In our column last week (“Sex during pandemic: Nothing kinky please,” June 16), we said that although theoretically, engaging in sex can increase the risk of getting the virus, it’s not pragmatic to advise limiting its frequency, or worse, complete abstinence.
The effects of abstinence on mental, emotional and physical health may be much more than can be quantified. It may create disturbances in the hormones, leading to more hormones that depress rather than preserve or enhance the body’s metabolism, leading to reduced production of the blood’s natural killer cells which are activated when a virus or bacteria enters the bloodstream.
The weakened immune system could be vulnerable even to a small amount of virus invading the body, allowing the virus to replicate in an exponential manner.
This may seem a remote pathophysiologic train of events, but studies have actually shown that regular sexual activity enhances the body’s capability to produce protective antibodies and natural killer cells. By inference, restricting sexual activity may inhibit the body’s innate immune system defenses, and may lead to disease. The same thing can be said of the economy. If we totally stop all economic activities for too long, the downstream effects are similar to sexual abstinence. Many will be left unemployed, health and wellness will suffer beyond a certain point of quarantine or lockdown, people become restless, peace and order is compromised, anarchy may ensue, and total sociopolitical and economic collapse may happen.
Just as we recommend regular sexual activity during these pandemic times, it’s worthwhile to rev up the country’s economic engines. The challenge is to determine just how much economic activity we could allow.
For couples, we advised that if either one feels some symptoms (fever, cough, muscle pains), they should abstain until the partner is fully well for at least two weeks in mild cases, three weeks in moderate cases, and four weeks in severe cases. Again, theoretically, there may still be remnant viral particles in the body after two weeks in mild cases, but they’re no longer infective, and there’s minimal risk of infecting the partner.
Blunting the curve
The same thing is true for economic activity. If there’s really a surge in cases and the capacity of all healthcare facilities is nearly maxed out, like what happened in March and April, there’s good reason to impose a complete lockdown. In fact, we sounded the alarm early on then because the health-care system was hardly able to cope with the cases that needed hospitalization and critical care with mechanical ventilators.
The lockdown and the varying degrees of quarantine may not have flattened the curve, but they have blunted it fairly well, and this gave the government and health-care system precious time to enhance its capacity to absorb a possible second wave any time soon.
So we’re looking not only at the actual number of cases, but also at the number of cases that need hospitalization, and at the number of cases that need to be admitted to the intensive care unit for respiratory support with a respirator or mechanical ventilator.
If we look at the stats daily, we’ll really panic on days when there seems to be an increase in new cases. I myself just look at it weekly. That evens out the fresh and late cases, and one gets a better perspective. It’s like when you’re looking too closely at an object—you don’t get to appreciate the object as a whole. You need to step back for better perspective.
More than 95 percent of cases are mild, and do not really need hospitalization. They could either be isolated at home or made to stay in various quarantine facilities of local government units around the country.
Only 5 percent could require confinement and roughly only 0.1 percent or one in 1,000 new coronavirus disease (COVID-19) patients will require critical care with mechanical ventilator support. A census of various hospitals shows that only 20 to 35 percent of their COVID-19-designated beds are occupied. Less than one-fifth of available respirators are being used by patients.
Health-care capacity should be able to absorb and adequately manage a modest second wave caused by the loosening of restrictions on economic activities.
Two weeks ago, a leaked internal memo from the Philippine General Hospital (PGH) stated that there was a surge of new patient admissions. Social media was again abuzz with an “imminent second wave.”
But again, this has to be taken in the proper context. PGH is the go-to government hospital of the public. When one gets a positive swab and feels some symptoms, PGH is among the first hospitals to rush to. Again, we just need to step back and look at the whole picture. There was no such unusual surge in other major hospitals.
Another thing that makes us more confident about gradually resuming business activities is that we now have more drugs to combat COVID-19.
Last week, a major study in the United Kingdom has shown that dexamethasone, a commonly available and inexpensive steroid, can cut the risk of COVID-19-related death by more than a third in critical cases. We’re about to start a clinical trial on high-dose melatonin funded by the Department of Science and Technology-Philippine Council for Health Research and Development, which also hopes to improve survival in moderate to severe COVID-19 cases.
The favorable result of the dexamethasone trial lends support to our hypothesis that in COVID-19, it’s not the virus that kills but the so-called inflammatory cytokine storm the virus causes. Hence, antiviral drugs may shorten the disease course but it can’t save lives once the cytokine storm has been activated. It’s drugs like dexamethasone and high-dose melatonin that may favorably impact survival.
Our research project also got another morale boost when President Duterte included our clinical trial on high-dose melatonin in his weekly report to Congress last week. It’s a tall order to complete the study in four months but the research group of eminent local and foreign scientists and clinical researchers is committed to finish it on time.
The long and short of it is that unlike at the start of the pandemic when we were virtually clutching at straws, not knowing what could help save our patients, doctors now know much more about the drugs and other modes of treatment likely to benefit COVID-19 patients.
Counterintuitive as it may seem, there is some room to allow more economic activities nationwide especially in Metro Manila, provided the usual precautions of social distancing and hand hygiene are strictly practised. The morale boost people will get from it may be such that it could also boost their immune system.
COVID-19 may not yet be past tense, but we should not allow it to stress our socioeconomic system too long to the point of collapse. INQ