Founder's Story - Infectious Disease Specialist Provides Current State in Philippines | Ep. 1 with Dr. Daisy ilagan-Tagarda

Episode Date: March 28, 2020

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and then just edit it later okay so good morning everyone my name is Kay Hancock and welcome to my first episode inspired by her and my first guest today which I'm very excited Dr. Daisy Ilagan-Tagarda she is internal medicine infectious disease specialist and active consultant and head Infectious Disease Specialist and Active Consultant and Head of TB Community University of Santo Tomas Hospital Chair, Infection Control Community Diliman Doctors Hospital. Dr. Daisy, welcome. Hi, good evening here in the Philippines and good morning there in US. How are you? I'm very good.

So I'm very excited. Thank you for doing this. I know you've been working around the clock. So tell us what you can tell us about what's going on in the Philippines right now. Okay, so right now we have a sustained local transmission of COVID-19 right now, so we have the sudden increase in the cases. So we had a problem actually on how to accommodate all the patients who are considered as PUI or person under investigation, which means that a person exhibiting symptoms consistent with COVID-19 but not yet confirmed with the test, and confirmed cases of COVID-19, meaning with symptoms of COVID-19, and has been tested and confirmed with positive results. So we are working double time right now, especially for us infectious diseases.

Wow. Wow. Okay, but before we'll talk about COVID-19, I want to know your story. I'm very interested in your story. I know at one point, I met you in LAX and you're hitting Harvard conference. So how did you decide to become a doctor? What's your story? Okay. So actually, I'm very excited to tell my story on how I became a doctor. Since I was three years old, I was inspired, I think, by my pediatrician during that time to become a doctor. I can't remember any other ambition that I thought of only to become a doctor. And then when I entered high school, I had to decide on what degree I should take in college.

So we are living in the province of Batangas. And in Batangas, we don't have medical school there. So I need to go to Manila to take the pre-medical course and then go to the medical school. Unfortunately, my father, who is, I'm the favorite daughter of my father, so he did not first allow me to go to Manila. So I begged and cried so many times every day just for him to allow me to study and take up biology as my pre-medical course and then enter the medical school.

The reason for that is because my father is old already. I think he's already seven years old when I'm in fourth year high school. And he told me that he will be too old enough to send me to school when I will enter the medical school. So during that time, if I enter medical school, it was already 80s. But I still insisted. I want to go to medical school. And then, true enough, after finishing three years of BS biology, I entered medical school in UST.

And when I finished medicine, initially, I wanted to take up endocrinology specialty. So I took internal medicine. And then, however, when thinking of the subspecialization that I'm going to take, there's too many endocrinologists in Manila already because that time I met Lonji. He's living in Manila, and there's a lot of endocrinologists in Manila already because that time I met Longy. He's living in Manila and there's a lot of endocrinologists already

and I considered other specializations. So lesser in number but more interesting. So I think of taking hematology, rheumatology, and infectious diseases. And also oncology. But among the four, I think the most reversible type of diseases, meaning the higher the chance for the patient to be cured is when they have infection. So that's why I took infectious diseases. And true enough, I did not regret any decision that I made regarding the specialization that I took. And as of the moment, I think I made the right choice. Even if it's very difficult, my parents are even asking, why did you choose infectious diseases? There's a tendency for the patients to infect you

or to transfer the infection from the patient to the doctor. But I think it's more fulfilling because if you just give the right treatment, then there is a higher chance that your patient will survive. Wow. So before we started this, you were telling me that a lot of nurses are calling you or like you're on call right now for patients. Yes. Tell me what you normally would ask. Okay. So I'll just tell you on how my everyday schedule when this happened, this COVID-19 outbreak happened in the Philippines. So actually, I'm an instructor in a university. So I also teach.

But right now, because of the outbreak, I decided not to stop for a while, temporarily. So I made rounds every morning. And during making rounds, I have four hospitals that I see that I have four hospitals, which I am affiliated of. And then I see the different patients. Right now, I have 33 inpatients that I have to see every day. So most of them are cold PUIs or COVID-19 confirmed cases. So every time they have questions regarding the management or if the patient has difficulty, like, for example, they complain of something, difficulty of breathing, they have pain, then they call me as a consultant.

And then it's like I'm the captain of the ship. I decide for the patient. I decide for the patient. I decide for their management. And then even as infection control head in the hospital, the protocols being implemented in the hospital are usually made by the IPCC head like me. So it's a very big responsibility. At the same time, it's fulfilling as well. So even at night, Longy will sometimes complain

that he wasn not able to sleep because my phone kept on ringing. So yeah, I'm 24-7 on call. I don't have a holiday. Yeah, I can imagine. We're planning to go back to US

after everything will be okay because I want to have a vacation after this so toxic days of COVID-19 outbreak. Yeah, so you deserve it and thank you for doing that. I mean, it's so amazing listening to you, how you mentioned this is a fulfilling work and it just, you're making a difference of people's lives. I mean, especially in this. Thank you. Thank you.

I appreciate your service. And so there's a lot of information out there. There's a lot of myth and I don't know what's the truth, right? You see it all over Facebook. Recently, I was, I mean, people are talking about they have to eat egg in order to get cured or bananas. Can you tell me about this? Is this a joke? Definitely eating egg is not proven effective.

So the difficult thing about COVID-19 is just it's a new type of infection, meaning everything is new to us. We have information, but we don't have good evidence. But right now, supplements are not yet proven to be effective. Even eating more than 1 million eggs, it will not, as of the moment, no evidence that it can cure COVID-19 or it will prevent. Somehow zinc-containing food or supplements, theoretically, it can prevent the, theoretically meaning it is not

proven by clinical trials. So it can somehow has an antiviral activity, but some of the medications being used for COVID-19 like chloroquine, it's an anti-malarial drug. But in China, it has been proven that it decreases the viral load and patients who took the chloroquine will have a faster recovery as compared to the patients who did not take the medication. So other medications are still under study. But of course, as I'm telling to my patients,

it's better to give something that we think can work compared to something that we can't give anything. So these are still understudy, but we are giving to our patients for whatever benefit it may give to them. So right now, yeah, banana and egg. Not true, it's a myth. Yeah. So, so far this anti-malaria medicine has been working for recovery for patients?

Is that data you're getting? Yes. Okay. Yes, yes. In Famuhan, China, they give to the group of patients that received chloroquine, they had a faster recovery. I think in the US, there's a small study showing that hydroxychloroquine combined with azithromycin, hydroxychloroquine is some medication being given to autoimmune diseases. They are usually being used by the rheumatologist, but it has been proven also that it has an antiviral activity against COVID-19.

So I think hydroxychloroquine and azithromycin is also a good option to be given to these COVID patients. Yeah, so far what I've been hearing in the news, that's what they've been using in the U.S. because it's the only option, right? Like you said, it's better to give something that not giving anything anything yes go ahead okay go ahead no so like for everyone who's self-quarantined I mean they're at home they're stuck at home they're bored what can they do what can they take what what would you recommend for them to eat or okay definitely There's no prophylaxis for COVID-19. What do you mean by prophylaxis? It's something that you have to take to prevent

the infection. No strong recommendation yet. But what we usually, what we strongly recommend is actually for the people to practice social distancing. I think this has been proven to be effective. And also wearing protective gears when you're dealing with sick patients, especially for healthcare workers. They have to wear masks. But for something that they have to eat, what I can advise is if they have diabetes,

for example, their sugar should be controlled. If they have to eat, what I can advise is if they have diabetes, for example, their sugar should be controlled. If they have hypertension, their blood pressure should be controlled. A balanced meal because basically those who suffer severe disease of COVID-19 are those who are immunocompromised. So this includes malnourished people, people with comorbidities. So they just have to at least control their comorbidities so they just have to at least uh control their comorbidities like hypertension or diabetes that's all so no specific uh um any supplement has been proven to be very very effective just eat the right meal a balanced meal and if you have diabetes then you have to take your maintenance medications. Okay, wonderful. Now, before in the

beginning, they mentioned that this is only harder for patients over 60. Now, I'm seeing all over the world that 18 years old get affected or anyone under the age of 50 get affected. Is that the same case in the Philippines? What's the data? Yes, I have patients being affected who are less than 60 years old. But what I noticed is that these infected people are those with comorbidities or diabetes. So, for example, I'm a 40-year-old female. I got infected. I have a higher risk to get the COVID because I have another disease like diabetes. So the mortality and the complications actually increases as the age increases and other comorbidities like asthma as well. So it's not true that if you're young, you cannot get it. You can still get it, but the prognosis and the chance of the patient to leave and to be able to survive decreases as the age increases.

So they are inversely proportional. That means you can still have the disease, but the chance of you surviving it will decrease as your age increases. Gotcha. Okay. So for the mild symptom patient, have you had any patients that fully recovered? Yeah, a lot. Actually, the data, for example, 80% of COVID-19 cases will have mild disease. And around 20 of COVID cases will have moderate to severe disease. And from that 20%, only 5% will have a severe disease. And from that 5% of severe disease,

when you say severe disease, these are the patients being intubated or being admitted in the critical unit like ICU. And the mortality rate is around 3% to 4%. So meaning the chance of you to die is lower. However, it's very infectious. A lot of people are getting it. A lot of people are getting the disease. But the percentage of these people dying is very, very same as compared to other diseases like Ebola.

So yeah, most of the people will present with mild disease or mild form of disease. Yeah. Okay. So if you get infected, you have a mild symptoms, you fully recover, what are your chances of getting it again? Because I've heard- Well, there's no strong data yet, but following the principle on immunology, if you're going to be infected with exactly the same strain of SARS-CoV-2,

then I think you're going to be immune with the disease already. So meaning, what do you mean by immune? You're already protected because you have an antibody present because of the previous infection, and the chance for reinfection is very low. Wow. Okay. Okay. So, wow. So, is the Philippine government super prepared on this?

Or I know... Oh, definitely. I know no country. I know for sure this is so big that no country is prepared by this. No country is prepared, especially for a third world country like the Philippines. So we had a difficulty getting the testing kits. The turnaround time is very long. It's very important for us to make decisions in terms of management.

So unlike first world drug countries like Singapore, even US, you have the capability to test immediately the infected person. But however, in our setting, we only have several testing kits available. So we just select those who really need it. Like for example, with moderate to severe type of illnesses because for mild diseases, we don't have the chance to test them. That's why our mortality rate is actually higher because I think we have selected patients to test only for those with severe type of diseases.

Gotcha. Okay. Wow. So I know the cases right now in the Philippines, pretty much in Manila area, like the huge number of patients. Yeah. Yeah. Which I'm grateful Inca Menganu have zero case, which is great. We're on lockdown. But I've been seeing some other cities that's high populated and they're not doing the seriousness of this. It's scary for me because then the recovery will be longer and harder.

Yeah, it's true because, you know, the way of living here in Manila, we have a lot of, we have a large population. So the transmissibility of the infection is very, very high because of that factor. Also for the living conditions of the people here, it's not really that ideal. How many people living in one house? And we have only small space in their house.

So the chance of you getting the virus is very, very high as well. So I hope it will not have that high incidence of infection to the provinces as much as we have here in Manila. Yeah, I think we have so much space and we have fresh air. So I think we're very congested here in Manila in NCR as compared in Camiguin and in Iligan City. Gotcha. So what did you do yourself personally? Can you tell us what do you do for you not to get infected? Okay of course as a healthcare worker and as an infectious disease I am considered the frontliner so I think this is my duty that I have to see the patient personally

who are infected with COVID-19. Number one is I use personal protective equipment. If you're going to look at the different pictures in the internet or even in the Facebook, you wear goggles and 95, gowns, masks, and even booties to at least make sure that we are protected. Because in an infectious emergency, it's not actually an emergency because we have to protect our serves first than seeing the patient first. So PPE is number one, very important. Number two, hand washing, so as not to bring the infection to our houses, to our loved

ones, and to have enough rest. So usually, as much as I can, I have to sleep and rest. I have separate rooms with the kids, so as not to know the chance of just me transmitting or giving them the virus will be very very low as well i'm also a diabetic i'm diabetic so i take my medications religiously so as to have a good immune system wow okay so those are really great information now you mentioned about zinc um any fruits that have zinc or vegetables is loaded with zinc? Yeah, vegetable has a high zinc content. But the level of the zinc that is being recommended to have its effect is around 5 to 20 milligrams.

So you check the supplement that you take if it has that type of level of zinc. But again, this is not evidence-based. This is just a theory that zinc has an somehow antiviral activity. How about vitamin C? Everyone's talking about vitamin C. Vitamin C or ascorbic acid, again, this is not proven to be effective. More than vitamin C, zinc has better data to support the boosting of immune system than vitamin C. But again, the safety profile of the supplements are very good. Unless you abuse taking medications or vitamins, generally they don't have that severe side effect.

So you can take the supplement. Again, why do you call it supplement? You can have it or you cannot have it, but it can help somehow. But the evidence is stronger for the chloroquine or hydroxychloroquine as compared to the supplements. So right now we have about 1,000 cases in the Philippines, is that correct? Yes. Okay.

Yes, more or less 1,000. Okay, but you mentioned because we don't have enough tests, so the numbers could be higher. Yes, I agree with you. Yeah, go ahead. No, I agree with you. Yeah. Yeah. Go ahead. No, no.

Go ahead. Okay. So, as I've said, because of the incapacity or the capacity of

the government to provide kits cannot meet the demand, so I think we are underreporting the cases in the demand. So I think we are underreporting

the cases in the Philippines. Wow. That was your name. Thank you so much, Daisy. Thank you. Thank you so much. And again, thank you for service. That was great information

and we got a lot out of it. Thank you and have a great night. Thank you.