As the Covid-19 pandemic transitions into endemicity, it is important to remember the lessons of how a tiny microbe can wreak so much havoc. With nearly seven million confirmed deaths and perhaps more than double that in unconfirmed ones, SARS-CoV-2 has taken an immense and bloody toll on humanity.
In addition, it has had a catastrophic impact on long-term health, mental well-being, and the economy. Even as we celebrate the lifting of the pandemic emergency, the seeds of the next pandemic are already scattered and sown. It is not a question of if, but when.
So, what’s the best way to protect ourselves from respiratory viruses? Same way we protected each other from Covid-19—the PDITR strategy, which stands for prevention, detection, isolation, treatment, and reintegration. Put another way: Wear a mask, vaccinate, stay home if you are sick, and talk to your doctor. The application of these measures is not as draconian as that of Covid-19, but will have a significant impact on influenza, (endemic) Covid-19, and other respiratory viruses moving forward.
One major intervention that has finally been scientifically proven is the efficacy of masks in preventing infection. It is ironic that now that we have an effective intervention, it is also when most people just want to get rid of their masks and no longer test for illness. Viruses such as influenza and SARS-CoV-2 don’t stand still. They constantly mutate and the more hosts they infect, the more likely they are to stumble onto a serendipitous mutation that can make them more transmissible or deadly.
During the pandemic, there was a lot of acrimony regarding which mask was most effective. We now know that any mask is better than no mask at all. N95 respirators remain the best for preventing infection, but even surgical masks when worn consistently and correctly can approximate the protection of higher quality respirators. We now also know that aside from Covid-19, these masks work to prevent other respiratory diseases, including influenza and the common cold.
The original (or “OG” as young people say nowadays) pandemic organism—influenza—is already starting to make its appearance this year. Thanks to the wider availability of molecular testing, it is now easier than ever to check if someone has the flu. I’ve had three patients in the hospital test positive for influenza A while undergoing a respiratory panel test to check for Covid-19 this week alone. One patient has already died and I believe that his concurrent influenza infection made his prognosis worse. All these patients tested negative for Covid-19, the suspicion for which was the reason they underwent testing in the first place.
This is why the US CDC is encouraging multiplex (multiple organisms at a time) testing based on the presence of symptoms. A cold and a fever can be from any respiratory virus. Whether it is a coronavirus or an influenza virus, it is important to track small outbreaks like these since they can represent the tip of the iceberg of ongoing community transmission.
Multiplex molecular testing also helps us avoid the unnecessary use of antimicrobials since it tells us what specific virus is causing an illness and some multiplex tests can concurrently test for common bacteria that cause pneumonia.
For instance, a positive influenza A test and a negative Covid-19 test means we can confidently do away with molnupiravir or nirmatrelvir-ritonavir (Paxlovid) and use oseltamivir instead. A positive influenza A test can explain a high fever in someone with respiratory symptoms and a doctor is less likely to prescribe antibiotics, unless there are other indications of bacterial infection.
Unfortunately, molecular testing remains expensive and needs a sophisticated laboratory to run the tests. Perhaps multiplex antigen testing, which is much cheaper and easier to perform, will be the next innovation. We already have separate Covid-19 antigen and influenza antigen tests but understandably not very many people want their noses poked twice. With hope, the diagnostics revolution that Covid-19 inadvertently forced upon us bears fruit downstream and rapid testing will become affordable and ubiquitous for all manner of respiratory pathogens.
The unprecedented vaccination campaign for Covid-19 has opened our eyes to just how important vaccination is not just for children but for the adult population as well. Yearly influenza vaccination has never been popular in the Philippines, but the data backing up its benefits is very solid. Like Covid-19 vaccines, influenza vaccination isn’t very good at interrupting transmission or preventing illness. But similar to our Covid-19 vaccines, influenza vaccination is very effective at preventing severe disease, especially in the most vulnerable. Influenza vaccination can decrease the risk of an elderly person ending up in the ICU by over 70 percent.
Other adult illnesses like pneumococcal pneumonia and herpes zoster are likewise vaccine-preventable and we should all take advantage of these vaccines to safeguard our health. Bivalent Covid-19 vaccines are already being rolled out and those who qualify should avail of these as soon as possible. Further Covid-19 boosters downstream are still up in the air but it is important to stay up to date on these by talking to your doctor.
Quarantine and isolation were among the least popular measures during the pandemic. In fact, many people nowadays are not testing for Covid-19 because they know they’ll be obliged to isolate.
In general, if someone has respiratory symptoms, it is prudent to isolate at home for a few days if possible to prevent the spread of infection. Even if a test isn’t done, wearing a mask if you have recently been sick can help mitigate viral transmission, whether it is Covid-19, influenza, or something else. “Reverse isolation” of vulnerable household members along with masking can also help mitigate severe disease among the elderly and the immunocompromised.
As Covid-19 becomes just one of many respiratory viruses circulating in the community, it is prudent to mitigate the impact of these pathogens by repurposing the tools that worked so well during the pandemic. This will go a long way toward decreasing the risk of community outbreaks of not just Covid-19 but also of influenza and other viruses of pandemic potential.
But since we are no longer living in a health emergency, the government is no longer requiring adherence to minimum public health standards. It will have to be a personal choice to protect yourself and to protect others with the choices we make on a day-to-day basis.
With hope, we all make the right choice.
From left to right: Former presidents Joseph Estrada, Gloria Macapaga-Arroyo, and Rodrigo Duterte (Wikipedia, Rep. Arroyo's office, Malacañang photo)
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