To close or not to close?

To close or not to close?

WE DECIDED TO CLOSE

We did not need to close our clinic, and the ministry’s SOP does not require us to close as well. The SOP does not even require us to be tested. The reason is because the conditions of our initial close contact – when you take into consideration all relevant factors – means that we are at a very low risk of getting the infection.

According to the SOP, we fall under the low risk category because both the patient and our staff wore face masks at the time of the close contact encounter. This highlights the importance of wearing your face mask as it greatly reduces your chance of infecting someone with the virus if you have the Covid-19 infection and also protects you from getting the infection should you encounter someone with the infection.

Yet, despite the above, we decided to close and we sent our staff off to be tested even though the SOP does not require it. Fortunately, all our tests are negative.

Still, we are aware that even the rt-PCR test that we used – though it is the most reliable test to date – is not 100% sensitive, meaning that it can still miss some positive cases.

So, we also need to consider the possibility of a false negative result from our swab tests. False negative results are often due to the fact that the test was done too early, or the areas that were swabs just happened to be free from any virus. The optimum time to test is 72 hours after initial close contact, which is what we did.

We also consider the pretest probability, which is how likely is one to be infected from the close contact. The infectious period for someone with Covid 19 infection actually starts 1-2 days before the onset of first symptom. First symptom typically appears 5 days after being infected. Our patient was seen 1 week after started having fever. That puts the patient about 12 days into infection, which greatly reduces infectivity.

In fact, infective period generally ends after 10-12 days, which explain why self quarantine is 14 days. This also explains why the ministry’s SOP does not require the clinic to close and does not require active follow up.

In a pandemic like this, closing clinics unnecessarily can lead not only to more fear but also stretch the hospitals to their limits. Today in Sabah, 3– – 400 new cases are being picked up daily. Can you imagine what would happened if all these clinics have to close for 14 days after picking up these patients? The hospitals would be overwhelmed. As it is right now, they are already stretched to the limits. In addition, imagine the panic this would cause to the community when they see clinics closing one after another like flies dropping dead. There would be uncontrolled chaos.

Therefore, we should all play our parts and take actions and decisions based on evidence and science.

Despite all the above, we still decide to close the clinic until 25/10/2020 (Sunday) – 14 days from the initial close contact with our infected Covid-19 patient. We wish that rationality would prevail and all these unfounded fear could be curbed or contained, and we could go on with our clinic business as usual. Unfortunately, fear trumped rationality in this instance. So we decided to take a step back, rest and stay away. We will be back once the 14 days self quarantine period is over, i.e. we re-open on Monday (26/10/2020).

The clinic was disinfected and sanitised on Wednesday (14/10/20).

One big question arises – imagine if no one had sent out the first inaccurate message that became viral. Since the SOP does not require us to be tested, nor does it require us to close, the clinic would have run as usual and nobody would have been the wiser.

We did everything right according to the SOP, and take even more extra precautions that were not really required in order to ensure and safeguard the safety of our staff and our patients, yet the unfounded fear continues to spread within the community. We did nothing wrong.

What is wrong is for the person to send out that first message without first verifying the facts with us. That has caused all the confusion, fear and panic.

There are important lessons to be learned from this episode.

  1. The power of the Internet – The Internet is a very powerful tool, and “with great power comes great responsibilities” (well said by Spiderman’s wise Uncle Ben). Thus, it falls on each and every one of us to use it wisely, to spread love and care, instead of fear and confusion.
  2. The importance of wearing face mask – This cannot be emphasised too much. When you wear your mask, you are helping to prevent the spread of Covid-19. Remember, the most infective period is actually when you are asymptomatic. So you may have the virus and not know it. At the same time, wearing a mask prevents you from getting the infection easily.
  3. Fear in this Covid-19 pandemic – I have written about this during the early phase of this pandemic. You can read about it here. I have also written about the importance of truth in this pandemic. Click here to read it.
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