Residents should not panic but should also not ease health precautions – Doctor

Doctor Jorge Sales Marques informed Macau News Agency (MNA) that, although the SAR has so far managed to avoid any new confirmed Covid-19 cases in the last two weeks, residents should keep up with the recommended health measures considering the high level of contagion of the novel pneumonia.

“As a Doctor, I have noticed that since last Friday people have been easing their precautions a little. We’re on the 14th day without new confirmed cases now, and this has led the whole population to end their ‘quarantine period’, but it is at this phase that new cases can occur”, he told MNA.

“We know that this virus is extremely contagious […] especially through spit droplets […]; some studies suggest it can also spread through faecal matter, but this has not yet been validated by the World Health Organisation. It is important that residents maintain their good habits of using masks, washing their hands and avoiding indoor locations.”

According to the health professional, Covid-19 is the second virus with the most cases of infection in the last 50 years, after H1N1 – known also as swine flu – which has infected around 1.6 million people since 2009.

“Some 80 percent of Covid-19’s DNA matches that of SARS [in 2003], it is eerily similar […] and in clinical terms this new virus matches a flu infection.”

However, the health practitioner also noted that, despite being so contagious, new pneumonia also shows one of the lowest mortality rates when compared with other epidemics.

“Only 25 percent of Covid-19 cases require hospital care, and the mortality rate is low – between 2 and 2.5 percent […], which is comparatively low when compared against SARS (9.6 per cent mortality rate), MERS (34 per cent), or H1N1 (17 per cent)”, Dr. Marques indicated.

“We also have to consider that the virus mostly affects elderly people over 60 years of age and who have chronic illnesses such as diabetes.”

A pediatrician, Dr. Marques is currently part of a medical ‘reserve’ team at the Conde S. Januario hospital who can be called for assistance for Covid-19, if needed.

According to Dr. Marques, local health authorities set up a frontline medical team – named the ‘Dirty Team’ – of 23 doctors and 60 nurses who are directly involved with the treatment of Covid-19 patients and suspected cases.

“[The team] works in a 14-days shift system. Usually, a doctor will work a 12-hour shift with a nurse working a 6-hour shift. During the 14 days, the team supports patients, conducts exams and collects samples. Afterwards, a different team takes over, with the doctors who were in contact with infected patients having to remain home in self-quarantine or in the hospital quarters if they have elders or family members with week immune systems at home.”

Currently, 100 rooms are available at the Conde S. Januario Hospital’s medical workers residence quarters.

The first confirmed case in Macau was reported on January 22, with the total number reaching 10 cases on February 4 – three locals and seven Hubei Province residents.

Since then, five confirmed patients have been discharged, with the remaining five people considered light-risk, stable cases.

“Luckily [all 10 cases] were not serious cases. They did not require breathing assistance or anything like that”, he expressed.

The long way back home

Dr. Marques described to MNA the process in which suspected cases are identified and taken care of by local medical authorities.

“A suspected Covid-19 case involves fever, at least 38 degrees, sharp coughing, muscle pains, fatigue, and diarrhea, with at least three instances in the last 24 hours. If these symptoms can be associated with a history of having contact with other cases or a travel history to risk areas, we divide cases into three groups, high risk, middle risk, and low risk”, he stated.

The high-risk group includes people who have been in a region with a large number of cases, such as Hubei, in the last 14 days; someone who has been admitted in a medical institution in Mainland China; or someone who has had close contact with an infected patient for more than 30 minutes, with no protective gear.

The middle-risk group includes people with breathing issues or pneumonia, but with no close contact with a suspect case presenting symptoms; or maybe someone in a profession that involved contact with many people from Mainland China, such as hotel receptionists, casino workers or bus drivers.

“We carry out a test at the hospital’s Emergency Room special area. Middle- or low-risk patients are sent home, and if a positive result comes up we go and pick them up to be admitted to the hospital. In high-risk cases with negative outcomes, we have two procedures: if patients show no symptoms, we place them at the Alto de Coloane isolation center for 48 hours, after which they repeat the test. If it is negative, patients can be discharged but they are always followed by the Centre for Disease Control”, he added.

If patients have symptoms and test positive to the virus, they are admitted in two special units for infectious diseases at the Conde S. Januario Hospital, after which another test is conducted 48 hours later. If the outcome is still positive, then patients will need to remain in the hospital and receive treatment.

Treatment includes a chest X-Ray and two main antiviral medications administered for 14 days, Lipornavir and Riptonavir, which were also used successfully during the SARS outbreak.

“Patients will only be discharged when they do not show any more symptoms and test negative in at least two tests”, he added.

The lessons learned from SARS

Macau managed to overcome the SARS epidemic in 2003 almost unscathed, with only one suspected case reported. Although he was not in Macau at the time, Dr. Marques describes how the crisis led to changes being made to local epidemic prevention plans.

“Many things changed since SARS. First of all, we have a larger technical capacity for diagnosing this kind of virus. Secondly, we have many more medical support materials […]. Of course some mistakes were made at the time, but we have had more than enough time since then to learn and prepare to deal with new viruses like this one”, he added.

The health expert underlined that the number of medical personnel is currently sufficient and prepared to deal with the outbreak, with 250 beds still available for any future cases.

Health authorities now also know how important it is to recommend to the general public to maintain crucial habits such as using health masks, washing their hands and avoiding indoor locations with large gatherings of people.

“Personal hygiene is fundamental to avoid any infection, be it Covid-19 or any bacterial and viral infection”, he noted.

The Doctor then proceeded to describe the correct way to follow these crucial health prevention steps, which are all intertwined.

Hands should be thoroughly washed for at least 20 seconds, following certain steps such as washing the palms, backs, thumbs, fingertips, joints and fists.

Health masks also need to be used correctly, the blue side turned outwards and the white side turned to the mouth. If they are just white masks, the bendable area should completely seal the nose so as to not allow bacteria to enter.

“We should also avoid staying in areas with large gatherings of people, especially indoors, where health risks are higher. This virus is more easily spread if contact is made under 2 meters. Staying under one metre with someone not using any protection for at least 30 minutes, the risk of infection also increases”, Dr. Marques added.

“Following all preventive measures recommended by health authorities will be the only way to win this battle.”