Let’s Talk About COVID-19 With Dr. Kathleen Modina

While the COVID-19 pandemic rages on with no signs of abating, the public continues to suffer its debilitating effects both to their minds and bodies. That’s why Philippine Primer asked Dr. Kathleen Modina to answer the most frequently asked questions and debunk misconceptions about the virus, hoping it will help disseminate indispensable information to the Filipino people as they continue living their lives in the new normal.

Dr. Kathleen Modina

What is COVID-19 and its symptoms?

COVID-19 is an influenza-like illness that manifests as a respiratory disease, but actually attacks your circulatory system. Lots of people recently during the pandemic who suffered from strokes and heart attacks also had COVID-19 and there are studies linking these two diseases together. Someone who has difficulty breathing, cough, cold, sore throat, slight fever, body weakness, diarrhea to a rare extent, is vomiting, or lost their sense of smell is already a COVID-19 suspect. Any symptoms similar to a cold or influenza is COVID-19 until proven otherwise. Aside from that, it can also mimic lots of medical conditions: strokes, heart attacks, among others.

What are the differences between mild, moderate, severe, and critical cases?

When you say mild category, patients just experience mild symptoms like cough, colds, some fever but breathing is not compromised and there is no evidence of pneumonia on x-ray. In the moderate category, patients have pneumonia on x-ray and must be hospitalized so they can be monitored for the sudden worsening progression of the disease.

However, if you are over 60, have underlying medical conditions, or obese, and tests positive for COVID-19, you will have a greater chance to develop severe coronavirus symptoms. Severe COVID-19 is classified as follows: A patient under this classification has very low level of oxygen or chronic diseases that cannot be controlled. Just like in moderate cases, infected persons need to be confined in a hospital too.

Why is this important? Because days 7-10 is the critical period when monitoring COVID-19 patients. During this time, if someone’s condition worsens, they will be consequently placed under the last category: the critical case. The COVID-19 death rate for healthy people is less than 1%, while the overall death rate is less than 2%. Senior citizens have a death rate of 10%. If someone has severe COVID-19 and intubated, the death rate rises to more than 40%.

How do you treat patients with COVID-19?

For mild cases, patients just need to self-quarantine at home if they are able to. If you’re a moderate COVID-19 patient, we’ll have you admitted in a hospital, where you’ll undergo a lot of tests to monitor your condition. If you have severe COVID-19 symptoms, you’ll be automatically confined in the intensive care unit (ICU), where you’ll be monitored extensively. We also offer these patient experimental drugs for compassionate use since there’s no known cure for this condition yet. 

What are the different kinds of tests used to detect the virus?

The standard test for detecting COVID-19 is called RT-PCR test. Ideally, you’ll be swabbed in the nose and the throat, you put the samples in a machine that copies the virus for 30, 40 cycles. If the sample goes past 30 cycles of amplification, it means the patient doesn’t have an infection. Otherwise, the patient is most likely infected.

The next one is the antigen swab test. It’s a kind of test where a sample will be taken from the nose. This test is promising, but it doesn’t amplify the virus, making it less sensitive than the RT-PCR test and not useful for patients with no or mild symptoms only. According to our guidelines, if your antigen swab test is negative and you are still showing COVID-19 symptoms, you need to undergo a RT-PCR test.

The third one is the Rapid Antibody Test (RAT). Most doctors discourage the public from using it because it only tests antibodies. What does that mean? For example, if you have COVID-19, your body will form a defense against the virus only after 2-3 weeks in the form of antibodies. And that’s what the test detects: the antibodies that your body makes, not the virus itself. The problem with this is your body makes the antibodies 2-3 weeks after your infection. Thus, it’s very unreliable.

On the job

What should I do if I feel like I’m infected?

First, you have to stay at home. Schedule a teleconsultation with a doctor using an app. But if you feel really sick or weak, go immediately to the emergency room because anyone who shows COVID-19 symptoms are not allowed to go to clinics. After talking to the doctor and undergoing some tests, stay at home, drink lots of water, get lots of sunlight, and make sure your room is well-ventilated because you need fresh air. Normally, we also give vitamins, especially vitamin D which is great for preventing cough and colds. You also have to exercise because studies show that having a strong body and lungs significantly reduces one’s COVID-19 mortality rate. If your lungs are healthy, you can survive the infection. So having a healthy lifestyle is more important than ever.

Which vaccines would you recommend taking?

I think the vaccines that are most effective are those manufactured by Moderna and Pfizer because theirs have a very good efficacy rate. I think they have a 95% chance to prevent severe COVID-19. Astra-Zeneca has a 85% chance of preventing severe COVID-19 and 60% for moderate COVID-19. Johnson&Johnson has more or less around the same rate: 85% for severe COVID-19. They say that Sinovac has a 100% efficacy rate against severe COVID-19. Sinovac is 65% to 91% effective versus mild disease in general population, specific data on healthcare workers 50.4% effective against at least mild disease, 78% against at least moderate disease, and100% versus severe disease. Novavax is really good, but we’re not done yet with the safety inspections. Personally, I would suggest taking vaccines from Moderna, Pfizer, Johnson&Johnson, and Astra-Zeneca. The safest vaccines available are the best vaccines for me.

I would like to add that before deciding on a vaccine, discuss it with a doctor, because data on these vaccines are updated all the time.

How do we prevent ourselves from getting infected?

There are certain things you need to remember. It’s scary to go out because of the imposed lockdown and the different variants of COVID-19 that appeared in different parts of the world such as the UK, Brazilian, and South African variants. But if you do, I would not recommend eating inside an establishment or restaurant, like an air-conditioned room, because it is one of the places with the highest rates of contamination. Why? Because the air conditioner circulates the air around the establishment.

Number two, you need to get a good mask. How do you know if your mask is good? Make sure that it can filter. It’s actually useless if it leaves so many gaps on the face. Personally, I wear KF94 mask from South Korea. It’s like a N95 mask, but it’s very comfortable. You can also use a medical surgical mask as long as it fits and leaves no gaps on the face. If it does, you need to tighten it. Remember, a good-fitting mask is better than one with good filtration rate. Washable and cloth masks will do as long as they fit on your face.

Number three, you also have to use a face shield. It blocks 95% of the aerosols from someone coughing beside you which is great. However, you also need to wear a mask in order to protect yourself from getting infected.

Number four, take good care of your body. Drink your daily dose of multivitamins and lots of water. You also need to exercise to strengthen your lungs as it is essential for surviving COVID-19.

Number five, you should also take your flu vaccine. It may not prevent COVID-19, but it will help you fight its complications should you get infected.

And most importantly, always assume that the people next to you is infected. Do not ever let your guard down, even when you’re with your family. You see, most of the frontliners got COVID-19 from their loved ones, not in hospitals.

How do you deal with the dangers of being a frontliner, especially during the peak of the pandemic last year?

At the onset of the pandemic, a lot of my colleagues died, especially in the Philippine Heart Center. It really affected our morale because we were thinking that we could die in the line of duty as frontliners soon. In fact, many nurses and doctors from different hospitals quit their jobs because they have experienced traumatizing things. I myself am pretty much stressed because I have asthma, among other things that makes me very susceptible to COVID-19. I struggle wearing N95 masks for 8-12 hours a day as it triggers my asthma. The thing is, even though we’re taking every single precautionary measure against it, many of us still get infected. That’s why lots of doctors and nurses wouldn’t even go home for months last year, fearing that they might infect their families and loved ones with the virus. I coped with it through faith and the support of my family. I’d also take breaks once in a while. Now, things are better for me more or less.

Is It True That Chloroquine Cures COVID-19?

Last year, a lot of people like former US President Donald Trump were saying that chloroquine could help against COVID-19. Of course, the medical community were thrilled to hear this so we did a lot of studies, randomized control trials, and all that, but they didn’t show any good effect. If people are still using chloroquine, please don’t because it causes heart problems and color blindness. We only use it against malaria. So I just want to emphasize that chloroquine is not for COVID-19. There’s no cure for it yet, but we’re still working very hard to find drugs that will do so.

*About the doctor…

Dr. Kathleen Ann Modina is a Filipino-Japanese emergency medicine specialist and a certified American Heart Association Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) instructor with over a decade of experience in the field of medicine. She also do consultations in Japanese, which is particular handy to those speaking the language here in the Philippines. As of the moment, she’s been working as a frontliner in the emergency outpatient department of a tertiary hospital in Makati, where she’s been treating countless COVID-19 patients since the onset of the pandemic.