 In December of 2019, a new form of infection was identified in Wuhan City, the province of Hubei in China. It was later identified to be a new form of coronavirus, and it quickly spread in January to infect this city of Wuhan of about 11 million. By late January, the government of China declared a lockdown in this city. Let's discuss more about this novel coronavirus. This is Dr. Teddy Herbosa, your host. In this episode on the novel coronavirus, we have Dr. Ronald Law, Chief of Preparedness Division of the Health Emergency Management Bureau, Department of Health. He is responsible for policies, plans and programs on the health and disaster resilience. He is also a faculty of the UP College of Public Health and is also a Fulbright scholar on health security and author of several articles on health emergencies and disasters. Welcome to our show, Dr. Ronald. It's my pleasure, Dr. Ted. So it's very hot nowadays, and all the newspapers, social media sites are talking about this outbreak or public health emergency of international concern from the province of Hubei or the city of Wuhan. What is NCOV-ARD? That's the new term they call it. NCOV-ARD 2019 is their official term. Okay. So it's a 2019 novel coronavirus acute respiratory disease. It's a novel virus, meaning to say it's a new strain of disease. It belongs to the coronavirus family. The coronaviruses, what do they cause normally? Coronaviruses, like if you remember our experience with SARS and MERSCOV, they usually cause a range of symptoms ranging from the simple cold, you know, coughing colds. Our common colds can be caused by a coronaviruses. And then, of course, it can also lead to severe respiratory problems. The pneumonia in the SARS. Yes. Causing some difficulty of breathing, and unfortunately, sometimes it can also lead to death. Correct. Death from the pneumonia or the complications of the SARS. So where did this novel coronavirus ARD acute respiratory disease come from? Okay. We have to go back to the timeline. So back in December of last year, the World Health Organization was alerted to a new mysterious disease coming from China. It came from a seafood market. So some workers there have been showing up some of the symptoms and they were able to point out that specific... They all came from that market. They call it, in epidemiology, we call this clustering of cases. Yeah, clustering. In the outbreak, they identified a clustering of several. I think the initial was report of about four cases. Yes. And they all came from the... From the same... The doctors identified it came from a source in the Wuhan seafood market. Yeah, seafood market. Was it from seafood? So we're still not so sure about it. So studies are still being undertaken to really pinpoint. So going back to the timeline. So a month after, so that is January of this year, January 2020, the Chinese authorities have started reporting this... To the World Health Organization. To the World Health Organization. This is part of what we call the international health regulation. Yeah. If you have an outbreak, clustering, epidemic in your country, it is your duty as a country or as a member state of WHO to inform the regional office that there is an outbreak in your country so that your neighboring countries can prepare. Yes, exactly. So China did this. Yeah. They informed WHO that there is a clustering or outbreak in Wuhan city in January, correct. So this coronavirus, how different is it from SARS, Severe Acute Respiratory Syndrome. That's what they called it because they didn't know it was a coronavirus. So the old term was SARS, which also came from China. I think it came from a civet cat. Mm-hmm. And then MERSCOV, which is the Middle East Respiratory Syndrome Coronavirus, which came from camel. Camels, right. Which came from camels and happened in the Middle East, right? So can you differentiate all these three? Okay. NCOV, SARS, which is the first one, NCOV and MERSCOV. Okay. So they have two commonalities. So first commonalities that all of them belong to the same family of virus, which is coronavirus, which is basically the way the virus looks like. Yeah. If you look at it on the electron microscope, they are like having crowns around the virus, right? Yeah. And then second point of commonalities, these are zoonotic diseases. What do you mean by zoonotic diseases? Okay. A zoonotic disease basically is a disease that's transmitted from animals to humans. So you have an animal and you get the infection from them. They have some sort of colds or cough. You get the virus from them. Can this be transmitted to other humans? There is a case of person to person transmission. So it comes from the animal. It goes to a human being. Yeah. And then from the human being, it's transferred to another human being. Yeah. And then you start an outbreak. Yeah. So that's basically what happened to these three different coronaviruses. So they're all different viruses, right? They all belong to the coronavirus family. Right. Family. The same way as the cough encodes belong to. But they have different pathological behaviors, right? Yeah. And they come from different animals, correct? Yeah. Correct. Around the middle or I think early on when this was reported that several thousands were already infected by the Chinese government. They declared a lockdown and we in the health sector was waiting for WHO to the end. There were several cases already reported in Thailand, in Japan, in the nearby countries. There were already cases of citizens from China who have reported positive for animal. And there was a lockdown by the Chinese government. But we were waiting for the WHO to declare a public health emergency of international concern. Can you tell me first what is a public health emergency of international concern? Okay. A public health emergency of international concern is being declared by WHO when they've seen based on available statistics that a certain disease has started in one country and more than that it has already crossed borders. Meaning to say, many different countries have cases and the critical thing to do here is contain and mitigate to limit further spread. And this is especially important, especially in the context of countries which have health systems that have some problems, you know, weak health systems are more vulnerable to this and aggressive strategies is important. Because if I remember right, the World Health Organization developed the term public health emergency of international concern because they were criticized all the time that when they declare an outbreak or an epidemic, they were already late. So I think the former director general, DG, who was also an epidemiologist, devised this concept of declaring public health emergency of international concern. In the first meeting, after the first meeting of the core group of infectious disease and epidemiologists at WHO headquarters, they decided that they would not yet declare public health emergency of international concern. It took them another week or so and then eventually today it's already declared as a public health emergency of international concern. What changes once you declare public health emergency of international concern? What changes, number one, are the strategies of different countries. So we will have our own Department of Health will implement certain strategies to prevent the entry and control the spread if it's already in the country. So each country has its own governance. They will take care of how to control the epidemic based on the system and the vulnerabilities. So the responses will be different per country. So it's a public health emergency of international concern. I think it's several 18 countries already reported as of this day. Let's understand, how do you get end COVID infection? So as I've said, studies are still underway, but most likely the mode of transmission is through the droplet infection referred to aerosol infection or contact, hand contact. Ebola, you get it by hand contact. I think influenza, you get through an aerosol. And this one, colds and coronavirus, you get to a droplet. Can you discuss the differences of these? So a droplet kind of transmission is the analogies like that of, when you cough or sneeze and you emit some particles. Your sneeze. So the distance is kind of limited. Less, less. So the virus cannot travel far. If I cough or sneeze now, the droplet will fall. Once the droplet falls on any surface and by any chance you get into contact with that and you don't do proper hand washing and any sanitation techniques, you can get that possibly. So this is how it's transmitted. By instead of doing the proper way to cough, which is cough through your elbow, which you did not touch, you cough through your hands. And then I shake your hand. And then you touch your eyes and nose. I'm now transmitted the coronavirus from my hand to your hand, to your face, mouth and nose. And then it will now develop and reproduce in your body and then you can represent with an illness. Exactly. Other than that, it's through close contacts. So most of the cases happen to be people who have taken care of those who fell ill or those who are really close family, friends or contacts, which we've seen. So that's the other definition. Close contacts because you're taking care of somebody who has cough, colds and fever, trangasso and what we call it. And they're lying down. You take care of them. You touch them. You touch each other. The chances of you getting the virus is higher. But this is coming from those people who have the cases. Who have got the cases. Confirmed positive. Confirmed positive. Patients, people who have been established to have contacts with these people who are positive. How do we know a person has N-Covid? What are the symptoms of N-Covid? Okay, of course, aside from the travel history now, so we have... So we have to add number one risk factors. They traveled or was exposed to Wuhan, China. So the current case definition now is, of course, it includes the travel history. But yet we have to find out if there are locally occurring cases of coronavirus here. But that's another story. So other than that, of course, the classic symptoms are fever, cough, colds, shortness of breath. So that's already severe. That's pneumonia already. Yeah. So the range of symptoms. So as of now, the important elements are they have traveled to Wuhan. They are presenting with fever. They have colds, cough, and may have difficulty of breathing. Yes. These people are what we call the probable cases, suspect cases, persons under investigation. Yeah, we call them PUIs or persons under investigation. So the term we use now is person traveled from Wuhan and has cough, colds, fever is considered a person under investigation, correct? Yeah. And how do we determine that it is the novel coronavirus? Okay. So goodness is that we already have the polymer. So now we have the ability to test. So previously, we were subjecting our test out to Australia. Now we have that capability. Victoria. Yeah. Australia. Yeah. So we can detect it. That's why we were able to confirm some cases already. I also asked our Philippine Genome Center because we have DNA sequencing. And I was told that Dr. Distura is also waiting for the reagents so that they can also help the Department of Health do the test. Yeah. So it's a test. Yeah, yeah. So they will take what sample would they take? It's basically through the sample swabs. They'll take a swab of your throat or nose. Yes. And they put it in a vial. Yeah. And then it's run and they look for the PCR or the DNA sequence because the nice thing that they did, I think sometime in the middle of January is the Chinese government published the DNA sequence of NCOV. Yes. How does that help? Publishing the DNA sequence. Of course, knowing about that is very important in terms of developing the necessary interventions. Developing the test. The test. Developing an intervention. Yeah. And then we sent a vaccine which are very important. So is there a vaccine now for NCOV? Unfortunately, as we speak, there's none. But the scientists are doubling their efforts to find out about it. Yeah. And I think the Australian Institute where we sent our samples have been able to recreate the virus in the laboratory, which is very interesting because then they can reproduce it and we can virus, which can be a potential vaccine. So now there is no vaccine. How do we treat it? Okay. So there's no specific treatment yet because it's a novel coronavirus. So what we do is the traditional, we call it of course, symptomatic treatment. So supportive treatment in terms of just treating the signs and symptoms and preventing any further complications, especially those people with comorbidities or those with other diseases. So there's an interesting report of the Thai government. The Thai Ministry of Health reported the use of antiviral with an HIV antiretroviral, a combination cocktail that they claim had some results. How does this work? I heard that it shows some promise, but as of now there's no recommendation for still experimental patients to take this HIV medication. Still experimental, but we have to closely follow up the developments. But that's how it is in medicine. If you have no treatment, you'll try anything that's close to possible treatment under experimental control parameters. So that seems future. How about the vaccine? How fast are people or laboratories able to produce a vaccine? In most countries, I heard that U.S. has been into it already since... For the SARS. I think they were developing SARS or MERS-CoV-type vaccine and they want to try that particular product. That's also going to be experimental when they introduce that. Japan is in some other countries and other different research groups around the world are doing the extra effort. Let's talk a little bit more about the virus. The virus seems to reproduce faster in cold weather. The weather today in China and in the Philippines and the other neighboring countries is more or less winter weather. So it's cooler as of why the virus, they say, stays longer outside so the transmission becomes more prevalent. Yeah, that's what we commonly know, however, but we cannot say that just because the weather in the Philippines is hot doesn't mean it's going to kill the virus. So that's a myth. Because we've seen also in other countries that are tropical getting some of the cases. So that's not correct. Just because it's hot in the Philippines doesn't mean we're going to be spared from this because it's going to kill the virus. So that's one factor. What's the other condition that actually will lead to the contagiousness of this virus? Is it very contagious? Is it contagious enough or should we be scared? Should the people be scared about it spread? So that's a very good question. So in terms of studying this virus, sometimes we describe their infective potential, their ability to reproduce how one person, how many person can one infected person infect. So that's the measure that's called RO. RO or R0, they call it. And the epidemiologists describe different diseases. So what is the published R0 or R0 of NCOV? In most of the literature, it's from two to two point, if I'm not mistaken, two to four. Anywhere between that. So what does that mean? A person with NCOV, infected person, can infect potential. Two people in a room. For example, I'm in a room, I'm with you, I'm talking. I can infect you, I can infect the cameraman if I have NCOV. And maybe four if the other value is correct. Up to four people in the room. How about another disease like measles? What is the R0 of measles? Do you know the R0? It's higher. It's higher. It's a more contagious disease. It's far off. It's far off. It's 16. A child in the room, in a classroom, can infect 16 of his classmates. So it spreads faster. So like when we had the measles outbreak, immediately the whole city of Metro Manila was already having several cases. Correct. So this one is containable because it's R2 to 4, right? So we're able to control it. We will control its spread. We understand that. It's R0 is even less than that of the MERS. This one? Yeah. Okay. So MERS is more, it's a higher R0. I think that was six, right? Yeah, five to six. I think five to six. How deadly is this virus? There are about 300 deaths already reported internationally. Okay. But I think 19,000 have been infected and majority recovered. Yeah. So how deadly is NCOV? In the latest double-HO situational reports around 360 plus deaths. So the measure that we look at is what we call the case fatality rate. The case CFR. Or the CFR. CFR. It means if you get the disease, what's the likelihood that you're going to die? You're going to die. So now it's at 2.4%. 2.4% or 0.2? 2.4%. Meaning to say out of 100 people who will get it. 2 to 3 people can die. 2 to 3 people out of 100. That's fairly serious because dengue, for example, has a case fatality rate of 0.5%. That's what the department felt. It's less than 1% of mortality for dengue. So this one is higher. I think what are the other? Ebola had a very high case fatality rate. I think it's almost 6 out of 10. 6 out of 10 was the case fatality rate. So you have a very deadly disease like Ebola. The good thing about deadly diseases is when the host dies, the infection stops. So Ebola is good because if they kill the host, but a virus like measles, he'll infect many kids. They don't die. He'll infect other kids. It's something like this. This one has a high contagiousness, but also a pretty high mortality. Who can die? Of course, first, those who are immunocompromised. What do you mean by immunocompromised? These are people who belong to the elderly ones, elderly group. Right. Sorry. Because I was looking at the statistics and they were like 45 years old, 60 years old. So what's their definition of elderly? Okay. Not only about age. It's about the presence of other conditions as well. Comorbidities. Comorbidities as we say. So if your person has several diseases, hypertension, diabetes, high blood, whatever disease, asthma, their chances to die is higher. Correct? Yeah. Are the children also at risk? Yeah. Young children, the younger age group and the older. So the people in the extremes of age we call are high risk. How do we prevent end COVID? This has been now a panic buying of masks and N95 surgical masks. Yeah. Is that correct? No, that's not correct. So the first thing that we need to really prevent it is we have to educate ourselves using the right information. From the right source if I may add. Correct. You said earlier it's droplet infection. Yeah. And how do you prevent droplet infection? Okay. Droplet infection, as I've said, we're not saying that use of masks is not needed. So use of masks is still good to, if you're, for example, symptomatic or ill. If you're ill, you wear the mask. Yeah. So you protect the population. Other people from being infected by you, you use the mask. Many people are wrong. They're normal and they want to wear a mask to prevent the illness. What should they do to prevent the illness? So avoiding large crowds. Handwashing. Handwashing is. Alcohol Rob will help. You mentioned because it's a droplet infection. So handwashing is. The first priority. The first priority. For aerosol it's the mask. Yeah. N95 aerosol. But for droplet infection it's really handwashing. Handwashing. And cuff etiquette. Yeah, cuff etiquette. Making sure that if you cuff, you cuff with the tissue and throw it away in proper disposal. Or if you don't have tissue, you cuff in a. Can I use my handkerchief? And cuff with my handkerchief? Yeah, sure. I can, but I put it back in here and then my hand is also affected. Oh, you have to make sure you're. Yeah. Also, so handwashing is the key. I think the message really here is that frequent handwashing, every time you go to the toilet, wash, take that opportunity to use soap and water. If you're a lady, they probably have an alcohol gel, a hygienic alcohol gel and hand sanitizer. Yeah. You use that as often as possible. Yeah. So that you prevent any spread and you don't touch her nose and mouth with unclean hands. Yes, exactly. And if you can prevent. I think that they say the wearing of the surgical mask prevents you from touching your nose and mouth. And that's why it looks effective. The truth is, it's really the handwashing. Yeah. So that's a very interesting. And with handwashing, you also prevent other diseases, not only. Not only ENCOPE. Yeah. So it's part of hygiene. Yeah. Wash your hands frequently, use alcohol in the office. Yeah. Because you transmit paper or whatever. Correct. What other measures should we do? Of course, with the mention of people who are immunocompromised. So part of our strategy is strengthening our immune system. Proper nutrition, diet, exercise. Exercise. No sleep well. Yeah. Sleep power. Enough sleep. No over fatigue and be able to make sure that you eat well. Yeah. Don't skip meals so that your constitution and health will be strong. Yeah. Basically, all these infections are happening nowadays. But we need to also address how we can prevent more of its spread. I mean, contain it. Our Department of Health has several measures. So one is quarantine. Yeah. One is contact tracing. Mm-hmm. Another one is isolation. Yeah. So let's go define this for the people who are bills. What is quarantine? Okay. Quarantine is, you've heard a lot about that. It's basically to keep people away from people who are possibly infected or those who are being monitored because of the probability. So a person does not have to have symptoms. Mm-hmm. Maybe just one factor. They came from Wuhan. I can quarantine them. Yeah. As a health authority, I say, you're coming from an area where there is an outbreak and epidemic. I'm going to quarantine you. How long do I quarantine them? So the standard is not less than 14 days. So these people who came from Wuhan should be quarantined in a special location and should not meet the general population until they do not exhibit any symptoms. If they exhibit symptoms within that 14 days, they start to have cough, cold, fever, and they came from Wuhan. We isolate them, correct? Yeah. So what is isolation? Okay. So isolation is, again, same principle as quarantine, to closely look into the situation of a certain patient. So now it's a symptomatic patient. It's the symptomatic we isolate. It's the asymptomatic we quarantine. Yes. Yes. So what's a lockdown? Okay. A lockdown has been imposed in China. China. So it's part of a strategy to contain and mitigate the spread. The spread. But that's interesting. In the reading articles, they say this is the first time in the history of public health that a city with 11 million people was put on lockdown. So nobody knows if this is going to be effective, if China has done something good, if they've discovered a new way to contain infectious diseases. What do you think of the lockdown they did? It's not yet a good time to talk about how appropriate the strategy was. But surely we can only surmise that the Chinese authorities have been trying to do their best. Correct. But now it's under review how they were able to do it. And there are many criticisms. I see. Yeah. But I think that should be the subject of an investigation. But yeah. We should study it and find out because historically, no government has ever implemented a lockdown. We've implemented quarantine. We quarantined a... Remember SARS? Mm-hmm. There was a barangay in Pangasinan. Yeah. Our SARS patient was a nurse from Canada who came in and infected her father. Father. Who had colon cancer. Yeah. And then they went to Pangasinan, their hometown. And what we did was we quarantined. Yes. Quarantined or what do you call it? A lockdown. Yeah, basically a lockdown. Because no one could get out and no one could get in bed today. So it was a small lockdown because it was just a barangay. Yeah. So was that necessary or I think that was unnecessary at that time? It's going back. Yeah. In retrospect, when we review that, all we need is contact tracing. Yeah. So the principles of epidemiology, find the index case, the source. Yeah. And then make sure prevent human to human transmission through contact tracing. Yeah. So the contacts. So right now we have a death in the Philippines. So we're going after the passengers that sat beside this index case. Yes. The one that died and the fiance, I think. So the partners, the two partners. Those that sit beside them are what we call persons under investigation. Investigation. I think several of them reported already from all the three flights. And even the hotels they stayed in, they have also been identified so that people are warned and they told them to undergo voluntary self quarantine. Self quarantine. Can you define that? Yeah. Self quarantine is, yeah, we do that for people. Possible. Yeah, possible. Possible exposure. Yeah, possible. Possible exposure. That means you can manifest it within the incubation period. Yeah. Incubation period is the latent period, right? So they can manifest within seven to 14 days symptoms. Yeah. So we tell them to self quarantine and not go out. Yes. Correct. So they have to watch out for those symptoms and add to that, that they have to report that to, if they show some signs and symptoms, they have to report those of course to the health authorities. When I was in the DOH, we handled the MERSCOV. And it seemed that the rumors spread faster than the virus itself. Yeah. In fact, this is a dictum that I try to teach now in my classes about epidemics. That the rumors and the fake news, especially today in an era of social media, because this is the first time we're having this ENCOV with the spread of social media. And there's so many fake news and so much conspiracy out there. What is, this goes now to, in disaster and emergency, under risk communication. Risk communication. Can you explain what is risk communication? Yeah. Risk communication is a strategy to manage. So like with pandemics, with the ENCOV 2019 ARD, it's not only so much about the disease that we're managing. We're managing also the reaction of people. Correct. Resulting to panic, chaos, unnecessary, you know. I remember the meningococcipia. Yeah. Remember meningococcipia, which was allegedly identified in Baguio? There's so much effect because the rumors spread that children were dying of meningococcipia. And there was a lot of economic loss because many Filipinos didn't go up to Baguio that summer for fear of meningococcipia. Yeah. When the WHO came in and studied all the deaths, they weren't deaths from meningococcipia. So, you know, how the fake news cost fear and cost economic losses for several people, hotels, people that sell food, restaurants and everything. I think the city of Baguio died because of misinformation, that it was a meningococcipia outbreak when after several weeks, the WHO findings was opposite. So very important, the transfer of information. Information, yeah. So I see now that our Department of Health has press conferences twice a day. Yeah. One in the morning and one in the afternoon. I always open my social media and I see the face of our Secretary of Health explaining the developments and trying to combat fake news. And I open my social media. Yeah. There are also fake news about conspiracy theory. Yeah. This is germ warfare, that there are stuff. Yeah. So these things actually collide. Yeah. So it's very important that we also have transparency. Yes. In trying to answer the deals of this epidemic. Yes. There's been a very interesting discussion. Maybe you can have advice to our viewers out there about what to do to stay safe and healthy during this time of public health emergency of international concern. Okay. I'd like to take this opportunity to again encourage people to be very aware of the health risks, different health risks around. And one key thing here is getting the right information right from the right source. So let us not be a weapon of, let's not add to the confusion, let's not add to the misinformation and disinformation. So all of us, if we can at least be good instruments of information. So the government is doing its very best to combat it. So trust and respect to our health authorities is very important. And we need all the help that we can get from other agencies and most especially from people. So now it's not the time to panic, but I'm not saying it's not something worth looking towards something serious. So let's not panic, but let's take the necessary precautions. And then at the end of the day, it's all about our own health that will really help us out in this situation. So making our immune system strong, using masks sparingly only for reasons that are really, really reasonable. And then of course, hand washing is very important. The importance of hygiene we cannot overemphasize. And then, yeah. Well, thank you for all your advice. It's been an interesting discussion. We do a fist pump because they recommend no hand shakes. We didn't share our body fluids. Ladies and gentlemen, in an era of public health emergency of international concern, we need everybody's cooperation. We have the leadership. We have the government to address the issue of the entry of NCOV in the Philippines. We trust them. Let's be transparent. Let's not be part of the problem, but be part of the solution. Let's not share before we share anything we find on social media. Let us fact check and wait for the officials to actually declare. Have a healthy day and thank you for viewing health issues.