Coronavirus COVID-19

@BusinessJing  thanks for your question again. Critically ill patient can develop anytime any complications by secondary infections also.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152411/

SERS COV 2 does not cause directly meningitis, endocarditis but after attacking of this virus when immune system doesn’t work properly ,the patient may develop other complications by others micro-organism and can develop above mentioned complications.
When the virus enters someone’s cell through nostrils or inhalation ,cytokine release and develop alveoli oedema in periphery of lungs and can cause pneumonia.Patient develops breathlessness.
But some drugs need to treat the COVID 19 patient to prevent secondary infection(azithromycin,fexofenadin, hydroxyichloroquine) have some side effect of QT prolongation of heart and chance of myocardial infarction.that is why during under treatment of COVID 19 patient ECG should be routine check up. Singapore Government is very cooperative and treatment facilities is high standard comparative others country.
In late stage of COVID 19 patient who are in critically ill they may develop any complications at any time and can develop organ failure finally death.
Stay home and stay blessed. Because this is deadly virus and spread very rapidly.

@BusinessJing  thank you for your question.
Those who are on duty in Corona related patient they need respiratory filtration type mask and also need surgical type of mask with face sheild. But mandatory mask is respiratory mask.

N95 Mask:
(The N95 mask has a full name of NIOSH-certified N95 respirator, which means these respirators are tested of 95% filtration and certified by the U.S. National Institute of Occupational Safety & Health (NIOSH)

KN95 mask:
(The KN95 respirator is a particulate-filtering mask tested using the China criteria)

FFP2 mask and KF94 mask:
FFP2 made as Europian standard and KF94 South korean standard.

(The FFP2 is a filtering facepiece score of 94% filter capacity approved by Europe and the KF94 is tested by Korea criteria. Actually, both the N95, KN95, FFP2 and KF94 respirators have almost the same filtration efficiency, it means that KN95, FFP2, and KF94 are as effective as the N95 respirator mask. The main difference between these respirators is that they are tested by different nations.
 
Comparative criteria:
N100 (99.97%) = FFP3 (99.95%) > N95 (95%) = KN95 (95%) = FFP2 (94%) = KF94 (94%) > KN90 (90%).
Hope you can understand now easily.

The normal and the safest way to avoid and suffering from corona is to stay at home.We are frontliner fighter working at  battle field that u all are safe.Each and every life is important to the nation.
Plz keep maintain distance and wear mask in appropriate way.Stay safe.
Dr Mst Shabnam Shaila Sharmin.

Hi @jumpygiraffe 
That is a good thought. 
However, in some individuals, they may require serial testing before it turns positive as the virus has an incubation period. 
Hence, in high risk individuals, a single negative test does not mean the person will not be infected subsequently. Mass giving out kits may lead to misconception that a single negative test excludes one from being tested positive in the future. 

Currently in Singapore, they are already adopting a pro-active approach whereby healthcare workers are being rostered to swab people residing in clusters such as the recent dormitory cluster. I feel that that may give us a higher yield, to swab those individuals with known risks/exposure rather than the general public. 

Yes. It might be a possibility but the government is now enforcing food workers to wear mask of face fines. As Long S they have masks on, you should be safe. 

Hi @Shawn that is correct, patients that remain positive on re-testing will continue to be quarantined until they recover. They will need to test negative on consecutive days before being discharged as a safety measure to protect others in the community. The MOH DMS recently gave an interview about this which is covered in this article: https://www.channelnewsasia.com/news/singapore/covid19-coronavirus-singapore-discharged-patients-moh-12477696

As you can see here from the MOH data dashboard, most patients eventually test negative and have been discharged: https://www.moh.gov.sg/covid-19

For the few that do not, some eventually progress and end up requiring more advanced care and support. Having this group of patients under quarantine also affords added benefits for them - of closer monitoring and earlier intervention in the event they do deteriorate. Hope this helps!

Hi @Gabriel 

Thanks for ur questions. Sounded like an essay in the making. 

From my point of view: 
Pressing Problems:
1) Numbers of covid-19 rising- rate of community spread is relatively high in Singapore compared to other developed countries in Asia 
2) Resource allocation- with more cases, Increased need for resources such as ICU/isolation beds, manpower including lab staff, Nurses etc. And hence prioritisation of need for non-covid19 cases in healthcare setting leading to postponement of procedures and reviews 
3) Disruption of schedule with lockdown 

Solution:
Solution to the above mentioned issues would be to control the infection rates of covid-19. And how do we do that? 
Everyone plays a part.
Be socially responsible, stay home, minimise unnecessary travel, wear masks when out of the house. 
If we are able to control the numbers, it is hopeful that everything can return to normal. However, the bigger issue is regional and global as the economy has taken a great hit. 

How to cope better: 
 If you are unable to change the situation, the best way is to change your mindset. Circuit breaker is a national effort with an aim of curbing infection rates by minimising contact within the community and hence community spread of covid-19. Staying home may be challenging for some, but it is still better to be home healthy than to be in the hospital unwell. 

I hope this helps. 
J 

Hi @Charlycat
For your interest, this article talks about a Belgian-Dutch study which suggested that  safe distance when running, biking and walking during COVID-19 times is further than the typical 1–2 meter as prescribed in different countries!
In summary, the article suggested:
“for walking the distance of people moving in the same direction in 1 line should be at least 4–5 meter, for running and slow biking it should be 10 meters and for hard biking at least 20 meters.”
https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08

In addition, Paris has also started to ban daytime jogging as outlined in the article below:
https://www.channelnewsasia.com/news/world/paris-bans-daytime-jogging-to-fight-spread-of-covid-19-12618872?cid=FBcna

Henceforth, although the nature parks in Singapore are open air and safer than in confined spaces like indoor gyms, it is prudent for one to observe safe distancing measures to protect yourself and minimise travel to further curb the spread of covid-19. 

Hi @Concerned101 this is unclear as I am not able to find any descriptions on the effectiveness of Quat for this application, let alone the safety of doing this. Would not recommend it!

Hi @passerby  firstly, Im sorry to hear this and Im sure this must be concerning. Unfortunately as this is a new virus, the definition for what constitutes significant exposure that places you at risk is evolving as more information comes to light. That being said, I would reassure you that the risk in your situation is very low, unless you were directly exposed to the patient or their environment while they were coughing/sneezing. Also, not everyone with symptoms has the coronavirus as there are other common viruses that cause similar symptoms.

MOH has defined what you describe as “transient contact” that amounts to low risk, more information at this link https://www.moh.gov.sg/covid-19/faqs. The CDC, also considered by most as a reliable resource, identifies this as direct exposure to coughing/sneezing from a confirmed patient, spending 10mins within 6 feet of a confirmed patient, among others at this link: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDexposed.pdf

Ultimately, with respect to what to do - there is possible community spread in Singapore now so it would be best to adopt the recommended social distancing measures to protect your loved ones, and seek medical attention early if you feel unwell, especially since you may have been exposed. If convenience is an issue, the assessment can be done online via apps like DoctorWorld that provide video-based consultations, and depending on your condition, the attending doctor may be able to prescribe suitable medications and have them delivered to you. Here is a link that shares more about this: https://www.todayonline.com/brand-spotlight/doctor-will-see-you-next-app

Hope this helps! 

In the absence of Covid-19, sewage is usually considered odorous in general. It should be not a major concern with regards to increasing your risk of exposure to covid-19. 

Dear @Kevin . Thank you for your question! It does sound like a troubling time for you; I do hope that everything remains well for you and your family especially with the number of cases in America. 

I would say that it is appropriate for you to sleep in a spare bedroom. Beyond that ensure to always use gloves when you are working, wash your hands thoroughly during working hours as well as before you leave for home and before you enter your house. It would not be out of the question to even shower before going home. As it has been found that a small proportion of people can remain asymptomatic with the virus and still spread it around, it would not be out of the question to stay somewhere else entirely. It would be best to limit your contact with your wife and especially your younger child. Though the number of serious cases amongst children have not been very high, they are at higher risk given their physiological state (poorer reserves) compared to adults.  

These measures are necessary as COVID tends to linger on surfaces as they are unable to remain suspended in the air. Hence it is more likely for you to get it from touching an "infected surface" followed by touching your face or eyes/eating/sharing food or drinks with colleagues. I hope your company has thoroughly disinfected the premises as well. 

Wishing you and your family all the best!

Hi @workerbee great questions! Answers as follows
1) The best thing to do, will be to wear a mask which can be cloth-based and obtained at your local CC, in alignment with our country's latest recommendations. If you do develop symptoms of a flu, such as cough, sneezing, running nose, body aches, fever, etc - see a doctor early for a review for further assessment.
2) It may be difficult to differentiate the two without seeing a doctor for an examination in the current context, unless there is a clear precedence with an established diagnosis of nasal allergy and exposure to a known trigger just prior to the onset of symptoms. To save time, you may want to try having an initial conversation with a doctor online using apps like DoctorWorld that provide video-based consultations, and the attending doctor would be able to prescribe medications and have them delivered to you if you need them. Here is a link that shares more about this: https://www.todayonline.com/brand-spotlight/doctor-will-see-you-next-app
3) The current crisis has exposed inaccuracies of some of these thermometers and fundamental flaws in some non-contact thermometers sold online that consistently produce inaccurate readings. As a general rule of thumb, a temperature more than 37.5 is considered a fever regardless of device. Small variations may occur due to calibration settings and will be indicated on the device packaging. Use the “probe” type thermometers for an accurate measurement of oral or armpit temperature, which you can purchase from established brands such as Guardian.

Hope this helps!

Dear someone, covid-19 may present with mild symptoms initially. If you still feel unwell after 5 days of MC and still has some runny nose symptoms. It will be advisable to visit the same doctor who saw you previously. Do call for 995 if you have any breathing difficulty. Hope this helps.

Hi @Lucas great question! Unfortunately, this is untrue and there is no basis for that recommendation. The modelling techniques are flawed and do not reflect real-world events as they unfold, as techniques like these are purely experimental. Whereas in the real-world, there are many other considerations and factors influencing behaviour that can affect the epidemiologic "curve" and behavioural responses to measures like Quarrantine.

Such an extensive, and prolonged quarrantine  can have many unintended effects. For example, it may place many casual workers and daily-wage individuals in a desperate financial situation, in which they may choose to overlook symptoms and continue working in an effort to feed families (presenting late - spreading to more people along the way). This will be detrimental to essential public health efforts such as contact tracing to fight the infection.

Ultimately, public health measures (like quarrantine/social distancing) are most essential to "flatten the curve" - that is primarily to reduce the RATE of new infections and not the NET NUMBER when the former gets too high. The reason for this is that health systems have fixed capacity to attend to cases at any one time. If the RATE is too high i.e. people are disseminating the infections quickly and the new cases are presenting quickly and all at the same time, healthcare services will be quickly overwhelmed.

To achieve their intended effect, public health measures need to be tailored based on many factors about the target population, some of which may be dynamic in the context of an unfolding outbreak (e.g. daily inter-city transport/mobility of the population, capacity of existing healthcare services, availability of financial support, proportion of incident cases identified through contact tracing, etc). Quarrantine is a targeted measure to reduce spread from high risk individuals, however more evidence is required to justify prolonging beyond the 2 weeks, given the potential detrimental effects of extended quarrantines. More important is for individuals to be empowered in being responsible and present early to medical professionals once they are symptomatic.

For instance, quarrantine measures or even a temporary lockdown for the duration of 2 weeks (covering the incubation period reported in over 90% of reported cases) applied at the time that infections are rising quickly can be a timely response to help to reduce the RATE of infection and thereby the speed of incident cases as they turn symptomatic in the following two weeks, in certain populations. These can help to regulate the case load such that the health system would be better positioned to attend to those that are falling ill. More about this at this link: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html

Hi @Min just to clarify - what do you mean by 4th degree contact? The traditional use of the terminology refers to "degrees" of contact by rings of exposure i.e. if direct contact with a confirmed case - considered 1st degree exposure. If direct contact with an individual with 1st degree exposure but not with any confirmed case - considered 2nd degree exposure, and so on.

The asymptomatic individuals are monitored closely following the exposure to the "contact" for a duration equivalent to the incubation period of the virus in question. Should any 1st degree individual develop suggestion of infection during this time, he is reviewed by a medical professional immediately to determine the need for testing early. More information about this here: https://www.straitstimes.com/multimedia/a-guide-to-singapores-covid-19-contact-tracing-system

This serves as a method to focus contact tracing efforts and identify at-risk individuals. At the 4th degree, the risk from the index case is commensurately lower. However, in the event of an infection with community transmission, it is still possible to have contracted the infection from other cases. Therefore, it is not possible to say how likely it is for someone at the 2nd-3rd-or-4th degree of exposure to develop infection, only that those at the 1st degree are at significantly elevated risk.

Ultimately, the next step for you would be to resume life as per normal since you do not have symptoms, following MOH's guidelines for social distancing and hygiene to minimise your risk of catching the disease. If you do develop symptoms, have a low threshold to see your GP, or consider using Teleconsultation for a detailed initial discussion with a medical professional to determine the need to have a review in person. More about this here: https://www.todayonline.com/brand-spotlight/doctor-will-see-you-next-app

Hope this helps!

Hi @Jojo . Thanks for your question! 

Hmm it is possible that paracetamol is suppressing you fever.  I would say if you feel your symptoms are worsening despite medication after 2-3 days, you should go for a review. Especially if you develop symptoms suggestive of a lower respiratory tract infection such as difficulty breathing, chest pain at rest or on deep breaths, worsening cough which thick phlegm/stuck phlegm, reduce activity tolerance and escalating temperature. Another thing to look out for is a sudden loss of smell. 

If you have seen your physician I would assume he would have taken a history to check if there is a probability of COVID infection and hence it would be ok to monitor for now. You may want to consider with holding your paracetamol and checking your temperature. IF it remains between 37.1-37.5 it is still alright. Having said that, we usually look at the patient as a whole and the severity of fever is not always directly proportional to the severity of disease. 

Hope this helps! 

Hi @Stefsz . Thanks for your question! It is definitely a concern and quite interesting. 

In general I would say that you should practice good hygiene and possibly choose to disinfect the box/container/goods even if you receive them for a local supplier. Packages often go through the hands of multiple people and can be considered as a vector for transmission (fomites). As per CDC recommendations, COVID droplets are too heavy to be suspended in the air and tend to drop onto surfaces. Hence if someone was unwell while handling you package, it is possible for it to act as a vector for transmission theoretically. However given that this is often an unsuited environment for the bacteria to remain, the risk is much lower. Unfortunately the duration that COVID remains on surfaces is difficult to determine and can range from a few hours to several days. 

Overall, practice good hand hygiene, do not touch your face when handling the product initially and be sure to dispose of the boxes appropriately and you should be good to go!

Hope this helps! 

Hi @Terrific4 thats a terrific question. Currently, front-line healthcare workers like myself are reusing masks on the basis of CDC's guidelines. The type with the elastic band that slips around the ear can be safely reused as long as it is not damp/ wet/ soiled. As an added precaution, avoid touching the mask and wash your hands thoroughly after handling it if and when you need to.

More information about this here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

Hope this helps, and stay safe!

Hi @Mia , thanks for your question! 

I would say any symptoms of flu like illness should be evaluated by your doctor given the current situation. More so if you feel you are at higher risk I.e going out frequently/sick contacts/travel outside Sg or to high risk areas in Singapore.  I would advise against self medicating in the current climate. Also sore throat and shoulder pain are rarely linked and may present as separate issues ! 

Hope this helps! 

Hi @Jm , thanks for your question! 

From your explanation about your symptoms it does seem possible to be related to a form of reflux especially if it is lasting for such a long duration. To be honest what I find more concerning is that you are having loose stools persistently as well (I assume this happens several times a day). I would say your constitution of symptoms would require another review to look for other possibilities. Even more so if you have a significant family history of cancers/gastric issues such as IBD/IBS. At present it does sound like you are still able to carry out your daily activities though it is bothering you. Your GP may come wider referring you for a scope at a gastroenterologist. 

In terms of the gastric Illness, I do not see any alarming features that would warrant urgent ANE review which includes things such as vomiting blood/black tarry stools/bloody stools/significant abdominal pain/alternating bowel habits. 

Having said that given you are having persistent blocked nose in top of your throat itching cough and phlegm, this is inconsistent with a diagnosis of reflux (unless u have a history of sinus). Please discuss with your family doctor (after a physical exam) if there is an indication to send u for COVID testing! 

Hope this helps!