會長通訊:新型冠狀病毒肺炎V : 為什麼會有第三波? | President's message : WARS V : Why third wave?

HKDU⠀ Published at 2020-08-15

新型冠狀病毒肺炎V : 為什麼會有第三波?

 

Doctors and cilnic staff must have worn adequate and appropriate PPE during consultation! (For details of Medical Suppliers of PPE procurement, please refer to Page 19 of this Bulletin). 醫生和診所工作人員在給予病人診症時必須穿戴適當及足夠的個人防護衣物! (更多個人保護裝備供應商資訊,詳情請參閱本會訊第19頁)

 

 

在7月19日(星期日)早上我替幾位病人診症後,看了幾份由診所工作人員傳遞給我的傳真。突然,我注意到一份來自衞生防護中心公共衞生化驗服務處的報告,指出有病人的新型冠狀病毒肺炎核酸檢測結果出現陽性。噢,天哪,到目前為止我已發送接近100個檢測樣本往公共衞生化驗服務處,這是第一個呈陽性結果的病人。我立即通過電子郵件,傳真和電話向衞生防護中心報告,但不幸的是,沒有得到當局即時的回覆。我要做的第二件事是打電話給該病人了解他的狀況及過去發生了什麼事。不過他告訴我,在得知報告結果為陽性後的12小時仍未收到衞生署的來電跟進。我給他寫了一封轉介信到就近的公立醫院,瑪嘉烈醫院並提點他叫救護車為他接送。

 

當天早上結束診症後,我再次打電話給該病人跟進。他告訴我他的症狀隨著藥物治療而消退。此外,衞生防護中心已與他聯繫,將安排他轉送至大埔雅麗氏何妙齡那打素醫院接受治療,而他的兩名家人均為親密接觸者亦會於通告後24小時內的同一個晚上送往檢疫中心。但是,沒有人與我聯繫及跟進。

 

由於衞生防護中心沒有指引,因此我自動自覺在周日的早晨和翌日徹底清潔和消毒我的診所。終於在第二天上午11時半,我收到了來自衞生防護中心醫生的電話,詢問我與該名新型冠狀病毒病陽性病人診症時的狀況。我告訴她,診症期間我們亦穿著合適的個人防護衣物。事實上,由於最近新型冠狀確診病例激增,我們在兩週前已開始佩戴了合適的個人防護裝備。我告訴她,我們在診症室的接觸時間少於15分鐘,病人有輕度上呼吸道感染症狀,在諮詢時病人並沒有發燒。衞生防護中心醫生的直接反應是,在這情況我們是相當安全的。衞生防護中心的職員不會來清潔或消毒我的診所。他們給我的建議是自行清潔和消毒。我們亦沒有必要進行任何形式的隔離或檢疫。當然,我們可以繼續照常應診。實際上,在當日早上我已主動安排本人及所有診所員工發送了深喉唾液樣本進行新型冠狀病毒病測試。

 

確診的病人於7月15日上午來我診所就診,對我來說他是新症病人。他於7月16日上午完成了新型冠狀病毒病測試,並在2至3天後的7月18日晚上得出結果,報告呈陽性。我們也於7月20日完成了新型冠狀病毒病測試,但直到7月31日才得知結果。您是否認為等候檢測結果時間太長?雖然結果是陰性,我也這麼認為。我想知道那些可疑病例經過測試後是否應允許在城市中自由活動?若他們最後得出的檢測結果為陽性,則意味著這些病人在被隔離和治療之前的三至七天已經於社區內傳播病毒。我希望我們的政府能夠理解,並利用所有資源,縮短等候新型冠狀病毒檢測結果時間,希望測試最快可在24小時內有結果。

 

本人向各位報告我病人的情況,因為局方仍未有就私營診所接獲確診病例的處理上發出明確指引。在這段時期,當政府沒有標準指引盡量減低交叉感染的機會時,我真的不知道我們能否可以界定我們自己採取的措施是足夠呢?政府和衞生防護中心真的欠我們一個答案。我認為,本會應該在這個困難時期與他們就管理整體疫情的情況進行會議,就像在17年前非典型肺炎的時期一樣。

 

誰的錯?

 

接下來的問題是,自從7月初以來於香港的確診病例宗數減少,為何突然出現大反彈。可以預防嗎?據不少本港醫學專家意見,他們一致質疑豁免強制檢疫安排帶來檢疫漏洞,讓跨境貨車司機、機組人員及船員等可自由出入社區把病毒傳播是導致第三波的主因。我絕對同意專家的意見建議港府應立即採取措施堵塞漏洞。我們應該至少提早一步來遏制該病毒,否則我們將被該病毒牽著走。

 

接下來要做什麼?

 

我每週在安老院舍巡視兩次。我跟安老院舍報告我病人的事件後亦跟他們的經理交代,由於我仍未得知新型冠狀病毒檢測結果,因此我暫時無法到該安老院舍。如果我的診所工作人員的和我的檢測結果均為陰性,我將在下次到訪安老院舍時要求適當的個人防護裝備。確實很難相信,有些已感染的同事仍然到安老院舍看病。

 

談到巡視安老院舍,最近有報導指有六名醫生簽署空白院舍約束衣物申請表而被香港醫務委員會定罪。罰則包括警告信以致從醫生名冊中除牌。其中一名醫生曾被定罪幾次,上次犯錯的時間已經超過17年。即使定罪已經有那麼多年,香港醫務委員會還是要將他現在的案件與他過往犯錯考慮在內。因此,在簽署任何表格時請務必小心,不要在任何空白表格上簽名以保障自己在醫務工作上的安全。

 

關於第三輪抗疫基金,我們已與立法會代表和香港牙醫學會聯署致函特首,要求政府為每間私營診所提供50,000港元資助。(請參閱本會訊第17頁)。我希望政府能夠回應我們的訴求。對於疫苗資助(外展)計劃,我們已經與立法會代表合作去信要求陳肇始教授研究今年下半年,學校有好大機會因疫情關係而停課,這將會令到參與該計劃的醫生不能為學童進行流感疫苗接種而帶來的後果及金錢上的損失。這信件已印在本會訊第14頁上,供大家仔細閱讀。

 

所以,各位同僚,請在這困難時刻保持健康,及密切留意本會與政府爭取的事項。

 

楊超發醫生

 


 

WARS V : Why third wave?

 

After managing few patients on the morning of July 19 (Sunday), I looked at some fax massages passed to me by the clinic staff. Out of a sudden, I noticed that there was a report from the Public Health Laboratory Services Branch of Centre for Health Protection (CHP) stating that COVID-19 was detected. Oh my god, this is the first positive result for COVID-19 among almost 100 patients whom I have sent so far for testing in the Public Health Laboratory. I immediately reported to the CHP through email, fax and phone message, but unluckily there was no reply from the authority. Next thing I did was to phone up the patient to find out what had happened to him. Alas, he told me that he was not contacted by Department of Health, 12 hours after being reported positive for COVID-19. I wrote him a referral letter to the nearest public hospital, Princess Margaret Hospital, and told him to call ambulance for the transfer.

 

After finishing clinic session that morning, I again phoned up the patient for follow up. He told me that his symptoms subsided with the treatment. Furthermore, the CHP had contacted him and would arrange his admission to Alice Ho Miu Ling Nethersole
Hospital with his two home close contacts being transferred to quarantine centre at the same night, 24 hours after positive report. While there was still no person contacted me for follow up actions.

 

As there was no guideline from CHP, I took the liberty to thoroughly clean and disinfect my clinic on that Sunday morning and subsequent days. Only at 11:30 am the next day that I received a phone call from a doctor from CHP asking me the circumstances of the consultation with the positive COVID-19 patient. I told her we worn appropriate PPE during the consultation. As a matter of fact, we worn appropriate PPE for over 2 weeks due to the recent upsurge of COVID-19 cases. I told her that our contact time inside the consultation room was less than 15 minutes and the patient experienced mild URI symptoms with no fever on consultation. The immediate comment from the doctor of CHP was we were pretty safe from COVID-19. The staff of CHP would not come to clear nor disinfect our clinic. The advice we got was to do the cleaning and disinfection ourselves. It was not necessary for us to undergo any form of isolation or quarantine. And we could of course continue to manage patients as usual. In actual fact, all the staff and myself did send deep throat saliva for the COVID-19 tests in that early morning already out of our own initiative.

 

The patient came to visit my clinic on the morning of 15 July and was a new patient to me. He got the COVID-19 test done on the morning of 16 July and the positive result returned on 18 July night, 2 to 3 days later. We have our own COVID-19 tests done too on 20 July and there was no result till 31 July. Do you think the return time for the result is too late? I think so even if our results turn out to be negative. I wonder should those suspected cases go freely around the city after being tested? If they later turn out to be have positive results, it would mean that these patients are spreading the gems around the community for 3 days to even 1 week before they are taken for isolation and treatment. I hope our Government can understand and by all means use all resources to quicken the COVID-19 test return time, preferably within 24 hours.

 

I reported my case to YOU to illustrate that there is no definite clear guideline from the authority for private clinics to follow if there are confirmed cases among the patients. I really don’t know if it is alright at this period of time to just apply our own measures by ourselves without a standard one from the Government to minimize cross infection? The Government and the CHP really owed us an answer. I think we should go for a meeting with them on the whole scenario of management in this difcult period as in
the days of SARS 17 years ago.

 

Who’s at fault?

 

Next is the question on why is there a sudden upsurge since early July after a damp down of cases in the city earlier. Is it preventable? According to all medical experts in town, the Government should be blamed for building up a loop hole for the COVID-19 to enter our community through those inbound quarantine exempted sea crews, air crews and drivers etc. I agree totally with the experts that we should immediately plug this loop hole. We should do at least one step in advance to contain the virus, or else we are led by virus instead.

 

What to do next?


I do rounds in Residential Care Home for elderly (RCHE) twice a week. After I have reported the incident to the RCHE, I told the Home manager I could not visit the RCHE as my COVID-19 test result was not yet back. I would request for appropriate PPE when visiting the RCHE when my clinic staff and mine results are all negative. It was hardening to learn that some of colleagues being infected but still had to pay visit to RCHEs.

 

Talking about visiting RCHE, there is a recent report of 6 doctors having been convicted by the Medical Council of Hong Kong on signing up blank restrainers forms for the residents. Penalty ranged from warning letter to removal from the general register
without suspension. One doctor has been convicted few times before and the convictions took place more than 17 years ago. Even though the convictions are many years back, the MCHK did take all the past convictions into consideration for the gravity of penalty. So, please be careful in signing on any forms, and do not sign on any blank form to protect oneself in medical practice.

 

Regarding the Third-Round Anti-Epidemic fund, we have signed a conjoint letter with our Legislative representative and the Hong Kong Dental Association to request for a relief fund of HK$ 50,000 from the Government for each private clinic. (Please see page 17 of this Bulletin). I do hope that the Government can answer to our request. For Vaccine Subsidy Scheme (outreach) programme, we have worked with our Legislative representative to request Prof. Sophia Chan to look into the problem of the great chance of frequent school closures at the latter half of this year when influenza vaccinations will be done through VSS. The letter, which is self-explanatory, is printed on page 14 of this Bulletin for your perusal.

 

So, brothers and sisters, please stay healthy and stay tune to all our negotiations with the Government during this diffcult period.

 

Dr. Yeung Chiu Fat Henry