Author: ongtim

Examining our own fears

Examining our own fears

What is fear and why do we fear at all? Traditionally, we say that fear arises when the self is threatened with harm. This can be threat to the physical body or the psychological body, or both.

What are the conditions that allow fear to arise? For fear to arise, two conditions are required.

The first is that we do not see reality as it actually is. We have this fear of the unknown. Some scientists say that this fear of the unknown is innate in us. So, the more we don’t know or don’t understand something, the more we fear it. Conversely, if we know more about that thing, we have less fear of it, and if we know it completely as it actually is, we should have no more fear of it. Yet, from our own observation alone, we realise that even when we know something completely, we can still be fearful of it. This is because the second condition is also present.

The second condition is that we are unable or unwilling to accept things as they really are. If we are not able to accept reality as it is, we will resist it. Fear will arise because deep down inside, we know that we cannot win this resistance. We will lose, and then we will grief what what we have lost. We will feel the pain of not getting what we want, or of getting what we do not want.

Conversely, if we can see things as they really are, and if we can then accept them as they are, then we can eliminate fear.

How to reduce or eliminate fear

So the first step to eliminate or reduce our fear in anything is to learn as much about it as we can. We must know it objectively and rationally. For this, we need a discerning mind that is free from bias, free from the ego.

This is where the ability of our mind to examine and analyse a situation is important. In this Covid-19 pandemic, for example, we need to be able to differentiate facts from fictions, truth from beliefs, real news from fake news, rationality from fearful emotions. If we can do this well, we can reduce our fear. If not, we are only going to make matter worse. We see how nations following science are faring much better than nations that follow beliefs. Countries like South Korea, Singapore, China, and Taiwan are doing so much better than countries like USA, UK and other countries in Europe.

The next step is to have the courage and determination to change the things that we can and have to change, such as changing our lifestyle, our daily routines, our expectations, our desires, and accepting the things that we cannot change, such as the fact that the virus is here to stay for a long, long time. Accept the reality that the virus IS in our community, and then protect yourself accordingly by following strictly to the SOP – wear you face mask properly, wash your hands regularly, physical distancing, and avoiding contact with others as much as possible. Accept also the fact that our lifestyle has to change. We can no longer go back to how it was before the pandemic – at least not for a long, long time. Adapt gracefully into the new situation instead of resisting and fighting it all the time.

So, learn to see things clearly and rationally. Have the courage to change what needs to be changed, and the ability to accept what cannot be changed. Do these and you will start to be able to manage and reduce your fear.

Suspected case of Covid-19

Suspected case of Covid-19

The guideline below is meant for doctors and HCW. Doctors need to have a high index of suspicion and be actively on the look out for possible Covid-19 patients, especially if you are in a red zone.

You should be highly suspicious if your patient meets BOTH the clinical AND epidemiological criteria, AND in the absence of a more likely diagnosis.

Understanding the Covid-19 tests

Understanding the Covid-19 tests

There are generally two types of tests being used currently to detect Covid-19 infections.

The first type of test looks for the presence of the virus in the body. It is called rt-PCR test (real time polymerase chain reaction). It can be used in the early phase of the infection to detect whether the virus is in the body or not. This is a swab test of the nose and throat. A positive result is diagnostic of a Covid-19 infection. A negative result means there is no virus presence in the body. However, this is also dependent on how the swab is done. There is still a small chance that the area swabbed was free of the virus despite it being present elsewhere. This is the sensitivity rate of the test. No test is 100% sensitive.

The second type of test looks for the antibody response to the Covid-19 virus. Since these antibodies take some time to appear in the body even after the virus is present, this test may not pick up an infection if it is used too early. This is called a false negative. A repeat test after 7 – 10 days is recommended. This is a blood test.

There are two types of antibodies that can be detected in the body. IgM appears earlier than IgG, which can remain for a long time even after recovery from the infection. Thus, a positive test for IgG does not necessarily mean the infection or virus is still in your body. It unsure, it is best to get your doctor to interpret the result for you.

Get to know your Covid-19 enemy

Get to know your Covid-19 enemy

How you may be infected

A typical Covid-19 infection begins with a close contact with an infected person as that contact exposes you to a possible infection. It is not certain that you will be infected. That depends on many factors, including the viral load, how well you are protected and how good is your own immunity.

Close contact is a very specifically defined term. It does not apply to you if you just happened to walk past a known Covid-19 patient, or even if you happened to talk to the patient for a brief time when both are wearing masks. See the image before for its definition as applied to HCW.

For a more general definition of a close contact encounter with a Covid-19 patient, see this image below:

(PUI stands for Person Under Investigation)

Generally, the rationale is that the longer you are exposed to the patient, the higher is your risk of getting the infection. As a general guideline, the recommended cut off point for the encounter is taken as 15 minutes, i.e. if your encounter lasted less than 15 minutes, you are less likely to be infected. This is, however, not absolute, and should be assessed together with other factors, such as whether face masks were worn, there was any cough or sneeze, or vigorous talking, and the infectious period of the patient.

A viral load is the amount of virus present. The bigger the viral load, the more viruses are present, and therefore the higher the risk of infection. Viral load is determined by how much viruses are in the body of the infected person that you are in contact with at the time of the close contact. It is also determined by whether the infected person sneezes or coughs in your presence, or whether he or she talks to you, and how long. The duration of your exposure is another factor to consider. The longer you are exposed, the higher the risk of infection. Therefore, minimise your contact with other people, and if you cannot avoid the contact, make it as brief as possible.

On the other hand, the further away you are from the infected person, the less likely you are of getting the infection. This is why physical distancing is so important.

How the virus may get into your body

Fortunately, the virus cannot enter your body through the skin. Its most common route of entry into the body is through the eyes, the nose and the mouth. That is why it is important to wear your mask. Your mask protects your nose and mouth, preventing the virus from entering your body. Nose swabs and throat swabs often yield more positive results from the nose than the throat, suggesting that the nose may be a more important entry point for the virus compared to the mouth. Therefore, make sure you wear your mask properly and cover both the nose and the mouth. For added protection, especially for HCW (healthcare workers) who are frequently in contact with patients, a face shield is recommended to protect the eyes as well.

So, whether you get infected or not depends on how well you protect yourself. Wearing a mask greatly reduces the risk. If the infected person also wears a mask, the risk even even smaller.

What happens when the virus gets into the body

Once the virus gets into your body, it incubates for about 5 days, multiplying in your body and increasing the viral load.

Symptoms typically appear about day 5 of the infection. Symptoms are fever, body ache, cough, and general feeling of unwell (often indistinguishable from other viral infections like flu and dengue). In severe cases, there is difficulty in breathing.

You are infectious about 1 – 2 days BEFORE your first symptom appears, so you may not know it and may spread it to others unintentionally. The infectious period may last 10 days, i.e. day 3 to day 13. This is the rationale for the 14 day quarantine.

However, we must also bear in mind that some Covid-19 infections may present atypically, meaning they differ from the above typical infection. Some may actually last longer, and become more severe, even deadly.

How to protect yourself from infection

Very important – follow the SOP strictly. Do not be negligent. Do not take this lightly, yet at the same time there is no need to panic. Be rationale in your approach.

  1. Wear your face mask properly

2. Wash your hands regularly and thoroughly, especially before you touch your face or after you have touched your mask. Always regard your mask as though it is contaminated with the virus. In this way, you will be more careful when you handle your mask. Also, dispose your mask properly and safely.

3. Practice physical distancing. The further you are, the less likely for you to be infected. The minimum recommendation is 6 feet apart.

4. Regard everyone as a potential spreader. Therefore, limit your contact with others. Avoid unnecessary contact. Where contact is unavoidable, make it as brief as possible.

The Danger is real, but Fear is optional

The Danger is real, but Fear is optional

I have said this before, and I will say it again here – In this pandemic, we are not just fighting against the Covid-19 virus. We also need to fight and manage our own fears.

The danger is very real, but fear is optional.

It is almost instinctual for human to fear the unknown. At the initial outbreak of this Covid-19 pandemic, we know very little about the virus. So, the exaggerated panic was not unexpected.

However, we are now 9 months into this pandemic, and we have learned a great deal more about this virus. We know how it spreads, and therefore we know how we can protect ourselves. We know what happens when it enters our body, and so we are more prepared to treat and support patients infected with the virus.

Let the doctors deal with the task of caring and treating the infected patient.

Our own task – which is the task of everyone – is to protect ourselves from this infection, and to prevent this infection from spreading to others.

To face an enemy, we must first learn as much about the enemy as we can. Accurate information helps us to make rationale decisions. So, firstly, let us learn as much about the virus as we can, and especially the relevant information that we will need to protect ourselves. Click here to learn about the Covid-19 virus. This will give us an understanding of the virus and the rationale for the SOP in place. Follow them strictly and diligently.

The more we know the enemy, and the more we know how to protect ourselves, the less we have to fear. There is less unknown factor.

However, for the majority of us, there will still be some lingering anxiety and worry. Do not dwell on them. Instead, turn your mind to some productive activities. Read, cook, exercise, do some gardening. Do anything that can keep your mind occupied in a positive way.

For the more discerning ones, observe your own mind. Look at the thoughts that arise, and see how they affect and give rise to your feelings of fear and anxiety. Examine your views, beliefs and attitude, and review them in light of the new evidence and information we know about this virus. Perhaps some old beliefs and fears should be discarded, and some new more informed precautions put in place. See how tightly you cling to your body, feelings and thoughts, and learn to let go of that clinging. You might even be able to reflect on your own fear of dying.

Know that you can surrender or let go of any or all of these – views, beliefs, attitude, even clinging to body, feelings and thoughts. All can be let go of. Try it and see how it relaxes your muscles and body, and loosen your tightly bound mind as well. Feel the tension eases away.

When you are able to manage your own inner feelings and thoughts, you would have gained an inner peace that you probably never knew was there all along.

The original message that started the panic

The original message that started the panic

The problem with this type of unverified and inaccurate messages is that it unnecessarily adds to the fear already existing and heightened in the community.

The other problem is the repercussion of such a message.

Imagine if another doctor who is facing the same situation sees this, and realises the damage it will do to his clinic. He may end up keeping everything under wrap, and not take the extra precaution that we did, thereby increasing the risk for both staff and patients, and the community as a whole.

We must take it upon ourselves to take responsibility for all our actions. Therefore, we should reflect before we act. This is especially important in our Internet age where news travel almost instantaneously.

However, what is even more damaging is that a hugely important message is loss under all this noise. This virus IS in our community. It is spreading quietly. It is infective even before you are symptomatic, and therefore you may not know that you have it when you spread it to others.

Thus, it falls upon all of us to take this CMCO seriously, and to follow all recommended SOP strictly.

  1. Wear your face mask, and make sure you wear it properly. 3-ply surgical mask and N95 are the best. They are proven and tested. I do not recommend cloth mask. They may look good and feel comfortable but they are not proven to be equal to the surgical masks.
  2. Practice physical distancing. Also, minimise your exposure time with anyone you come into contact with.
  3. Wash your hands regularly and thoroughly with soap and water, and avoid touching your face with your hands. Be mindful where your hands go to. If they touch your mask, wash them.
  4. Stay home as much as possible. Do not go out unnecessarily.

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.
Clinic staff all tested negative for Covid-19

Clinic staff all tested negative for Covid-19

We have just received the Covid-19 swab test results from the hospital. All our staff – Dr. Ong and the 2 nurses – tested negative for Covid-19.

We take this opportunity to thank all our patients and friends who were concern about our well being and were supportive of our effort to be transparent and safe.

A friendly reminder again – please do not be too quick to share unverified messages! There is already too much fear in the community without us adding to it unnecessarily.

We have disinfected and sanitised the clinic today.

Important Announcement

Important Announcement

Last Saturday, we saw a patient with fever who was later tested positive for Covid-19, and warded.

As a precautionary measure, we decided to send all our staff to a nearby hospital for the Covid-19 swab tests this morning. We expect to get the results soon, probably by tomorrow.

Since both the patient and our staff wore masks, we are considered at low risk of getting the infection (according to the Ministry of Health Guideline – see image below), and the clinic staff are not required to be tested, nor the clinic to be closed.

However, as an extra level of precaution, for the safety of both our patients and staff, we have decided not to see any patients until we know our results.

The clinic was closed for disinfection and sanitisation today.

Meanwhile, we are happy to report that we, the staff, are all in good health.

We are aware of a message being viralled in the social media implying that we are infected with the Covid-19 virus. If this is true, why would we still need to be tested? We should already have been warded and quarantined.

This notice is to give you the true story.

Please do not share unverified messages and spread more unnecessary fear in the community.

And please wear your face mask at all time when you are out. It can make a huge difference.

Stay safe!

Truth and the Covid-19 Pandemic

Truth and the Covid-19 Pandemic

Truth and the Covid-19 Pandemic

If there is any blessings arising from this Covid-19 pandemic, it is that it is showing us the importance of truth.This is because we cannot fight this pandemic with denials, lies and distortion of truth. Doing so only makes the situation worse for everyone.

There have been many reports of patients who have history of close contact with known Covid-19 patients denying this very important aspect of their medical history when they go and see their doctors. This resulted in triage error, thus sending them to doctors who are not properly attired and protected. Later, when they are tested positive, they finally admitted but by then it is already too late. Scores of healthcare personnel would have to be quarantined for at least 2 weeks. Sometimes, an entire clinic or department had to be closed down. At a time when we are already short of all kinds of healthcare resources, including skilled personnel, this is nothing short of a disaster.

Another important tool to fight this pandemic is accurate and truthful information. Unfortunately, there have been wide and indiscriminate dissemination of fake news and suspicious information disguised as coming from authentic authorities or experts. This means we will waste valuable time trying to sieve through what can be trusted and what are lies. Accurate information can help us understand the disease better, and make it easier for us to protect ourselves. Fake news are harmful, often giving false sense of security or trigger outright fear or panic.

Lastly, truth is not a privileged but a necessity in healthcare. One may distort reality and still succeed in politics or even business, but it is disastrous and even deathly when applied in healthcare. Little wonder that we now see our politicians, who are used to distorting realities, having a difficult time trying to cope with this pandemic. Their method is useless in this fight.Let the scientists and doctors take the driver’s seat in this fight, and the politicians humbly taking the backseat.