新型冠狀病毒肺炎V : 為什麼會有第三波?
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