COVID-19

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?

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 or are deemed unstable, 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 strictly 5 days as of 27 March 2020. Please note that you have a legal obligation 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.
   
   At the time of writing, the test is not widely available to well individuals unless deemed necessary meeting certain criteria. As various clinics do have different workflows depending on physical constrains and resource availability, please call in advance to find out.
   
2. Antibody Tests
   
   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.

Circuit Breaker Measures

Starting from 7 April 2020, Circuit Breaker measures have been implemented in Singapore which is similar to a partial lockdown. Our clinics are open during this period but the EasyCare HQ is closed. Telebooths at Unity Pharmacies are also open, subject to availability.

Please note that the COVID-19 circuit breaker measures have been extended to 1st June 2020.

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.

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This page has been updated on 2 April 2020. Updated information are as follows:

• MCs are now strictly 5 days. There is legal obligation to stay home.
• PCR sample collection is now available at some GP/FP Clinics and also at the polyclinics. This is also available at our Hougang branch but availability depends on the staff on duty.
• Our Hong Kah branch is considering becoming a testing centre but will review the workflow changes required first.
• Flatten the curve graphic added.