COVID-19: ``Hand On Your Heart`` Episode on 4 March 2020

It's been over a month since the first infected case of the coronavirus was reported in Singapore, and now we are into our third phase of COVID-19. Glenn and The Flying Dutchman have once again, invited back Dr Leong Hoe Nam, Infectious Disease Specialist, for more answers. Find out more!

Dr Leong Hoe Nam visiting ONE FM's Glenn and The Flying Dutchman on March 4, 2020. The team showing an example of the "Hand On Your Heart" declaration. 

"Hand On Your Heart" Episode with Glenn and The Flying Dutchman
Interview with Dr Leong Hoe Nam, Infectious Disease Specialist from Mount Elizabeth Hospital, Rophi Clinic on 4 March 2020.

[See related episode on 15 April]

Transcript

[00:01:02] Glenn & The Flying Dutchman: It’s been over a month now, since we last saw you. What is the situation right now?

[00:01:09] Dr Leong: We’ve gone into what I call, the “third phase” of it. The first phase is where the Chinese come over to Singapore. So the original ones from China, from Wuhan, comes over and infects. The second phase is when the Chinese starts presenting themselves or starts infecting the local people. And local people start infecting local people. The good news is that because of what you have done, Singapore, because of what you have done as a nation, we have actually blocked it off, and we are into third phase now, where we have guerrillas attack. Guerrilla attack coming in where sudden people who have traveled to countries where active transmission is now, such as Italy, Iran, Korea, Japan then they will bring the case in. We cannot recognize that because it will come through the fever screeners, and they will develop fever later on and they fall sick later on, and thereafter they pass it on. So this is the third phase, I’m not so worried about the local people. I'm more worried about foreigners who comes in, who fall sick, they do not know how we look after ourselves and how to prevent ourselves from falling sick, and we have tiny cases here and there. 

[00:02:19] Glenn: So you’ve coined the term, “Your Face Is Sacred”. And now we were talking earlier on, you have a COVID-19 declaration that you would like to introduce! 

[00:02:30] Dr Leong: The COVID-19 declaration is actually quite simple. I want to shout out first to a few people. Jacob Neo - from FFPS, from Fairfield Primary School. I love your video, I love your song. I also want to shout out to [the] Raffles Institution student. He was the one who fell sick with  COVID. But he did the right thing. He is what I would call  the model student. He was sick but he didn't go to school. So that's the declaration which we want to do in future. Everyone who is sick and not feeling well, you are feeling under the weather, you don't go to school. We are going to show a little bit on how we're going to do later. So the Raffles Institution student, to me, you are my model student, you didn't go to school when you're sick. That’s the more though, all of us adults, all of us in Singapore, or even foreigners should do it. If you’re sick, you’re not feeling well, you have a fever, cough, or you feel unwell. Don't go into work, because you might be carrying COVID. Now the third thing I want to tell you is this. Unfortunately this trying time brings out the true intent of men. I see men and women who actually cower in front of COVID. I've seen children, I’ve seen adults, who actually stood out, and stood in line with the healthcare workers with us like a shield wall. And I’ve seen men, women and children who really help everyone, stand in line and hold the shield wall really tight and good. And know what do they call themselves? They call themselves Singaporeans. To all those people who have been helping and pushing out for everyone, I salute you, you have my full respect. 

[00:04:32] FD: So, what are some of the difficult challenges that we’ve had to face so far? 

[00:04:38] Dr Leong: One of the difficult changes which we have is actually contact tracing. The better you have in contact tracing the more likely you can control the epidemic. The scientists have done the modelling, if your contact tracing is at least 80% and above, then we can actually make a difference in the epidemic. If you look at Singapore, Singapore spared no effort in tracing all these people. And they wanted to catch simply as many as them as possible. But our problem is - my memory - I can't remember where I’ve been to in the last 3-5 days! Think about it, what did you do, who did you meet, what did you eat, I can't remember what I ate 2 days ago, let alone the people I met 5 days ago. With that, it becomes a limitation of contact tracing. If we don't get to know everyone whom we came in contact with, then we’re in trouble! Because I could sit next to anyone, you 3 guys, for lunch, and I forgot about it, I forgot to mention it. And mind you, this is under stress. You’re distressed, how can you even remember that?

The question then is, can we make some way of remembering it? Could we use technology to help us remember all these things? Could we actually use - when you enter a meeting, you write down where you’ve been to and the places, who's attending and where you attended the meeting - so that you can know who was there, and who you could possibly pass the infection to. One of the things which you look at is the phone. And if you think about it, the significant contact is 2 metres. With 2 metres, and you have exposure for more than half an hour, 30 minutes is significant. So is there anything on our phones that we carry with us, that detects something with 3 metres or 2 metres. The answer is there is! There is Bluetooth technology. Bluetooth technology, at this point in time, my Bluetooth is on. It’s trying to talk to your Bluetooth phone, and they’re trying to see if they ever have the handshake before. So that little bit of engagement could actually potentially share information and say “Hey I have come in contact with FD, I’ve come in contact with Glenn, come in contact with anybody else in this room”. So if you think about it, then I don't really have to remember where I really went, and I don't need to. All I need to know is who did I meet, or come into contact with. And it could be the very person you've been sitting next to on the train, or the bus, and you're commuting for the last 30 minutes, and the person could actually be the one you could actually transmit the infection to. Now I'm not the technologist, and certainly not an entrepreneur. I'm going to ask the technologists out there, can you do something about it? Where the Bluetooth, when you shake the handle, could they actually communicate such that they find out who’s in contact with whom. 

[00:09:08] FD: Dr Leong, we were also talking about when people go to clinics, sometimes they don't have the typical symptoms. 

[00:09:15] Dr Leong: You're right - at the very, very beginning, you have what you call the prodromal symptoms, before it comes. You know something is not right, there’s a bit of muscle ache, a bit under the weather, you may have a fever but you may not have the cough yet. So when you suspect you have COVID, you may not have the full house cards of symptoms. So just simply, feeling unwell and having fever, that alone may be the presenting symptoms of COVID. Remember, fever happens in about 80% of the people, and cough happens in 60% of the people. So in some of those patients who we’ve seen, they would end up with these symptoms, see 2 or 3 doctors, eventually they get tested, and they are positive. So what does this it mean to you? We can't tell between COVID and the regular cold. So if I can't tell then I do not know if I am a perpetrator of this virus. If I can't tell I am a perpetrator of the virus, the moment I feel a bit under the weather, I don’t go in to work. When I don’t go in to work, I am going to do Singapore a one-up. Because I am going to prevent a transmission. Better be safe. So if you feel under the weather, you have a fever, or you just feel not well, don’t go in to work. Put on your mask, go and see your doctor. And get your doctor to check you up. If they can't find any symptoms at all, that’s fine. Ask for MC 5 days. MC 5 days - you stay at home and what happens is, your symptoms will progress. If you get your dry cough next, or some of your acquaintance had COVID, then go back to your doctor and say something’s not quite right, could this be COVID. Then you might be sent in for testing etc. During this time, take your mask, you don't want to spread the infection to anybody else. When you do this, you are making COVID go kaput, because you prevent the transmission to other people. No doubt you can end up transmitting within your family. But because it’s within the family, it stays within the family, you’re going to not add huge numbers to the Singapore list.  

[00:11:28] FD: What's this thing I hear about, because you mentioned you go and see doctors, I’ve heard that we should try to go back and see the same doctor. Is that correct?

[00:11:37] Dr Leong: Yes, because the same doctor would have recorded down your symptoms, and would have noted the progress, and seen that you're getting worse, then we’re to do something about this. Also, for the record, we have a little bit of a dengue outbreak. There are a lot of dengue cases now. So your symptoms which you have, might still be dengue too, and it presents very similarly - feeling unwell, fever, and some of them do get a cough. 

[00:12:02] Andre: Last month when you came, you said that the test can be very costly. After a month, do we have a new test that can diagnose COVID earlier, and faster, and cheaper?

[00:12:16] Dr Leong: At this point in time, no. They’re still relying on what we call, a nucleic acid amplification, or PCR. That unfortunately is still costly. If you add in the manpower etc, and the usual cost of doing business, it would easily cost $100 to $200. 

[00:12:32] Andre: Because in South Korea, they have this new system, it’s like a drive-thru. How does that work?

[00:12:39] Dr Leong: Yes, so it will be exactly the same, they still use PCR, so you drive through then you swab and then send it in for testing. Your name gets recorded and if it turns out to be positive, then you get signalled out and then you quarantine yourself and then get medical treatment and etc - so that's good. Because the person doesn't really need to see a doctor. The person is confined within the own car. So the risk of transmission is nothing, and I thought it’s very innovative. But it is labour intensive, because someone needs to swab, and the person who swab shouldn’t be spreading the infection to anybody else. 

[00:13:17] Glenn: Now doctor, you’re talking about the third wave. We’re now into the third wave of the virus. What does that mean? 

[00:13:22] Dr Leong: It means that if cases were to appear suddenly unexplained, we would have no idea whom I came in contact with, and they will come. But the good news is, these numbers are very few and very infrequent - one or two, one or two. You will not have any epidemiological links, which means I may not have visited the Wiz link, I would have visited the medicinal hall, equivalent. And you would just simply fall sick. So think instead that as long as I am sick, I may be. 

[00:14:57] FD: Dr Leong, while we were on Facebook you mentioned something - the fact that we have zero mortality rate, but everywhere else around the world, to put bluntly - people are dying. What is it? Is it our system? Is it our people? Is it our diet? What is it?

[00:15:19] Dr Leong: The reason is that we have an excellent team of doctors. Remember, Singapore is a referral centre for all the doctors, all the patients around the region. All the way to India, to the north, to even Taiwan and China, right down south. But, I think it is very, very important to understand that the hospitals are not overloaded at this point in time. The government did the right step, they decanted. If you’re not emergency - get out, get out, get out - so you actually have free beds, and a lot of free doctors, who have a lot more time and thought on how to manage this disease, and so far they are doing a great, great job. So a shout out to my NCID colleagues, a shout out to all the doctors who are looking after, all the healthcare workers, as well as nurses, thank you very much for looking after them so well. 

The hospitals are really the flagships. Everyone who is interested in wars, you realise [hospitals] are like the aircrafts carriers which the country send out to, and you cannot afford to let them fall. If you fall, it is a major disaster for your battle. So at the same time, when you actually go out for this aircraft carrier, you have all your Figuarts and Destroyers that will surround, so that the Pedos don't come. Who are the Destroyers, who are the Figuarts that are protecting the hospitals, these would be the GPs. I shout out to the GPs, to my colleagues, of holding the fort and trying to sieve out the cases, what's real, what’s unreal. So when you are sick, you should go and see your GP first and you will do your first screening. Yes they may get hit, but so far, my GPs were fabulous. No one fell sick! So GPs are doing a fabulous job. So they will do the first screenings and if they are not well, then the patients are not well, they refer in. Remember they have the PHPC clinics now? These clinics offer subsidized care. So they can see it’s a centralized fever, they have all the protective equipment ready. We have been planning for this since 2003, the days of SARS. So all the old textbooks, the manuals all come out. And we are doing this. GPs - they are protecting Figuarts and Destroyers, and the hospitals cannot be overloaded. 

The scenario in which you have in China and Wuhan was that they didn't have a good network of GPs at the start, and they didn't trust the GPs. In fact they only have about  60,000 GPs for 1.3 billion people. That's crazy mathematics. In Singapore, we have a good network of GPs, very well-trained. And they were there feeding and they will protect the aircraft carriers, which are the hospitals. Hospitals - as long as they are not overloaded - we are going to hit very low mortality. We are going to show the world we’re united Singapore where everyone cooperates together and looks after, I look after your back, you look after my back, we can actually go through this. And guess what? Not only are we seeing it for ourselves, the banks are seeing it. Morgan Stanley actually issued a buy call. Can you imagine? Buy Singapore stocks, 2 days ago. Why? Because Singapore is doing it right, and Singapore will come out. And when this whole COVID goes kaput, Singapore is going to emerge the first economy to be ready, to take on the new wave, and we’re going to get out of this recession. 

[00:19:04] FD: Our Minister of National Development, Lawrence Wong has come out and said that we need to be mentally prepared for a spike in cases. This was in the Straits Times this morning, what are your thoughts on that? 

[00:19:15] Dr Leong: That's psychological warfare, and he's doing it right, he's playing psychological defence. There will be little clusters of cases that appear, and when the clusters appear, then we realise that the transmission have occurred. How did the transmission occur? Probably from the traveller that went past the system, wasn't aware that they could report sick or see a doctor, and then transmit it to a few people. We need to be on a lookout, again, the same rule applies. If you’re sick, don't go in to work. Don't meet anyone. Stay at home. If you do end up going to meet anyone, please let the other people know that you returned unwell, and get them checked out if they have COVID. In fact, if you go into any meetings, you should go into the meetings in declaring “I am not going to be a perpetrator of COVID, I am coming in clean”. So one of the things which I came up with, if I'm going to try and demonstrate a bit -  fingers peace [sign], to your heart, hand to my heart I have no fever, I have no cough, I don't feel unwell, and I give you love, because I am coming into the meeting without spreading any infection. 

[00:20:49] Glenn: A question that everyone’s asking, because of a recent case, a woman had COVID-19, and then she was discharged, and then they found out that she had contracted it again. 

[00:25:07] Dr Leong: The historians will come back and look at each and everyone at the cities, did we do it right? Did we do it the Singapore way where we actively trace? Just a recap, China and Wuhan alone has 50,000 contact tracers for 11 million people. Second question which we ask, did you do a Wuhan lockdown in your city? Unfortunately, history will judge each and every one of the city. Singapore, you guys are doing a great job now. So we have to keep our streak clean, which means is, we have to carry on living life. The phrase we got was, COVID will one day pass on, and our lives will simply go on. We have to keep the economy going, which means we will have to carry on working. To those people who are in the tourist industries, they have been hit very badly. What they have done is what I salute them for - temperature screeners and those people are taking on different jobs, you are repurposing, you are adapting. You are really the real fighter, one who knows the situation and changes accordingly. My shout out to you, my salute to you. You are living on. You are not letting COVID push you down. And that’s the motto which we will have to do from now on. When things don’t work right, we repurpose, we readapt. Indeed this radio station has adapted so as to cope with COVID.

Second thing, we need to have our hands ready. The concept is this, I am a doctor. My most powerful weapon is a pen or a stethoscope, so I will hold a pen or stethoscope in my hand, because I have to keep working. But at the same time, my other hand is ready - a shield, clean hands. In the yesterdays about 1,000 years ago, you literally be - one hand having a hole as you dig into the ground, or you could be building a wall, or a house, the next hand is your sword or your spear, because your enemies will come and hit you anytime. That's the mentality which you have - clean hand in one, pen or work in the other. We keep Singapore safe, and yet we keep the economy going. If you feel sorry for yourself, then you are actually giving a one-up for the virus. Go out. The best thing to do is, look out for the neighbours next to you. Is he feeling down? Get some food, you don't even need to be the person - give a phone call, knock on the door, encourage the person. That makes a major difference. 

[00:27:56] Glenn: But if you are staying at home for whatever reason, working from home, or stay home order, don't overeat. If you get obese, then that’s a problem. Obese people are at high risk. 

[00:28:15] Dr Leong: The obese peple are at high risk. Simply being obese if you have pneumonia, your risk is bad. So what does it mean? BMI more than 30. Weight divide by height squared, if more than 30 [BMI], you are at risk. How does obese people actually be at risk? You do this simple experiment - lie on the floor, get a 10kg sack of rice, put it on the chest, and try to breathe, try to cough. You’re going to have a hell of trouble, it’s going to be really difficult. So try doing it for 1 minute you’re fine, but by 10 minutes you’re really tired out. That's what happens - you have pneumonia in the lungs you can’t cough it out - the phlegm will stuck inside, it’s the gunk and the dirt and the evil poisons you. If you are obese, if your BMI is more than 30, think about exercising. You can just go out. Open is beautiful. you don't have to worry about the virus in your park. The park is great - the open air - the risk of transmission is practically zero. The risk of transmission in enclosed places like this where it’s cold [in the studio],  it’s cold, it’s dry. The virus transmits better. But out in the open, hot, humid Singapore, the virus goes kaput. Do your walks there, you keep 2 metres away. And you are fine. No virus will come to you. And chances of you meeting anyone for more than 30 minutes, almost kaput, so don't worry. Go to the park, go and exercise. Lose that kilograms, and gain a life.

[00:30:21] FD: So once you’ve got the virus, you’ve gone in, you done your quarantine, you come out of hospital, are you ok? Can you catch it again? Can you spread it?

[00:30:31] Dr Leong: So when the person comes out of an illness, before he's discharged they’re swabbed in the nose twice, to make sure the virus is no longer there. So it goes out into the community, and perfectly well. In China, there are reports of people who came out,  “fell sick” again, found to have a virus, so these people “have the infection” again. My honest truth, and the rest of the scientists in the world - no, we don't think that happens, once you have immunity to this virus, you can act like god, and walk around and no one can infect you. These people once they are discharged from Singapore, they are safe. 

[00:31:18] Glenn: Any news on the vaccine?

[00:31:20] Dr Leong: Vaccines - there are lots of videos circulating out there. Many researchers can design the vaccine now, in a matter of hours. Why? Because they have done it for MERS, they have done it for other viruses. What they will do is take out the cassette for MERS, and put in the COVID-19 or the SARS-CoV-2, but that's not the end of it. Because there’s the next trial on rats. After trying on rats, you need to show the rats survive and nothing happens, and if the rats can survive an infection, after that you need to try out on normal healthy human beings without any exposure. Then you need to try it on humans who are in the midst of an epidemic. This will not be in China. This would possibly be in Korea, or the next place where it strikes and show that the vaccine actually works.

This is the trials which the country has to go through. I know some president of some big country has insisted it will be ready in 2-3 months. Anthony Fauci, a man I truly respect, he heads the vaccine arm, he says “no way José, it’s going to take at least a year”. Now why is this important? There is a respiratory virus, called RSV, or respiratory syncytial virus. When they designed it, they worked it in a lab, in a test tube, it worked beautifully. But when they tried it on children, those people who had the vaccines, had it worse. So it doesn't mean that it works well in test tubes, or on rats, it will work well on us. Please let science go through its rigors. The FDA, Singapore HSA, will vet through all these and make sure they’re safe, before we actually get a vaccine. So please don’t depend on the vaccine. At this point in time, you depend instead on clean hands, depend instead on your working tool, and doing this together. You depend on “hand on your heart” as you go into the meeting, with no fever, no cough, - I’m not feeling sick - and you’re going to share your peace to the others.

 

Stay Safe. Stay Healthy.