CLINICAL MATTER

At long last, it is official. Covid-19 as a public health emergency in the Philippines is over. After more than three years of living in fear of the next surge in cases, the government has sounded the all-clear. This was not a surprising development since the World Health Organization (WHO) already declared this last May, and the Department of Health (DOH) had signaled that it was just a matter of time before our country followed suit. Moreover, the drawdown in restrictions has brought us to as near-normalcy as possible, notwithstanding the continued mask use among a cautious and prudent populace. Despite this seeming anti-climactic set-up, it was still cathartic for many people to see the actual document…well, screenshots of it anyway…in black and white and in bureaucratic legalese, proclaiming that we were moving on from a disaster that claimed so many lives and cost us so much. As the dust settled from the announcement and the euphoria surrounding it, the inevitable questions came thick and fast. Do we finally remove our masks? Do people exposed to Covid-19 and those who test positive still need to quarantine and isolate? The announcement stated that all previous proclamations made during the state of emergency were rescinded, except for the emergency use authorization for vaccines, which would remain valid for one year. Per the document itself, each government agency was enjoined to amend existing policies and promulgate new ones taking this into consideration. The health community was bombarded with questions very quickly and the DOH clarified that it was releasing updated guidelines. While the public health emergency is over, Covid-19 is still very much around. Aside from SARS-CoV-2, many respiratory viruses continue to circulate in the Philippines. Two of the most important lessons we learned during the pandemic were that vaccines and masks save lives. With these in mind, and in concurrence with the scientific experts, the DOH has modified the different recommendations on masking, quarantine, and isolation. These new guidelines reflect not just the increasing endemicity of Covid-19 but also the continued utility of public health standards in protecting Filipinos from respiratory illnesses. Should you keep your mask on? This is now a personal choice, although some places like hospitals can choose to retain masking through their Infection Prevention and Control Committees (IPCC). It is expected that most healthcare facilities will keep some form of masking at least in patient care areas. This will protect both doctors and patients not just from Covid-19 but also from the flu and other respiratory viruses that sick patients coming in for a checkup may harbor. What about other settings? Consider wearing a good quality mask as much as possible in these instances to prevent Covid-19, decrease the risk of transmission of other respiratory viruses, and to protect the most vulnerable: 1. If you have any cough or cold symptoms, wear a mask around other people for at least 10 days from the start of symptoms, and keep masking for as long as you still have symptoms. 2. If you were recently exposed to someone with cough or cold symptoms, whether they tested positive for Covid-19 or not, wear a mask around other people for at least 10 days from the time exposure. 3. If you are elderly, have comorbid conditions, or are immunocompromised, wear a mask when around other people, especially indoors. 4. If you have not been fully vaccinated against Covid-19, wearing a mask around other people is strongly recommended, especially when Covid-19 cases are on the rise. 5. Wear a mask when visiting a hospital or a clinic. Some hospitals may require this and so you might not be allowed to enter without a mask. 6. Wear a mask whenever flu or Covid cases are on the rise. 7. Consider wearing a mask whenever it becomes crowded, especially indoors. 8. If you live with elderly or immunocompromised people, wearing a mask around them can significantly decrease their risk of getting seriously ill. This list is not exhaustive, and the risk can vary considerably based on individual circumstances. Remember that lifting the mask mandate doesn’t mean we don’t wear masks. It just means we are free to judge when they will be most useful. Just like seat belts are used in cars to guard against a catastrophe, masks can increase our protection against infectious diseases. What about quarantine and isolation? To review, quarantine is a period of seclusion you observe when you are exposed to someone who is sick, while isolation is something you do when you are sick and/or symptomatic. Since most people are now fully vaccinated, the distinction between protocols for vaccinated and unvaccinated persons has been removed for simplicity: 1. If you were exposed to someone with confirmed Covid-19 or with Covid-19 symptoms, there is no need to quarantine. Wearing a mask for 10 days from the time of exposure is recommended. 2. If you test positive and are asymptomatic, isolate for five days from the date of the positive test and continue wearing a mask for 10 days. 3. If you test positive and have mild symptoms (cough, colds, low grade fever) and do not have any comorbid conditions, isolate for at least five days and wear a mask for 10 days. As long as the symptoms are improving and you have no fever for 24 hours without having to use paracetamol or other anti-fever medication on the fifth day, you can end isolation. Extend isolation and see a doctor if your symptoms get worse or if the fever does not go away after the fifth day. Wear a mask beyond 10 days if your symptoms are not completely gone yet. 4. If you have moderate disease, contact a doctor in case you need to take antivirals. Moderate disease is either mild symptoms in a patient with comorbid conditions, or pneumonia in someone without comorbid conditions. If you think you may have something more than mild Covid-19 or if you have comorbid conditions, talk to your doctor as soon as possible. If you are diagnosed to have moderate disease, isolate for at least 10 days or until your doctor tells you it is safe. Wear a mask for at least 10 days, or longer if your symptoms haven’t disappeared by then. 5. Patients with severe Covid-19 belong in the hospital. Severe Covid-19 is when you have a hard time breathing and your blood oxygen level goes below 94 percent. Your doctor will determine when it will be safe to stop isolation, but it will be at least 10 days from start of symptoms. In immunosuppressed patients, your doctor may order a repeat test prior to stopping isolation. Wear your mask for at least 10 days after you have recovered. Covid-19 isn’t gone but we’ve transformed it into a more manageable disease. The new guidelines reflect the diminished impact it now has on our lives. We’ve survived, but there are still those among us who can get hurt badly not just by Covid-19 but other communicable diseases. If there is a silver lining to the pandemic, it is that we now have many more weapons to fight infectious diseases. Let’s keep using them to save lives.