COVID-19: Circuit Breaker Special Episode on 15 April 2020

In this circuit breaker special episode, Glenn and The Flying Dutchman discuss some pressing concerns with Dr Leong regarding the latest circuit breaker measures put into place from April 7. How do we fight COVID-19? Are reusable masks efficient to prevent transmission of the virus? Find out more!

Dr Leong Hoe Nam visiting ONE FM's Glenn and The Flying Dutchman on March 4, 2020

Circuit Breaker Special Episode with Glenn and The Flying Dutchman
Interview with Dr Leong Hoe Nam, Infectious Disease Specialist from Mount Elizabeth Hospital, Rophi Clinic on 15 April 2020.

[See related episode on 4 March 2020]

Transcript

[00:00:50] Glenn & The Flying Dutchman: Dr Leong, why are there more and more cases? Singaporeans are getting worried, we are finding cases, quarantining contacts, and yet unlinked cases keep popping up? Why is this so?

[00:01:05] Dr Leong: The government is trying very hard to search, isolate and quarantine these patients. This methodology has its history back from SARS - it’s tried, it’s tested and it’s worked. We managed to control many cases. But something has gone wrong. Science explains it - it boils down to the behaviour of the virus. We think there is something more we’re missing, and these are the asymptomatic or pre-symptomatic transmission. Data from China, Italy, Singapore have found that of all the patients that are infected they’ve found,  between 10% - 78% that are identified have no symptoms - i.e I have no fever, I have no cough, I feel good and yet I can be transmitting the virus. The virus is now a trojan horse - on the surface you look well, but you’re shedding the virus. If you meet this person, they can spread to you, even though they look perfectly fine. 

[00:02:28] FD: So how does this compare to influenza? 

[00:02:45] Dr Leong: Influenza - we know it transmits before the onset of illness, about 1 day. For e.g if you have any headache, fever, and you’re unwell, 1 day before that you could actually transmit [the virus]. For COVID, it beats influenza, it one-up against it - 4 days before the onset of symptoms, you can shed the virus, whoever you meet and - even though you are well- you can pass the virus. 

Second thing, if we sample the nose, we look at a patient with influenza, we find about 100,000 viruses per sample. That's the usual, typical for most viruses. For COVID, you find a billion viruses - that’s one thousand times more. When you sneeze, one sample of it comes out as one billion, you just need about 2-5 viruses to infect. To get the 2-5 out of billion [viruses] onto you and infecting you is very easy. 

[00:04:00] Glenn: We beat SARS. Why can’t we seem to do it with COVID? 

[00:04:12] Dr Leong: SARS was an easier virus to beat, science has explained it all. At the very beginning of SARS, the amount of virus inside the body that’s excreted out is very little. It gets more as the illness progresses. So in the first 7 days if it doesn't transmit well, after 7 days it works very well. But when you have symptoms, you get rested, you go into isolation, quarantined, you prevent transmission. That's how we arrested SARS coronavirus. But in the case of COVID, it transmits even before the onset of symptoms. The viral load is very, very high at the very beginning. 

[00:05:28] FD: Why the U-turn on masks? 

[00:05:38] Dr Leong: As the epidemic progresses, we begin to realise the virus is sneaky.  It disobeyed all the rules that other respiratory viruses have been giving us. They are asymptomatic viruses, they have very high viral copy numbers at the beginning. The best science evidence is of physical distancing. Singaporeans have failed miserably before the circuit breaker. We are still queuing to buy toilet paper, and the IKEA furniture before the circuit breaker. If this fails, we have to go for the second backup - Masks. The masks will prevent my transmission to the next person. But the mask isn’t perfect and isn’t good. Because many people do not know how to wear the mask. You see them exposing the nose, exposing the mouth, and talking, and the mask gets wasted at the same time. It is beyond just wearing masks - you need to wear it correctly. Masks are no longer an issue, be it reusable or disposable - use it, wear it and kill the virus.

[00:07:24] Glenn: How can we fight this? Is there an expiry date to this novel coronavirus, do you see the coronavirus slowing down and when do you think it will all be over?

[00:07:50] Dr Leong: The virus actually has an expiry date. There is a transmit-by date or use-by date. When the virus comes onto me, it will start shedding the virus, it will continue to do so for the next 20-30 days. And if it fails to transmit to someone, the virus dies within my body, because my immune system will fight it and win it. Think of it as a self-destruct timer. It self-destructs in 30 days. What happens now is if you don't meet anyone for 30 days, you physically block off with the physical distance with the mask, you can actually allow the virus to self-destruct inside you, without causing more injury, and prevent transmission. 

[00:08:47] FD: So if the body naturally kills the virus in 30 days, does it mean the virus cannot infect the person again?

[00:09:00] Dr Leong: No, you cannot infect a person again. Once you have the virus, you have immunity to it. The virus has a habit. It is found in the nose one day, and not in the nose the next day. If [results are] negative, it doesn't mean it’s truly negative. [The person] may actually have small amounts of [the virus] thereafter. What happens if you do find the virus, it doesn't mean the virus is alive, it is culturable. There is no need to worry anything about it because you can’t transmit. Second evidence that we can actually control, it comes from our blood, our blood contains blood and antibodies that kill the virus. They have taken the blood and isolated antibodies in the plasma, or “plasma therapy” and people have recovered from that. Third evidence, meerkats. [Scientists] infect meerkats, and the meerkats developed immunity. They tried to infect the meerkats again, it doesn't work. The last stage of evidence - this is our 7th coronavirus. All the other coronaviruses, when you get it, it means you get immunity, and you will have lifelong immunity. You are picking up dead viruses that can’t kill you or infect you. 

[00:12:09] Glenn: What is truly accurate when we are talking about safe distancing, is 1m good enough?

[00:12:20] Dr Leong: Some people have read in the news, there is such a thing about airborne transmission. That is disputed. In the interest of time, we are going to talk about droplets. All of us breathe, when we breathe, the droplets which we breathe will fly about 1m. If you cough or sneeze, it will fly out about 2m. 1m is for regular breathing, 2m is for cough and sneeze. Keep 2m [of safe distancing], that's even better.

[00:14:14] FD: People who are going out there and exercising, they are breathing forcibly. Should people who are exercising do 2m/3m apart? 

[00:14:25] Dr Leong: Please go during the time when there are less people, people are breathing in and out very fast, which means you're going to spread a lot more virus to the surrounding area. Option 1, don't run. If you have to run, choose [to run] at good times, away from the crowds, very early morning or very late at night. Wear a mask. If you are going to do a brisk walk, wear a mask. Please don't transmit the infection to anyone. 

[00:16:00] Glenn: Should we all be tested for COVID-19?

[00:16:07] Dr Leong: No, this is a sneaky virus. It appears when you least expect it. You may test yourself today, and you’re negative but this doesn’t mean you’re negative 10, 14, 30 days later. Then should 6 million people, living here, go for testing every 10 days? No way. We’re going to burn resources unnecessarily. The understanding now should be, if you’re asymptomatic now, go for testing, or if someone next to you has infection, go for testing. Otherwise we’re shooting blank bullets or wasting bullets. 

[00:17:06] Glenn: What is the testing process like for COVID-19?

[00:17:15] Dr Leong: One way is putting a swab in the nose and throat. This will look for the body parts of the virus. This is most effective because you look for live viruses. Second alternative, it’s through a blood draw. The blood draw comes from antibodies. This doesn’t come on now, but about 10-14 days after, which is too late. If you want to look for active infections, do a swab in nose or throat. If you want to look for immunity or antibodies, you look for blood samples. 

[00:18:05] FD: The 30-day restriction on movement. Why 30 days restriction? 

[00:18:15] Dr Leong: The virus incubation period is 14 days. We’d like to think virus control is 2 incubation periods, so about 28 days, hence the CB is about 30 days. 

[00:18:45] Glenn: The cloth masks that have been distributed, the washable masks, are they effective? 

[00:18:55] Dr Leong: The surgical mask works best. We’re talking about 90-100% efficacy in preventing transmission. If you use different cloth masks, it gives different efficacy. On average, studies suggest that it’s 50% effective. If you look at this figure on its own, it is pathetic but don't think singly. Think about when everyone uses a cloth mask. E.g I’m an infector, I wear a cloth mask, I cough out, my mask blocks 50% of that. You are next to me , you are wearing a mask, [the infection rate] drops another 50%. All in all, you have a full reduction in transmission, and yet the mask is reusable again and again. Use a surgical mask, if you don't have, then use the cloth mask, because they help. 

[00:20:08] Glenn: I have actually been able to make a mask in 2 minutes, using paper kitchen towels. I put 4 layers together, I believe this could possibly be more effective than a cloth mask. How much truth is in that for theory?

[00:21:00] Dr Leong: You need to do a cloth mask test. There are 4 steps. Check the integrity is good. When you put it on, it covers the sides quite well. And the hooks are secured. The 4th step, and most important step, you try breathing in and out through the mask. If you feel the air comes in through the front and not through the sides, it’s not too bad. Then it really boils down to the filtering capability and effectiveness of the layer which you have. I’m a bit worried about the paper mask you have made, primarily because we spit when we talk, and there will be lots of saliva. And you wet it, you break [the mask]. But this is better than nothing. 

[00:22:55] FD: What is Anosmia? 

[00:23:00] Dr Leong: Anosmia is the inability to smell. You lose the smell sensation. We don't know how many more people get affected. Recent study said about 60%. Anosmia happens to people who have sinusitis, allergic rhinitis. If you use anosmia together with other symptoms like cough or feeling unwell, the sensitivity and specificity go up, the pickup improves. If you use anosmia, together with epidemiological links, but someone next to you with COVID, your pickup is better. If you have anosmia, think about COVID. But if you always had anosmia, it is a chronic problem, it’s not something new. To see how anosmia affects your appetite, try eating your nasi lemak, or durian. If they taste different that’s how  anosmia works. It will affect your appetite. 

[00:24:32] FD: Will there be a cure for COVID-19? 

[00:24:42] Dr Leong: Eventually, science will beat the virus. I will think we will find [a cure] one day. Scientists are working very hard - if you heard of the drug Hydroxychloroquine - there was a study released over the weekend, those people who took Hydroxychloroquine ended up worse. There are other trials for other drugs. Let the studies show and let us know what works and what doesn't work. It will be about 1 year before we see the vaccines hit any country’s shores. 

[00:25:53] FD: Which is more deadly? MERS, SARS, COVID-19 or Ebola?

[00:26:00] Dr Leong: The MERS risk death is higher, about 70%. SARS is about 15-20%. COVID-19 is about 0.1-10% depending on where you are. Ebola depends on where you’re getting treated. If you’re treating in West Africa your risk of dying is approx 90%. If you’re treated in the US, with better healthcare systems, the risk is about 10%. 

[00:26:50] Andre: Are our hospitals running at capacity with the recent spikes?

[00:26:58] Dr Leong: No, we are not running a full capacity yet, but we are very, very close. Please, Singaporeans, don't test the capacity. The Ministry of Health has segregated people according to risks, those with low risks where they predict are going to do well, they go into Expo, and places where there will be healthcare workers looking after you, but outside of hospital. For those people, who are a little sicker with slight risks, remain in hospital. For those who are very, very sick, they remain in hospital. We are very, very close to breaking point. We need to have fewer patients now, more than ever. 

 

Stay Safe. Stay Healthy.