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):
Monday, November 2, 2020
Monday, October 12, 2020
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
https://www.sciencedirect.com/science/article/pii/S0960076020302764
https://www.frontiersin.org/articles/10.3389/fmed.2020.00389/full
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157
https://link.springer.com/article/10.1007/s40520-020-01570-8
Saturday, September 26, 2020
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.
Friday, September 11, 2020
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
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157
https://link.springer.com/article/10.1007/s40520-020-01570-8
https://www.frontiersin.org/articles/10.3389/fmed.2020.00389/full
Tuesday, September 8, 2020
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).
While most people around the world are still worried about
the rising number of COVID-19 cases, the analysis based on statistics of
EuroMOMO, The European Mortality Monitoring Activity, has actually shown that
COVID-19 did not cause more deaths than the mortality rate projection for 2020,
especially in countries that responded well.
EuroMOMO is the official body monitoring EU member states’
mortality data. Their analysis in the end of April, when the pandemic still
looked bad in Europe, has already shown the deaths from COVID-19 did not make
the total mortality be over the projected normal range in Germany, Austria,
Greece, Norway, Finland and Denmark. Even in Sweden, with a controversial
“no-lockdown” strategy, its death toll number was still under the extremely
high excess mortality.
COVID-19 became a frightening killing bug of the new decade
right after it was emerging in China mainly because the coronavirus is in the
same family with SARS and MERS. However, the comparison of case fatality rate
(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, actually
showed SARS had a CFR of around 10%, MERS killed 34%, and a collaboration of
Hong Kong University and Harvard University in February estimated the CFR of
COVID-19 would be around 1.4%. The latest data from Singapore, 27 deaths out of
55,938 cases found by its aggressive testing and contact tracing protocols,
indicated a CFR of 0.48%, which is getting closer to a seasonal flu’s CFR 0.1%.
The key is absolutely to well respond to the pandemic with
proper strategies. When Singapore government decided to reopen the country
after a two-month lockdown on June 2, the city state, with 6 million residents,
had reported over 35,000 COVID-19 cases and 24 deaths. As of August 14, its
total confirmed cases were over 55,000, which means 20,000 increase after
reopening, but Singaporeans have switched their focus to watching
hospitalization rate, instead of paying too much attention to daily testing results,
and the death toll therefore increased 3 only during the period.
On the same day, August 14, when Guam’s cumulative COVID-19
cases reached 500, there were 8 patients who were hospitalized. This number was
actually four times higher than the hospitalization rate two weeks ago, which
was 2 hospitalized patients only on July 31. It has even jumped to 45 on August
31. It's two times higher than the record-high hospitalization rate during
Guam's first lockdown, which was 21 hospitalized COVID-19 patients on April 6
when the confirmed cases were just over 100.
The increase certainly needs to be taken seriously. However,
do not forget the hospitalization number did go down to zero on July 23 after
the island lifted the restrictions on Mother’s Day. There is no doubt that the
majority of Guam residents have been doing their part to avoid infections and
severe illness and Guam’s medical community has done a great job to treat
patients and save lives in the past several months although many people have
been thinking the medical capacity on Guam is relatively weak. Obviously, It is
very important that we keep living the healthy new normal and our government
keeps supporting our medical heroes to help our island get through it together.
The new normal is not a guess, or a theory only. A number of
solid research findings have actually proved that there are effective
protection measures helping people live with the coronavirus in the long run.
For example, a research article published on June 11 in the Proceedings of the
National Academy of Science analyzed data from three epicenters - Wuhan
(China), Italy and New York City - and proved that mandated face covering
“alone” significantly reduced the number of COVID -19 infections. The researchers
concluded that this inexpensive practice, in conjunction with simultaneous
social distancing, quarantine, and contact tracing, represents the most likely
fighting opportunity to stop the COVID-19 pandemic.
There are, of course, studies showing lockdowns help as well.
However, the excess death analysis based on EuroMOMO’s data, mentioned earlier,
proved that the strictness of a country’s lockdown measures had little
associations with its fatality of COVID-19. These analysis concluded that it’s
better to respond quickly, with proper testing and tracing protocols, rather
than relying on strict lockdowns.
The biggest myth about lockdown is to believe it is the only
solution when the epidemic gets worse. In fact, lockdown is a measure to lock
the seriously-affected area in order to protect people in other areas. When
SARS hit Taiwan 17 years ago, the health authority there locked a hospital
where a serious nosocomial infection occurred to protect the community
outsides. When Wuhan became a miserable epicenter of China in January, Chinese
government issued a lockdown order in Wuhan to avoid the coronavirus’ further
spreading to other cities and provinces. The price the whole world had
paid for the chaotic restrictions was the collapse of supply-chains
happening in the second quarter. It sadly led to many frontline medical
personnel being forced to fight the coronavirus without personal protective
equipment (PPE).
When new cases are emerging, it is time everybody should be
told that there are not any “coronavirus free” places in the world and we are
inevitably going to live with the coronavirus for a while. Only a sustainable
strategy can help us carry on together.
The US CDC Morbidity & Mortality Weekly Report on July 24
emphasized, again, that older adults and those with chronic obstructive
pulmonary disease, heart disease, diabetes, chronic kidney disease, or obesity
are at higher risk for severe COVID-19-associated illness. An estimated
prevalence of any of five underlying medical conditions, mentioned above, among
US adults was 47.2%. The percentage could be higher in more rural areas like
Guam, especially of diabetes and obesity.
The most relevant measure is therefore to protect the
vulnerable, including the elderly and people with those underlying medical
conditions, from the risk for severe illness, and watch those who ignore
response advice and continue high-risk behaviors. Don’t forget the coronavirus
has such a highly contagious nature and the aggressive testing and contact
tracing policies will definitely dig more infections. Paying too much attention
to daily testing results is just causing panic and very likely to result in a
chaotic response.
Wednesday, August 19, 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).
Sunday, July 26, 2020
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/
Mucosal Immunology:
https://www.nature.com/articles/mi201775
Wednesday, July 15, 2020
Monday, July 13, 2020
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
https://www.pacificislandtimes.com/amp/2020/07/11/lessons-from-taiwan-only-sustainable-measures-can-curb-covid-19
Friday, July 3, 2020
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).
Friday, May 22, 2020
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
https://www.taipeitimes.com/News/editorials/archives/2020/05/21/2003736770
Sunday, May 3, 2020
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.
Friday, April 24, 2020
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.
Tuesday, April 21, 2020
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
https://www.upmedia.mg/news_info.php?SerialNo=85780
Monday, April 13, 2020
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):
https://www.euronews.com/2020/04/08/the-eu-should-learn-lessons-germany-coronavirus-protocols-life-can-return-to-normal-view
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
Tuesday, April 7, 2020
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.
Sunday, March 22, 2020
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).
Friday, March 20, 2020
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:
Bloomberg's report:
Tuesday, March 17, 2020
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://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
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 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
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
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