COVID-19: Important Information and General Advice

Disclaimer: The details here may change according to new information made available.

Where can I find out more about the number of new cases and active cases and deaths?

Click to view larger image

The above image is from https://covid19info.live/
You can also find more statistics at https://www.worldometers.info/coronavirus/

What are the symptoms of coronavirus?

The common features of the coronavirus is a fever and a dry cough, but the absence of such features does not mean you do not have the symptoms.

Some patients may get stomach upsets or diarrhoea and this may raise suspicion of more severe disease.

The incubation period is suggested to be less than 14 days (anywhere from 3-10 days) for more than 90% of individuals but there have been cases that do not fit the above timeline and not everybody is similar. There have been cases of spread from individuals occuring even after the 14 day quaratine period.

Are we able to detect 100% of cases?

It is impossible to detect 100% of cases as there are many factors in place that can prevent this such as the honesty of travellers, compliance failure with the LOA, nature of the disease (spread through asymptomatics), availability of testing, etc.

It is not possible to test the virus at the GP or family clinics at the moment. Some clinics have become PHPC clinics to deal with the situation. This can be found in the link below.

https://www.flugowhere.gov.sg/

What are PHPC Clinics?

PHPC stands for Public Health Preparedness Clinics. These clinics will provide subsidies for Singapore Citizens and Permanent Residents diagnosed with respiratory illnesses (e.g. common cold).

Doctors have contingencies in these clinics to suit their day-to-day workflow to manage such patients.

If I have a cough or flu, what would the PHPC do?

The doctor will first assess if you have any signs of pneumonia or fit into the criteria of suspected cases (definitions change accordingly). If you have pneumonia, you will need to be sent to the hospital. If you fit into the criteria of suspected cases and do not have pneumonia, you would be sent to NCID for testing.

The number of days of MC provided is based on the clinical judgement of the doctor. If you are given 5 days MC, it would be best to stick to it. Please contact your doctor if you would wish to shorten or extend your sick leave.

Why do we need to stay at home if we have the common flu?

While it is true that having the common flu does not warrant quaratine, it is impossible to know if you are shedding the coronavirus as not all individuals with the coronavirus develop severe symptoms or pneumonia.

Staying at home reduces the possibility of spread.

Is it not possible to test for the flu at the PHPC clinics? I have read about test kits being made available at the clinics.

There are two methods to test for the coronavirus.

  1. PCR

    This method is the most accurate method to test for the coronavirus and is available at hospitals and at NCID. However the test cannot test for those who have recovered from the infection. This is a good test to determine if active disease is still present.
  2. Antibody Tests

    This method of testing can be made widely available very quickly even in most GP and family medicine clinics. However, there are concerns about the false positive and false negative rates and how it would affect public health should these be made widely available. As COVID-19 is new and we do not have much information on it, releasing a test with a limited degree of reliability can do more damage than good. This may very well replace the test above in the future. At the time of writing, FDA has just approved this test a few hours ago.

Who are more vunerable to the disease?

Older people and those with long term chronic disease do less well with any kind of lung infection.

Children however don’t seem to get sick more often in this case. It is important to note however that the coronavirus can also infect young adults and the symptoms can also be severe.

Once you become infected with the virus, can you get it again?

There have been case reports of re-infection but the quality of these studies aren’t the best. Current studies on macaques seem to development of immunity and low risk of re-infection.

If the Coronavirus spreads widely and it is no longer possible to contain, can we all go out and party?

Social distancing and good hygiene have been show to reduce the rate of spreading. I personally believe that there is a possibility to bring the epidemic under control. Some countries apart from our own, such as Taiwan, Hong Kong and South Korea have shown moderate successes with such measures. It would be prudent not to look down on the danger of the disease.

Meanwhile, should we no longer be able to contain the spread, it is still important to maintain social distancing and good hygiene. We know for sure that the success rate of surviving the disease is directly related to the availability of healthcare resources. Even if we cannot contain the spread, it would be important to delay the spread so that we can ration our healthcare resources and ensure as many people survive the disease as possible.

eg. 4 ECMO machines for 5 patients is still 1 machine too little.

No matter what your beliefs are with regards to the disease and whether the disease can be contained or not, social distancing and good hygiene is necessary. Every single person is important when it comes to containing the spread.

Some countries have mentioned herd immunity in response to the coronavirus. Shouldn’t we try to achieve that?

Herd immunity in the traditional sense (spreading) shouldn’t be mentioned without care as millions will be left for dead. Considering the disease affects young adults as well, this will destroy the social fabric of our society if the disease becomes widespread. If there were development of a harmless vaccine, this would be the next course of action.

Vaccines are not easy to develop. One of the main concerns is that a vaccinated individual may develop greater lung injury due to the presence of the antibodies and the body mounting a stronger immune response. Adequate testing is required before the vaccine can be rolled out.

Where can I get masks?

PHPC clinics have been advised to provide symptomatic patients mask and you should see a doctor if you are symptomatic. After that, you should stay home as much as possible. Please note that we have temporarily suspended the sales of masks in the ePharmacy but will provide masks without charge to those who are symptomatic. It is important that you wear the mask to prevent spread to our healthcare staff and others visiting the clinic.

Is N95 better?

N95s should be worn by healthcare workers where deemed necessary but the mask is uncomfortable to wear for prolonged periods especially if the user is not used to wearing them.

Healthcare workers who are used to the N95 mask and do not need to keep adjusting the mask may opt to wear them where necessary, but for the general public, I would advise against that. The risk of spread from adjusting the mask through hand contact is higher than that from just wearing a surgical mask, which already provides very good protection.

What are the best methods to improve hygiene?

More important than masks, keeping your hands clean is key in containing the spread of the illness. Try not to touch your face, such as adjusting masks. If your are not sick and you find yourself touch your mask more often than usual, it is better not to wear.

Washing hands with soap and water is key, as pathogens are removed mechanically. If this is unavailable, alcohol or benzalkonium chloride can be used. A list of active ingredients can be found on the NEA website.

https://www.nea.gov.sg/our-services/public-cleanliness/environmental-cleaning-guidelines/guidelines/interim-list-of-household-products-and-active-ingredients-for-disinfection-of-covid-19

For handrub, alcohol handrub and benzalkonium chloride wipes for hard surfaces are made available on our ePharmacy. Please do not buy alcohol swabs for wiping surfaces. These swabs are required by diabetics and for healthcare professionals to disinfect skin surfaces.

How can Telemedicine be used to fight COVID?

We encourage the use of our ePharmacy and Telemedicine during the period to prevent spread of diseases especially for non-urgent health issues and to obtain medical supplies and repeat medications. For some acute illnesses, we can also use telemedicine in selected cases.

However, if you do have respiratory symptoms such as cough, runny nose, sore throat and/or fever. We recommend that a physical visit to a doctor is made. We are unable to determine the presence of lung infection through a telemedicine call and the disease can progress rapidly.

Movember Monthly Article 2 – Prostate Cancer

Prostate cancer is the most common cancer in men. Most prostate cancers are slow-growing but some prostate cancers are aggressive. Increasing age is the most important risk factor for developing prostate cancer. However, a small number of cases can happen to men below the age of 65.

The prostate gland and age-related changes

The prostate is located between the bladder and the penis, measuring about the size of a walnut. Its main function is to secrete prostatatic fluid, one of the components of semen. Enlargement of the prostate is called benign prostatic hyperplasia (BPH) and is common in men above the age of 50.

Benign Prostatic Hyperplasia (BPH)

BPH is not cancer and is considered part of normal age-related changes. It does not increase the risk of cancer but it could produce symptoms that can affect your quality of life.

These symptoms include

  • Incomplete bladder emptying
  • Nocturia, which is the need to urinate two or more times per night
  • Trouble urinating
  • Discomfort in the pelvic area
  • Painful urination
  • Blood in the semen or urine

BPH and prostate cancer have similar symptoms, so it’s sometimes hard to tell the two conditions apart. Make an appointment with your doctor if you have any signs or symptoms that worry you.

Top left: Enlarged prostate pressing onto the rectum and bladder
Bottom left, Prostate cancer pressing onto the rectum

Prostate Cancer: How do you tell it apart from BPH

Prostate cancer begins when some cells in your prostate become abnormal. The abnormal cells accumulate and multiple to form a tumor that can grow to invade nearby tissue. Some abnormal cells can also spread (metastasize) to other parts of the body. Hence, prostate cancer that’s detected early has a better chance of successful treatment.

When you first have symptoms, your doctor will arrange for a Prostate-specific antigen (PSA) test. This is a blood to detect a protein your prostate gland makes which can be high when your prostate grows. It can’t tell for sure that you have BPH or prostate cancer. Your doctor may also examine your recturm with his/her finger to check if your prostate is enlarged.

If abnormalities are found and there is suspicion of possible cancer, you will need to be referred to a specialist where a biopsy can be done, which removes a sample of prostate tissue and checks it under a microscope for cancer.

Imaging such as ultrasound and MRI can be useful to assess the prostate gland.

Is there a cure?

The curative treatment for prostate cancer depends on the stage of the disease. In most cases, if there is no spread, curative treatments for prostate cancer include:

  • Active surveillance or watchful waiting: Your doctor watches your symptoms or does regular DRE and/or PSA tests to check for cancer growth. Many people die with prostate cancer instead of prostate cancer. Hence no treatment is needed in some cases.
  • Surgery: A procedure called a radical prostatectomy removes the prostate gland and some of the tissue around it.
  • Radiation therapy: Radiation uses high-energy X-rays to destroy prostate cancer. It can be done with a radiation beam or you can get it through small radioactive pellets or seeds placed inside your prostate.
  • Cryotherapy: This treatment uses intense cold to destroy prostate tissue. Freezing often damages the nerves near the prostate that control erections and can cause erectile dysfunction after treatment.
  • Hormone therapy: You take medicine to block the male hormones that fuel the growth of prostate cancer.

When treated, the five-year survival rate for all stages of prostate cancer is almost 100 percent compared to men without this cancer.

How are my symptoms treated?

Symptomatic treatment for prostate cancer is similar to BPH.

Alpha-blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), and tamsulosin (Flomax) relax muscles in your bladder and prostate to help you urinate more easily.

5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), shrink your prostate.

How can I prevent prostate cancer?

If you’ve already been diagnosed with BPH or prostate cancer, see your doctor for regular follow-ups. Routine screening isn’t recommended for prostate cancer, you might want to get screened with a DRE or PSA test based on your age and risks. Ask your doctor if you have any questions.

Several studies have shown that there is relation between HPV and prostate cancer. As the HPV vaccine is relatively new, the preventative role of HPV vaccines in prostate cancer requires more data to validate its use and further investigation. However, the HPV vaccine has been shown to have warts and other types of cancers in men.

What we can do for you:

Click here to make an appointment.

iDOC Clinic services:

  • PSA tests
  • DRE examination
  • HPV vaccinations
  • Referrals for Prostatic biopsy
  • Follow up for BPH

Movember Monthly Article 1: Erectile dysfunction – Getting Hard isn’t Hard

Erectile dysfunction ishe inability to get and keep an erection firm enough for sex. Up to 50 % of men at the age of 50 may experience erectile dysfunction.

This week we explore the many causes of erectile dysfunction and various methods to get around it.

What causes erectile dysfunction?

Having problems keeping an erection once in a while isn’t necessarily a cause for concern but if it is an ongoing issue, it can affect your self confidence and relationships. Problems keeping an erection can also be a sign of an underlying health condition that requires medical attention and a risk for heart disease.

Some of the common causes include:

  • Obesity
  • Smoking
  • Diabetes Mellitus
  • Obstructive Sleep apnea
  • Chronic Kidney Disease
  • Hormonal problems.
  • Psychological causes such as depression and anxiety or even performance related issues.

Some medications/prior treatment can also cause erectile dysfunction:

  • Blood pressure medications
  • Benzodiazepines
  • SSRI Antidepressants
  • Alcohol
  • Prostate Cancer Treatment

What is the best treatment for erectile dysfunction

Lifestyle modifications are considered first-line therapy can can have a significant impact in ED management. However, despite the benefits of behaviour modification, men presenting with ED may want the physician to help with measures that can have an immediate impact.

What is viagra?

Viagra is a PDE5 inhibitor which works by increasing blood flow to the penis. Viagra and other PDE5 inhibitors have been the mainstay of ED treatment since 1998. These medications are able to induce good effect within a short period of time and various medications have different duration of potency.

There are also different methods of dosing, for example to take a dose before intimacy or to take a tablet everyday. PDE5 inhibitors are considered very safe and effective but a doctor will need to review you medications to ensure there arent any interactions, especially with nitrates.

It is also important to take as what your doctor has prescribed. Overdosing can lead to irreversible side effects such as blindness. It is also important that you obtain your medication from a registered clinic/pharmacy. 80% of websites claiming to sell Viagra were in fact selling counterfeits.

Are there other medications other than Viagra?

Injections such as alprostadil can also help to induce erection. A small needle is used to inject the medication into the side of the penis through a small-gauge needle.

An intraurethral form is also available, consisting of a tiny pellet of drug inserted into the urethra.

Non-medical approaches

1. Vacuum constriction devices are clear plastic chambers placed over the penis, which directs blood into the penis. If an adequate erection occurs inside the chamber, the patient may slip a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 min is not recommended.

2. Low-Intensity extracorporeal shock wave therapy is a useful and noninvasive treatment for erectile dysfunction. This consists of low-intensity shock waves that are applied to different areas of the penis, stimulating new blood vessel growth and improving blood flow.

Seeking Medical Advice

If you’re concerned about erectile dysfunction, speak to your doctor. Psychosexual counselling can sometimes play a huge difference. Treating an underlying condition is enough to reverse erectile dysfunction and given how common it is, there is no need to be embarrassed to seek professional advice. Lifestyle modifications, medications or other direct treatments might be needed. This is available through our telemedicine service.

Contraceptives Awareness Month: Week 4 – Combating Side Effects

Oral contraception Side effects

A small number of women may experience side effects from taking oral contraceptives and they can range from negligible to irritating. These are but not limited to:

  1. Temporary Weight Gain
  2. Nausea
  3. Breast Tenderness
  4. Breakthrough Bleeding
  5. Mood disturbances

However most of the symptoms are temporary and often reassurance that symptoms will likely resolve within three to five months is often the only treatment required.

Continue reading Contraceptives Awareness Month: Week 4 – Combating Side Effects