Lessons from the San Lazaro experience

| Written by Fred Dabu

Screenshot from the replay of the fifth webinar in the UP “Stop COVID Deaths” series on the TVUP YouTube channel.

 

In the fifth presentation of the UP webinar series,“STOP COVID DEATHS: Clinical Management Updates,” on May 22, 2020, Dr. Rontgene M. Solante, head of the Adult Infectious Diseases and Tropical Medicine unit of the San Lazaro Hospital, shared valuable insights from their care and management of COVID-19 patients with pulmonary tuberculosis (PTB), human immunodeficiency virus (HIV), and other infections.

The San Lazaro Hospital is a 500-bed infectious diseases referral hospital and is one of the 31 subnational referral laboratories for COVID-19. It is also an HIV treatment hub, DOTS and multidrug-resistant TB referral hospital. It was the hospital that admitted the first two COVID-19 cases in the Philippines on January 23, 2020.

Dr. Solante, one of the Philippines’ top experts on infectious diseases, discussed how the hospital is managing COVID-19 cases and is participating in the World Health Organization (WHO) Solidarity Trial for interventions using investigational drugs, wherein hospitals in more than 70 countries compare treatment options to assess effectiveness against COVID-19.

In Solante’s presentation on COVID-19 and other infectious diseases, dengue was shown as the top case admitted in San Lazaro, followed by tetanus, TB, and others. He explained that anybody who is admitted with fever now has to be tested for COVID-19. “We have to look at the history and findings of respiratory tract infections. Focusing on COVID, we now have a total of 88 confirmed cases (as of May 14). Most of the deaths (total of 19) were of males 50 years old and abovewho died due to sepsis or acute respiratory disease syndrome,” he said.

Dr. Solante said the patient’s age is a major risk factor of determinant for survival, as well as patients who are immunocompromised, with TB or other infections or comorbidities. The majority of those who died have comorbidities, with hypertension as the most common, followed by diabetes, which also reflect the findings from COVID-19 research in China. He added that there were also patients who died with influenza B, streptococcus pneumoniae and staphylococcus hominis bacteremia.

Dr. Solante explained that the radiographic findings for 16 of those who died showed that they had bilateral pneumonia and two had lobar pneumonia. Some of their Chest CT (Computed Tomography) findings showed ground glass opacification, but most showed none. The RT-PCR test must always be used in detecting COVID cases, he added.

 

Screenshot from the replay of the fifth webinar in the UP “Stop COVID Deaths” series on the TVUP YouTube channel.

 

Interventions using investigational drugs

Dr. Solante said that as part of the solidarity clinical trial for COVID-19 treatments, the San Lazaro hospital is among those that test the following investigational drugs for inhibiting viral replication or entry, and for preventing receptor activation of inflammatory molecules: remdesivir, lopinavir/ritonavir, lopinavir/ritonavir with interferon beta-1a, chloroquine or hydroxychloroquine, and tocilizumab. He said the use of tocilizumab on selected patients showed significant improvements seen in radiologic and chest CT results. However, extra care should be done to prevent the use of these drugs that would have interaction or effects on other medications needed by the patients, he explained.

 

Screenshot from the replay of the fifth webinar in the UP “Stop COVID Deaths” series on the TVUP YouTube channel.

 

Managing COVID-19 and co-infections (bacterial, PTB, HIV)

Dr. Solante explained that if one is a COVID-19 patient with multiple infections, a higher rate of mortality is also expected. For instance, a COVID-19 patient with PTB would have a higher mortality rate, especially if untreated, or if the patient is immunocompromised, elderly, and with comorbidities. “It is advisable to test for TB with the Genexpert. COVID-19 and PTB would exacerbate the symptoms of each other,” he said.

Dr. Solante advised that people and “patients with TB lung disease should limit their exposure to high-risk environments. Stop using tobacco or vape products.” He emphasized that the TB treatment programs for patients should continue, with the daily observed therapy (DOT) replaced with alternatives, such as self-administered therapy (SAT), video-observed therapy (VOT), and mobile-phone supported adherence strategies.

“If a patient has HIV but continues the antiretroviral medication, the risk would be the same as with a normal person.But if the medication is stopped, the risk of getting the infection is very high since the patient is already immunocompromised. The antiretroviral treatment for all HIV patients should continue,” he added.

Dr. Solante emphasized that “prevention and precautionary measures are very important for these high-risk populations, including the elderly. Hand hygiene, face mask and physical distancing,” plus vaccinations (influenza and pneumococcal vaccines) should be up-to-date. Patients should also be screened for COVID, TB, and HIV, he reiterated.

Care for healthcare workers

In addition to personnel safety protocols and precautions, Dr. Solante said San Lazaro Hospital conducts regular health surveillance and testing for its healthcare workers. He said that out of the 196 given rt-PCR testing, seven were found positive (one doctor, three nurses and three lab personnel), although none of them had fever. Their common symptoms were fatigue, headache, cough, and sore throat, among others. Since healthcare workers are highly vulnerable, they should be monitored and tested regularly, he explained.

UP webinar series

This series of webinars is conducted by the University of the Philippines, in partnership with the National Telehealth Center and the Philippine Health Insurance Corporation, to promote the highest possible standards of care for COVID-19 patients and also to seek to protect the entire health system against COVID-19. The webinars, scheduled every Friday from 12nn to 2pm,are hosted by Dr. Raymond Francis Sarmiento of the National Telehealth Center, Dr. Susan Pineda-Mercado of Philhealth, and Dr. Eva Maria Cutiongco-De La Paz of the National Institutes of Health and UP Manila.

The video of this webinar is available at TVUP’s website and YouTube channel.

On June 5, 2020 (Friday), 12nn, Dr. Paulyn Jean B. Rosell-Ubial, former Secretary of Health, Medical Volunteer at the Quezon Institute COVID-19 Community Isolation Facility, and Head of the Philippine Red Cross Biomolecular Laboratories, will talk about “Supportive Care for Mild Pneumonia in Community Isolation: The Quezon Institute Experience.”

Interested parties can sign up for the next webinar here

 

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