 Good day, viewers. Welcome to Kalusugan, Aykarapatan. I am Dr. Menchit Tadilia and today's topic is very timely and relevant. The world we once knew is being disrupted by this invisible enemy. The virus SARS-CoV-2 are commonly known as COVID-19. In late December 2019, a new coronavirus, now known as SARS-CoV-2, was identified as the cause of an outbreak of acute respiratory illness in Wuhan, Hubei province of China. We saw through January that this spread through China with sporadic global cases throughout the world. In January 2020, the first case of COVID-19 was reported by the Department of Health in a Chinese national with travel history to Wuhan. And by January 30, 2020, the WHO declared a world health emergency. Everything changed for the Philippines in early March 2020, when the first local transmission of COVID-19 was confirmed. An increase in number of COVID-19 cases ensued prompting the declaration of the state of public health emergency throughout the Philippines, placing the whole of Luzon and some parts of the country under community quarantine. As of May 5 of this year, there have been 9,684 confirmed cases of the disease with 1,408 recoveries and 637 deaths. The Philippines has the third-most number of cases in Southeast Asia after Singapore and Indonesia. Worldwide, there are over 3.5 million confirmed cases with 243,540 deaths. To appease the fears and anxieties and root out misinformation brought about by the disease, it is my pleasure to introduce our resource person, Dr. Marisa Alejendria, a professor of the U.P. College of Medicine and president of the Philippine Society for Microbiology and Infectious Diseases. Give us an overview of this virus, SARS-CoV-2, and the disease COVID-19. Good day, Dr. Marisa Alejendria or Dr. Isa. Good morning, Chansy Manjir. Well, thank you for joining us in this episode. And we're all looking forward to knowing more about the coronavirus. So let's start the conversation. What is coronavirus? Coronavirus is a family of viruses that causes our common colds and newly emerged infectious disease na kumakalat ngayon sa umundo ang COVID-19. And it is also the cause of Middle East Respiratory Syndrome, or hindi ang tawag na MERS, that emerged in 2012, and severe acute respiratory syndrome, which emerged in 2002. This virus is a single strand RNA virus that infects mammals, such as cattle, camels, cats, and birds. Dr. Isa, napakalaki pala nito ang family. You're saying that coronavirus is the cause of common colds. So, pagusatan natin mo na yung common colds do yan, because common colds is something that's very common among the general population. And you are saying now that the coronavirus that we're talking about is in the same family. So can you tell us about this family? Napakalaki, sabi mo may MERS, may SARS, but now we're talking about COVID-19. So can you at least give us the difference between the different coronaviruses? So under this family, there are four children or four generals, alpha, beta, delta, and gamma. Yung alpha and beta coronaviruses, ito yung nag-infect ng humans. And these are the ones that cause the respiratory infection. Yung common cold, this one falls under the four human coronavirus na. We see in everyday occurrence, it's endemic globally, and it is the one responsible for 10% to 30% of upper respiratory tract infection in adults. Alam naman natin na, lahat sa atin dito nakadanas na ng sipon, and that is caused by the coronavirus. Ngayon, yung meron din siyang isang genus or ka-familia yung beta coronaviruses. Dito magpo-fall yung MERS coronavirus yung SARS coronavirus. At yung pinakabago natin ngayon na virus dito sa pamilya na ito, ang SARS-CoV-2. Itong tatlo na ito ay nag-originate from animals. And based on genetic sequences, mukhang galing sila sa bats or yung panikit. So kaya tinatawag na sonotip kasi nag-transmit siya from animals to man. Pinatawag din natin silang emerging infectious disease. So nangyayari yan, pag yung virus nagkakaroon ng spillover event, yung virus na na sa animal, so kagayon itong SARS, MERS, siya ka SARS-CoV-2, sila ay na-transmit yung SARS from cats to human, yung MERS-CoV naman from camel to human. Yung SARS-CoV-2, hindi paklaro kung saan talaga ano yung nag-intermediate throws from bats. Tapos sa kung naalala nyo sa Wuhan seafood market, dun sinasabi nga na, doon nagmula yung SARS-CoV-2. Pwede nga... Topik isa. Sa topik isa, parang napakapopular kasi ngayon ng COVID-19, parang hindi naman ganong kapopula yung MERS-CoV-2. Is there any reason for this, the differences in its presentation? Yung MERS kasi nagmula siya sa camel, so wala siya dito sa atin, ang pinagmulan niya sa Middle East. Yung SARS, na-experience natin yan yung 2002, kasi yun yung time na madalas na rin ang travel, ma-bilece na rin ang travel non, so na-transmit siya dito sa Pilipinas through, if I remember right, it was a nurse na-travel from Canada to our country. So during ang SARS naging pandemic yan, nagspread yan across the globe, pero hindi siya kasing dili's ng SARS-CoV-2, ang spread niya. Sige, so papusapan natin yung COVID-19, so unang-unang sabi mo nga ay travel is so crucial sa travel became more accessible than we were able to move the virus across the world. So pagusapan natin ang COVID-19. Ang sabi mo nga, wala ng camel, kaya parang hindi na uso yung iba mga viruses. So let's go straight to COVID-19 now. So what else do you want our viewers to learn about COVID-19? Yung SARS-CoV-2 yun yung virus nang cost ng COVID-19. COVID-19 natawag natin dun sa respiratory infection that cost the virus, that cost the disease. So SARS-CoV-2 yung virus, ang respiratory infection ay yung SARS-CoV-19. So ano ba itong COVID-19 natin? So paano siya nagsisimula? So it usually starts at some mild illness which can progress to moderate, severe, or a critical phase. Pero 80% is mild to moderate, 15% severe, 5% is critical. So ano mga symptomas? Sa mild, naki kita natin sa mild ay para lang siyang upper respiratory tract infection. So meron fever, cough, shortness of breath, or difficulty of breathing. Pwede rin may muscle pain, may algia, parang flu, except na dito sa COVID-19, wala masyadong sipon para sa flu. Tapos ang iba pang mga symptomas, headaches or throat, yung iba, napapansin nila na wawala yung kanilang pangamoy o panglasa. So yun yung mild type ng COVID-19. Yung moderate naman, yun na yung nagkakaroonang kiraap ng paghinga, mas lumalala yung ubo, pag inextray meron nang makikita ang pneumonia. Tapos yung CBR naman, mas lumalala yung hirap ng paghinga hanggang sa, kuminsan, magiging, kailangan na silang ilagay sa ICU dahil kailangan nila ang respirator, meron din ang mga, kailangan na rin silang medialysis. So ito yung critical stage ng COVID-19. May isa ang sabi mga ayong symptom. So can you tell us again about the spread para makatiyiwasang ating mga viewers from getting busy? So can you tell us how it spreads from one person to another? Okay. Panos tayo na hahawa na pano na pinakapuhay ng virus natin? It's mostly spread from person to person among close contacts. So kung na-exposed tayo, we didn't lead to six feet to someone who is carrying the virus, pwede tayong mahawa sa papanong paraan. The spread occurs mainly by respiratory droplets pagumubo or suminga, machin. So when a person coughs or sneezes, similar to how we get fluke. So nagkakaroon ng droplets. Pag-ubo natin, lumalabas yung virus kasama ng ubo or yung pagsinga. Tapos kung merong tao na malapit sayo within three or six feet, then that person can inhale the virus into his lungs. So yun yung paraan kung paano natin na pukuka ang virus na ito o itong SARS-CoV-2. Tapos kung pag-ubo mo, yung ibang virus it drops into the table or into the surfaces na sa computer, tapos hinawakan mo yun at hinawakan mo yung muka. Then there's a possibility that virus can also enter through your nose and enter into your respiratory tract. So yun ang mode of transmission na tinatawag na din for COVID-19. Sa Dr. Isa ito yung basis kung bakit inadvise ang social distancing or physical distancing dahil sabi mo nga ay nililipat mo na sa pagbahing. So na paka-importante talaga ng part niya na imemintay natin yung physical distancing. Sabi mo kasi, how many feet kapag bumahing antao letingan natin kapag bumabahing antao papano, kalayo pwede mag-arating itong droplets na ito? Three to six feet. We didn't three to six feet. Dapat a travel ng virus. Okay. Napangkit mo rin kasi nakonnyare iko ay bumahing at umbo at napunta sa surface. So dapat talaga pala laging malinis din ang atin paligid. Kaya yung ba ang this is then kung bakit tayo pinapayuhan ngayon tayo nakamask para kung saling tayo ay hindi makakarating sa iban tao ang virus o ang droplets o kaya hindi sila makapunta sa ating mga workplace sa ating mga mesa yung ba ang dahilan? Yes, that's one way to prevent the spread of the virus. So in a we advise the public to wear mask. Tapos din kasi there is what we call a presymptomatic period. Dito sa virus na tono. What is this presymptomatic period? Parang two days before you experience symptoms you are actually shedding the virus already and pwede ka ng makahawa. Although ang main driver of transmission talaga ay yung may symptoms yung mga inukubo. So para makover yung part na yun na tinatawag na presymptomatic period yung period na actually kung isan parang akala mo wala kang nararamdaman pero meron ng konte and usually binabali wala natin yun. Parang masamaing pakiramdang pero hindi patalagang yung ihihigam mo. At that point pwede ka ng nagsesiyad ng virus. Kaya ang advise is to physical distance and then wear mask always wash our hands after every activity para na maiwasan na mahawa tayo. Tapos yung symptoms kung ikaw ay na expose sa isang may virus pwede siya mag-start two days up to fourteen days after mong ma-expose to the virus or an average of five to six days. Yan yung isang isang napakahala ganun kasi alam mo ka dalasan pag masamaang pakiramdang natin at binabaliwala binabaliwala natin ang sinasabi natin ay pag-good lang. But what you say now in the current situation na meron tayo talagang pandemic dito sa Pilipinas hindi natin dapat binabaliwala ito mga nararamdangan natin. Tapat talagang magpahingan na. Tama ba yun? Yes. Lalo na kasi karakteristit nito ng virus nato. It's highly infectious starting two days before you actually have the symptoms and within the first week. So yun yung kaibahan niya kasi sa SARS yung symptoms niya may just doon pa sa second week talaga naging highly infectious. Ito sa simula pa lang highly infectious na yun yung stage yun yung time na hindi mo masyadong binibigyan ng pansini yung nararamdaman mo ubo. Kaya, mas mabilis siyang kumalat mas mabilis ang pangkalat niya kumpara sa SARS yung homearscope. At nakita rin nung inaral ngayong mga kasos sa China na mataas ang kanyang reproductive rate o hindi nintrawag na transmission efficiency. Kano siya kabilis maitransfer So for every person that is infected with the virus you can infect 2 to 4 persons ka agad and then that 2 to 4 persons can infect another 2 to 4 persons. So kaya kumakita natin yung pangkalat nitoong SARS-CoV-2 so very steep yung curve compared sa SARS na ito 8 months to infect 8,000 people versus itong SARS na in 1 month ang dami nanyang na-infect ka agad dun sa nung inaral yung transmission dynamics nitoong SARS-CoV-2 sa China. Pero dopre Isa ang sigurang yun is something good about the disease that karamiya naman talaga ay mild so kunti lang naman talaga ang malala pero ganun paman dapat magiingat kasi nga napakabilis nyan mag-spread. At siguro pwede natin nipakusapan ni kasi hindi naman talaga lahat ay may low-risk kaka high-risk di ba so para sa mga nununuot nating kasi let sila naman karamihan dito ay probing di high-risk but then pwede mo lang ba magangkit sa amin yung in general ano ang low-risk at high-risk para yung mga nakikini hindi naman sila magpapanik pag naring nigaling ating pinangkausapan. So gaya na nabangkit ko kanina di ba majority or 80% mild illness na yung nararamdaman so yun yung konting ubo, lagnat, parang sore throat sa mga young and healthy usually in one week mga nararamdaman nila nag-recover na sila nag-improvement na pero yung mga elderly yung 60-an yung mga comorbid condition or may mga ibang sakit kaya ng diabetes hypertension chronic kidney disease chronic lung disease HIV or cancer sila yung at-risk naman karoon ng moderate or severe or critical illness natinatawa so sila yung dapat nababantayan kaya dapat papakiramdaman mo kung yung cough na yan ay hindi nawawala or mas nahihirapan kang huminga usually during the second week by the time nararamdaman mo na hindi nawawala yung ubo, lagnat, mas nahihirapan kang huminga or sumasakit ang dib-dib dapat mga consulta na sa doctor para ma-admit or tawag kayo sa barangay health emergency response team para transfer na kayo sa COVID referral hospital ito rin yung mga pag ang ina-advice namin na kailangan talaga ma-admit yung mga elderly at siya kama yung mga comorbid condition or may mga ibang sakit nabangitung ang gaya na diabetes or hypertension so sila mas ang priority na ina-admit natin para ma-monitor kung mag-progress yung kanilang sakit kung mag-progress yung COVID-19 to moderate severe or critical stage so maganda na nasa hospital sila para ma-bandaya So mga nakikin ay majority ay 80% ay mild pero kapag ikaw yung pinatawag ang comorbid napatalaga ay mas lang i-ingat ka nabangit mo kanina doke isa na napakabilis ang kanyang pagkalat sabi mo ba makagarong kandalawa apag anggang mamaya buong komunidad na buong barangay na ito kaya pinatawag kasi ang pandemik pero paliwadag lang sa aming na pa-difference ng epidemik sa pandemik Yung pandemik kasi the term pandemic it's a term it refers to the spread of the disease tinatawag na siyang pandemik pag it's has spread across all continents in the world yung COVID-19 nagsimula siya pandemik sa China tinatawag natin mo ng epidemic pag yung big lang dumami yung number of cases from the usual and for example yung dengue ang laganap yung dito sa bansa natin pero kung anabawa meron tayong tinatawag na surveillance system pag kasi reportable disease yan kung sabang minumonitoryan ng ating Department of Health ating municipal health officers pag nakita natin na it's higher than the usual ang tawag natin kasi yung usual yung endemic pangkaraniwa natin yan nakikita pagtumaas siya ng more than the usual din nuna tayong nagtatawag naga alert na baka may outbreak or may epidemic so yung nangyari sa China sa Wuhan initially nakita napansin nung isang doctor doon na dumadami yung mga patienten na may severe respiratory syndrome or severe respiratory illness dumadami yung na sa ICU tapos initially na pick up nila na karamiyan sa kanilain na expose sa Wuhan food market tapos noon after that so unusual din yung presentation nung respiratory illness na yun yung sabihin di siya yung pangkaraniwa namin nakikita na respiratory illness na alam namin na djuto bacteria o yung mga virus na alam na ito parang kakaiba so yun yung nag-re-raise ng alert na baka may epidemic na tapos kasi big lang dami tapos iba yung presentation tapos kagaya nito nung after nung nakikita nila na hindi mayro ng mga patienten na kahit wala sa Wuhan ay kahit hindi na punta sa seafood market ay nangkaron din ng infection meaning yung mga na expose dito sa patienten na na kasambahay nangkaron na rin so dun nila nakikita na mayro ng person-to-person spread so nandeclear na ng epidemic tapos nung so because of easy travel din so kumalat na siya sa ibang bansa so nangkaron tayo yung first case natin was in february yung first three cases natin na taon natin important cases nanggaling sa Wuhan so kumalat siya tapos and then nangkaron na rin sa US south Korea di ba dumamin na sa japan ang gam sa nandeclear na siya na pandemic kasi nga kalat na siya sa poong mundo so yan yung pandemic thank you so it's very good information to find out to know that the difference between an epidemic and the pandemic in the recent papers the newspapers we have been reading about the Spanish flu according to the papers the last pandemic was actually the Spanish flu of 1918 can you tell us a little about this pandemic and can we learn from from that pandemic in 1918 okay yung the 1918 Spanish flu pandemic the reason why we're trying to go back to histories because the scope of the COVID-19 pandemic now is somewhat similar to the scope that occurred when the Spanish flu was declared sa pandemic in 1918 so in 1918 the Spanish flu also spread across continents from America Europe Asia and at that time also there was no treatment or vaccine available which led to really a significant number of lives lost during the Spanish flu pandemic and as we all know that pandemic affected almost 500 million people and about 50 to 100 million people died yung kaya siya parang we're all parang we're equating or trying to compare the current pandemic to the Spanish flu and also during that time similar dahil na wala pang wala din gamot walang vaccine the people during that time also tried barious remedies like they also tried to gargle garlic mouthwash and that time they tried mega doses of aspirin which probably aggravated the illness and contributed to the deaths and to control that pandemic they also implemented quarantine and isolation measures similar to what we're doing now kasi nga hindi na at that wala ng ang vaccine at siya wala ng gamot so ganun pinagbawal din ang mass gathering schools were closed so people were not allowed to go out unless it's essential so yung similarity between the Spanish flu and the COVID-19 pandemic that we are experiencing now so the scope of the the disease is almost the same in terms of numbers and also so are there any I mean of course we did the quarantine we were doing the quarantine right now but then how long did it last and are there any other lessons that we can pick up from that pandemic that we can apply to our current situation right now or is the world so different the pandemic then lasted from 1918 to 1920 so it's much longer and because they also experience a second wave after they relaxed the quarantine measures na karunang second wave so it's probably so that's something that we have to learn from how to calibrate our responses in terms of the quarantine measures or the non-pharmaceutical interventions that we are implementing now to contain and mitigate this pandemic pero doka isa wala naman mga testing kits at that time I mean how did they diagnose the cases at that time was it all clinical at that time in 1918 yeah it was all clinical because that's why I think it lasted more because wala panalaga na much shadow research wala pa yung diagnostic because wala rin treatment talaga silang na discover pa at that time kaya mas matagal I think yung duration ng pandemic so when did the treatment was a treatment discovered at what point in the history were we able to put a treatment to this kind of blue yung oseltami beer na ginagamit natin na yung was only in already in early 2000 that we were able to discover oseltami beer and then yung vaccine naman maraming klasing vaccine na develop good time and it's only in 2000 that we really were able to produce effective cost effective vaccine na minibigay na natin ngayon year year year di pa so I mean the world is different now we're lucky because we have we have research and as a matter of fact Dr. Isa is part of a big research is a participant in a big research involving countries around the world so research is important number two we have technology in our hands we have testing kits now we're able to make diagnosis without getting the full blown picture of the patient so we're hoping that this one will not last that long we're hoping that we're not going to wait for two years before it really goes goes away you mentioned the second wave so I understand we have to watch after the second wave sabi mo ang gano pailangan natin i calibrate but calibrating will really talk about making the right decision on or making the right assessment kung kailang magka-flatten ang curve laging pina-guusapan kasi ngayon ang second wave nabanggit mo na iyon pero pinag-guusapan din kasi ngayon yung flattening the curve so that we know when to start opening the doors of businesses and schools and so on so maybe you can tell us a little about flattening the curve ano ba ito naringinik natin pinag-guusapan kailangan talaga magflatten ang curve ok sure, I'll start off with the rational why bakit tayo na implement ng enhanced community quarantine or actually it's a term that we use para hindi masyadong nakakatakot sa tao kasi pagsinabing lockdown so ang ginamit na term I enhance community quarantine and main objective na is because we did not we do not have a vaccine or a treatment for this virus is to implement physical distancing measures and enhanced protective measures para madelay yung peak ng epidemic to reduce transmission why do we want to reduce the transmission kasi nga we all know already we have seen in China the exponential growth of the disease because of its high reproductive rate so 2 to 4 yung reproductive rate na in so it's a fast pandemic if you peak very fast it will also end very fast but at the expense of losing lives because your health system will not be able to cope with that surge of cases so what we wanted when we did when we the government impose the enhanced community quarantine measure is to reduce the transmission of cases so you prevent people from going out you lessen their chances of being exposed you lower the risk of transmission you lower the average viral load and with that you lower the number of cases you plant supposedly the peak instead of having a sharp peak you slower you lower the spread of the virus so you have lower number of cases less severe infection less infectious cases so bababa yung it's not necessarily bababa pero hindi siya magpipi mas mahabang ang bago natin ma totally control yung virus so yung yung ibig sabihin natin we are flattening the curve you are slowing down the spread of the virus at the same time you are buying time for the health system to be capacitated because when we so if we look at our epidemic curve we started off with first three cases na imported in february and then in march when we started seeing localized transmission already yung first two cases na atin sa green hills and then our private hospitals then are starting to see also more cases of COVID-like illnesses so merentayin criteria na fever respiratory symptoms and then history of travel and then we were also able to find out that some of the cases did not really have history of travel so that signal to us that there is some local transmission already going on and that alerted us that we really need to be more aggressive in our containment measures because at that point when the number of cases were starting to increase our hospitals were already experiencing difficulty accommodating the number of cases going into the ER and then we only have one laboratory the national laboratory that's our RITM and then number of specimens coming in are increasing and then the turnaround time is getting longer so with that you are prolonging the stay of the patients in the hospital so we are seeing already some a strain into the health system capacity so that is why then we recommended that we have to really now impose the ECQ so that we can slow down the spread of the virus and allow our health system to be able to cope with the increasing number of cases Alam mo na apakahala gano I think that's very important we hear flattening of the curve asking the experts have we reached 30 and as you said the reason we want to slow down the transmissions because we want to make sure that the health system can actually cope because as you said if the peak happens too fast then we're going to lose too many lines and so it's really a balancing act no? Hindi siya pa e din para bang you want to get all the cases and then get out it doesn't work that way so that's the reason why I think the our department of health is working closely with our experts and also with our epidemiologists to make sure that we are able to come up with a balancing act well fortunately now we have more laboratories but I think we need more we have we started really with just one and we couldn't cope but I know that now we have about 20 and I know that the department of health is trying to open up some more labs in other parts of the country so you actually can you just give us the difference in an eCQ and a GCQ we're now in eCQ no? so eCQ we prohibit mass gathering schools are closed work is also close except for essential services health then travel also is restricted where public transportation is not operating in GCQ you are slowly opening up why is that so no? because we need to be able to at some point start opening up if you see that there is already platinum of the curve and that the health system is also able already to manage the number of cases because eCQ as you have seen has consequences lots of income lots of savings businesses are also suffering so there is collateral damage to that we cannot go on eCQ forever eCQ is not the cure to the disease yung ay sabi ka we have to calibrate if we see that there is already some platinum of the curve in terms of the number of cases and the other indicator also is if the number of deaths are also platinum so that means at the quality of care probably is already improving the system is able to cope and the public is now more aware that they have to consult earlier so you now reduce the delay in consultation because we saw that in the early part of the our epidemic that there was a delay in consultation so we had a higher number of deaths during that time so we also look at the doubling rate how fast do we double our cases and at the time that we implemented the eCQ our doubling rate our cases double every three days now we are seeing a slowing down of the doubling rate meaning we are now able to there is reduced transmission so the doubling rate now is about five days compared to the three days before so kaya nakikita na natin na medyo na pag-latin na and that gives us now some confidence that we can probably open up open transportation but still maintain the principle of physical distancing implementing personal protective measures hindi ibig sabihin na pag inopen na magwawalan na tayo lalapas na tayo lahat no hindi hindi ibig sabihin na wala ng kaso there are still cases that still need to be managed it's just that it is now hopefully at a manageable rate even the R not the reproductive rate na initially 2 to 4 during the time that we had the eCQ now it has gone down to 1.1 to 1.2 so it's like for everyone infect person that's infected you infect another one the effective R not is it if it comes down to less than 1 then it means you have started to control already the pandemic so sa yun yung sa gcq so pwede nang mag-operate yung transportation but still maintaining physical distancing then work there are industries now that can be allowed to open as long as they are able to maintain yung minimum health standards such as physical distancing so yung workshops should be managed in such a way that you are able to implement physical distancing personal protective measures and then proper ventilation in the office regular disinfection of the workspace toilets and please so those are and then being able to screen also your workers because to be ensure that the workers do not have fever cough when they come in so may parents cleaning symptom you need to have a clinic that will be able to handle symptomatic workers o doka Isa definitely it's a new normal you know I think everybody is talking about the new normal so I'd like to ask you this time even on a road you're a practicing specialist in the field of infectious diseases you see these patients every day but what is what will be new normal for you as a doctor right now because I'm in an infectious disease specialist so we're really always conscious of protecting ourselves so we do washing now the it will be enhanced personal protective measures because again we still do not have the vaccine the treatment kaya we advise people to still wear masks so we have to wear masks in our clinic because of that what I described earlier the pre-symptomatic period na two days before you have the symptoms pedika ng akahawa so as an extra precaution you will have to wear masks and then always hand washing before and after at the patient and then and then if you are going to perform procedures that will generate aerosol that is the time that you will have to wear N95 and now because we try to limit contact na or face to face transactions there is now a use of telemedicine wherein you do your consults by phone I used to not like that I prefer really face to face contact but now I think there will be really opportunities it has now become important to use this technology of telemedicine especially if you are patients we have to travel and it can be effective to provide still to continue to provide health service to our patients in telemedicine para magiging mas bago na strategy for to in this new normal PG-8 is getting ready for launching telemedicine in its outpatient department whether we like it or not we have to reach out to our patients thousands of patient in our outpatient department of PG-8 at pinagahanda ngayon so that means both in the government hospitals as well as the private hospitals telemedicine will be part of our life we will have to use technology for ourselves napang kasi kanina yung the use of the mask no so I just want to and you know if you look at the the the features on wuhanaw even if it's gone the people as you're wearing mask so is this something that we proceed to happen in the Philippines that even if let's say the virus is gone away we'll still be wearing mask I think kasi na if you look at the culture of Japan they did not implement this lockdown because they have really this culture of having a distance and then when they greet people it's they bow and not they are not touchy persons and if you see them in the train they actually wear mask if they have cough or cold kasi dapat naman talaga na yun si culture na kailangan na to imbibe in this new normal is being conscious of yun na yung cap etiquette not speaking in the public many of you have cap and cold wear mask and consult or stay at home do not go to work so yun yung measures that we have now to be aware of as a person to be conscious of this health measure preventive health measures hand washing cap etiquette not speaking in the public wear mask if you are sick so that will be the new norm that we will see and yun and then our environment also dapat we should be able to provide adequate supply of soap and water up to regular cleaning of our public space public facilities work spaces yun regular maintenance what we started in this COVID pandemic should continue should be sustained so that that health consciousness the culture of being clean and healthy will stay because prevention is really treatment it's the first thing in infectious diseases being able to adapt this preventive measures the new norm is that we have to make sure proper etiquette of cough and protecting others when we are sick COVID that has to be the new norm can you just repeat the part about infectiousness because people really need crucial to remember is how to handle this COVID-19 makikulit lang ngon kasi yun na ang isas ang mensai na dapat natin maparating sa ating mga viewers ngayon close contact with someone who has the virus through droplets when you cough or sneeze then you spread the virus to someone who is close to you repeat if you do not cover your cough or you do not practice the proper cough etiquette proper sneezing etiquette then you will be spreading the virus through droplets spread So Dr. Isa in our last few minutes of our conversation you have many messages from our viewers I'd like to request you to have a message for maybe the top three messages for the general public and then since you mentioned also the need for preparing the environment and the the country in general may be a message that it can give to our policy makers first the top three messages for our general public for the general public we really need to have a healthy lifestyle and for us to be able to control this pandemic discipline and cooperation in implementing personal protective measures following physical distancing that will help a lot as we move from ECQ to GCQ and then as we relax as I mentioned earlier the personal protective measures hand hygiene cap etiquette and of course do not stress yourself with misinformation kailangan being responsible tayo time of the day that you will listen to a credible TV station or read credible articles or journals wag tayong be tempted to be to spread fake news we have to be able to distinguish which is fake and which is true now for our health workers we have to continue this fight for against COVID-19 we have to work together in solidarity to be able to control this pandemic and as I always said in presenting health education is very important we should not forget that as clinicians it's not just about the laboratory test it has to be being being astute and being able to determine in whether you are in a new case or a new disease kailangan maging very alert tayo we should not forget our clinical eye clinic judgment it's not just about test the test are important in an epidemic and in a surveillance because you will be able to monitor the numbers and then another thing is we have to adhere to guidelines which are evidence based and then we have to follow reporting standards as clinicians we have to comply with reporting notifiable diseases so that we can monitor and really determine if there is an increasing number of a new case or we are reaching an epidemic or an outbreak or we are controlling the disease for our government the other message is public health is everyone's business and I think one of the lessons we've seen here in this pandemic is that we can see that health is a valuable cost effective investment with the spread of this virus we saw a lot of losses economic losses so we can see that if we invest in our health system we invest in the health of our population can probably prevent another type of another epidemic or pandemic so this minimum health standards that we are now imposing if we implement that seriously and we monitor it in a long way not just for COVID but for other diseases and this is also now the time that we can preventive health at our universal health so this will be the for us to start implementing universal health care and start with preventive health packages then we need to have or expand and have an effective surveillance contact tracing and responsive laboratories so this is now the time to really make good use of technology so that we can easily monitor if we have increasing number of cases so we need to work together across all sectors both public and private the academe so bayanihan para sa we have to continue full of society of approach full of government full of system approach for a healthy condition we look forward to another another episode with you it seems like we need another episode just talk about the new things that will happen months from now maraming salama thank you Chancellor Menchit the clarity needed to fight this invisible enemy is important recommendations based on evidence and expertise will guide us through this uncertain times we stand with the world forging our future to fight this enemy and delivering health for all good day to our viewers this is Dr. Menchit Padilia kalusugan ay karapatan