Life in the Time of COVID-19

As part of our pledge to bring original and better content this year, we are introducing Online Kapehan, where we talk to experts about the most pressing issues we face today. 

The first installment of Online Kapehan focuses on the emergence and spread of COVID-19 in South Korea. COVID-19 is an infectious disease caused by the most recently discovered coronavirus originating from Wuhan, China. As it is novel and new, scientists are working on very little detail to combat the disease. As of February 25, South Korea currently has 893 confirmed cases and is expected to rise as the government continues its scramble to contain the spread of the disease.

I talked to Ph. D. candidates and fellow PIKO members Erica Españo (Life Science in Pharmacy, Korea University Sejong Campus), Paula Cammayo and Rochelle Flores (Preventive Veterinary Medicine, Gyeongsang National University) and discussed some of the common questions and concerns related to COVID-19. I also talked to Dr. Marilen Parungao-Balolong, professor and university scientist at the University of the Philippines-Manila and former post-doctoral researcher at Dankook University, who specializes in medical microbiology and immunology. Her inputs and opinions were incorporated in the interview of Erica, Paula, and Rochelle.

Everyone is aware of COVID-19 but last week saw the highest increase in reported patients in Korea. Why is that and should people panic?

[Erica] The rise in the number of reported patients in Korea is linked to the discovery of a patient (61 yo woman) in Daegu linked to the Shincheonji church, which conducts services by the thousands. Contact-tracing conducted by Korean health authorities led to the discovery of possible contacts with this 61-yo woman and possibly all the other contacts of the people connected to this woman. Also, this case was discovered last week, and the woman may have attended services and had contact with other people before the discovery of the case, which further bloats the number of contacts for tracing, which also increases the number of persons under investigation.

[Paui] In my opinion, there is no need to panic naman. It just so happened that Korea has the means to detect COVID19 kaya tumataas ‘yung record ng diagnosed people kumpara sa ibang bansa na need pa mag-send out ng samples. Natratrace nila agad ung source (sa Daegu) kaya alam nila agad sino ung dapat i-check, kaya mataas ‘yung detection rate doon. Therefore, nai-implement ng maayos ‘yung surveillance dito sa Korea at mas nagiging aware din ang citizens.

[Rochelle] I agree. Proper population to test and available diagnostic means.

We are constantly being updated with the increase in the number of patients affected. Is this a good thing in your opinion or does it contribute to panic and hysteria?

[Rochelle] I think increase number of patients affected is alarming but should not cause panic and hysteria. As this could only mean that the measures of surveillance and diagnosis are working well. In fact, I think it raises awareness rin. Na mas maging ma-ingat.

[Paui] A good thing kasi part ‘yun ng disease surveillance so nagiging aware tayo doon sa nature nung disease spread. Tapos kaya naman nagkakaroon ng panic din is dahil hindi ganoon kaalam ng common people ‘yung statistics siguro ng disease kung ikukumpara siya sa other diseases na mas mataas ‘yung fatality rate.

[Erica] I agree that it shouldn't be a cause of panic, but instead a word of caution. It is better to be made aware of what's going on than not know what's happening. And it tells us which places to avoid, if we can help it, or whether to be particularly cautious in a place we are visiting.

[Rochelle] Information dissemination goes a long way.

Before we started, I was also talking to Dr. Marilen Parungao-Balolong regarding her opinion on this. She highlighted in the importance of proper hand hygiene. How does this fight off the virus and its spread?

[Paui] Disinfectants are effective in killing the virus through disruption of envelope or structure nung virus. We have the habit of putting our hands near our mouth without being that aware what or where our hands come in contact with, so hand sanitation through proper handwashing or use of sanitizers can prevent contact from the virus. Kaya pinagma-mask din kasi aside from the air droplets, it lessens the probability of us touching our faces/mouth.

[Rochelle] Handwashing prevents the transfer from possibly touching a contaminated surface to yourself.

So, the masks are not necessarily para ma-prevent ang droplets from sneezing and coughing but also less touching ng face?

[Erica] Yes.

There have been reports regarding COVID-19 being airborne. Is this true?

[Erica] So far, the consensus is that the virus is spread through droplet transmission. And the virus is enveloped. Frequent washing also helps us kill the viruses if we touch surfaces that contain virus particles (fomites). However, scientists are still looking into the fecal-oral route of transmission (so the poop) and airborne transmission. For example, pig coronaviruses also have the fecal-oral route of transmission and have high morbidity rates. If the fecal-oral route is indeed true, then all the more should we practice good hygiene.

[Paui] Ang coronavirus kasi sa aso, usually manifested through gastro-intestinal signs. Sa pusa nagma-manifest din through both gastro-intestinal and respiratory signs.

[Rochelle] And by nature, coronavirus is from the family that infects generally the respiratory system. But yes, may cases sa aso na coronavirus via fecal-oral transmission.

Does this mean it will be a bigger problem if mag-spread siya sa lesser developed countries without a proper sewage system?

[Erica] Yes! And one of the theories as to why it spread in the Diamond [cruise] ship.

How potent is it on a dry surface? People are also afraid, what if these droplets land on a surface or on your clothing and you touch it. How long can it survive on a dry surface and is it a possible mode of transmission?

[Erica] I don't think there's an official study on the fomite transmissibility of COVID-19. But the statements are generally about the fomite transmissibility of MERS-CoV and SARS-CoV.

Now that you have mentioned MERS-CoV and SARS-CoV, I want to follow up on that. Is COVID-19 more lethal than the two?  

[Erica] While it's hard to make an exact calculation of the case fatality rate of COVID-19 (because it's usually calculated at the end of an outbreak), the quick answer is actually a NO. MERS-CoV has a CFR of ~35% and SARS has a CFR of ~14%. Based on the numbers in Korea, the current mortality is at <1% (7 in 800+ cases).

[Rochelle] May statement na ni-release ang WHO before regarding sa fatality rate. Compared to the first 2 coronavirus outbreak before, lower ang fatality rate ng COVID-19.

[Paui] Lethality translates to the number of mortality kasi with the statistics that are currently available, mas mataas ‘yung cases of mortality ng MERS-CoV, followed by SARS-COV, and not so much with COVID-19 in relation to infected individuals.

Building on Erica's answer, Dr. Parungao-Balolong mentioned that the seasonal flu is actually more fatal than COVID-19. She said, "But the difference lies on we know flu already and we know how to prevent flu and how to manage flu. Sa COVID-19, information comes na parang tingi so nangangapa lahat sa start."

[Erica] YES.

And she continued, "But then again the ultimate way to be safe from Covid-19 is back to basics: hygiene and healthy lifestyles. Iwas muna sa puyat and alcohol but it would keep your immunity up to help you with the virus when exposed accidentally or if exposed without a choice. Avoid gatherings which will force you to meet people within one-meter distance unless you can be allowed to mask up and hand sanitizer often (like every time you’ll touch a surface or hand).

[Erica] I'd like to add boosting the immune system and proper hydration.

So, we can look at it as something similar with how we combat the common flu? And currently due to lack of existing info regarding COVID-19, the only way we can address it so far is through how we approach the common flu.

[Erica] Exactly. To add to what Ma'am Lhen said, the current COVID-related deaths are generally related to old age, previous illness, or immune problems. So, it really is looking a lot like the flu.

[Paui] There is no direct treatment kasi sa viruses, usually symptomatic treatment (kung may lagnat binibigyan ng analgesic, may sipon antihistamine) or supportive treatment (pampalakas pa ng resistensya) ‘yung ginagawa.

Which brings me to the next question, and concerning the answer earlier by Rochelle regarding outbreaks, can this be considered a pandemic rather than an epidemic?

[Rochelle] Pandemic, worldwide ‘yun and affects a large number of people. Epidemic is concentrated in a certain area, pandemic kapag global concern.

[Erica] I think only the WHO can say that. But several scientists are worried that it's on its way to being a pandemic because of its spread. But as is the case with the A(H1N1) influenza pandemic, not all pandemics have high mortality rates. They're just really able to spread around the world.

If this becomes a full-blown pandemic, what is the best course of action? Talking about hypothetical situations here.

[Erica] We haven't really faced a pandemic in modern times since A(H1N1) and it was a mild pandemic. Hopefully, this one really stays mild in the general population. But, yeah, proper hygiene and good health na lang talaga. (We don't need another flu.)

[Paui] Be mindful of proper hygiene lang talaga tapos palakas ng resistensya.

Dr. Parungao-Balolong said, "If the embassy offers for repatriation though, please accept it. I’m sure they won’t do that move without logical data." Do you guys agree?

[Erica] I guess so. Because, I think, it's not only the health that's going to be considered, but the actual quality of life. Kasi in case mag shut down ang ibang establishments in Korea, like in Daegu, medyo mahirap mabuhay.

[Paui] Although mas may means ang Korea, given na rin ‘yung healthcare nila advanced, to treat infected patients compared kung sa Pilipinas.

With the end is nowhere in sight, how far are we from a vaccine?

[Erica] FAR. It has to be tested in animals for safety and efficacy, and then the several trials in humans, which are important for safety and effectivity. And each trial usually takes at least a year. So. Give it around 5 years. (Unless WHO decides to expedite the process.) Scientists can of course claim to make vaccines. But that is merely the design and construction of the vaccine.

Is there a chance that the virus will mutate before the vaccine arrives?

[Paui] Yes, RNA viruses have that nature.

Even Dr. Parungao-Balolong commented on this. “All viruses mutate, whether the consequence is good or bad for us it is their physiology. Even flu mutates.”

[Erica] But I think CoV like SARS have lower mutation rates than the flu virus.

For now, what should we do?

[Rochelle] Be informed and stay safe.

[Erica] Be confidently beautiful: sleep well, take vitamins!

[Paui] Look into the statistics of the disease and you'll realize that there is no need to panic. Kalma lang tayo. Stay healthy by having enough rest tapos taking vitamins na rin.

[Dr. Parungao-Balolong] Hand hygiene, healthy lifestyle and hotline (connect to facts and connect for help) - it’s your 3Hs to keep free from COVID-19. Also, #NoToFakeNews that may cause panic.

Moderator's note: The interview has been edited for brevity. We once again thank Dr. Parungao-Balolong, Erica, Paula, and Rochelle for sharing their knowledge.