"This is the only way."
We've already argued in our past two columns for the urgent need for the Department of Health to resort to mass testing of Filipinos for possible infection from the coronavirus. We reiterate our stand that this is the only way to keep the crisis from escalating further and causing more fatalities in the days ahead.
The DOH insists that the Real-Time Polymerase Chain Reaction (RT-PCR) assay method is the "gold standard" in determining who's positive or negative for the virus. The problem with this "gold standard" is that it takes too long to know the results, taking as long as ten days or more, with patients dying without even knowing they tested positive.
That tells us our health authorities should use every available means to expand mass testing and use the rapid test kits that show results in as fast as five minutes.
The experience of other countries that have tested for infections using the rapid or on-site test kits delivering fast results and slowed down the exponential increase in COVID-19 incidence demonstrates very clearly that the DOH should now use more weapons in its arsenal to contain the plague.
We can understand that the DOH appears totally overwhelmed by the sheer scale of the crisis because it lacks the necessary resources to do more. But it can offset these with wise decisions, chief of which is to move firmly toward mass testing. Saving more lives should be the priority.
What happens if you're hospitalized from COVID-19?
We've already seen many guidelines on avoiding falling ill from COVID-19 issued by various agencies. But from another perspective, this time from the actual experience of top Chinese medical experts, the "Handbook of COVID-19 Prevention and Treatment" (available for free download from Alibaba Cloud), provides a close look at dealing with COVID-19. Some parts may be too technical for the layman, but on the whole it gives you a good idea of what to expect if you find yourself under hospital care.
The handbook lists down four clinical classifications of the infection: 1) Mild Cases: The clinical symptoms are mild and no pneumonia manifestations can be found in imaging; 2) Moderate Cases: Patients have symptoms such as fever and respiratory tract symptoms, etc. and pneumonia manifestations can be seen in imaging; 3) Severe Cases: Adults who meet any of the following criteria—respiratory rate: 30 breaths/min; oxygen saturations; 93 percent at a rest state; arterial partial pressure of oxygen/oxygen concentration of 300 mm.; Patients with 50 percent lesions progression within 24 to 48 hours in lung imaging; and 4) Critical Cases: Those meeting any of the following criteria: occurrence of respiratory failure requiring mechanical ventilation; presence of shock; other organ failure that requires monitoring and treatment in the ICU. Critical cases are further divided into early, middle and late stages according to the oxygenation index and compliance of respiratory system.
Medical personnel will continuously monitor patient condition, especially changes in consciousness, respiration rate and oxygen saturation. They will also monitor symptoms such as cough, sputum, and chest tightness, and adjust oxygen therapy as needed.
In mild cases, medical personnel will perform air isolation, blood oxygen saturation monitoring, conduct 2019 Novel Coronavirus RNA Detection in sputum and feces; perform blood routine, biochemical profile, urine routine, stool routine; coagulation function; blood gas and lactic acid analysis; thyroid function, and respiratory virus test, among others. They will also perform liver, gallbladder, pancreas and spleen ultrasound, echocardiography and lung CT scan. As for medication in mild cases, patients will be given Arbidol tablets, Lopinavir/Ritonavir tablets, and Interferon spray.
In moderate cases, patients will undergo all the above procedures and will be given Ambroxol as additional medication.
In severe cases, all the above procedures and additional medications: NS 100 ml and methylprednisolone; NS 100 ml and pantoprazole; Caltrate tablet; lmmunoglobulin; and NS 100 ml and Ambroxol.
In critical cases, patients will undergo all of the above plus blood culture, electrocardiogram, cytokine, and sputum culture. Additional medication will include Thymic peptides; NS 50 ml and isoproterenol; Human serum albumin; NS l00 ml and piperacillin/tazobactam; and Enteral nutrition suspension through nasogastric feeding.
What do we make of all this?
COVID-19 can be fatal, particularly for the elderly—the most vulnerable to the infection, according to experts, since they already have pre-existing medical conditions such as hypertension, diabetes, kidney and liver problems, and chronic obstructive pulmonary disease.
But there are also recoveries especially if given the proper care by hospitals.
We're glad to know that PhilHealth has promised to pay the full cost of treatment of COVID-19 patients. But what if the patient dies without an official test result showing that he's positive for the disease? Will the hospital charge him an astronomical amount? A friend of mine estimated that it would cost around P500,000 for all the tests, medication and hospital bed in a very short period of about 10 days, and you can't even be sure that you'll be able to get leave the hospital in a vertical position.