To Guam | We Should Do Our Best to Avoid Hospitalization for Any Reason

An advisory article titled "We Should Do Our Best to Avoid Hospitalization for Any Reason" published in Pacific Daily News on October 31, 2020 (Guam time):

https://www.guampdn.com/opinion/letter-we-should-do-our-best-to-avoid-hospitalization-for-any-reason/article_94db6431-0b1b-5d99-b364-e4209d56bb9d.html

Nutrition | Vitamin D & Probiotic Are Clinically-proved Adjuvants to Help COVID-19 Recovery

Several clinical studies with nutritional ingredients on COVID-19 have been published in scientific journals. They proved that vitamin D and probiotic could be helpful when patients try to get recovered from COVID-19.

Vitamin D

In a newly published clinical study carried out in Spain, researchers gave calcifediol, an active form of vitamin D, to 50 people hospitalized with COVID-19. All of 76 patients were treated equally with hydroxychloroquine and azithromycin, but another group of 26 patients didn’t receive vitamin D. Only one (2%) of the patients treated with vitamin D ended up in the intensive care unit, while 13 (50%) of the untreated patients did.

In addition, of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged. Of the patients treated with calcifediol, none died, and all were discharged, without complications.

The study published in the October issue of the The Journal of Steroid Biochemistry and Molecular Biology (Ref.1). Researchers from the University of Córdoba, Spain, studied 76 patients admitted to Reina Sofia University Hospital for COVID-19. Their findings suggest that calcifediol (three doses, in this study — .532 mg on day one, .266 mg on days three and seven) could reduce the severity of COVID-19 infection and lower the risk of complications.

Probiotics

A clinical study in Italy showed probiotics helped reduce COVID-19 symptoms in 7 days and also avoid severe illness that might require intensive care (Ref. 2).

The study enrolled seventy COVID-19 patients, hospitalized between March 9 and April 4, 2020 at Sapienza University of Rome. These patients had a fever and required non-invasive oxygen therapy. 42 of them received hydroxychloroquine, antibiotics and tocilizumab, alone or in combination. The other group of 28 patients received the same therapy added with an oral probiotic supplement.

Around 90% of 28 patients in the “probiotic” group actually showed remission of symptoms, including diarrhea, in 3 days. The percentage reached 100% on the seventh day while the one in the control group was lower than 50%.

The estimated risk of developing respiratory failure in patients treated with the oral probiotic supplement was eight times lower than those in the control group, according to the odds ratio statistics. The prevalence of ICU usage and mortality were both higher among patients who were not treated with the probiotic formula.

Dr. Giancarlo Ceccarelli, a specialist in infectious diseases at the university, told the media that “Our preliminary results evidenced on improved survival rate and a lower risk of transfer to an intensive resuscitation for patients supplemented with the probiotic compared with those on standard treatment only.”

Low Vitamin D Level is a Risk Factor

The University of Chicago’s research published in September actually showed vitamin D's possible role in COVID-19 prevention. Subjects with sufficient vitamin D status had a lower risk for getting tested positive (Ref.3).

In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status, a difference that was statistically significant.

In May, the cross-national analysis published by British researchers and Northwestern University both showed a significant relationship between low average vitamin D levels and the higher number of COVID19 cases, particularly COVID-19 mortality rates, per head of population. (Ref. 4)

Reference

1. https://www.sciencedirect.com/science/article/pii/S0960076020302764

2. https://www.frontiersin.org/articles/10.3389/fmed.2020.00389/full

3. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157

4. https://link.springer.com/article/10.1007/s40520-020-01570-8

To the world | 14-day Quarantine Before Trip

If visitors would be totally free after 14-day quarantine on arrival, it seems reasonable to have them do quarantine for 14 days in their home countries before they depart and then allow them to enjoy themselves from the very first day of their trip.

My idea about “14-day quarantine before your trip” actually means you did not have any COVID-19 related sickness during the 14 days prior to your trip, and the practical way could be to have your physician issue you a health certificate to prove your health of “the 14 days before your trip”. I think we should trust the credibility of physicians in certain countries, for example, Japan, Korea and Taiwan. We could ask for a negative testing result on top of the “14-day” health certificate if we prefer a testing result to comfort us.

Nutrition | Researches We Should Know During the Pandemic

Several human nutrition researches specifically focusing on COVID-19 have been published in scientific journals. They gave people a good direction regarding how to integrate nutrition to the response to the pandemic and stay well.

Vitamin D

The University of Chicago’s research published in September showed convincing effectiveness of vitamin D on COVID-19 prevention. Subjects with sufficient vitamin D status had a lower risk for getting tested positive (Ref.1).

In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status, a difference that was statistically significant.

Overall, 71 participants (15%) tested positive for COVID-19. In multivariate analysis, testing positive for COVID-19 was associated with increasing age up to age 50 years (relative risk, 1.06; 95% CI, 1.01-1.09; P = .02); non-White race (relative risk, 2.54; 95% CI, 1.26-5.12; P = .009), and likely deficient vitamin D status (relative risk, 1.77; 95% CI, 1.12-2.81; P = .02) compared with likely sufficient vitamin D status. 

In May, the cross-national analysis published by British researchers and Northwestern University both showed a significant relationship between low average vitamin D levels and the higher number of COVID19 cases, particularly COVID-19 mortality rates, per head of population. (Ref. 2)

Probiotics

A clinical study in Italy showed probiotics helped reduce COVID-19 symptoms in 7 days and also avoid severe illness that might require intensive care (Ref. 3).

The study enrolled seventy COVID-19 patients, hospitalized between March 9 and April 4, 2020 at Sapienza University of Rome. These patients had a fever and required non-invasive oxygen therapy. 42 of them received hydroxychloroquine, antibiotics and tocilizumab, alone or in combination. The other group of 28 patients received the same therapy added with an oral probiotic supplement.

Around 90% of 28 patients in the “probiotic” group actually showed remission of symptoms, including diarrhea, in 3 days. The percentage reached 100% on the seventh day while the one in the control group was lower than 50%.

The estimated risk of developing respiratory failure in patients treated with the oral probiotic supplement was eight times lower than those in the control group, according to the odds ratio statistics. The prevalence of ICU usage and mortality were both higher among patients who were not treated with the probiotic formula.

Dr. Giancarlo Ceccarelli, a specialist in infectious diseases at the university, told Nutraingredients.com that “Our preliminary results evidenced on improved survival rate and a lower risk of transfer to an intensive resuscitation for patients supplemented with the probiotic compared with those on standard treatment only.”

Reference

1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157

2. https://link.springer.com/article/10.1007/s40520-020-01570-8

3. https://www.frontiersin.org/articles/10.3389/fmed.2020.00389/full

To Guam & the world | Protect the vulnerable, develop testing and tracing, and don't put faith in lockdowns

 An opinion letter was published in Marianas Business Journal on September 7, 2020 (Guam time).

https://www.mbjguam.com/2020/09/07/letter-to-the-editor-sept-7-2020/

To Guam | Hospitalization Rate, Not Daily Test Results, Is Important to Watch

An analysis article titled "Hospitalization Rate, Not Daily Test Results, Is Important to Watch" published in Pacific Daily News on August 19, 2020 (Guam time).

https://www.guampdn.com/opinion/hospitalization-rate-not-daily-test-results-is-important-to-watch/article_2b5039c6-b44a-5925-ac2c-7c79da282ec6.html

Nutrition | Clinical Study: Probiotics Reduce COVID-19 Symptoms & Prevent Severe Illness

Probiotics are well known as an immune defense booster. A clinical study in Italy finally showed probiotics helped reduce COVID-19 symptoms in 7 days and also avoid severe illness that might require intensive care.

The study enrolled 70 COVID-19 patients, hospitalized between March 9 and April 4, 2020 at Sapienza University of Rome. These patients had a fever and required non-invasive oxygen therapy. 42 of them received hydroxychloroquine, antibiotics and tocilizumab, alone or in combination. The other group of 28 patients received the same therapy added with an oral probiotic supplement called SivoMixx, a mixture of different species of lactic acid bacteria and bifidobacteria at a concentration of 800 billion CFU (Colony Forming Unit) per sachet, administered in three equal doses a day.

Around 90% of 28 patients in the “probiotic” group actually showed remission of symptoms, including diarrhea, in 3 days. The percentage reached 100% on the seventh day while the one in the control group was lower than 50%.

The estimated risk of developing respiratory failure in patients treated with the oral probiotic supplement was eight times lower than those in the control group, according to the odds ratio statistics. The prevalence of ICU usage and mortality were both higher among patients who were not treated with the probiotic formula.

Dr. Giancarlo Ceccarelli, a specialist in infectious diseases at the university, told Nutraingredients.com that “Our preliminary results evidenced on improved survival rate and a lower risk of transfer to an intensive resuscitation for patients supplemented with the probiotic compared with those on standard treatment only.”

It is worth to notice that the dosage, 2400 billion CFU a day, of probiotics used in the clinical study was extremely high. When it comes to regular immune support, the daily dosage is usually up to 150 billion CFU only. A randomized controlled trial of 152 subjects infected with rhinovirus in 2017 even showed those who took probiotic supplement at a daily dosage of 2 billion CFU for 28 days had a better immune response and the dosage was good enough to lower virus levels in the nasal mucus.

A 2017 animal study publish on Science reminded that, with help from good bacteria in the gut, plant flavonoids could be converted to a substance called DAT, which can activate antiviral response to significantly help mice reduce the incidence of flu.

Researchers therefore suggested that it is a great immune support plan to get more plant flavonoids from vegetables, berries, tea and chocolates, and also eat cheese, yogurt, miso, sauerkraut and kimchee or take probiotic supplements to foster good bacteria in the gut.

Previous researches actually showed that intestinal metabolites significantly affect not only local intestinal immunity but also other organs through the lymphatic and circulatory system. For example, the Italian researchers highlighted in their report that short chain fatty acids (SCFA), produced primarily by bacterial fermentation of dietary fiber, act in the lungs as signaling to attenuate inflammatory and allergic responses. The immune support plan, mentioned above, with probiotics and vegetables is therefore even more convincing because vegetables provide lots of dietary fiber.

So, what about making a salad with greens, berries and using yogurt as its dressing?

References

Frontiers in Medicine: https://www.frontiersin.org/articles/10.3389/fmed.2020.00389/full

Beneficial Microbes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797652/

Science: https://science.sciencemag.org/content/357/6350/498.full

Mucosal Immunology: https://www.nature.com/articles/mi201775

To Taiwan | 台灣大可開展更恢弘的全球戰疫作為

標題為「台灣大可開展更恢弘的全球戰疫作為」的評析文章，台灣時間7月14日獲刊於《上報》：
https://www.upmedia.mg/news_info.php?SerialNo=91433

To the world | Only Sustainable Measures Can Curb COVID-19

An analysis article titled "Lessons from Taiwan: Only Sustainable Measures Can Curb COVID-19" published in The Pacific Island Times on July 11, 2020 (Guam time).
https://www.pacificislandtimes.com/amp/2020/07/11/lessons-from-taiwan-only-sustainable-measures-can-curb-covid-19

To Guam | Don't Let Negative Result Bring Fake Relief

An analysis article titled "Don't Let Negative Result Bring Fake Relief" published in Pacific Daily News on July 2, 2020 (Guam time).

https://www.guampdn.com/opinion/letter-don-t-let-the-negative-result-bring-you-fake-relief-from-coronavirus-prevention/article_436e68af-46e9-513a-9ce2-aad1c0a49ed9.html

To the world | Taiwan, Sweden showing the world

An analysis article titled "Taiwan, Sweden showing the world" published in Taipei Times on May 21, 2020 (Taipei time).
https://www.taipeitimes.com/News/editorials/archives/2020/05/21/2003736770

Nutrition | What Foods Help You Stay Away From Virus' Harm?

When the coronavirus is spreading, you may find that it's difficult to get a bottle of vitamin C pills and there is nothing in the orange juice area at the supermarket. While you are loading up vitamin C, you had better think of probiotic and garlic as well if what you really want is “prevention”.

Take probiotics & eat vegetables

You have probably heard that probiotics foster good bacteria in the gut and support immune defense. There is actually science behind what you heard. A randomized controlled trial of 152 subjects infected with rhinovirus showed those who took probiotic supplement for 28 days had a better immune response and lower virus levels in the nasal mucus.

A 2017 animal study publish on Science reminded that, with help from good bacteria in the gut, plant flavonoids could be converted to a substance called DAT, which can activate antiviral response to significantly help mice reduce the incidence of flu.

Researchers therefore suggest that it is a great immune support plan to get more plant flavonoids from vegetables, berries, tea and chocolates, and also eat cheese, yogurt, miso, sauerkraut and kimchee or take probiotic supplements to foster good bacteria in the gut.

Garlic

Garlic is one of members in the allium family. Nutrition experts usually suggest should eat every member of this family, including onions and leeks, to help build up immunity in order to fight off common cold during fall and winter. A trial randomly assigned 146 participants to either a garlic supplement (with 180 mg of allicin) or a placebo for 12 weeks. The trial reported 24 occurrences of common cold in the garlic intervention group compared with 65 in the placebo group.

Other nutritional solutions

There are scientific researches on vitamin C, zinc and echinacea as well. The only thing is their results usually showed benefits of reducing symptoms of upper respiratory infections and shortening the duration of colds, instead of prevention.

To make the duration of colds shorter, nutrition experts also recommend chicken soup. It is good for avoiding dehydration. In addition, its amino acids is essential for supporting immune system. When you cook chicken soup, it is absolutely a good idea to add mushroom, carrot and celery.

To the US | Study Germany’s and Taiwan’s Success to Form a Reopening Strategy

Why does Germany close dining and entertainment businesses only while France, Italy and Spain enforce nationwide lockdowns? Why are people in Taipei keeping daily life while Singapore closes schools and businesses and asks citizens to stay home till June 1?

The most important lesson we should learn from Germany is to stop being worried about the number of confirmed cases. Due to the coronavirus’ highly contagious nature and the country’s massive testing policy, Germany is certainly finding a lot of COVID-19 cases. The focus therefore ought to be mild cases’ quarantine and severe cases’ medical treatment. Germany did it right, so their domestic patients got well treated and they have been taking care of patients flown in from other European Union member countries.

While many countries have been calling for flattening the epidemic curve, as of April 13, Taiwan, with a population of 23 million citizens, reported 6 deaths from COVID-19 and only 273 patients who are still hospitalized. Taiwanese have been promptly wearing a mask since the middle of January even though many experts did not agree it could help at that time. Taiwanese government also coordinated mask manufacturers to increase productivity to meet people’s demands of purchasing masks. In contrast, most of western countries did not add wearing a mask into COVID-19 control guidelines until April.

It definitely makes a lot of sense that the governors who want to lift the restrictions do their researches on the experiences of those countries that have never place any restriction order during the pandemic to form a relevant and sustainable exit strategy. I am glad to see Mr. Governor Gavin Newsom tweeted California’s “flatten the curve” graph on April 11, which showed California has used “hospitalization rate” to replace “infection rate”, or confirmed cases, to monitor the epidemic curve. I would like to acknowledge California for its action of bringing COVID-19 control to a right track and to carefully thinking of its reopening plan.

Our organization, HSVG Mission, also want to remind that it is better to still suggest the elderly should spent most of time at home during the early stage of the reopening. People with underlying medical conditions, who have a relatively higher risk of developing severe illness once contracting the virus, should be told to thoroughly practice good hygiene and to pay more attention to having their chronic diseases under control.

Data showed more than 22 million Americans have filed for unemployment since state-mandated lockdowns have been enforced. The spike in new jobless claims is believed to result from the lockdowns that have kept Americans from their workplaces and forced many companies to shutter or to lay off employees. With wearing a mask in public as a careful precaution measure, healthy young and middle-aged adults should be allowed to resume daily routines as soon as possible to avoid households’ miserable financial consequences of workplace shutdown. Probably it’s time for some states to ease lockdowns or any other similar restrictions with a carefully-formed exit strategy.

To Taiwan | 給海軍一個機會 好好向美軍學習

標題為「給海軍一個機會  好好向美軍學習」的評析文章，台灣時間4月21日獲刊於《上報》：
https://www.upmedia.mg/news_info.php?SerialNo=85780

To Europe | The EU should learn lessons from Germany’s coronavirus protocols so life can return to normal

An analysis article titled "The EU should learn lessons from Germany’s coronavirus protocols so life can return to normal" published in Euronews on April 8, 2020 (Paris time):

The European Commission announced the concept of short-time work (reducing employees hours) on 1 April as an initiative of helping people keep their jobs and go back to full work as soon as the lockdown will be over. We would like to support this initiative and share our evidence-based analysis showing that healthy adults should be allowed to resume their daily lives as soon as possible to have a fully-operated system efficiently tackle the pandemic.

New data released in the US on Thursday 2 April showed 3.28 million Americans filed for unemployment benefits in the previous week. The spike in new jobless claims is believed to result from the pandemic control lockdowns that have kept Americans from their workplaces and forced many companies to shutter or to lay off employees. We all know that unemployment could not only affect people’s finances but also their ability of taking care of their health.

In addition, “stay home” orders in some states in the US have also affected certain senior care operations; for example, free meal delivery to the seniors were delayed or rerouted even though the elderly are actually a group of people who need extra care most during the pandemic. It is better that healthy adults are allowed to resume their routines soon to help the community get back to normal early.

According to a report published by Italy’s National Health Institute on 17 March, 96.3% of fatal victims in Italy were patients over 60 years old. 99.2% of Italy’s coronavirus fatalities were people with at least one chronic medical condition, such as hypertension, diabetes and heart disease. Based on the demographic, we suggest the system should have the vulnerable stay home and, more importantly, offer them extra care. Young and middle-aged adults without serious health conditions should keep their routines to maintain the community’s full operations and, in addition, to help many households avoid the miserable economic consequences of workplace shutdowns.

Only when the system is fully-operatation are we able to take good care of the vulnerable and to end the pandemic. It is worth to noting that Hong Kong and Taiwan seem to have contained the spread pretty well and Japan and South Korea have been seeing a good trend in calming down the epidemic. All countries mentioned above did not enforce a nationwide lockdown or issue “stay home” orders at all.

Germany has not shut down daily life either; only food and entertainment outlets have been closed since the end of March. Germany has been conducting intensive testing and strictly quarantines sick people and their contacts. It has also made its medical system ready for a pandemic. Therefore, as of 28 March, Germany has had around 53,000 confirmed cases and 395 deaths recorded. Its case fatality rate (CFR) is 0.7% while a collaboration of Hong Kong University and Harvard University estimated the overall CFR of COVID-19 would be 1.4%. More impressively, Germany has now started taking care of patients flown in from Italy and France.

What Germany is doing is actually following flu control protocols. Although COVID-19 is not flu, the coronavirus appears to be showing a highly contagious nature and “flu-like pandemic pattern” after so many countries around the world reported cases. Thoroughly following “modern” flu control protocols is therefore the most relevant and sustainable measure for most countries.

What does “modern” flu control protocols mean? The protocols should include a surveillance network that asks clinics and hospitals to report patients with flu-like symptoms for further virus testing and early advanced treatments. Furthermore, they also entail adjusting resource allocation to help the medical community get ready for a huge amount of patients to save the vulnerable, and reminding healthy people to practice good hygiene all the time as well as implementing home or institutional quarantine on sick people and their contacts to flatten the epidemic curve.

Lockdown probably worked well during the 1918 Spanish flu pandemic - but not now. Lockdown probably helped China, but it does not fit all countries. We are looking forward to seeing the European Commission helping its member countries to ease their lockdowns as soon as possible. We are also hoping the EU shows the world a good leadership and helps countries in other regions cope with the pandemic together in the near future.

https://www.euronews.com/2020/04/08/the-eu-should-learn-lessons-germany-coronavirus-protocols-life-can-return-to-normal-view

To Guam | When Guam's Total COVID-19 Cases Were Over 100

Guam reported the first three COVID-19 cases on March 15, 2020 and as of April 5 the total cases were over 100. After looking into the profiles of those confirmed cases released by Government of Guam, I actually think that the honorable Governor Lou Leon Guerrero could be more confident with the island’s COVID-19 control measures.

As a public health professional with solid epidemiologist training, I’d like to remind people on Guam that as of April 6, among 113 cases (Picture 1), there are 61 in stable conditions and 27 recovered. The percentage of the “61 plus 27” is 77.9% and it’s awesome! Keeping the number of hospitalized cases low at 21 comforts people who worry about the capacity of the island’s medical system, doesn’t it?

Picture 1

In addition, according to a report published by Italy National Health Institute on March 17 (Picture 2), 87.7% of fatal victims in Italy were patients over 70 years old. That means people over 70 have a higher risk of developing severe illness, or losing their lives, once they got infected. Please notice that, here on Guam, we have 14 over-70-year-old cases. It’s 15% only. It helps a lot when everyone of us really hope to avoid tragedies as possible as we can.

Picture 2

However, the percentage of cases of age 60 to 69 is 27.4%. This number should remind us that we need to offered extra care to the seniors in our community to help them prevent from contracting the coronavirus.

The report from Italy mentioned above also told us that 99.2% of Italy’s coronavirus fatalities were people with at least one chronic medical condition, such as hypertension, diabetes and heart disease (Picture 3). I believe the prevalence of those chronic disease is high on Guam. Our epidemic response has to include special preventive care for chronic patients as well to really flatten the curve and save the vulnerable.

Picture 3

Although COVID-19 is not flu, the coronavirus appears to be showing its highly contagious nature and “flu-like pandemic pattern” after so many countries around the world reported cases. It’s almost impossible to contain the spread. That is why Germany stops being worried about the big number of infected cases they found thru the vast testing and really pays attention to preventing severe illness and avoiding deaths. Guam may need to learn from Germany and keeps the good job we have done so far to take good care of the vulnerable in our community.

To Guam | Thoroughly follow flu prevention measures with coronavirus

An analysis article titled "Thoroughly follow flu prevention measures with coronavirus" published in Pacific Daily News on March 23, 2020 (Guam Time).

https://www.guampdn.com/opinion/thoroughly-follow-flu-prevention-measures-with-coronavirus/article_24108fb5-4cd2-5f3a-9d5c-fc2704d891ac.html

To Guam | What Happened to You Last Flu Season?

As a public health professional, I would like to remind everybody on Guam, while living with the islandwide shutdown order, to immediately recall what happened to your family last flu season.

If flu virus was passing around within your family, your workplace or your circle of friends, you and your family would be at a relatively higher risk for contracting the coronavirus during this pandemic because of your lifestyle. What you have to do now is to make major changes to start eating healthy, living healthy, covering your cough, and practicing good personal hygiene right away to protect your family.

After so many countries around the world reported cases, the coronavirus appears to be showing its flu-like pandemic pattern with its ability of easily spreading among people. Thoroughly follow flu prevention measures is therefore the most relevant protection for everybody. More importantly, a collaboration of Hong Kong University and Harvard University has estimated the case fatality rate (CFR) of COVID-19 should be around 1.4% while the CFR of a regular seasonal flu is 0.1% only. Obviously, we have to take the virus seriously with a right strategy. 

In fact, most of infected people around the globe experienced mild flu-like symptoms only. According to a study published by Italy National Health Institute on March 17, 96.3% of fatal victims in Italy were patients over 60 years old. 99.2% of Italy’s coronavirus fatalities were people with at least one chronic medical condition, such as hypertension, diabetes and heart disease. Therefore, If the resources are limited, our system really has to focus on taking care of the elderly and people with underlying medical conditions in our community because they are at a higher risk for severe illness.

(Photos: Screenshots of Bloomberg's webpage)

References

Report released by Italy National Health Institute:

https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf

Bloomberg's report:

https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says

To world leaders | Trump should be more confident in the US’ coronavirus response

An analysis article titled "Trump should be more confident in the US’ coronavirus response" published in Euronews on March 12, 2020 (Paris time):

https://www.euronews.com/2020/03/12/trump-should-be-more-confident-in-us-coronavirus-response-an-eu-travel-ban-won-t-help-view

https://euronews.al/al/bota/2020/03/13/trump-duhej-te-kishte-pasur-me-shume-besim-te-aftesia-e-shba-ve-per-t-i-bere-balle-virusit-ndalimi-i-udhetimeve-me-be-ne-nuk-zgjidh-gje

As COVID-19 becomes a global issue, most people seem too nervous to notice that the virus is actually showing a flu-like epidemic pattern with more countries reporting more cases around the world. Based on the pattern observed, the epidemic could be ended if an international organisation steps forward to coordinate a global force to thoroughly implement flu control protocols, including public education on good personal hygiene, the home or institutional quarantine of sick people, a flu surveillance network that asks clinics and hospitals to report patients with flu-like symptoms for further testing and so on, in most of countries as soon as possible.

At the end of January, Germany’s first two cases contracted the virus from a colleague who had flown in from Shanghai to join their company’s workshop, with a further two colleagues – who did not come into contact with the Chinese visitor – testing positive as well soon after. This cluster has preliminarily showed the human-to-human transmission of the virus could be very easy, and very similar to what the flu virus does. Furthermore, the similarity of the German patients’ Coronavirus symptoms to very mild flu hasn’t gone unnoticed.

Singapore and Japan offered significant evidence of a larger scale in February. As of 29 February, Singapore had reported 93 cases, including five clusters and quite a number of patients whose source of infection is not known. It was showing that the spread of the virus could easily happen in the community, exactly as the flu virus would do. And, just like the earliest German cases, patients in Singapore were fighting with only flu-like symptoms; no severe cases were reported.

Excluding the cruise ship cases, Japan found more than 250 cases in different cities and prefectures in February. Most of infected people just had flu-like symptoms and six elderly patients died from pneumonia. So, in Japan, the virus was also showing a flu-like epidemic, which usually puts senior people at a higher risk in terms of severity and morbidity.

That is why the world’s leading countries should consider flu control protocols and call for all countries to move forward in the same direction for a quicker resolution of the epidemic.

In addition, a BMJ (originally called British Medical Journal) article published on 18 February shared evidence from the comparison of case fatality rates (CFR), which is the ratio of deaths from a certain disease to the total number of people diagnosed with this disease for a certain period of time representing a measure of disease severity. SARS had a CFR of around 10%. MERS killed 34%. COVID-19’s overall CFR was around 2%. A collaboration of Hong Kong University and Harvard University also estimated the CFR of COVID-19 is around 1.4%.

As it stands, the COVID-19 virus appears to be mostly causing a flu-like illness only. It does not seem to be the SARS-like or MERS-like super killing bug of the new decade. The frightening death toll in China, for instance, could be the result of a medical system collapse caused by too many patients rushing into hospitals, which is the scenario we have usually seen during a flu pandemic. Countries with increasing death tolls – such as Italy and Iran – therefore need international aid.

Although the CFR number of COVID-19 (mentioned above) is lower than that of SARS’s and MERS’s, most experts agree the CFR of a seasonal flu is around 0.1% only in comparison. Therefore, we still have to take Coronavirus seriously, and more importantly, implement the right strategy to deal with it.

Based on its flu-like epidemic pattern, the goal of a global response to COVID-19 should change from containment to mitigation by, for example, helping the elderly and people with underlying health conditions to avoid potentially fatal exposure. We shouldn’t waste resources on finding asymptomatic infections. We should make sure that medical institutions are ready to deal with a large number of patients. We should remind healthy people to wash hands more often and sick people to stay home. Besides these, Taiwan’s recent experience shows that wearing a mask is an effective extra precaution.

Excluding three small clusters with the index case contracting the virus in January, Taiwan did not report any new domestic case after 31 January until a local woman tested positive on 28 February. Besides washing hands, it is worth to notice that the majority of Taiwanese have been promptly wearing a mask since the epidemic started concerning people at the beginning of January, even though many experts claimed that wearing a mask was not necessary at that time. Although the shortage of surgical masks has caused chaos, the chaotic situation is believed to have become a reminder for most Taiwanese to practice good personal hygiene at all times, which is the main preventive measure before we have vaccines and new drugs to combat it.

Before Valentine’s Day, the Centers for Disease Control and Prevention (CDC) in the US had actually started applying the existing flu surveillance network to COVID-19’s prevention and control. It honestly works, and thus far, the US is doing well. President Trump should have been more confident in his country’s efforts and not announce the travel ban on visitors from 26 Schengen zone countries. If the US needs to take extra precautions, it would make more sense to ban Italian citizens only – as Italy has almost locked the whole country down – instead of affecting other EU member countries.

Research on the virus takes time and epidemic control can’t wait. It is necessary to find clues through the epidemiological analysis of reported cases to help form a proper response strategy. The best solution for now is to strictly follow flu control measures to the letter, plus taking a few extra precautions – such as wearing a mask and maintaining healthy immune defense – to carry everybody through. The EU should learn lessons from the current situation, especially from the US’ latest travel ban, and take responsibility for leading a global force to handle COVID-19 with flu control protocols as soon as possible.

To Taiwan | 社區感染風險低

標題為「社區感染風險低」之文章，2020年2月11日獲刊於《中國時報》：
https://www.chinatimes.com/opinion/20200210004732-262105?chdtv

To Taiwan | 中國以外國家 新一波防疫挑戰開始

標題為「中國以外國家　新一波防疫挑戰開始」之文章，台灣時間 2020年2月4日獲刊於《上報》：
https://www.upmedia.mg/news_info.php?SerialNo=80493

To Guam | New coronavirus epidemic could calm down in a week

An analysis article titled "New coronavirus epidemic could calm down in a week" published on The Guam Daily Post in January 31, 2020 (Guam Time):
https://www.postguam.com/forum/letter_to_the_editor/new-coronavirus-epidemic-could-calm-down-in-a-week/article_1d3cb9a6-432b-11ea-b706-b78751aa454a.html

To Taiwan | 不能排除武漢肺炎人傳人的可能性

標題為「不能排除武漢肺炎人傳人的可能性」之文章，台灣時間 2020年1月16日獲刊於《上報》：
https://www.upmedia.mg/news_info.php?SerialNo=79576