 Good morning, good afternoon, good evening everyone. Welcome po saan mampalig ng daigdig kayo na ron sa ating 90th episode and the beginning of Season 8, the Stop COVID-19 webinar series brought to you by the University of the Philippines. Thank you for being part of our credible online community and to all those who have just discovered us for today. Welcome po at sana po magustuhan po ninyo ang ating topic for today and our future topics na patutunguhan po at least for Season 8. In today's webinar, we will be tackling about repeat COVID-19 infections po or reinfections with SARS-CoV-2 which refers to a person being infected, recovered, then reinfected again. So recovery from COVID-19 and vaccination po, mayasip po ninyo na they do not seem to prevent reinfection particularly among our frontline healthcare workers na lagi po ang expose lala po sa mga may COVID-19. On the other hand, meron din po tayo nung tiyatawag po natin na long COVID which is a topic that we have discussed at least twice in our previous webinars. These are post COVID conditions po that may be continuing, ongoing, recurring, returning or even new symptoms after one has recovered from an infection. So marami po sa atin na nagtatanong ano po ba ang mga sintomas ng long COVID, sino po ba ang may mas mataas na risk ng pagkakarong po ng repeat version po ng pagkakovid? Ano po at alin sa mga variants po natin ang nagkakos po ng greater risk for reinfection. So if you want the answers from the most credible experts po for today, please stay tuned for our webinar entitled COVID-19 na naman. Repeat COVID-19 and long term effects. Be sure po to tune in lala po sa ating mga nanonood sa YouTube at sa ating Facebook. Saan na rin po ay makasali rin po kayo sa ating webinar for today? Dito po sa Zoom, please share our webinar po webinar details to your family, colleagues po, your network, mga katabaho po to be able to get the latest science-based and evidence-based information. Dr. Raymond Francis-Sarmiento, director of the National Telehealth Center, National Institutes of Health University of Philippines Manila. Always a pleasure to be with all of you during a regular Friday lunch date. Medyo marami-rami po ang nasa webinar po ang ito for today ng ganito po kaaga, which is a good sign of our topic for today and our expert panel po. Always look forward to Fridays because I get to share hosting duties with my partner and beloved mentor po, our adjunct research faculty at the National Telehealth Center. Also, a special envoy of the President for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi Raymond. Good afternoon. Magandangapon po sa inyong lahat wherever you are. Great to see our usual audience here na tutawa akapag naihikita ko yung mga pangalan nyo sa chat. So, magutin ang dito kayo. In fact, I was going to ask, parang meron tayong kwad ng exercise kayo na, Raymond. Pong sino sa inyong nagkaroonan ng repeat COVID, ilagay mong nga sa chat nyan. If you have had COVID more than once, we just want to get a sense of that. But that's our topic and we know that our frontliners are very concerned about this and we have excellent, excellent speakers. As always ang kaposalamat ay sa mga speakers natin na napaulakan tayo ulit. So, we will talk about reinfections and we will talk about long COVID or post COVID. Okay, so over to you Raymond. Thank you, Dr. Susie. So, eto pung topic pung ito, lalo na po sa mga medyo bago-bago po sa ating webinar. We usually start off our webinars po with what we call the person on the street. Conducted by our team over at TV UP. Para po sa ating person on the street video or parts video for today. Ang tanong po that na itanong po namin sa ating mga interviewees sa palagay nupuba na maaari magkaraon ng COVID-19 ng paulit ulit at sa tingin pubanin nyo. Ano ang mga pwedeeng gawin para hindi paulit ulit na magkaraon ng COVID-19? Please watch this. Infect ulit. Yung tao pwede pang ma-infect ng paulit ulit kasi meron naman po mga cases na ganun na na kahit bakon na do na rin po na i-infect pa din sila. Pwedeeng magkaraon ng COVID-19 ng paulit ulit ang isang individual. Meron po akong kilala na nagkaron po ulit siya ng COVID-19, infect po ulit siya, twice po na working din po nga sa hospital kaya po siguro mas exposed po siya. Meron na kung kilala na nagkaron siya, nag-test siya ng positive, then after a month or two nag-test ulit siya ng positive. Nag-COVID kami actually twice na. Nung una, yun talaga yung medyo severe kasi ako siya kaya yung partner ko. Kung ano po yung dinawa, before test kung saan ka na-infect, siguro dapat po iwasan na po yung para hindi na maulit. At saka makinig din po sa mga experts kung ano po yung payo ko nila. Pagiging mas accessible po ng ating mga healthcare system dito sa ating mas, halala na sa ating mahihirap na mga kababayan. We're going there na matatapas din yung COVID. Pero hindi siya mga wala, pero kaya natin siya i-control, kailangan mas mapalakas pa rin at mapabilis yung pagpapakuna doon sa ating eligible population, especially yung mga na sa priority group na sa high risk. Sinikap namin na mga pampampleto agad yung vaccine namin. Bumaling na kami, after one month kata, talagang kinampleto namin yung vaccine. Tapos naggabuster na rin kami. Unang party na pinuntaan namin, ending after that party, nag-positive. Tapos yung partner ko asthmatic, kaya medyo kinabahan kami kasi nagwarenta yung temperature namin parehas. Sa mga public and private hospitals na rin po, na siguro po skeletal workforce para hindi ko paulit-ulit yung taon na i-infecting. Pero ngayon po nag-alert level one, so unti-unti na rin naman po yung lumuluwag yung restriction. So, hopefully po, by this year kahit hindi ko talaga siya matapos na, pero mabawasan na po lalo yung mga active cases. Okay, thank you very much, TV UP. It's always good to hear from ordinary people when they think of this and it looks like a lot of people have had repeat infection or reinfection. And I'm looking at the chat, marami rin sa inyo ang mga nag-garo ng reinfection. So, alamin natin, we'll know more about this. And we will of course be talking to some experts who can give us more information about reinfection and long COVID. So, before we proceed, I just have an announcement. Sabi ka ni Raymond 90. It's the 90th webinar, my goodness. Okay, and it means we're preparing for our second year anniversary. And for our second year anniversary, we just wanted to remind everyone, as we did last year, we have a COVID-19 Heroes Memorial. And that is to honor our global Filipino medical frontliners who have succumbed to COVID-19. We continue to collect photos that will be included in the COVID-19 Heroes Memorial Digital Album in the Stop COVID Deaths Facebook page and the Special ADP. So, we're preparing another audiovisual presentation. And so, if you have a Filipino medical frontliner family member or a friend or a colleague in the Philippines or even in other countries, please send us a high-resolution portrait photo of at least 300 DPI with their name, date of birth, date of death, and their occupation. Please send that to Television UP, TVUP. Television at up.edu.ph before April 9. And, you know, ano, na parang, it's a good thing we're slowly opening up or moving. I think we're seeing the light at the end of the tunnel, but there were those who sacrificed their lives. And we don't want to forget that. We want to honor them and we want to remember. So, please help us by sending us photographs and names of people you know who were frontliners. Thank you very much. Raymond, over to you. Thank you, Dr. Susie. So, orita lang po namin, the Filipino medical frontliners have been recognized as one of the best, if not the best in the world. We want to be able to immortalize po ang kanilang sacrifices and their selfless contributions dito po sa laban against COVID-19. Before we proceed, just to let you know, our webinar po can accommodate a maximum of 3,000 participants. Meron na po tayong little over 900 attendees here sa Zoom. I'm sure meron pa rin po sa mga YouTube and Facebook po natin. So, please join us. Kumaka-join po kay sa Zoom. So, you can fully experience the interactive program. Pero hindi naman po ibig sabihin, makakalimutan po namin kayo na sa mga na sa YouTube or na sa Facebook. Lagi po kami nakaabang lalapos sa comment section. Kung meron po kayo mga in any comments or katanungan po, that would be very, very interesting to be posed to our panel of experts. For those who are asking, certificates of attendance will be given to those who have watched at least 50% of the webinar duration po. Ang ityuran ng e-certificate we have already distributed completely. For all 88 webinars po, up to webinar 88, medyo may pahabul papuka may webinar number 89 with regards to the certificates po. Please let us know. If you have any trouble receiving them or if you feel you should have received them but did not receive them, please let us know. And finally, before we introduce our opening remark speaker, we would want to show onto the screen especially for those who are nandito po 938 and counting at 939 sa ating zoom. If you open your browsers especially for those in YouTube and Facebook, go to www.menti.com and type in the code 29341486 that's 29341486 for you to be able to join in our fun quiz which will also serve as your pre-test for our webinar. For today's webinar, we will be still utilizing our standard panel discussion format. Speakers will present their slides. We have a reactor who also will be weighing in followed by a Q&A session entertaining all the questions that we will be receiving sa lahat po nang konan sanman po kami na livestream. If your question po, is selected po and you will be asked to open up your video po. Sana po paunlakan nyo po kami na makasama po sa ating panel to be able to ask your question live to anyone of our panelists. Over to you, Dr. Susi. Okay, thank you very much Raymond. I know you're all excited to get started and for our introductory remarks we have somebody who you all love. You always like him when he's on the webinar and I think our country has just been very fortunate at this time and I'm sure when he looks back over the past two years, we have a lot to write about. What happened to his life? We have the director of the Philippine General Hospital Dr. Herardo Gap-Ligaski Gap. Welcome to the webinar. Kamusta ka na? And congratulations Sir Gap sa Lincoln Bayon Award, sir. Oh, Lincoln Bayon Award. Mas maraming deserving doon pero maraming salamat. I'd like to congratulate you first for this 90th edition. Going to the 8th season, madami nakaintila setting na talo at 8 seasons na but rightfully so because of all the knowledge and the wisdom that has been imparted and congratulations on that. And it's my honor to open this very special series now of our staff COVID which tackles with the repeated infection and I think as a frontline and I see a lot of healthcare workers on the chat group and I think being one of the early ones to have tested positive let me just take some time to share with you that those experiences. We very well know that we prepared one whole week to set up PGH as a COVID referral center opening in March 30. We barely had any sleep. We were here for seven days a week. The tension, the emotional and the physical tension probably shut down our immune system but still we were following protocols and in the first week that we opened this COVID referral center we had to test ourselves and lo and behold I got the text from Dr. Rasellia Carlos that I'm positive dati isang lingo bangulong mabasang risulta so kumakain akunuhan sa harap ng aking mga ka-familia dahil na hindi naman wala naman ako nararando naman na nulang kami routine test after opening at na siguro may imagine nyo anong terror ang napunta sa isip ko na na-expose ko aking pamilya sa isang lingo na yon. So katulad ng silasabi ng protocol noon I isolated myself for two weeks and thankfully so I was asymptomatic all the way but of course at that time I think we had personally I had four Dr. Friends who have died and around my age also and I think the emotional toll was bigger than the physical toll at that time so lahat na nag-positive nung bandang early 2020s makaka-relate kayo jaan. So ang lesson noon ay talagang pwede kang mag-positive at wala na walang symptomas and you'll be carrying it around lalo na wala pang vaccination noon. Fast forward to 2021 when we thought we've learned a lot about COVID-19 and it's a transmission and in the whole course of that time before the big surge in July we were already careful because of the protocols that we've established and I know probably I have napaka-baba sa siguro importanting malaman ati ma-co-health workers napat mababa ang threshold atin sa pagpapatest nung time na yon. An ordinary sore throat of body ache was already enough reason for us to test and thankfully in the next month and soon after my initial positive was always negative until July when I felt persistent body aches after a weekend of biking which I thought attributed to the biking but as I said dahil napat medyo praning ka pagkaikaway na sa hospital at lagahandel ng mga paciente nagpates ako ng maaga and through enough I tested positive but I was I continued to be symptomatic with body aches fever and some cough and sore throat that was the delta variant raging at that time and I think again the very high mortality rate sent naman ako bata ako ay may hypertensive ang tuluk ko ikulang ba aro-araw so kinaman ako ulit na for the second time and rightfully so and I had my workup meron mga ground glass opacity sa aking CT scan ng chest at ako yung pinauwi ng doctora Berba at nagagrikame na dahil mild lang yung moderate lang yung ating findings sa chest city sa bahay nalang so I think ang point doon yung na halubiluan mo na nakasamam mo ng mga ilang araw inalala inaalala mo na naman so pamily ako inalala ko ang mga kasama ko sa trabao thankfully I think because of the early testing that we do with the slightest with the slightest symptoms all 57 of my contacts were negative including my wife who I I'm with every day my children as well so I hope that message is clear taking care of others also is a factor in protecting ourselves in the same process. So after that ako po yung na isolate ng sampong araw ulit dalong lingo kasi delta yun. I was delta number 11 sa gene sequencing marami salamat kiy Dr. Laura Eva dalapas nalaman ko nang maaga ako yung delta so ang precaution silalong tumindi because of the virulence of the virus at that time but after going through the protocols of monitoring and early intervention in COVID thankfully I surpass all of that without any symptoms but I think alam natin lumalabas ang mga datos ngayon tungkol sa effecto ng COVID sa utap sa baga sa puso sa mga nerves at ito yating matutong hayan ngayong hapon sa mga expert na natin makasama saan ay matututu tayo na kung ito man ay bumalik ulit sa ibang classing form in another variant ma-apply natin lahat o natutunan natin with repeated infections but for now I hope you're gone full circle at kung kumakonti ang caso dahil tayo na bakunahan at tayo lalong mas magaling magingat it's a major achievement para us in the crisis at Phil Jessica. So maraming salamat ulit and I'm excited to listen to our speakers especially Doctor Chancellor Pidel Lamez who's a co repeated infection patient. Thank you very much and good afternoon to everyone. Okay, thank you very much it's Doctor Gapligas Pidi director of the Philippine General Hospital. Gapang ganda ng background mo ng very historic I love the love the zoom background it's a painting. That's the only remaining artifact of PGH after the war at 1939 painting alam nakamay ibang nakita. That's amazing. That's amazing. And again you know as I said you will be one of those who will look back at these two years and have so many books to write about what happened not just COVID pero na sunog pa ano-anong nangyari hopefully I don't know hopefully we're seeing the tail end of this already and we're just so glad that you're all okay and those who have had COVID no so I thought it was really great for you to start that way kasi marami tayong mga frontliners na tayong nagkaroon ng re-infection so maganda na rin malinawan tayong mga experts natin about this and about no COVID Okay, so Raymond over to you we're going to do our fun quiz or we're going to do our fun quiz? Yes Yes, Dr. Suzie Thank you Thank you again to my idol director Gap Maraming ramin, salamat sir We hope your health continues to improve po at wad di na po kaya mag-COVID ever, sir Maraming, maraming salamat po So for our audience po what we usually do is we encourage to be able to put in your questions in the Q&A box lalo na po sa mga nasa zoom we are now numbering almost 1100 attendees here in the zoom so maraming, maraming salamat po and we'll wait for additional numbers from YouTube and Facebook but for today's pre-test or fun quiz po no those in the zoom may kita nyo po may lalabas po on your screen na para po opinion poll po na kalabas yun po ang ating pre-test quiz for today it's the same set of questions that we have for our mentee meter again may mga nangikita po ako nang tatatanon ng code sa chat po ang code po namin ay anong abang code natin ang code po natin ay 2934-1486 that's 2934-1836 so para po makasay po kaya sa mentee meter for our first question when do we consider post COVID-19 we have four options option one two weeks after the acute illness option two one week after the acute illness option three continuing illness and option four all of the above isa lang po ang tamang kasagutan dito po sa opinion poll po natin before we proceed let me take the chance to greet those who are joining as locally po no from Nueva Ecija Doctors hospital in Cabanatuan city in Nueva Ecija or mock medical city and or mock city the city health insurance office in Cagayan de Oro Galinato family clinic and hospital in Sultan Kudarat and the Vicente one of the bigger hospitals in Sibu Vicente Soto Memorial Medical Center in Sibu po our second question for today is reads what is the most important precaution that our healthcare workers need to continue to observe again iisa lang po ang tamang kasagutan po dito number one wearing face mask number two full vaccination and booster option three physical distancing option four improve ventilation and option five lahat po na nabangit or all of the above we are seeing more than 500 respondents in the zoom and more than 100 or 170 respondents sa mentimeter we will not be closing ang ating zoom poll po at ang ating mentimeter po as we move on to our webinar proper Dr. Susie ok thank you very much Raymond and I'm still fascinated by that parang white blood tell ako dito na ko dyan parang tiktak sakin na na it's very what should I say it's very satisfying to watch ok so we go to our first speaker for today and oh gosh we have really a good panel today and we're starting off with someone you know somebody we all respect leading pulmonologist in the country internist and he recently got a special award so we're going to show that ok so we would like to say congratulations to our first speaker Dr. Camilo Roa Jr who is now a new national academy of science and technology academician congratulations sir well be served over june and welcome to the webinar so dr. Roa is professor of medicine at UPPGH and yanan takbuhan natin sa lahat ng mga tanong sa katanungan Dr. Roa go ahead sir yes to say thank you very much for the invite today and as you have reminded me tayo yung na una sa dito sa webinar first first of the very first month number one number one 90 my goodness go ahead yes so I will share my screen now so I'm so happy that with me also as a speaker is Nina Berba who will talk about the nitty gritty of the virus what I would just like to show in my part is the fact that while we may have gotten through this pandemic may be we are not clean yet so my topic is about the known COVID the known haulers which has been mentioned by Raymond to have been discussed actually in this series before now so I have nothing to declare as personal conflict to this topic and while we are now alert level one we don't have to limit the spaces, restaurants even the church and so on what is left is actually for us to just continue our mask and other minimum health standards and continue vaccinating and that's very important I will show you partly the reason why now the reason why we are in alert level one is actually we went through this curve of infection the one on top the blue and the last one was fairly like shocking because the Omicron infect the whole family and and we we had it so fast okay, I think we lost Dr. Roa did we lose Dr. Roa sir Najimbayo hello, I'm back still here go ahead go ahead sir I'll say it again so yes and while we had a very high infection rate that came so fast but it went out also that fast in a month's time the mortality did actually go up that much and it continued to go down and and now we really have very few of these cases of course PGS still has a big number because it's a referral center but in my other private hospitals we don't even have a single case now in two of them and so so is this it go on a batay well, let me just go to this caution and mentioned by Susie Kuligbunya that was the Dr. Gupta Smith in WSO before and she cautioned us that if one is still experiencing some symptoms even after so-called COVID recovery it may be something like still part of the COVID they call it the long COVID so what is it how do we we define it this is very new and definitions can still change it's still a fluid situation so persistence of symptoms I mean having symptoms even after COVID that is not explained by other conditions can suggest the presence of this post COVID-19 syndrome and there will be other names that I will show you and this seen in 10% to 20% but if you actually look more closely it's even much higher and I will show you the statistics and the manifestations can be varied from something you can see to something you do not see and something that you do not see that is very disturbing will be fatigue breathlessness you know I have patients who come to me I am a pulmonologist and yet the lungs are clear even lung function is acceptable not enough for these patients to cause to come to me and and complain of breathlessness the oxygen saturation is good but they are breathless and that goes also with cognitive function they have the so-called brain fun that they have problems in thinking being forgetful and slow in reaction and also some psychological disorders I will go to that also later and these manifestations partly to answer the questions earlier actually may have started at the time when there is covid but of course at the time of the acute covid people focus on the acute inflammatory situation at the time so the fever and the coughing and so on but then they notice after recovery after they are negative already in the testing if they continue to have some cough they continue to have some inability to do these things or as I mentioned even a problem of breathing so some persistence and in other situations it's relapsing it gets better then it gets worse again not necessarily due to re-infection but I'd love to see what Doctor Berber will tell us in a short time and the recovery can be fast the trend is towards recovery but that recovery can be fast or also very slow more than six months sometimes and note this is not just a marker of the disease this persistence of manifestations can actually be very important in a good number of patients in fact people have been prevented from going back to work because they go back to work they cannot think and some become depressed and we have reports of even suicide successful suicide okay so the group of Lopez Leon published last year a study looking at all the reports about long COVID or you have the terms here on the left and the different ways these are actually described and in her publication after drilling through the reports and removing those that are not easy to verify or not well done she came down to papers about 15 where actually these are studies that cover almost 50,000 subjects and what did she find out in this slide you see that you have here different manifestations related to or attributable to different organs and some are more common than others but 80% of those asked actually felt something so it's quite common but not very disturbing in most okay now the quite most common manifestations that are significant okay include fatigue then headache this is the attention disorder now the hair loss I didn't get so my hair loss but some people do and this I was mentioning to you okay and in this study by Davis and her group she showed that the trend towards in time and this is a seven month study is actually towards improvement and long term we expect resolution although we have known some people who did that fully recovered okay and if you look at these based on the severity reported in the first week after the month seven you will see here the time trends like there are at the end of the acute COVID when they are declared COVID recovered there are those which still some really problematic manifestations but they tend to track down across time but take note some of them actually get worse sometimes along the way and those who are destined to recover faster are actually recovered early on I mean they know that they are getting better but those who tend to have still continuing symptoms more than three months then they can expect that those symptoms to actually even go even longer longer than probably six months okay so what's causing this all now we know that COVID infection really ravages the organs the cells where they are located so and the COVID virus is trophic to the ACE2 receptors plus another receptor beside it and it usually affects the lung the respiratory system the upper respiratory system and then the lung but fortunately the omicron is not so trophic to the lung itself so that's why we did get that much mortality and severe illnesses in the omicron but delta delta is and so you know and well fortunately I just saw the latest statistics most of the countries where omicron is now ongoing as the dominant variant there is no more delta left so they take over the colony so to speak but of course we are not sure if there's a future virus that will be more delta like okay so anyway so this is how it goes the infected areas gets affected by the virus and then there's an immune activation and in fact the hyperimmune response can actually add to the damage and you get into problems like in the lungs you have respiratory failure shock and even death but if you are able to control the immune response modulate it by a natural means sometimes the body just does it okay or you are able to give treatment that reduces the immunologic response the hyperimmune situation like corticosteroids even fossilizumab and other anti-inflammatories you can get into the phase of recovery okay so this is recovery but then some people will continue to is unable to do that and continue to have persistent inflammation persistent immune suppression if this goes to the other side it becomes immune suppression and you can have also activation of some even of the you know our bodies have resident viruses there that are not active get activated and even secondary infection and that can be to death so the most favorite pathway is towards this recovery able to correct the immunologic response just to the right extent okay now having recovered now it depends on how much damage was done before the recovery accord then you can have residuals okay and most of the time the residuals are not much unless one gets a very bad damage in the target organ so we have seen patients with white outlook so when they recover it really takes time and they may have some residuals also the fact that sometimes we give interventions like mechanical ventilator that can actually cause some damage by itself because this is an artificial way of supporting breathing then you can get a residual from that okay so those are some mechanisms why symptoms persist either from the intervention or from the extent of the damage that was done before and I mentioned the lung but the other organs are probably just as affected similarly the initial damage by the virus by the immunologic response to the virus and the treatment for that also can affect as well as our mechanical intervention and let me look at the example okay as this is going on in the body so you have the virus that got into the lungs created a problem in the lung decreasing oxygen and creating increased pulmonary pressure and then this virus also goes to the heart and the heart now is also directly affected but now has to content with the effect of the lungs of the hypoxemia of the lungs resulting in a double whammy effect on certain organs like the heart fortunately the heart reserve is also light and in many cases this kind of residual or damage to the heart is not obvious at the start but when when some analysis or manifestations happen and already post-COVID state and workup then they have seen residual myocarditis happening there and this myocarditis actually takes a longer time now this has one implication because in general and I have some friends who actually did this and they try to exercise because they want to get over because their lungs are already better the oxygen is better but they didn't realize that there was and damage also in the heart and in the process of exercising and trying to recover the damage heart in the situation where you have the acute damage of the heart or recent damage of the heart we don't over exercise the heart that's why for example acute myocardial infarction patients are not allowed to do that much effort immediately but if they did not know that and they went on to exercise run the way they used to take morning exercise then they can get into trouble and I guess some of them after they get into problems including death so and the medicines that we use before after they also harm the heart so we can have this situation happening in the organ both directly from the from the effect of the virus itself from the effect of the other organs affecting that the heart again as well as the medications that we use now let's look at the brain now the brain also around the brain there are blood vessels and we have also ace two receptors and of course we can have direct effect of the virus of the pain also you have plaques forming in the vessels because they have ace two receptors and that can lead to stroke and then the respiratory effect the hypoxemia can also affect the brain and the medication that we use sometimes you know we have to turn patient on their tummy prone position like the ones shown in the picture just so to improve a little bit more the oxygenation and in this for the patient to tolerate this it has to be on deep anesthesia sometimes that can also affect some of the brain and all this can be potentially causing some residual effect of the brain and Dr. Gap is here and you can actually tell us bit more of this now this is a common story that those who had severe COVID they had to be in the ICU actually will have more neurologic deficits and actually have poorer performance in psychological tests because of the severity of the illness and the effect of the COVID now this is I think my last slide to just show that more recently sex has shown that there may be other factors that triggered by the virus and then some predisposing situation in the host that can actually predict who will develop long COVID or persistent COVID manifestations even after the viremia is gone and this is early days but they have looked at the the you know the biomic metabolic situation in the lungs in the flora as well as in the GI tract they have looked at antibodies there are some auto antibodies produced I mentioned latent viruses including inside the the virus and so on and we are waiting for the results of this you know we are out of the pandemic but we have still to content with what the pandemic has obscured sequela has shown and early days means we don't have proven therapies so the advice we cannot begin to our patients if they feel something they have to consult the doctor the doctor will have to find out if there's something there in addition to just being post COVID and if this is really post COVID and specific therapies are not available then you might want then to actually do this you know a graduated exercise or eat healthy diet avoid alcohol and other unnecessary drugs have a good sleep and duration and we maintain your brain like you do a read a novel you engage in music and so on and keep up your social life within the course limits so thank you very much for being mentioned okay thank you very much it's doctor Camilla Roa sanamat sir nako laging ganda ng presentation ay sir Milo I'm going to watch it again I want to watch it again and I'm sure you're going to see sir in the chat box how the audience appreciates your presentation Raymond over to you thank you doctor Susie and thank you also to Akademician Roa maraming maraming salamat po sir maraming po kaming natutunan please and stay po we have Q&A right after all of the talks have been in especially after our reactor for our next speaker isa rin po sa inyong mga paborito sukin na rin po natin siya very very busy person but always makes time for us thank you po if our first presenter was on our very first episode of this webinar series our next presenter is our second episode of the Stop COVID Deaths webinar series pa talagang parang destiny po na nakalain up po sila she is trained in clinical epidemiology and infectious diseases so sya rin po ang head ng hospital infection control unit sa Philippine general hospital but before we forget po we'd like to congratulate her for being selected as one of people people of the year in 2022 so maraming maraming salamat po to Dr. Moran ganda tina jaan hindi lang po tayong nakakita nito but also those from Saudi Arabia Caribbean Netherlands from the Miss Shop Health in Oman from Brunei, Vietnam Malaysia, Taiwan Saudi Arabia again UAE from Algeria, Fiji California, Australia Canada, England and the Netherlands until so maraming marami po naka pano'od po and really we are deeply honoured that all of you who are doing excellent service po to our country are here to share your knowledge po so without further ado turn the floor over po to Dr. Regina Burba Mamnina hello everybody biglang ninya ninya obviously ok parang naligaw anyway I'll share na my slides ok wait lang so thank you very much for having me again today eto naman po ay tungkol sa COVID-19 re-infection and I'll be showing the PGH data because that's what we have so far so as you have binilang ko din nga kong ilang beses na ako na na guest dito sa UPTV and I'm very very honoured each time you invite me so as you know we as in the past I always share with you what we've learned so far at the PGH where a COVID referral center we continue to be a COVID referral center but much much decrease na number of cases that we've been seeing pero yung siya-show ko po siguro the more important part is how our healthcare workers have been in the last 12 months no so as we sort of mirror what happens in the national scene no so pag kapalang dumadami sa community dumadami rin yung mga nagkakakovid among the healthcare workers pero ito through the months you would see kala namin so panang canolar code ko dito we've been through so many surges and variants so yung mga yellow nung March and April just as we were starting to roll out the vaccination program din panang big lang lumabas na yung mga alpha and beta we used to call them the UK variant and yung South African variant so na affect kami noon plus come August and September umakyat na naman yung numbers this is the delta variants kala namin so brang na overwhelm na kami nito anong mga there were days we had about 30 at most new infections among healthcare workers pero pagdating talaga nung January grave this was so overwhelming as many as 50 there was a day we had 150 healthcare workers sabay-sabay nakita na may infection so yan yung green part that appeared towards the end of towards the start of this year but I'm supposed to really talk about re-infection panang ito yung background so this is back to back with our efforts to vaccinate almost everybody in the hospital so this is how it's been kasabay nung habang nang yayari yung mga COVID infections nagkakaroon rin ng vaccination very very aggressive we tried to cover as many as we could with the healthcare workers lahat ng eligible and actually yung natiti rang mga 3% dito yan nalang yung mga we're trying to just make sure what their doses have been what their dose dates have been and this were the different kinds of vaccines that our staff has received so in terms of infection sito yung parang nakita namin when we look back at how we've been doing so we registered about 3000 plus healthcare workers na denominator of about 6000 staff so over 50% ang nagkakovid in the last two years in them we noted na meron mga 285 ang nag more than one infection actually 276 yung nagkaroon ng 2 COVID infections at 9 yung initial na nakita namin when we were trying to confirm these infections there were 7 healthcare workers who actually had more than 2, nag-register sila na 3 confirm PCR tests na nag-positive so what are the characteristics of those who had multiple infections when we tried to look at them there were really no difference in the assignments kung COVID versus parang logically isipin mo, siguro yung mga na-infect mas madalas baka sila yung nag-work sa COVID but it didn't seem like that there were also no differences that we noted sa nurses versus doctors versus other paramedical staff but we did see that on recurrence, ibig sabihin yung second time sila na nagkakovid if they were moderate COVID dun sa first infection they were mostly mild or even asymptomatic on recurrence as some of you may know we have a study going on on vaccine effectiveness in PGH so some of the staff we had them volunteer for antibody testing and we didn't see any differences in the trends of their antibodies kung mababa ba yung ba yung mga na-infect ulit o chaka yung matataas hindi na-infect so parang walang difference in individual antibody trends and eventually, lahat ng healthcare workers who were initially parang nakakari infection were vaccinated dun sa seven na nagkaroonan three times all of them had an infection nung June during the Omicron Surge and among those who's a PCR test we sent for genome sequencing these were the different variants that we noted so parang hindi kasi lahat na genome sequencing but these were the different ones that we that were noted among those who had re-infections parang madamingan na ka-delta and I'm sure when the results of the genome sequencing for January and February would come most of them will really be Omicron so why do re-infections occur so re-infection has been defined by CDC and also by the UK Health Systems as somebody parang inalay mainstream na-infect nag-recovered as na-infect ulit and CDC would define this as the difference or the period between the first and the second infection should be more or less 90 days apart or three months apart so yan yung parang consensus definition of most health systems and the re-infections nakita natin and experience natin here in PGH and I'm sure in your different institutions were similar to what was experience in other countries na so particularly during the Omicron surge so that makes us think that re-infections happened a lot because of the evolution of variants so variants allowed so this is one of the main reasons na the variants allowed the viruses to have increased transmissibility in the occurrence of the variants the mutations that happened allowed these viruses to evade the current immune system of the host so there was an increased ability to escape recognition of whatever immune system of that host has been so ito parang nakita to sa UK dito nga sabi nila 650,000 so from a baseline of about 1% re-infection during the Omicron surge there was really a marked increase of re-infection rates of most 10% so the other reason so yung isang malaking-malaking factor yun so pag nag-covariant ulit baka magkakasurge ulit na re-infections lalo na kung very multipli-mutated the other one is related to the immune response of the host so definitely there's some impact of a previous infection and the presence of vaccination status so what do we know so far sabi sa current evidence individually fully vaccinated individuals and then also those who have been previously infected they already developed some kind of a good immune response robust enough that there is a reduction in the risk for re-infection for at least 6 months ito yung sinabi ng CDC pero ano yung exact antibody threshold kasi yung yung yung hinahanap namin sa aming data parang wala talagang makadefine ano yung exact antibody na we need to achieve yung dapat hindi na tayo talaga on an individual basis trying to get our antibody levels na so it looks like both vaccination and prior infection would make you immune pero this is not 100% again the antibody titers seem to correlate and give us that reassurance that there is some protection on a population level so for example yung sa PGH na we are testing several people and looking at the trends we see na talagang after vaccination kataas tapas bababa over time but there is no exact titers so on an individual level I urge you not to do that anymore not to ask your staff on an individual basis or your patients to get their antibody levels kasi ang hirap e-interpret so just rely on researches or large cohort studies to give us more information on this tapas the third box here tell us na the antibody titers are really very very varied na but it looks like basta merung primary series tapas na yung dose one and dose two there is really a high correlation with high enough antibody response to protect us the other things that is known so far there are certain populations na kahit imesure yung antibodies para hindi makita para mas mababa na so that's why when some patients tell us bakit when they continue to not want to hesitate being vaccinated they would say kasi pumatanda na ako e so panang nakakalito for some individuals they think dahil matanda na hindi na sila eligible for vaccination on the contrary the more vulnerable they are so more immunocompromise or elderly the more we ask them to get their vaccines for increased protection even if overall hindi makita sa mga antibody responses na it's still better than no vaccine and one as I said kanina na that evolution or the emergence of new variants parang nahihirapan even the vaccines in our current immune states to give us full protection okay pag iway mo kasi yung mga contrabida di ba sa sabihin nila e de maghihintay na lang ako magkaroon ng infection rather than vaccine kung ayaw nila talaga magpavaccini pero when you look at the body of evidence talagang parang mas strong, mas consistent yung immunity the strength of the immunity that happens after a vaccination so let's not get into that argument na sige papa maghintay na lang ako magkaroon ng infection para magka antibody response let's not even start or get into that argument kasi wala hindi ganyong evidence so basang alam natin so sa mga na re-infect sa mga audience natin as was noted parang maraming na we had that experience of getting multiple infections over the last several months just be affirmed nagkaroon talaga kayo ng mga antibody responses so here it says na yung B, B responses B cell responses produces that kind of neutralizing antibodies that sort of persists maybe up to 6 months ang longest mga 8 months tapos there's an equivalent increase in the T cell response also minsan lang talaga mahirap in measures ilalahat and to protect ourselves from re-infection we still say na and that the bakuna even if there's some reduction over time there's still strong protection against hospitalization, severe disease and death and of course yung consistent practice of precautions most of us in the audience here probably belong to some kind of health institution or health practice so sa PGH po kahit na nag-alert level 1 na dito sa NCR we opted to really be cautious so even if we allowed face-to-face activities already I think it's important for us to keep in mind and always remind our staff and everybody around us to continue to be vigilant yung practice talaga it's one of the main things that we need to remind ourselves and remind everybody so prepare, be vigilant since we've been in this together talaga sama-sama pa rin tayo trying to protect each other so we continue to at this time interim recommendations to maintain all the PPEs on board until we see talaga that things are under control or until the pandemic really really ends so yung of you who's listening to us it's important talaga to eto nga we keep on releasing in for graphics para yung mga staff natin is they remember all of these precautions and they keep in mind usually kasi paga parang ibanay na ririnig nila and especially if they're exposed to a lot of other things in the social media for example they get different messages but if you just keep them focused and remind them of what's important to protect themselves and the entire institution para everybody's safe you have to like really take an extra effort to make the infographics really attractive parang madali mas save sa phone nila or sa laptops nila so that's part of good communication so this is my last slide what should we still advise to all our patients meron tinatawag na term yung superimmunity nang even among those who have been previously infected with SARS-CoV-2 even those who are vulnerable basta eligible for the vaccine that's an important that's an important significant and crucial critical part of our COVID response yung vaccines that's it na po, thank you very much okay thank you very much nina again very nice presentation no chakat alagang direct to our frontliners mukhang kailangan pa rin natin magingat we have to be vigilant but very very what should I say a very very evidence based presentation based on your data in the Philippine General Hospital I'm sure our audience is learning a lot from this okay so Raymond did you want to ako mag-introduce next okay so our next speaker is a reactor and you've met him before infact when he was on the webinar siya admitted sa PGH nondahil nagkakovid siya so we'd like to welcome the Chancellor of UP Dilliman Dr. Fidel Nemen so Fidel welcome to the webinar and good to see you here gandang hapon magandang hapon Dr. Susi and Dr. Raymond do you hear me? yes sir yes sir but you can take out your mask Fidel kasi may dumaan kanina dito kaya ilang beses Fidel may ask you how many times did you get COVID 3 okay we're going to listen to your story okay go ahead please Susi and Raymond congratulations sa 90th webinar na pala napakaypotanting public service ng UP Manila at ng TV UP nakamusahing ko rin ang kaibigang kung si Doc Gap isang capwa three timer ng COVID and hello Dr. Burba so we actually saw me during my hospitalization tumutulog din siya sa COVID response activities namin sa UP Dilliman and congratulations Dr. Burba for being chosen as one of the people of the year see Doc Rowe one on one was my father's doctor pasensyan na magpapasalamat mo na ako maayong do, maayong do Doc Rowe asalamat kayo congratulations for your Dilliman sa N-A-S-T Akademisyon gaya na nang sabi ni Doc Susi, tatlumbesa sa ko nag COVID last year and early this year so that was May 2021 September 2021 and January 2022 binilang ko kan pala to, talagang exactong four month gaps between the COVID bouts at bukod sa three times ako nag COVID tinging ko meronin ako symptoms ng long COVID from the second one kaya medyo natakot ako kung pinapakinggang ko si Dr. Milo when he was talking about the long term effects of COVID at sabi na niya minsan at inaabot ng mahigit at 3-6 mga buwan at minsan na nago worse ng conditions kaya medyo nakakatakot ang pala kaya mahalaga talagang pag-ingatan ng katawan ka-kaiba ang magkaroon ng COVID dahat ay hindi ko naligama isit na magkakovid ako nang naging chancellor ako ng UP Dilliman March 2020 talagang kasagsagan ng unang lockdown it was the COVID pandemic job as chancellor of UP Dilliman it was really an immense challenge of leading a university at a time of disruption dahil walang mga templates no previous experience to draw from at walang mga how to do man was kaya talagang you learn along the way and you just learn from experience sometimes trial and error but of course this is a community of academics we also look at data and base decisions on data napakak complex ng problem dahil ang UP Dilliman ay napakalaking university hindi lang mga sujante, kawani at faculty meron ng mga residential communities iba-iba ang kanilang mga interest at talagang lalupasa panaw ng pandemiyo may balancing act when na nagaganap and but of course aside from trial and error and learning along the way we really gathering of data and gaining insight from data was really important for us and we took advantage of the multidisciplinary the range of expertise that we had in the university so our task force we really brought together different minds from different disciplines and then make decisions along the way that then nakakatakot ng upisa dahil we were confronting a different type of situation a different kind of enemy isa isa nagkakasakit ilang mga faculty kawani at ilang nga silang na matahinga alam namin yung gravity yung bigot ng problem nung una nagkaroon ng transmissions sa aming health workers dito medyo nagreact pa ako pinagsabihan ko pa ang aming university health service why did you put your guards down nagkaroon ng kawaan sa university health service namin dahil sabay-sabay ang asilang kumakahin pinagsabihan na kami na mga kasama mula sa PGH na magingat sa mga kwato kung saan kayo kumakahin at kung saan kayo nag-BBS dito nag-aganapang transmission sabi ko sa aming health workers na ko sa lahat ng tao, kayo pa magiging mas-kampantin na kayo pa magkakakovid dahil dapat pinapakitan natin yung mga tamang protocols pero panayang reminder sa community medyo nag-disturbing pala sakin ako mismo ay nag-kakovid alam niyo, bihira ako lumabas hindi kagaya ng ating mga frontliners lalo pa si Dr. Gap na gaya ko tatlong besos nag-kakovid alam kung lagi siyang nasa PGH ako bihira ako lumabas dahil marami sa mga meeting namin dito alas lahat ay nakazoom ang aking praning ang aking asawa in a sense, magandang praning siya dahil siya sa pamilya namin siya na lang ang hindi nag-kakakovid pero baga mag-bihira ako lumabas wala talagang assurance na hindi ka magkakovid unless you cut yourself cut yourself 100% from the physical community community out there I had my first bout of COVID in May 2021 I really didn't know what to do because this happened between my first and second jobs of vaccination ang sabi nila mag-take effect lang ang bakuna a few weeks after the second job pero minalas ako nag-akovid ako nung pagkatapos na aking first job and it turned out looking at my activities I was infected before my first job and just got my RTPCR my test results after the first job I think correct me doctors maybe that was the alpha or the beta variant that was May 2021 wala akong severe symptoms but I did I did notice shortness of breathing I did not have fever but I always felt feverish and during my meetings my colleagues who I had meetings with noticed that I had difficulty breathing sila mis mo nag-saben I also talked with Gap ang sabi niya I suggest you go to the hospital so I spent about ten days in the hospital I had I have comorbidities no hypertensive ako and in the hospital although I never had the severe symptoms buko dun sa dun sa early symptoms of weakness and feeling of fever and shortness of breathing and very slight coughing ang problem ako at that time was anxiety I had difficulty sleeping at night kasi laging siya sabi sa kaningat ka binabantayang ka namin dahil in some cases after the 10th day things can take a turn for the worst nakakatakot pa layo nag-anticipate na at some point in your hospitalization things can actually take a turn for the worst and I've heard so many stories about those who have died who actually felt that everything was okay at the start of their COVID infection so yun yun it was severe anxiety that I was battling with also because this was an unknown condition for me even though I was not intubated and mukhang ang sabi ng doctors and were between mild to moderate ang symptoms nakakatakot dahil hindi mo alam ang mga ring mangyare at marami kang nabasa na remake na poyent na iban tao na talagang dumahan sa matinding infection I had my second bout so after my first bout of COVID at the end of the month May 2021 I had my second jab I got different opinions on how my first bout of COVID would affect the effectiveness of my vaccinations nandunga between first and second jobs may nagsasabi naman makakailang kong uliten ang aking vaccination in the proper order may nagsasabi na my COVID just help increase my antibodies Anyway, I got my second bout of COVID in September 2021 of four months after my first bout eto sa kasagsagan ng Delta at sabi nga ni Gap ay asyumong Delta dahil mukhang pareho ang aming mga I had fever very intense headaches nagpa-hospital ako nung unang mga gabe na hirapan na kumatulog dahil sa sakit ng ulo at may atmaya yung ubo hindi ako nagkasipon bagamata okay ang aking o2 levels ay nandon ang talagang nakapanghina sa aking yung hirap akong matulog dahil na sa sakit na ulo when I recovered from when the headaches when no-alain headaches ko siyempe pangasok naman ng boredom and then the usual anxiety I was I continued with my meetings from PGH I think Doc Suzy this was around the time when I joined one of your seminars I also needed the meetings because sometimes being cut away from the world adds to my anxiety because I always think of things that needed to be things that need to be done but what was strange about my second bot ito yung Delta ay pagkatapos nung recovered na akong mula sa intense headaches after around one week I lost my sense of smell matyong kakaiba kakaiba pala yung mawala ng pangamoy nakakapanlasa ako pero yung pangamoy talagang na wala pati yung kinakain ko hindi ko maamoy ang kapay hindi ko maamoy ang maamoy ng banyong hindi ko maamoy at one day before I was supposed to be discharged I had diarrhea so my confinement in PCH had to be extended for three or four more days ito yung itong second bot ko umpisa ng long COVID symptoms I had shortness of breathing laki akong hinihingal especially during certain times of the day persistent yung fatigue usually in the afternoons sometimes I just explain this pag pag-good sa trabaho pero nag-upisa to talaga pagkatapos ng second bot ko yung mas persistent kaya sinabi ko baka long COVID dahil nagbabasa ako ng articles about long COVID ito ng aking nararamdaman may occasional body pains minsan I explain this away by say ay siguro idad ko yan dahil sumasa kitang liquid sumasa kitang mga paa ang mga binte pero baka na bahagin ng long COVID ay yung brain fog pa minsan minsan nagkakaroon ako pero hinyisip ko baka rin dalan ng idad dalan ng pagod ng pag-iisip sa gabin nagkakaroon ako ang bouts of anxiety and at some point kumukawa ako ng sleeping pills I still have my box of sleeping pills in my bedside just in case I have difficulty breathing so that was in September yung sense of smell kung itong pinakama tagal unti-unting bumalik I started smelling food food liquor coffee pero until recently hindi ko talaga maamoy ang mga foul smells sabi ko nga sa iba kahit ok lang sa akin hindi kay maligod hindi ko talaga maamoy ngayon na nararamdumang parang nakakamoy na ako na ponte pero hindi nawala na yung acute sense of smell alam ko meron ako dati that was in September ngayon alam nila gabto I had heart problems in October which cost me to be hospitalized again I do not know whether this is a result of COVID na because this came one month after my second bout of COVID nag-akala unakala sa heart center ay heart attack pero nung nag-patesta ko sa PGH ang sabi na nila it was unstable on China I was scheduled for my anggiogram and anggioplasty but when they looked at my heart they saw blockage in my lab artery 50% to 60% at ang sabi nila ay maali naman in the meantime let's address this using just maximum meds therapy I do not know whether this has to do with COVID but because I've read that COVID does we can certain organs in the body my third COVID came last January panahon ng Omicron and most likely Omicron asymptomatic ako pero dahil na na praneng ako na lama kung may isang taong na sa isang kwarto na pinontohan ko ay nag-test ng positive kahit na malayo siya ay nga praneng ako nag-patesta ko nag-gulat ko nung nalaman kung positive nag-gulat ako dahil pagkatapos ng dalawang COVID na na vacunahan na at boosted na gaya nang nasabi na ba akala ko ay puno-puno na ang antibodies kaya mapalad ako dahil hindi naman talaga naging severe napaka mild ng symptoms ng Omicron I had some coughing my fever never really can hindi naman talaga tumas ang ang fever ko pero yun kasaba ito nung patuloy na narananasang kung symptoms ng long COVID na mula dun sa second bout ko so those were my three three bouts of COVID plus my heart my cardiac episode in October that I still don't know what cost this anyway so since then it's really just been an experience of learning lessons first lesson never put your guard down never be complacent they say that I'm full of antibodies but after COVID-1, 2, and 3 hindi ko alam hindi ko na alam whether I'm really full of antibodies or whether a new variant would arrive and put my health at risk again this is really a long battle and we learn along the way even as I also belong to the UPD Limang COVID Task Force nung mahalaga lang dito nagbabago sa ito siyon and really just have to learn our lessons along the way we need to be agile with our responses we need to be ready to shift our ways of doing things and never put our guards down on a personal level this experience with COVID and of course that Karjak episode really gave me an acute awareness of the limits and infirmities of the body minsan mahidap ngapin lumihina na may illusion kasi ako minsan na malakaspako gaya ni Dr. Gap I really led an athletic life when I was young I survived a life-threatening injury sabingan nila masamang damo pero wala palang wala palang na-exempt dito sa mga sakit na ganyan ito lalo pa sa mga bagong bagong disruptions like COVID napaka-disorienting but of course the good outcome here is that it made me more careful made me more conscious of the habits of things that I put in my mouth it made me maybe do long walks more and there's really no choice but to become philosophical about about this and the life is really short we never take our we never should take our health for granted we need to learn our lessons along the way we need to live the lessons we learn and every day we make decisions and choices with these lessons in mind and it has always made and I mean this is what I want to do it's really to live live every day with intention because we do not know when the next disruption and the next variant will come and usually these disruptions usually upend our lives and so we just need to adapt and be as resilient anyway ayun lang manami pa questions about my COVID my especially my my long COVID doctor and one of these days I want to get insights from our doctors who have learned who are studying the experiences of COVID survivors with long COVID ayun manami salamat po okay thank you very much Chancellor Fidel Nemanso I would say very personal and I would say a touching story of your journey and for being very candid sharing about your feelings and what you went through and maybe at our panel discussion we can talk a little bit about you know how do you know if something is caused by COVID or something else right? Manami tayong mga tanong e anyway thank you so much Chancellor Fidel sure our audience also appreciates your candor and your willingness to be open and vulnerable to our audience thank you so much okay Raymond over to you thank you Dr. Susi and thank you again for such a detailed napagsasalarawan po Chancellor Fidel before we ask our panelists Dr. Roa, Dr. Burba and Chancellor Nemanso to open their Q&A we will be having what we call our special public service announcement for today Sigurado ka na ba si reservations natin? Oo naman Bakit bis na bis ka? Oo, magiging escort mo ako e Mokong may date si Lolo Lolo Ilagay mo kaya ito Ang ganda naman Maganda yan Special anulakan natin ready ka na? Mam, dad alisi Lolo Lolo Oo anak after lunch Sanalakad nyo po para sa atin lahat ito magpapapakuna kami dahil mahal namin kayo dahil mahal ko kayo magpapapakuna ako Thank you so much TV UP The COVID Communication Public Service Announcement is one of the many outputs of the UP Research Entitled Communicating COVID-19 in post-quarantine Philippines It's headed by the UP Vice President for Public Affairs, Dr. Elena Perna and funded by the PCHRD of the DOST and the Department of Health through its AHEAD HSPR project Over to you Dr. Susi Thank you so much Reema So we're going to ask our panel to come in I think GAP had to leave we had an emergency but we have Dr. Milo Roa and we have Dr. Nina and we also have of course Chancellor Fidel Nemenso So, Sir Milo I think I'll start first with Dr. Roa I think from the sharing of both GAP and Fidel Chancellor Fidel Yung naglalaroo talaga sa isip is if you had COVID and then you have you get sick again how do you know if that's post COVID or long COVID completely different illness Susi sabi na Nina three months Nina you have another positive after being negative you can classify it as another COVID but then long COVID can actually span across three months and can na sila mag overlap now so some of the manifestations including yung na takot when you are COVID you are feeling not so well you understand that this can be very bad in some cases you have friends who suffered and those things and you are alone in your room because you are isolated those things conspire to create an imprint in your mind so that when you have it again immortal can just fall into this thing simple na takot ka those things can come play again in your mind because you have another thought now Nina did you want to comment on that like aside from reinfection other symptoms because like what Chancellor Fidel said sa kanya nagkaroon siya ng heart problem without wanting to put you guys on the spot and making how do we more or less if we're talking to our frontliners now and let's say meron silang nararam na ang COVID sila at meron silang nararam daman na kakaiba na hindi naman hindi COVID anong advice natin sa kanila ako kasi Chancellor naman sa talagang maraming data rin yung effects of COVID-19 so I wouldn't really discount the fact nang baka related pero I think overall the management would be the same hindi na rin nila your cardiologist wouldn't like dwell into it they'll really just manage you kung ano yung kailangan niyo for your current status yun na yun isa sa mga differential mo baka this is a part of the complications of COVID-19 but perhaps kung na sa tamang age ka na at risk ka na talaga for a heart problem pading it's part of I'm not going to say aging process but it's part of getting part of becoming wiser it's part of becoming full of wisdom of maturing and gracefully aging that's all part of it pero siyempre kaya naman observational studies are trying to find out more about this kasi nga kasi rin nila i-advise yung population na o pag meron kayo na rambaman don't shrug it off as just something irrelevant kasi na tapos ng COVID-19 kailangan parang i-pursui to your doctor and have it diagnosed and evaluated well yun po ang sa suggest ko parang yun nga don't shrug off sometimes kasi kala natin pati po pag nakipag-usap kayo sa mga paciente maraming things na parang mi-isip nila ah wala yan ganyan lang yan pero minsan pag habang kausap mo na ririnig mo na na they sound short of breath there's hingal in between the statements habang kina kausap mo sila so parang yun kailangan lang babaan talaga yung threshold for taking care more more parang more vigilance in how we perceive things especially if we are care workers tayo kasi kailangan alagaan natin talaga sarili natin correct so dr. Roa go ahead kasi alam ko di kinipkento kayo sa akin na remember when we had that meeting the other day na sabi nyo may ron kayong paciente na nagkakaroon ng symptom sabi niya ah ano lang yun eh covid lang yun eh pero it was actually something else di ba so balik pa naman well probably almost on the same vein at Chancellor Fidel by the way Chancellor Fidel thank you for the kind words and figures of your family yes it's very important that these manifestations should not be just struck off as mentioned by a nina well it may be part of covid or it may be something else or they conspire you know if you have a arterosclerotic vessel there and you have something like covid that tends to induce clotting then that can spell trouble so it's very good that the doctors in PGA were able to discover what you have and then you are I suppose as mentioned by also you alluded to God telling you that you should be on maximal medical treatment that those things are being done and so the other scenario would be how's that? akala mo post ko bilang ang then you know exercise ko lang to and then you have problem pala ano a black coronary and you know that could be very disastrous and so this is the way people with post covid manifestation and there are a lot of them should be aware that this can happen but should also get medical help to be sure that these are really the kind of post covid that goes away or the kind that we worry because of the intervention that was made before or this may in fact be another disease and as I mentioned to you to see before we had a patient with infiltrating the lungs and it persisted a acute covid phase and so sabi baka post covid lang yan or the lung taking time to recover makutumas na and then the patient was getting worse and then after going through the city scan because we had several city scans by the way doctors there was an area where the duration was much less so the astute radiology said maybe let's biopsy this area and although and behold it was adenocarcinoma the albionocarcinoma side this is the kind of adenocarcinoma that mimics in pneumonia or a post pneumonia state and so that's very important to this program also we have nina di ba yung mga immune compromised patient nating they can have pneumocystis karay na yan makalam mo covid lahat yan yung paladers another thing that is causing the hypoxemia so it's very important to consult the specialist doctor for things like that really bothers and if there's really nang that is saying then the advice yung mga healthy advice that can follow will also be important as we get to know better this post covid condition Thank you very much Dr. Roa I mean ano talaga yung as we progress we learn more I was going to ask Chancellor Fidel if you wanted to ask Dr. Roa or Dr. Nina any questions by the way Chancellor Fidel you know your father and my father were sick at the same time and Dr. Roa ang lumalaga riyan between our fathers so na alalan nyo di ba na alalan nyo ang sabi ko nako talaga naman anyway o siya Chancellor Fidel anong did you have any questions for for Dr. Roa or Dr. Nina is it true that after three variants na so I have the Wuhan variant the Delta variant Omicron variant and then I'm fully vaccinated twice and boosted is it true that I'm I'm full of antibodies tato bang puno puno hun antibodies wunaw na ayok kayy assume yung dahil napat naman talaga napat naman talaga eh magingat talaga at hindi pwede yung maging campante pero tato ang naman napupuno may extra protection baka may super powers ka na oh, I'm sure may super powers ka na Chancellor but I'm not full talaga ya pagkatapos ng second ko akala ko nga may super powers ay hindi naman pala nag-third pa except kasi po dynamic kasi yung state natin and this antibodies or our immunity has been seen to really decline over time kaya yung parang estimate po mga six to eight months may mga nagtatanong sa chat box kung kailan yung next booster so wala pang wala pa pang advice ang WHO or ang Department of Health but I think they're studying that in our experts panels of the vaccination program will may be advices pero yun po either are definitely parang mas definite yung decline in antibody levels after a natural infection parang mas steady sya after a vaccination but both over time will reduce will go down yung both antibody levels at siguro some kind of T cell responses yung mga immune levels hindi sya static e ba ba ba po sya so even if at some point super super immune na po kaya after a while ba ba ba yan kaya po nagtabooster kaya pinupush talaga yung booster doses so nga ganba kayo do you suggest that you recommend another round of booster shots for those who have already been boostered? Parang I think we need to wait kasi we need to also standardize there's also problem gusto rin natin as many of the primary doses are given so marami pa rin po kasi yung hindi pa naka-received ng first and second doses parang yung yung gusto natin mafill in sa ating country to get everybody finished with their first doses first yung first series tapas pag napunoan na natin yung we've reached 70 to 80% din I'm sure mag-concentrate na silan with the boosters dito sa high prevalent areas talagang boosters have been pushed na kaya di ba several times sa kakaranang vaccination days to push for boosters yung sunod na booster schedule hintayin natin yung announcement ng DOH at WHO Okay, thank you very much Nina Alright, Raymond Do you have action? I'll just ask one question curious ako maybe Dr. Roa it's about my sense of smell dahil sabi kong gradual ang pagbalik niya may naunang mga ako na amoy nakaamoy na nang karamihan may mga hindi pa rin ako na amoy napag-arala na ba yan yung ano yung ato yung process of recovering of the sense of smell Yes, sense of smell Number one, there is no treatment It's a natural recovery but again the course normally is towards full recovery it may be faster in some and slower in others in your case you have recovered I suppose 90% recovered na it may take a while to catch up the last 10% but I mean from the reports I have seen it's good that most of the reports says that there will be very good probably complete recovery in time My question is why is it that there is a time when I could smell some things and not smell other things I had a very weak sense of smell for foul smelling things Yeah Sana nandito pa si Dr. Gap no? The sensory receptors may iba-ibang threshold yan sa iba-ibang stimuli Well I don't know we have those di ba yung gumagawa na na sa Europe yung gumagawa na perfume di ba meron silang denose na halagang heightened sensitivity to certain smells and not everybody has that So there's some Dr. Roa yung mga chef di ba magaling yung sense of smell nila Something like that So okay lang I mean it will take time but it will be back sensor On the issue of the antibodies and the immunologic response our system is gifted with that ability to recognize again the same culprit if it comes along Now Nuna mention our defenses are several cheered new antibody the case but there are others there that will come back to place in case that happens. Now the problem is baka the next virus is so mutated di na masyadong marakunize ng the defense that you were able to develop before actually coronavirus is correct me it does not change so much it changes in a way a bit like in the in the esprotein some areas there but it does not change like flu flu mapasama lang yata yung dalawang mag-exchange na sila ng genetic material and they can have another a daughter that is entirely different talos ng parent na nina kami explain to that whereas the COVID will have to be changed because of continuing replication parang zero machine that takes a while to actually have some errors So ganoon nga po baka sobrang nga natin is pang nagkaroon panauslit ng isang variant of concern and this becomes really very different na from the original Wuhan at yung mga recent variants and as I said kanina there is like increased capacity to evade our immune system already so yun po but otherwise I think our response kailangan natin hintayin ang advice alright okay Raymond do you have some questions you want to pick from our audience we can take a back there's one question coming in one for the infectious disease specialist and one for the pulmonologist for Dr. Burba does the effect or yung effect ko ba ng long COVID does it differ between persons based on gano po kailala yung symptoms po nila so yung po sabihin mas matagal po ba o mas malalala ng long COVID if you were asymptomatic versus if you had severe or critical COVID po Nina there's no naka-mute ka Nina you're on mute So yung ano parang hindi walang ganong trends panang pinit li ang nakikita nila is the re-infections yung recurrence of infection seem to lead to less complications parang ganin yung general trend or do yung sinabi ni Chancellor kanina parang iba yung sinabi niya parang he had more complications or long term persistent symptoms after his second COVID-19 so parang walang general trends okay thank you mam Nina for Hermilo the other one is how likely na naka- long function problems kapag naka-COVID at kung nagkarun man po ng long function problems malabon na ropo ang bumalik sa datay or 100% pulmonary function okay so we are talking about the long to perform its work mainly gas exchange yes, if you have this time very bad COVID-19 that practically ravages lang we are talking about both langs people can survive with just one lang but both langs are involved and the healing yung no does not really result in total recovery yung no you have some destruction of the architectural structures and when the architecture is disturbed even a few populated with surface cells like epithelium it will not be the same anymore also there will be some fibrosis that can happen, although we are not seeing here in COVID-19 the kind of fibrosis we call in the patik pulmonary fibrosis that actually multiplies on its own life and gets worse this one if you have it then you have it recent fibrosis can still improve so the answer is if the the effect on the langs by the COVID-19 or the intervention including the mechanical ventilation if we have damage on the lang or on the way can actually result in some residuals in the lang now these residuals can be seen in the x-ray if they are large enough or city scan but others are not these residuals are detectable in lang function test although in lang function test normality is 80% even 80% of the standard you are still normal because of the reserve that we have and people think we don't really have to have 100% function so it will be there but in most cases there will be a functional person after about COVID-19 it's not very common to have pulmonary in-belief after about COVID-19 there will be some improvements across time to the point that they can do the lang function now that's different from the long COVID-19 concept that affects like they feel something else so that one can also linger and can go in parallel with these structural things Marami pa tayong kilangan matutunan Raymond, okay na tayong I think we are good we are going to we are going to go to the fan quiz Raymond yes so we had two questions po especially for those who are asking ito po ang dalawang katanungan can we have it on the screen at least for Menti the two questions are as follows when do we consider post COVID-19 so we will ask this to Doctor Milo po muna the options po are two weeks after acute illness one week after acute illness continuing illness or all of the above Sir Milo ano po ang tama so the long COVID manifestation probably accord together with the COVID but will not be thought of as post COVID-19 yet because they are hardling the acute process and will come into focus after but so I would say that all of the above is the answer there okay the next question po is for Doctor Burba what is the most important precaution our healthcare workers need to continue to observe is it wearing masks, full vaccination and booster physical distancing, ventilation or all of the above po the answer is all of the above the best answer thank you so much okay so we're going to give our panelists a minute or two to formulate your parting words for our audience and we just really want to thank you in advance while we do the evaluations so go ahead thank you Doctor Susie our evaluation po uliting ko lang po na wala po kaming hiwalay na inilalabas we do not separate evaluation po this is it so for those who will be participating sana po makasama po kayo for this evaluation po it's a four point likered scale strongly agree up to strongly disagree the statements are as follows the panelists are demonstrated thorough knowledge of the topic the panelists were well prepared and organized the panelists spoke clearly and audibly the panelists used appropriate language with technical medical jargons adequately explained panelists contributed to new perspectives and knowledge on managing virus heat COVID-19 health issues we will not be closing the evaluation po as we move on to the final messages of our panelists okay so we'll start first with Chancellor Fidel Nimenzo Fidel go ahead please um yun lang ang gusto kong sabihin that um you know our vaccines our boosters in previous spots of COVID really uh will not complete you defend will not completely defend you against uh the next variant that might come along so there's no better defense than really just personal village vigilance uh just uh um take care of yourself as if uh you know um you are I mean just realize that you are vulnerable at any time so never let your guard down just wear your masks avoid the crowds if unnecessary uh eat healthily get your sleep just make your body stronger because you do not know when the next variant or virus would uh would strike okay thank you very much thank you very much that's uh UP Dileman Chancellor Fidel Nimenzo okay let's go to Nina Dr. Nina Burba Anaman I think I'd like to um leave with the note of hope I think we've uh we've gone a long way there's still a lot to do there's still a lot to learn pero the fact na marami sa atin bakonado na uh siguro nagbibilang natay doon sa mga immune uh high levels of immunity but then again we need to stay abreast with uh current situation tapos uh we just need to like follow guidance from our experts from WHO from the Department of Health and move along kasi parang hope na to for moving towards new normal yun uh let's just all be vigilant and work together thank you thank you very much to Dr. Nina Burba from the Filipino hospital and uh sir Miloroa go ahead sir yes uh Susie so uh in addition I'd just like to uh yeah again express my uh personally I I'm uh welcoming the situation that the infection rates are down and hopefully this is the last infection surge uh however uh also uh I hope I uh also express the message that this infection yeah is causing some uh new kind of disease uh uh coming after it so post COVID illness and uh while most of these diseases ultimately uh you know go towards improvement recovery uh it has to be emphasized that uh when the person feels it uh get professional help so that you can be guided kong yun na ba lang yun or there is something else or there is something else that will make uh that post COVID thing actually have uh more effect on the person so be worry of post COVID uh condition and again the better way is uh really attempt not to get COVID again or not to get COVID at all yeah thank you very much Dr. Roa so I'd like to thank all our panelists which is excellent if you have a little time there are some questions in the Q&A you might want to do a quick a quick reply um but now we'd like to call um we'd like to call on uh Dr. Stella Pegaspi Jose who will be giving us the uh sort of and summary and closing remark she's the deputy director for the Philippine General Hospital Doc Stella please go ahead uh good afternoon everyone uh we had a very interesting and enlightening webinar today so uh there are many learnings that we can we can derive from it from Dr. Camilo Roa hi sir uh good to see you uh he explained about post COVID uh and uh the signs and symptoms that are experienced by the patients such as fatigue breathlessness uh so he said that to retrieve paces it can be at the start it can be persistent for at least two months or longer and it can be the lapsing and the recovery phase it's also different uh some recover very fast some women some take up a long time the most common symptoms according to him are fatigue, headache, attention disorders, hair loss that mayon ko lang yung hair loss and this niya okay so symptoms might persist may persist because of the immunologic response of the body so yung uh um and the treatment that was used for example with mechanical ventilation which can also affect the lung function uh natuwa ako dun sa kanyang last uh last slide he said so what should you do when you get COVID? Perform aerobic exercises according to sir it mediterranean food so more of vegetables avoid alcohol ayan mga tagayuki sir sir nimen so usuyon sa mga bata alcohol after the exam anyway sleep well social activities and pursue other beneficial activities thank you very much Dr. Roa for those for Nina Dr. Nina Burba she explained the situation here in PGH and the characteristics of those who had multiple infections according to her in in PGH what the Tico found out there was no difference in the assignment whether in the non COVID word or COVID word so it really depends on how you follow the healthcare protocols there's no difference if you're a nurse a doctor or a paramedical uh it get most of them were mild and asymptomatic in the last surge and there's no difference in the antibody trends okay so ang agandang mensahe ni Nina is um the variants allow the virus to have increased transmission okay and the variants they may they avoid a host immune system so let's all be careful knowing uh many variants will still come along and the good thing is if you're fully vaccinated you have a lower chance low chance to have the infection okay so the immunity provided by the vaccine and the infection itself prior infection are uh it's good though because it increases your antibody levels but it is not complete current evidence indicates that level of protection may not be the same for all our viral variants okay so dahil marami merong alpha beta merong delta or micron iba iba talaga ang level of protection with this variant and atong pinakamaganda niyang statement the strength of immunity is greater in vaccine induced immunity so dapat lahat tayo magpabakuna talaga and as an aside from the start of the pandemic I will already go here to AGH every day because of my work awan ang jaw sir hindi pa ako magkakakapobid so kami dalawa ni Nina the last remaining remaining alos lap dito nang kapobid na sir anyway okay doctor for chancellor with the mental sir really sympathize with you sir yung patlong beses magkakobid it's not a simple thing and um from his personal experience yung breathlessness, fatigue brain fog, difficulty of sleeping, the sense of smell disappearing is sometimes you take these things for granted but when it happens to you then sir you cannot smell the flowers sir may makang bumalik na naman so okay na kayo sir anyway when he had the omicron he said your cough is persistent and that is so common to almost all the all the patients who had omicron it's the cough sabi nga nigap ang kate-kate ng lalamunan daw nga when he had the omicron and the lessons learned from doctor namin so do not take your health for granted we have to adapt and leave a seal thank you very much to all our speakers okay thank you very much doc Stella, ganda ng samari mo di ba? parang alahan ka hindi ka pa ng kakakobid hindi pa, mga ano tayo eh tako takoobid sa tayo okay so thank you very much dr. Stella Jose who is the deputy director of the Philippine General Hospital and next week nako nice topic and I'm actually glad that Chancellor Fidel was very candid I think very open sabi ko nga was very vulnerable when he was talking about having anxiety so I think next week what we're going to do is we're going to talk about kayo ba ay nade-depressed ahil nga kakobid kayo kasama sa pamilya mag-alert level one na pero ayaw pa rin lumabas or nagkarun ba kayo ng mga kasama sa pamilya na nagkarun talaga ng anxiety kamusta po yung mga seniors we will be talking about mental health all over the world people have experienced some forms of mental health problems because of COVID and we have to talk about it kasi parang ayaw nag-alert level one na pero marami pa rin paranoid sila may feeling talaga silang inside na kinakabahan pinapawisan, paglamalabas so we will talk about the second pandemic of mental health that came with COVID and we've got great guests for you so please join us next week pag-usapan natin karun ang depression anxiety karun ang post-traumatic stress at ang mga nag-grieve yung talagang masama pa rin nila kasi nawalan sila ng member ng pamilya so abangan yung po yung next week over to you Raymond because Raymond oh no, we will lose Raymond okay, well if we lost Raymond I will go to I will go to his part direct ganun ba so this formally brings our webinar to to a close we will okay so just for your information all of the stop COVID death webinars stop COVID deaths webinars are archived for viewing at tv YouTube channel so if you want to go back and I think for this particular webinar you might want to go back and look at this you can go to tvup and then you can find any of the episodes that you may have missed or want to watch again and we'd like to thank before we end all of those who make stop COVID deaths possible so we would like to thank the University of the Philippines the National Telehealth Center OVP PPA the ITDC tvup up Manila PGA at maraming maraming pang iba hindi po namin magagawa ito nanda kung wala sila at ang papasalamat nang kamin kasi kung wala kayo wala rin kamin so thank you very very much so we look forward to we look forward to next week and I don't know if Raymond is back is Raymond back? I'm back Dr. Susie but I'm having trouble with my camera so ako nang magsasara Raymond okay so everyone thank you so much so if you can open your camera try mo para meron kang ganoon it's a date okay na Raymond thank you very much everyone we'll see you next week so together we can stop COVID dates stay safe stay connected and see you online one more time I know you long for home but I am here you're not alone I'll stay with you until the coast is clear the other Spain before my fears the other loves it for my tears but right behind the mask I look into myself and ask do I have strength to carry on? so long as this go on and leave you here to keep me strong I'm here to hold the line I'll keep my until my his name to read is hold on to the word he gave this time we'll come to pass cause this salvation makes the last you'll carry you to see the break up the others pain before my fears the others loves it for my tears but right behind the mask I look into myself and ask do I have strength to carry on? so long as this go on and leave you here to keep me strong I'm here to hold the line I'll keep my until my his name to read is hold on to the word he gave this time we'll come to pass cause this salvation makes the last you'll carry you to see the break up the others pain before my tears but right behind the mask I look into myself and ask do I have strength to carry on? so long as this go on and leave you here to keep me strong