Education＆ScienceWebinars
UPDATE ON COVID-19 SITUATION IN ASIA-PACIFIC REGION (2)
Wednesday 29 April 2020
- 20:00 UTC+9
Each expert on the panel gave a 10-minute presentation on the situation in their country/region, and responded to participants' questions.
Thank you to everyone in the large audience for participating. The questions and some responses can be seen below.
Presenter's slides are available and you can also see a video recording at youtu.be/7PEfxLxFGVc.
Programme
Dr Yoichi Nakanishi
APSR President
Opening remarks
Japan
Dr Rongchang Chen
Director, Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital
Former Director, Guangzhou Institute of Respiratory Health
Past President of Chinese Thoracic Society
China
Dr Camilo C Roa
Professor, University of the Philippines, Manila
Global Governor, American College of Chest Physicians
President, Philippine Tuberculosis Society, Incorporated
Fellow and Past President, Philippine College of Chest Physicians
Member, Technical Advisory Group, WHO Western Pacific Region
Philippines
Dr Raymond Liu
Senior Medical Officer, Department of Medicine & Geriatric, Ruttonjee Hospital, HK
Infection Control Co-ordinator, Infection Control Committee, Ruttonjee Hospital
Past Infection Control Officer, Infection Control Committee, Ruttonjee Hospital
Hong Kong
Dr Fusun Oner Eyuboglu
Professor, Division of Pulmonary Diseases, Baskent University Faculty of Medicine, Ankara
Member of COVID-19 Advisory Committee of Ministry of Health of Turkey
Representative of Turkish Thoracic Society
Turkey
Dr Young-Jae Cho
Professor, Division of Pulmonary and Critical Care Medicine
Department of Internal Medicine, Seoul National University Bundang Hospital
Director of Fellowship training programme of Critical Care Medicine;
Republic of Korea
Dr Ser Hon Puah
Consultant Respiratory Physician and Intensivist working in the Respiratory and Critical Care Medicine Department in Tan Tock Seng Hospital
Programme Director for the National Health Group Respiratory Medicine Residency Programme
Deputy Clinical Director for the Respiratory Therapist Services in Tan Tock Seng Hospital
Singapore
Dr Arata Azuma
Chair of the APSR Education Committee
Questions for panelists and their responses
Current situation of Clinical management for COVID-19.
Dr Fusun Oner Eyuboglu (Turkey) responds:
Early start of antiviral treatment is effective to reduce ICU need.
How will COVID 19 end eventually?
Dr Fusun Oner Eyuboglu (Turkey) responds:
The outbreak may have several peaks until development of vaccine.
Management of severe covid
Dr Fusun Oner Eyuboglu (Turkey) responds:
Adequate MV support and ARDS treatment
May i ask for current sharing state of pulmonary rehabilitation during pandemic for covid patient in APSR country member?
Dr Ser Hon Puah (Singapore) responds:
We are beginning to prescribe physiotherapy sessions within ICU itself and post discharge to the ward as some patients can remain symptomatic and have presence of exertional desaturation.
Dr Fusun Oner Eyuboglu (Turkey) responds:
pulmonary rehab is significant particularly in patients with severe pneumonia to avoid pulmonary fibrosis
Role of small airway in atypical ARDS in COVID 19?
Dr Camilo C Roa (Philippines) responds:
probably minimal as dynamic hyperinflation is not a common feature in the respiratory failure phenotype of COVID-19. It adds to the complexity of ventilatory strategy among COPD patients with sticken with COVID-19.
Dr Fusun Oner Eyuboglu (Turkey) responds:
preexisting small airway obstruction worsens in COVID
Time required for vaccine to hit Asian market in current scenario?
Dr Fusun Oner Eyuboglu (Turkey) responds:
Not sooner than a year
Status of concept of Herd immunity considering the fact that COVID cured are getting reinfected?
Dr Fusun Oner Eyuboglu (Turkey) responds:
It would take years for a high population country to get herd immunity
Whats now the exact mortality rate (is it still 3%) after China corrected its data?
Dr Ser Hon Puah (Singapore) responds:
This will likely vary around the world depending on the country’s resources.
Dr Fusun Oner Eyuboglu (Turkey) responds:
Chineese colleauges would reply this
what clinical trials are being conducted in Asia in Stage 1 COVID-19 when patients are just in home isolation
Dr Fusun Oner Eyuboglu (Turkey) responds:
so far in Turkey cohort studies between the isolated and nonisolated group will start soon
What’s the best practices in addressing respiratory failure among Covid patients?
Dr Ser Hon Puah (Singapore) responds:
I don’t think there are any “best” practices. We just advise for early proning even before intubation. Once intubated, to follow as per ARDS protocol.
Dr Fusun Oner Eyuboglu (Turkey) responds:
Q is not clear
When can I expect COVID-19 vaccine?
This point was discussed during the webinar.Please see YouTube youtu.be/7PEfxLxFGVc.
What clinical trials are being undertaken in Asia for patients with stage 1 COVID-19 disease ie. in home isolation
Dr Fusun Oner Eyuboglu (Turkey) responds:
No idea
Covid19 virus looks like combination beetween virus Corona and HIV, is it true?
Dr Fusun Oner Eyuboglu (Turkey) responds:
not that similar
Virus mutation
Dr Fusun Oner Eyuboglu (Turkey) responds:
several mutations is repoted
Need information about pulmonary rehabilitation in covid management. Sharing expertise in the APSR country member
Dr Fusun Oner Eyuboglu (Turkey) responds:
pulmonary rehab is important after hospitalization
How to treatment COVID19 patient
Dr Fusun Oner Eyuboglu (Turkey) responds:
early start of HCQ, faviparvir, remdesivir, anticoagulant treatment,high flow oksigen and prone position seems significant factors of treatment outcome
How do you think about the movement of econmy ignoring present situation of the coronavirus pandemic?
Dr Camilo C Roa (Philippines) responds:
After the lockdown has reduced the number of infected cases, going back to work with mitigation measures like social distancing, use of mask in public places, compulsive hand washing and test-contact trace-isolate should be done to revive the economy.
Dr Fusun Oner Eyuboglu (Turkey) responds:
Very difficult to ignore
ⅰ. How should health care workers protect themselves at work against Corona virus infection?
ⅱ. How should asymptomatic patients with COVID-19 be handled? should there be at home (self isolation) or quarantined in a health facility?
ⅲ. How should health care workers who have come in contact with a patient with COVID-19 be handled?
Dr Ser Hon Puah (Singapore) responds:
In Singapore, we isolate all positive patients and we treat all health care workers similar to all patients. Contact tracing will occur after that.
Dr Fusun Oner Eyuboglu (Turkey) responds:
Healt careworkers should wear adequate PPE
What is characteritics fo clinical data about asymptomatic cases?
Dr Fusun Oner Eyuboglu (Turkey) responds:
Not so much is known
I’d like to know coagulopathy of Covid-19.
Dr Fusun Oner Eyuboglu (Turkey) responds:
satartin anticoagulant treatment is very important to reducearterial and venous thrombosis
How do you find out the infection rate in asymptomatic carriers?
Dr Fusun Oner Eyuboglu (Turkey) responds:
not a lot known I guess
What about reinfection????
Dr Fusun Oner Eyuboglu (Turkey) responds:
Immunity after covıd would be protective sor some time
if patient is asymptomatic, for those asymptomatic patient, will you offer treatment for them or just to obseve?
Dr Camilo C Roa (Philippines) responds:
just observe
Dr Fusun Oner Eyuboglu (Turkey) responds:
I would offer and see weather they become negative
prof Roa- what may be the indicators that we are beginning to turn the pandemic around?
Dr Camilo C Roa (Philippines) responds:
When the global number of cases no longer overwhelms the county’s health capacity and when there is consistent down trending of the test positivity rate (% of the total tested), case fatality rate and the reproductive number of the infection trnsmision is R0 < 1, then the pandemic is deemed to have turned around. The disease however, may still show localized outbreaks but there are much less in number and more mangeable. The infection can go on for years as a “seasonal” disease for decades until it is finally decimated either by herd immunity, widespread vacination or the occurence of another organism (like H2N2 in 1957) that can become the next dominant infection of the very host of the circulating residual H1N1 of Spanish flu (this is how H1N1 totally disappeared).
medicatiins are all “experimental” at this point. What do you think worked among survivors? were we just buying time for their immune system to just recover and clear the virus?
Dr Camilo C Roa (Philippines) responds:
yes
Dr Fusun Oner Eyuboglu (Turkey) responds:
I agree
Does any one have experience of Isothermal amplification testing for antigen detection and does it have any false negativity (RT PCR …25% false negativity)
Dr Fusun Oner Eyuboglu (Turkey) responds:
We have no experience about that
Do we should give medicine for asymptomatic patients?
Dr Camilo C Roa (Philippines) responds:
no
Dr Fusun Oner Eyuboglu (Turkey) responds:
I would start end see the result
I get to know trace measures to infected patients by using mobile device in Korea. What kind of problem about private data is there? Is there concern about using private data to another purpuse?
Dr Fusun Oner Eyuboglu (Turkey) responds:
I have no idea
When you use hfnc does the patient need to be in a negative pressure room?
Dr Camilo C Roa (Philippines) responds:
ideally
Dr Ser Hon Puah (Singapore) responds:
In Singapore, we isolate all positive patients and we treat all health care workers similar to all patients. Contact tracing will occur after that.
Dr Fusun Oner Eyuboglu (Turkey) responds:
It is recommended
Dear Dr. Young Jae Cho, how about pulmonary rehabilitation for covid in korea?
(No reponse yet)
What’s the Experience of treatment with convalescent serum? Is there any cut off values of neutralising antibodies??
Dr Fusun Oner Eyuboglu (Turkey) responds:
So far in Turkey cit is not promising.
When caluculating motality rate, apropriate denominater should be used. I think the denominator of total infections cases before 14 day adapt to death cases. How about this?
Dr Camilo C Roa (Philippines) responds:
yes, case fatality rate
Dr Fusun Oner Eyuboglu (Turkey) responds:
Definitely right. Cases should include definite and possible ones who received treatment.
do you perform angioscan to seek for pulmonary embolism
Dr Ser Hon Puah (Singapore) responds:
We have performed a few pulmonary angiograms for patients with persistent or profound hypoxemia. We think there is a role.
Dr Fusun Oner Eyuboglu (Turkey) responds:
when suspected yes
Does anyone have experience of using NIV with HELMET interface?
Dr Ser Hon Puah (Singapore) responds:
Not for us. None of our patients received NIV.
Dr Fusun Oner Eyuboglu (Turkey) responds:
No
Why you do not use methylprednisolon for ARDS patients?
Dr Ser Hon Puah (Singapore) responds:
Currently due to the lack of convincing evidence.
Dr Fusun Oner Eyuboglu (Turkey) responds:
ICU specialists would answer this Q