The Head of Disease Control at the Ministry of Health (MoH), Dr Justin Wong shared some information on advice, tips and precautionary measures in relation to COVID-19 outbreak in the country.
1. What is the difference between self-monitoring and self-isolation/quarantine?
The quarantine order and Self-Isolation Notice are policies under the Ministry of Health to protect the public by isolating those at high risk of COVID-19.
The quarantine order is given to the nearest contact and Self-Isolation Notice is issued to the person who recently returned from overseas.
Under the Infectious Diseases Act (Chapter 204), those who have been issued a Quarantine Order or Self-Isolation Notice must stay in their homes or at a specific quarantine area for a directed period and are prohibited from participating in activities involving the public and must monitor their personal health for 14 days.
Compliance with the quarantine directives and monitoring of health status will be handled by the ministry in collaboration with the Royal Brunei Police Force (RBPF) and the Brunei Darussalam National Disaster Management Centre (NDMC) on a daily basis.
This monitoring will be performed through video calls (Face Time), GPS tracking and spot checks.
Self-monitoring means observing the health of the person without isolation and if they show symptoms of coughing, high fever or difficulty of breathing, they are required to contact the Health Advice Line at 148.
Given the current situation and the World Health Organization’s (WHO) pandemic declaration, people are encouraged to monitor their health as a precautionary measure.
2. After 14 days of quarantine, after being tested negative, will a person be tested again?
Close contacts of confirmed cases will be issued a quarantine order and tested at the start of the quarantine period – if they are positive, they will proceed to the National Isolation Centre (NIC).
Those who are negative are instructed to complete their quarantine period, and if they develop symptoms at any point during their quarantine period, they must call 148 who will assess and direct them to an appropriate testing facility for re-testing if appropriate.
This is because, a person may become positive at any point throughout the incubation period (that is, the time from exposure, to developing symptoms).
It is therefore important that individuals comply with the full duration of their quarantine order.
Those who do not show any symptoms by the end of their quarantine period may be released from quarantine and they do not pose any infection risk any longer.
3. In general, how long does it take for COVID-19 patients to recover?
Typically, the duration of treatment for COVID-19 patients is approximately 14 days at a minimum, provided they do not cause/involve any other complications throughout the treatment period.
In this case, the patient has to fully recover and must undergo at least two tests and get a negative result within 24 hours before they are allowed to leave the hospital.
4. What is the situation of the individuals detained at NIC at this time, especially the first case?
At present, two individuals admitted to NIC are in severe condition. Intensive care specialists are monitoring their condition closely to prevent further deterioration.
The others admitted at NIC for COVID-19, including the first case, are in stable condition.
Evidence from other countries indicates that most people (80 per cent) who get infected by the disease only have mild symptoms.
The disease appears to be more severe for the elderly and those with chronic conditions such as heart disease, diabetes, renal disease and cancer.
This is why it is important that we all take responsibility to ensure that we do not get infected and in turn infect others who may be more vulnerable than ourselves.
We can take preventive measures such as avoiding unnecessary travel, crowded places, complying with the restrictions on mass gatherings, ensuring good personal hygiene, and washing our hands regularly with soap and water for at least 20 seconds.
Furthermore, at this time, it is advised to refrain shaking hands and we encourage other forms of non-contact greetings such as waving, particularly when we greet our seniors or elderly.
5. In terms of population ratio, the percentage of infections in Brunei Darussalam is higher than in countries like Singapore and Taiwan. Is this something to worry about?
Brunei has a smaller population than many other countries so even one case can skew the figures.
This makes a comparison between countries less useful as we cannot determine whether or not these comparisons are statistically significant.
The number of positive cases that are identified is also contingent upon the level of contact tracing and testing that is done by the relevant health authority of the country concerned.
Different countries have different testing criteria – Brunei has a lower threshold for testing than others – in fact per capita, we have one of the highest testing rates in the world with more than 1,500 tests already conducted, and activity mapping and contact identification are conducted in a very aggressive manner.
Furthermore, all evidence indicates that the current cases are related to imported clusters. Unlike other countries, there is no evidence to indicate community spread.
At this time, the situation is under control. The public should take precautions, be alert but not anxious.
6. Can you share the treatment method implemented by the Ministry of Health to treat COVID-19 patients?
COVID-19 is a new disease, and there is still no specific treatment for this condition.
At present, treatment is mainly supportive, but also dependent upon the severity of symptoms.
Mild cases, which comprise approximately 80% of all positive cases, are usually monitored and given symptomatic treatment.
At this time, all cases in Brunei have mild symptoms and are in a stable condition.
Specialists at the MoH, working with colleagues from across the region, have developed Standards Operating Procedures (SOP) and treatment protocols to deal with more severe cases and those who may become critical.
Special antiretroviral drugs that have been used in China, Singapore and elsewhere are part of this protocol, and the Ministry has also ensured adequate ventilators and other specialised heart and lung bypass equipment.
Different clinical trials are taking place across the world, and we continue to learn from new scientific knowledge and refine our practice to deal with this accordingly.
7. On the status of National Isolation Center in Tutong District – can you share the capacity of the center to accommodate patients.
What is the Ministry of Health’s contingency measures if more cases are found? Are there other isolation centers that have been identified?
Business continuity plans have been fully activated, and all inpatient wards at the Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital in Tutong has been converted into a special-purpose isolation facility for the treatment and isolation of patients with COVID-19.
In total, the centre has 166 beds including 22 paediatric beds.
Contingency plans are in place in the event that the total inpatient number exceeds with the Raja Isteri Pengiran Anak Saleh Hospital and the Suri Seri Begawan Hospital who are prepared to receive patients of COVID-19 in special isolation wings to prevent cross-infection.
Private hospitals are also part of this national contingency.
The Ministry of Health has been preparing for this event through scenario planning, forecasting and horizon scanning since the announcement by the Chinese Health Authorities in January, to ensure operational readiness and surge capacity to cope with potential worst-case scenarios.
Our aim is to ensure that we protect the vulnerable and continue delivering health care services with minimal disruption.
8. During self-isolation/quarantine, what activities can the individuals do?
If you are asked to undergo quarantine or self-isolation, it is important that you follow the advice which is there to help keep you, your loved ones, and your community safe.
You must comply with the instructions of the health officer, and failure to do so may result in penalties.
Quarantine or self-isolation may seem tricky at first, but across Brunei Darussalam, hundreds of people have already done it successfully.
If you have been advised to self-isolate, all the instructions you need to follow are available on the MoH’s website.
Meanwhile, those who have been instructed to quarantine themselves usually take place at home – this is what we call a home quarantine.
This means that once they reach their residence, they must:
• Stay at home
• Not going to work, school or public areas
• Not use public transportation
• Avoid visitors to your home
• Ask friends, family members or delivery services to carry out errands for you such as getting groceries, medications or other needs
Being isolated can cause you to feel more anxious, bored and stressed. Keeping active and maintaining a normal daily routine as much as possible can help you cope. Some suggestions include:
• Keep in touch with other family and friends by phone, text, e-mail or social media.
• Talk to them about COVID-19. Understanding the disease will reduce anxiety.
• Exercise regularly as it is a proven treatment for stress and depression. Options include floor exercises, home aerobics, walking around the backyard or using home exercise equipment such as a stationary bicycle.
• Arrange with your employer to work from home, if possible.
• Treat quarantine as an opportunity to do some of those things you never usually have time for, such as reading, music, and cooking healthy meals.
9. It is only advised to use a mask when one has symptoms such as fever, cough, and flu.
Therefore, if a person has no symptoms but has contacted the virus, doesn’t it mean that more people are already exposed to the virus since they themselves wouldn’t know it unless symptoms eventually develop days later.
Does it mean everyone should wear a mask whether they are unwell or not just to be safe?
At present, the World Health Organization (WHO) does not recommend the wearing of masks for those who do not show any symptoms.
It is important to note that so far, the cases are all clustered starting from an initial imported case. There is no evidence of community transmission in Brunei and so mask-wearing at this stage would be counter-productive.
Resources are not infinite and should be prioritised to individuals at the highest risk or if the situation in the country reaches a more severe stage.
Our advice on precautionary measures is a phased approach based on the current epidemiological situation and guided by the understanding of disease transmission.
Our public health advice and measures taken by the ministry are guided by a Scientific and Technical Advisory Group on COVID-19 comprising of experts and academics from MoH and Universiti Brunei Darussalam (UBD).
Given the current status, there is no evidence to recommend mask-wearing by the general population apart from those who are healthcare workers or those showing symptoms.
The Bruneian | BANDAR SERI BEGAWAN