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‘Promises’ of the new normal

June 05, 2020 - Friday 4:06 AM by Eva Aranas Angel

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Last week I wrote about the inscrutable appeal of the ‘new normal.’ Outside of the home however, the disruptive changes that the new normal imposes in the psyche is beyond what I have seen in my many years in practice. I have never seen so many patients unable to sleep. I haven’t seen so many people waking up with palpitations. I have never seen so many, as in the title of Pedro Almodovar’s iconic movie, ‘women on the verge of a nervous breakdown.’

??As a physician, it is my duty to listen. But three or four stories of anxiety and worry also affect me. Perhaps this is what my priest friends say, pre-COVID 19 times, that they, too, experience emotional fatigue after listening to confessions.

??These days I have been confronted with many challenges at work like what PPE to use, or if we should accept walk-in patients. Should I go on with house calls or settle for online consultation (which almost always ends up gratis because not too many people are familiar with G-cash and PayMaya payment portals)?

??I belong to about half a dozen group chats. Most of the time, somebody drops a one day-old journal from reputable sources like The Lancet and New England Journal of Medicine. With the COVID pandemic, one has no choice but to opt to know the enemy better.

??Below is a summary of the COVID 19 situation in the country. I have lifted this in toto from the Facebook Page of Dr. Edsel Maurice Salvana, as far as COVID-19 and SARS Cov2 are concerned.

??To those who are unsettled and distressed, there are snippets of silver linings in his words. Proper attribution is given to Dr. Salvana for a public post on his Facebook page. No intellectual property nor copyright infringement is intended as this is used to inform the public and reach a more heterogenous audience.

“A good time to focus on positive developments in COVID-19 prevention, diagnosis and treatment.

1. Nonpharmaceutical interventions really work if used correctly and consistently.
Physical distancing of at least 1m or more decreases risk of infection by 80%.
Wearing a mask reduces risk by 85%. Let's all try to do this and maybe we can keep the pandemic under control.
 
2. Remdesivir is coming to the Philippines! And an inhaled version is in the works.
So far, this is the only drug that has been shown to have a modest effect on severe COVID-19 disease. Hopefully one of many to come.
 
3. Monoclonal antibodies against COVID19 are coming! These are easier to scale up than convalescent plasma, and will be available much faster than any vaccine. Monoclonal antibodies also have long half-lives, meaning one dose might be enough. It also has the potential to act as a "passive" vaccine that we can give to our healthcare workers and vulnerable population. We should have some good data in about 1 to 3 months.
 
4. Better antibody tests are coming. Lab-based ELISAs are up to 99% sensitive and 100% specific if done 14 days after symptom onset. Some of these measure neutralizing antibody, which would be a much better immunity correlate. ELISAs are much more sensitive than rapid tests because they use laboratory instrumentation to quantitatively measure antibody levels rather than a visual result which is subject to interobserver variability.
 
5. Almost all COVID-19 patients are no longer contagious by the 11th day of illness. Korea and Singapore are changing their guidelines for clearing people from quarantine and are going for time-based clearance rather than test-based clearance. For context, RT-PCR can remain positive for up to 8 weeks, but people are no longer contagious by the 2nd week. This will allow us to record recoveries much faster (you used to have to have 2 negative RT-PCRs for clearance) and free up hospital and isolation beds. People will also be able to see their loved ones sooner.
 
6. More severe and critical COVID-19 patients are surviving as doctors get better at treating its complications. From early intubation, pulmonologists have moved on to high flow nasal cannulas and noninvasive positive pressure ventilation. IL-6 inhibitors like tocilizumab (available locally) are in trials and are showing promise in keeping people alive.

So much more but these are the highlights. This is yet another benefit of shutting down early. Aside from giving our healthcare system a chance to catch up, our knowledge of COVID-19 is growing and we will be better able to take care of those unfortunate enough to get infected. But prevention is still better than cure so keep those masks on and we should do our best to protect each other.”
 

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