Administration (FDA) and the ethics review board should first sign on before any medicine is given to COVID-19 patients, especially because the drug will be used for a purpose other than what it is indicated for.

In the case of ivermectin, Vergeire said caution should be taken since research on its supposed effects on SARS-CoV-2, the COVID-19 agent, had yet to progress from laboratory studies.

“I’m just warning those doctors who are [giving] this without [going] through the regulatory process as this may harm [patients]. We still do not have enough evidence that this can be used against or can help prevent COVID-19,” she told reporters.

“The studies on ivermectin done in other countries was done in vitro. This means that it has only been [tested] in the laboratory and has not been tested on animals or in humans,” Vergeire said. “We must exercise caution on the things we hear and read. We need to study this thoroughly because we may cause more harm than good to the public.”

In May, the US FDA warned against the use of ivermectin, saying “additional testing is needed to determine whether [it] might be appropriate to prevent or treat COVID-19.”

Ivermectin is used against parasitic worms and external parasites, such as head lice.