Improving Preparedness and Strengthening Pandemic Response: Lessons from COVID-19
22 Mar 2022
In the two years since the first case of COVID-19 disease was reported, there has been a total of 5.66 million deaths worldwide. The pandemic has shaken countries across the globe, jeopardizing economies and putting global health at risk. This greatest international public health crisis in more than a century is not yet over. In a webinar symposium series sponsored by Sandoz, in collaboration with medical societies in the Philippines, entitled Health Talk Asia, we revisit the experiences and best practices of countries in Southeast Asia, how they cope up with the ongoing pandemic, and their strategies towards better health emergency preparedness. The speakers on this 3-part webinar series were Dr. Ling Li Min, Senior Consultant Infectious Disease Physician at the National Center for Infectious Disease (NCID) and Tan Tock Seng Hospital (TTSH) in Singapore; Prof. Nitipatana Chierakul, Associate Professor, President of the Thoracic Society Thailand under Royal Patronage, Head of the Division of Respiratory Disease and Tuberculosis at Siriraj Hospital; Prof. Allan H. Young, Professor of Psychiatry, Chair of Mood Disorders, Director of the Center for Affective Disorders, Interim Vice-Dean for Academic Psychiatry, Institute of psychiatry, Psychology & Neuroscience, King’s College London, and was moderated by webinar chair and host Dr. Rontgene Solante, Head of Adult Infectious Disease at San Lazaro Hospital, Secretary of the Philippine College of Physicians, and co-chair Prof. Oh Kang-Seob, Professor of Psychiatry at Sungkyunkwan University, School of Medicine, Chairman, Korean Neuropsychiatric Association.
Stories from the front lines: How to overcome COVID-19
In the second quarter of year 2020, Singapore experienced a spike in cases to which they responded with a “circuit breaker” or what we know as lockdown, with safety measures such as compulsory wearing of masks, safe management measures, social distancing, limiting social gatherings, and visitations to households. These measures worked for a year until another spike was brought by the Delta chain in the third quarter of 2021 where cases were higher than the first spike.
Singapore has employed a 3-phase measure: safe reopening, safe transition, and safe nation. Phase I included reopening of some businesses, allowing of 2 visitors per household , opening of face to face classes for graduating students, opening of places of worship for private worship only, and allowing marriage in person with only 10 people attending. Over a few months, Phase II allowed reopening of retail outlets, dining services, gyms, and enrichment centers. All students were allowed to go to school. And finally, in the last phase, social, cultural, religious and business events were resumed with limited crowd sizes. Innovative measures for aggressive contact tracing were used. This includes the Trace Together application which may be downloaded in mobile phones, or may be worn separately as a physical token. Bluetooth signals exchanged with other tags or application users nearby. It automatically and quickly tracks those who are exposed to COVID-19 patients. Another application, Safe Entry, is used whenever people enter establishments. Contact tracing was sped up, dropping from 4 days at the start of the outbreak to only 1.5 days with the use of these applications.
Vaccination roll out started as early as December 2020 in Singapore, giving priority to healthcare workers in the frontlines, and vulnerable groups like senior citizens.
“Subsequently, we started to extend PCR testing to include travelers and even people who are not even close contacts but may be in a setting of higher risk exposures,” said Dr. Ling Li Min. According to her, aggressive testing, introduction of rapid antigen test and encouraging self-testing, helped reduce the number of days from onset of symptoms to isolation. Lastly, Dr. Ling Li Min mentioned that they introduced the home recovery programs where people were no longer admitted to hospitals unless they are part of certain groups such as senior citizens, or people with comorbidities.
Best practices & beyond: The comprehensive management of COVID-19
Dr. Nitipatana presented cases of patients who suffered the COVID-19 disease and illustrated the phases of the disease. He emphasized that the main treatment in Thailand in the early phase of the disease is use of antiviral drugs such as favipiravir, remdesivir, molnupiravir, and antibody cocktails. Adjunctive corticosteroids were also given to those declining with oxygen therapy. In the next phase of the disease where there is a bacterial co-infection and there is progression of radiographic opacities, immunomodulators such as tocilizumab, baricitinib and higher doses of corticosteroids are given. An essential part of treatment in this group is also the use of respiratory support with high-flow nasal cannula as noninvasive ventilation and mechanical ventilation in some cases. For the later phase where there is fibroproliferative phase of ARDS, persistent or worsening hypoxemia with stable or progressing radiographic opacities, presence of superimposed infections such as drug-resistant bacteria or fungus, and presence of acute pulmonary embolism, atelectasis, and pleural effusion must be considered. Treatment along with anti-bacterial agents also include tapering the dose of corticosteroids.
“Our country has prepared for security in healthcare resource supply especially the personal protective equipment or PPE,” Prof. Nitipatana Chierakul said. He also added that they now produce their own PPEs and are able to export to other countries who are in need.
When asked about his opinion for the management of the Omicron variant, Prof. Chierakul said that the disease will be managed in a similar way the Delta variant was handled. He also added that remdesivir is one of the drugs that made an impact in their management of patients, being given to patients requiring high flow nasal cannula oxygen support, while tocilizumab is reserved for those with severe cases with rising C-reactive protein and progressive respiratory failure.
Managing Mental Health: The Effects of Living with COVID 19
Prof. Allan Young illustrated the potential impacts of COVID-19 disease starting from the immediate mortality and morbidity, impact of resource restriction on urgent non-COVID conditions, impact of interrupted care on chronic conditions, and the last wave of psychic trauma, mental illness, economic injury, and burnout.
In a study by Hansoff, the impact of COIVD-19 lockdown on adults with a recent history of recurrent major depressive disorder was investigated. In the study, they used Personal Health Questionnaire. Depression Scale (PHQ-8), Rosenberg Self-Esteem Scale, and mean sleep duration. The results suggest that the impact of COVID on people with a recent history of recurrent depression was not that great.
In another study by Taquet, it was found that the risk of long-COVID is higher in patients who had more severe COVID-19 illness, and slightly higher among females and young adults.
“Change, perhaps, 10 years change, took place in 1 year,” Prof. Young stated. He said that people, especially healthcare workers around the globe had to be adaptable in the response to this health crisis. Another great change was doing many things virtually, digitally, or remotely, including consultation and digital psychiatry.
Digital psychiatry is emerging not only for assessment but as a modality for therapy. Initial assessment is conduct first followed by monitoring. According to Prof. Young, digital assessment if more convenient and acceptable to patients due to the convenience. Electronic cognitive behavioral therapy and other forms of therapies may also be done digitally. “All practice is likely to include a digital component in the future,” said Prof. Young as he ended his lecture.
“The pandemic has reached the two-year mark and the world has gained important lessons about health crisis preparedness, COVID-19 - its prevention, treatment and so much more. We carry this with us as we continue to chart through yet unknown truth about COVID-19,” said Dr. Rontgene Solante, chair and host of the webinar.
The COVID-19 pandemic transformed economies and societies and challenged our norms. The choices that we make will determine the success in building a transition to a more prepared, healthier, and more resilient tomorrow. It is an opportunity to chart a new path that empowers everyone to face the future with confidence.