The rundown on COVID-19: What you need to know

Dr. Erika Chua, a general practitioner in the Philippines with a license to practice in the UK, writes about essential COVID-19 facts.

WHAT IS COVID-19?
COVID-19 is the disease caused by a novel coronavirus, now called SARS-CoV2, that emerged late 2019 in Wuhan, China. Unfortunately, this new virus is highly contagious and can cause death in certain patient populations such as those with pre-existing medical conditions and the elderly. Common symptoms associated with the disease are fever, dry cough, and tiredness. Other symptoms are muscle or joint pains, loss of taste or smell, headache, diarrhea, conjunctivitis, a rash on skin, and shortness of breath.

In early March of 2020, the SARS-CoV-2 virus had started to invade Philippine shores and the country went into lockdown. Despite this, slowly, like so many other countries, we were unable to control the spread of the virus. Aside from the obvious medical problems it can cause, it has wreaked havoc on trade and global supply chains with shortages of medical supplies such as masks and essential medicines. Many businesses, big and small, had to close shop with thousands of Filipinos losing their primary sources of income. This is just but a picture of how the world has suffered in 2020.

And the world has responded. Front-liners and scientists work tirelessly every day to give patients a fighting chance. Governments have put into place guidelines and ordinances to protect their constituents while out in public. Business owners have shifted their practices and models to work in the “new normal.” And with resources being poured into scientific research on COVID-19, not only have we developed tests and medications for the disease, a vaccine for COVID-19 is in sight. This being said, people should not become lax with self-protection. It is still important to practice proper hygiene, practice social distancing and regular wearing of masks.

PREVENTIVE MEASURES
The World Health Organization has released several advisories for the public to keep them safe during this time. While these steps may seem tedious, it may mean the difference between life and death. The three most important ways to prevent contracting COVID-19 are as follows, with a more detailed explanation below:

1. Physical distancing
2. Wearing masks
3. Practicing good hand hygiene

To ensure protection for one another, there should be at least a one-meter distance between oneself and others. When indoors, it is recommended that there should be a greater distance between you and another person to reduce risk of infection when they sneeze, cough, or speak. Avoid meeting other people, especially in enclosed, crowded spaces that can involve close contact. In cases where socialization cannot be avoided, either socialize outdoors or ensure that the room has proper ventilation and that everyone is wearing masks.

This brings us to the next point: wearing a mask is a must when with other people. Make sure to clean your hands before and after you wear your masks. Your mask should cover always your nose, mouth and chin. You may use fabric or medical masks but make sure that you store them properly in clean plastic bags or to dispose of them after use. When selecting a mask, avoid masks with valves as this can still potentially cause to spread the virus to other people.

Hand hygiene is still the single most effective measure to prevent the spread of pathogens including that of COVID-19. Wash your hands regularly and thoroughly with soap and water or with an alcohol-based hand rub. Avoid touching your eyes, nose, and mouth. If you need to cough or sneeze, cover your mouth and nose with a clean tissue or with your bent elbow. And finally, make sure to regularly disinfect surfaces which are frequently touched such as phones and gadgets, door handles, elevator buttons and faucets.

If you feel unwell or develop symptoms associated with COVID-19, it would be best to stay home and self-isolate even if your symptoms are mild. Do not delay going to the hospital if you have symptoms such as difficulty breathing, chest pain, lethargy, or loss of consciousness. Seek immediate medical attention as these symptoms can indicate a serious condition.

COVID-19 TESTING
It is important that those who develop symptoms are tested for COVID-19. This is to prevent patients from spreading the disease to others, especially with those who live in close contact to them such as their families and loved ones. People who have had close contact with a confirmed case (within six feet for a total of 15 minutes or more) should also be tested. Certain local government units may also require testing for those intending to travel soon.

Currently, we have two types of tests available in the market: viral tests (antigen and RT-PCR tests) and antibody tests. An antibody test will tell you if you have had a past infection while viral tests tell you if you have a present or current infection. As for the viral tests, the two most commonly used and required in the Philippines are the rapid antigen test and the reverse transcription polymerase chain reaction, more commonly known as RT-PCR.

Rapid antibody tests
Rapid antibody tests are used to check for the presence of antibodies in your blood versus SARS-CoV-2, the virus that causes COVID-19. Antibodies are developed by the immune system as a response to an infection by a certain pathogen. This would mean that a positive antibody test assumes that the patient had been previously been exposed and infected by the virus and has perhaps now recovered. The test, however, does not tell us if the person is infected currently as antibodies may take weeks to develop or to be detected. Additionally, these tests are not that accurate, hence patients may test positive or negative falsely. For these reasons, antibody test results should not be used to diagnose someone with an active infection.

Rapid antigen tests
Rapid antigen tests are able to detect specific viral antigens such as proteins of a virus from a nasal swab. The presence of these antigens, meaning a positive result, suggest current or an active COVID- 19 infection. Since rapid antigen tests are relatively inexpensive and can return results in approximately 15 minutes, they are often used as point of care screening tests. However, the sensitivity of this test is lower than that of PCR. Positive results are highly accurate however the test cannot completely rule out the infection. Hence, proper interpretation of the test is essential for accurate identification of patients as well as diagnosis and management of suspected COVID-19 infections. It is best to seek consult with your physician for proper diagnosis when using antigen tests as there may be a need for a confirmatory test with RT-PCR, especially in situations where the result of the rapid antigen test is inconsistent with the clinical picture of the patient.

RT-PCR
RT-PCR still remains the gold standard for clinical diagnostic detection of SARS-CoV-2 as it is able to detect viral RNA or the genetic material of the virus from a nasal or throat swab. Similar to the rapid antigen test, RT-PCR only detects if the patient has a present infection. Of the three tests, RT-PCR is the most accurate and is often recommended for confirmatory testing for patients who are suspected to have the infection. RT-PCR is also usually required for international travel with the swab having been done around 48-72 hours prior to a flight. The disadvantage of this test is that it is the most expensive of the three tests and that the turnaround time is for result releasing ranges from 2 hours to days depending on the capability of the laboratory.

Timing of testing
The timing of testing is also important when considering getting tested for COVID-19. If patients have their test done too early, this may yield a false negative result for both viral tests. Testing on the same date of exposure will most likely produce negative results. Health care professionals recommend testing to be done around seven days after exposure or around three to four days after onset of symptoms to get the best and most accurate results. If you have any questions or concerns about which test to get or when should testing be done, it would be best to consult your doctor or test provider to get the most accurate picture of your current state of health.

Given this current health situation, Preferred Global Health’s partnership with AXA Philippines proves timely as it exclusively offers Preferred Consultation and Care (PCC) in the Philippines. PCC, a service available in AXA’s Global Health Access (GHA) product, assembles the best medical teams from the top 1% of U.S. hospitals to give expert guidance to patients.