We have to learn to live with Covid-19 rather than to react to numbers

[Leongsam]

torontosun.com

'We have to learn to live with' COVID rather than react to numbers: Top public health expert

Oct 02, 2020 • Last Updated 10 hours ago • 4 minute read

Vivek Goel Photo by File photo /Postmedia Network

It’s time to broaden the conversation in Canada around COVID-19 from one focused on just the daily case numbers to one that’s about maximizing the overall health and well-being of society.

That was one of the key messages articulated by Vivek Goel, one of the nation’s top public health experts, in a wide-ranging conversation with Postmedia
.
“What we seem to have developed, by and large, is a view that we need to focus on eliminating COVID-19,” says Goel, a member of the COVID-19 Immunity Task Force and a professor at the Dalla Lana School of Public Health. “And we have got people to the point that they’re so scared of COVID-19 that they’re not thinking about all the other consequences.”

Goel — who was the founding president and CEO of Public Health Ontario from 2008 until 2014 — says that “we certainly are in a wave … but we have to avoid overreacting to the daily numbers.”

Comparing the daily numbers to where we were in the spring is not an apples to apples comparison, Goel notes, pointing out that earlier in the year there were far fewer tests, far more cases in older populations and long-term care homes, as well as far more people in ICUs and on ventilators.

“We have way more in terms of control measures in place,” Goel says in response to the argument some have made that those most dire indicators are now on the cusp of flaring up. “If we look at how many companies and organizations still have people working from home, so the number of daily interactions are limited, we have physical distancing and other requirements, we don’t have big conferences, sports events, theatres — so we are already starting from a baseline of control measures that didn’t exist back in March.”

On Monday, Ontario reported 700 new cases of COVID-19, the highest number the province had ever recorded. Shortly after the figures were made public, the Ontario Hospital Association (OHA) called for the province to return to a Stage 2 lockdown, which included added restrictions for most businesses.

But Goel doesn’t believe such an approach is necessary and considers the OHA position “a very narrow perspective” that is focused solely on hospital operations and not on broader society.

“Even in the worst-case scenarios, we’re not looking at having our health-care systems completely overwhelmed,” Goel says, commenting on modelling put forward by the Ontario government on Wednesday. “And that modelling was done before some of the restrictions that started being imposed (in Ontario) about two weeks ago.”
The professor feels that any additional restrictions that will be imposed upon Ontario will be due to pressure put on the government from the public that feels scared of COVID-19.

“We have to really start to think more about all the different data elements and be very clear with Canadians on that strategy and also be clear with Canadians that the strategy is on maximizing overall health,” says Goel.

That overall health of society includes things like keeping businesses going and the schools open. “We know that unemployment is a major predictor for poor health outcomes and deaths,” Goel notes. “It’s not just about minimizing COVID-19. We also want to ensure our children can develop, we want to keep people working, because if you can’t put food on the table that will effect your health.”

Part of the challenge right now is that the government hasn’t clearly communicated their objective. “Is it containment or eradication? Is it learning to live with it? Is it trying to maximize health across all angles?” Goel asks.

“While eradication is a worthy stretch objective, we need to be realistic and unless we’re going to somehow build a wall and become more like New Zealand and have really drastic control measures, it’s going to be really difficult for Canada to have eradication.

“We have to think about what the world is going to be like until there are effective vaccines fully deployed, and even in that scenario we may still have some cases. So it means we have to learn how to live with this.”

This doesn’t mean Goel thinks there isn’t much more work to be done. He wants to see more testing, contact tracing and supports the use of tracing apps.

“We need screening tests on a larger scale to deal with schools, to deal with reopening borders and have testing capacity there,” he notes, citing the rapid testing conducted by the NBA as something of a small trial run of what can be rolled out for broader society.

The challenge right now is that the current tests being used across Ontario aren’t designed for that. “We’re sending the kids with sniffles into that process, which wasn’t really designed to help keep the schools open. It was designed to manage people who are very sick and you want to make sure they get into hospital quickly if the symptoms progress.”

As for the fact that medical experts are in public disagreement over how to proceed and are even sending competing open letters to government officials, Goel isn’t concerned. “It’s actually healthy,” he says. “If everyone thinks alike, you don’t get room for any creativity and innovation.”

There’s certainly going to have to be healthy debate as well as bigger-picture discussions if the virus sticks around for as long as Goel cautions is possible. “There is the likelihood that the vaccine is not perfect, like with the flu, that we will still have cases every year and we may have to revaccinate every year, and we will have COVID-19 in our midst possibly for some time to come, possibly indefinitely.”

[email protected]

 

[Hypocrite-The]

Just treat the wuhan virus as it's the flu

 

[syed putra]

I just hate the stare I get for not wearing mask. So its in my pocket just in case. Or wear it to get into restaurants, then take it off again when eating.

 

[sweetiepie]

I just hate the stare I get for not wearing mask. So its in my pocket just in case. Or wear it to get into restaurants, then take it off again when eating.

KNN my uncle carried a cup of coffee in the middle of the night 2am to indicate to security that he wanted to lim kopi but the security still can shout out hoi where is your mask KNN it has become a means for security guard to show their power even when noone is present at 2am KNN

 

[tobelightlight]

 

[syed putra]

Faith in gomen response to virus is crumbl8ng. Does not seem to have a ending.

 

[Hypocrite-The]

Since there is treatment. Why dont just end all lockdowns n get the economy going?
'No longer groping in the dark': NCID doctors share how COVID-19 is being treated in Singapore
Dr Ray Lin Junhao, a consultant at the National Centre for Infectious Diseases (NCID). (Photo: NCID)Bookmark
SINGAPORE: Singapore was one of the first countries in Asia to see COVID-19 cases back in January, when very little was known about the disease, and it was one of the first places where there was community spread.
Nine months on, the country has recorded more than 57,000 COVID-19 cases, but this is a fraction of the tens of millions of infections around the world.
So far, 28 people have died of COVID-19 in Singapore - one of the lowest mortality rates in the world. In the US, where there have been about 8 million cases, more than 200,000 people have died.
As of Saturday (Oct 17), 37 COVID-19 patients remain hospitalised in Singapore, with none in intensive care. More than 99 per cent of those infected have been discharged, while there are 41 in community care facilities.
READ: 64-year-old man is Singapore’s 28th COVID-19 fatality; first in three months

But it wasn't always like this. Three National Centre for Infectious Diseases (NCID) consultants told CNA how treatment of the novel coronavirus has evolved here and how NCID has kept the number of critical cases low.
The initial stages of the outbreak were fraught with uncertainty, said Dr Ray Lin Junhao, 37, an infectious disease consultant at Tan Tock Seng Hospital and NCID.
He was involved in the direct care of COVID-19 patients, including those who were critically ill. Dr Lin was also a co-investigator in several clinical trials that evaluated therapeutics for the disease.
"With the advances in research over the past few months, we now have a better idea of what treatment works and what doesn’t. Although the efficacy of the currently available treatment is modest, at least we are no longer groping in the dark," said Dr Lin.
"CONSTANT STRUGGLE"
One of the differences between the COVID-19 pandemic and previous outbreaks has been the vast amount of information about the coronavirus on the Internet and social media, available to both doctors and the general public.
This has influenced the course of the current pandemic, he said. In the early days of the outbreak, reports of potential treatments for COVID-19 made it "tempting" to use them on the sickest patients, he added.
"As a physician, it is in our nature to want to give some form of treatment to our patients, even if unproven, rather than to stand by passively and hope for the best ... This was a constant struggle in the initial phase of the outbreak," he said.
However, the potential harms of unproven therapy are real, such as in the case of hydroxychloroquine, he said.
The anti-malaria drug, which was endorsed by US President Donald Trump early in the pandemic, was said in small studies to be a potential treatment but proved during clinical trials to have little benefit. The World Health Organization (WHO) has since halted trials of the drug.
READ: COVID-19: Singapore, Hong Kong reach in-principle agreement to establish bilateral air travel bubble

Dr Mucheli Sharavan Sadasiv, 37, said that there was a feeling of helplessness in the early days, because of the uncertainty due to all the unknowns.
"I think it's normal to feel that way. Being exhausted physically and mentally did not help as well. As time has gone by, we have learnt so much more about the illness and that helps us with our work in taking care of patients," said the infectious diseases physician, who has been involved in the implementation of the convalescent plasma programme for COVID-19 in Singapore.
Dr Mucheli Sharavan Sadasiv, a consultant at the National Centre for Infectious Diseases (NCID). (Photo: NCID)
For example, one of the most effective ways of keeping patients alive in the early days was flipping them around to lie prone - or on their front - instead of on their backs when they were on ventilators.
Prone-position ventilation was one of the few early interventions that significantly helped the patients in the intensive care unit (ICU), said Dr Lin.
"These patients were so severely affected by COVID-19 that even with the maximum support from the ventilator, we were unable to achieve adequate oxygenation."
But the simple manoeuvre helped patients breathe easier and absorb oxygen better, buying time for the body to recover as there was no effective therapy at that point in the outbreak.
READ: COVID-19 pandemic creates 'surge' of flawed research

EARLY INTERVENTION
Other aspects have become clearer as well, for example, knowing which patients might get sick, and those who might need closer attention, the doctors said.
"I have much more confidence in counselling patients on their condition now," said Dr Lee Tau Hong, 39.
"Now, with the knowledge we have, we are able to allay patient fears and the doubts that we have with regard to this disease."

Dr Lee Tau Hong, a consultant at the National Centre for Infectious Diseases (NCID). (Photo: NCID)
That knowledge has led to clear classification guidelines for patients at higher risk of severe disease, as well as treatment guidelines, drafted by the national COVID-19 therapeutic workgroup lead by Dr Shawn Vasoo, clinical director of NCID.
As vice-chair of the Chapter of Infectious Disease Physicians, College of Physicians Singapore, Dr Lee provided comments during the drafting of the interim treatment guidelines. He also treated COVID-19 patients, drafted clinical workflows and was a co-investigator in several research publications.
For instance, it is now known that older patients, and those with underlying conditions such as heart disease or diabetes, as well as those who are obese, are at higher risk of developing severe disease.
READ: Britain rations remdesivir as COVID-19 hospitalisations rise

Dr Lee said that early diagnosis and identification of patients at risk of developing severe disease were some of the most important factors that have helped patients. For severe cases, medicines such as remdesivir and dexamethasone have proven effective.
NCID collaborated with Gilead and the United States' National Institutes of Health for the remdesivir clinical trials.
Explaining how the drugs work, Dr Lee said that remdesivir is an anti-viral agent that acts directly on the SARS-CoV-2 – the virus that causes COVID-19 – thus reducing the harmful effects of the disease.
Dexamethasone, a commonly used corticosteroid, helps to dampen inflammation, as patients can develop severe disease due to overwhelming inflammation in the body that is triggered by the viral infection.
FILE PHOTO: A lab technicians holds COVID-19 treatment drug remdesivir at Eva Pharma Facility in Cairo, Egypt June 25, 2020. REUTERS/Amr Abdallah DalshREAD: Fauci says 'reasonably good chance' Regeneron antibody therapy helped Trump
Dr Lin said he noticed that a good number of patients at NCID improved more rapidly on remdesivir when it was trialled there. It shortened the average length of stay in the ICU for patients on the study.
"Eventually, we were proven right with the official release of the trial results, which showed remdesivir to be the first drug with proven efficacy against SARS-CoV-2," he said.
Mr Trump, who contracted COVID-19 more than two weeks ago, was treated with both drugs as well as an antibody cocktail developed by US biotechnology company Regeneron. Antibodies are proteins produced by the body to fight against diseases.
It has been reported that the neutralising antibodies were developed by the US drug company with blood samples from three NCID patients who recovered from COVID-19.
Associate Professor David Lye, senior consultant and director of NCID's Infectious Disease Research and Training Office said the centre had responded to a request for collaboration from Regeneron, with no claim of intellectual property right.
As part of the collaboration, NCID was asked to recruit up to 20 patients who had recovered from COVID-19, to collect samples. After obtaining patients’ informed consent, it recruited five patients and were told by Regeneron that they had enough samples.
FILE PHOTO: The Regeneron Pharmaceuticals company logo is seen on a building at the company's Westchester campus in Tarrytown, New York, US on Sep 17, 2020. REUTERS/Brendan McDermid
"They eventually used the samples from three of our five patients, as the starting point for research using their technology to develop their monoclonal antibodies," he said.
Monoclonal antibodies are based on natural antibodies, but are created in laboratories and can be mass produced.
Dr Lee said that he had a patient who had an uncomplicated infection but was very grateful and wanted to contribute in some way. After he recovered, he volunteered to donate his plasma, which contain antibodies against the virus.
"There were many other patients who agreed to participate in clinical trials. They were randomly assigned to be given a placebo or remdesivir ... I wish to take the opportunity to thank our patients," he said.
NCID's interim treatment guidelines state that further data is required for interferon beta-based treatments and convalescent plasma, among others.
"Although we already have some answers, we still await the results of some important trials that are ongoing," said Dr Sadasiv.
A "HUMBLING EXPERIENCE"
When asked why Singapore has seen low rates of fatalities and severe cases, the doctors said that one of the main reasons was that many of the patients were young and healthy, as the majority of the cases in Singapore were migrant workers.
Early access to medical care and good supportive treatment have been important factors as well.
"The health system (has not been) overwhelmed by too many sick cases, unlike in some other countries with higher mortality," said Dr Sadasiv. "I think this has allowed us to be able to deal with critically ill patients better."
Dr Lin said the good public health response to contain community spread in the early part of the outbreak prevented hospitals in Singapore from being overwhelmed.
"This also bought us much needed time to better understand the virus, the disease and for an effective treatment to emerge," he said.
READ: Ebola drug remdesivir used to treat COVID-19 patients in Singapore as part of clinical trials

He added that research on COVID-19 in Singapore was achieved at a speed and with a level of coordination that was unprecedented, and this data and evidence helped guide the assessment and treatment of patients.
This information was then disseminated to the doctors on the ground by the Health Ministry and NCID.
"By the time the cases surged, we knew enough about the disease to be able to identify patients who were at risk of complications and to allocate the necessary resources and treatment needed to improve their outcomes," he said.
Dr Sadasiv said that the whole process has been a humbling experience, as different departments and agencies worked together to tackle the pandemic.
"It has taught me to embrace uncertainty and to know our limitations. It was a challenge to keep up to pace with the expanding information and the many changes to workflows and processes. I hope I've learnt to have more gratitude too," he said.

 

[Hypocrite-The]

 

[redbull313]

shoooo tiong shooo go back to china shoooo!

 

[whoami]

KNN my uncle carried a cup of coffee in the middle of the night 2am to indicate to security that he wanted to lim kopi but the security still can shout out hoi where is your mask KNN it has become a means for security guard to show their power even when noone is present at 2am KNN

No choice lah Bang. Mgmt very eng. Yes...even at 2am. He can actually observe the guard post. If caught not doing their duty, next morning Supervisor sure recd a "beautiful" email. So at times uncle jaga must drama lah.

 

[nayr69sg]

Politics.

 

[Hypocrite-The]

Mainstream Media Lies About Hydroxychloroquine Are Costing Thousands Of American Lives
OAN Newsroom
UPDATED 10:31 AM PT – Monday, February 1, 2021
For nearly a year, the mainstream media has promoted lies about treating the coronavirus with the medicine hydroxychloroquine. One America’s Pearson Sharp takes a look at the cost those lies have had on our nation.

https://www.oann.com/mainstream-med...uine-are-costing-thousands-of-american-lives/

 

[tanwahtiu]

Stating the obvious.... sickhead doctor...

 

[QANONSG]

Mainstream Media Lies About Hydroxychloroquine Are Costing Thousands Of American Lives
OAN Newsroom
UPDATED 10:31 AM PT – Monday, February 1, 2021
For nearly a year, the mainstream media has promoted lies about treating the coronavirus with the medicine hydroxychloroquine. One America’s Pearson Sharp takes a look at the cost those lies have had on our nation.

https://www.oann.com/mainstream-med...uine-are-costing-thousands-of-american-lives/

We have all taken hydroxychloroquine and it does not do anything for us. Some of us have had very bad dreams and now see visions.