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Hidden danger of 'new normal'
The asymptomatic cases are the real hidden danger of the new normal period. We don’t know people around us who might be sick, or even ourselves.
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Illustration of new normal world (Shutterstock/Laongphan)
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fter months of restrictions and lockdowns, some countries can now safely proclaim that they are winning the fight against COVID-19. Countries such as New Zealand, Australia and South Korea have reported diminishing daily new cases. Following suit, the Indonesian government decided to ease the social restrictions in the country – widely known as PSBB – on June 4. Then a new life seemed to begin underneath the banner of the so-called “new normal”. According to the government, apparently this term means “living together in peace with the coronavirus”.
In truth, COVID-19 has not really gone away in Indonesia. The number of cases still rises every day, even reaching a record high at 1,624 new cases on Thursday. Nonetheless, a reopening of the country was considered necessary to avoid a fiscal disaster. So despite the high number of daily new cases, Indonesians were forced to enter the new normal era, keeping in mind that they have to be responsible for their own health and safety.
The new normal has been our reality for a month now. Health protocols have been implemented in public places across the country with varying degrees. Almost every place prohibits guests from entering if they are not wearing a mask. Temperature checks are performed at public entrances. Physical distancing is implemented by limiting the number of guests inside stores at a time. To protect their workers, restaurants and retail stores require their employees to wear face shields and latex gloves. It seems enough to be safe from COVID-19 in a public place, right? Here is my observation.
From a medical standpoint, data from the World Health Organization (WHO) show that 80 percent of COVID-19 infections are mild or asymptomatic. This means that most people infected with COVID-19 might not even know they have contracted the virus. These people can easily pass through temperature checks in public places. Asymptomatic people might not be aware that they are sick and it is possible they might go out and about and infect other people.
The question is how likely are we to get infected when we come into contact with an asymptomatic person? A Japanese study published in the New England Journal of Medicine found that viral particles in asymptomatic people still appeared in PCR tests after six days of being infected. The researcher suggested that the coronavirus would be completely cleared from the body only after eight to 10 days. The WHO said that a person infected with COVID-19 could transmit the disease from one to three days before symptoms develop until the virus has cleared from their body (which is shown by a negative PCR test). However, this is mainly true for symptomatic people. For those without symptoms, it might be more difficult to determine when they start being infectious. We can conclude from the Japanese study that for at least eight to 10 days there is still a high likelihood of getting infected from asymptomatic people.
The asymptomatic cases are the hidden danger of the new normal period. We don’t know who around us might be sick, including ourselves. What’s worrying is that COVID-19 may be transmitted by asymptomatic people to others with a weak immune system or the elderly, for whom COVID-19 can be most dangerous.
Furthermore, what makes asymptomatic cases truly dangerous is Indonesia’s limited testing capability. An article published by Tempo pointed to research showing that Indonesia has the lowest rate of tests per positive cases in Southeast Asia. For one positive COVID-19 patient, Indonesia has performed 6.7 tests. The number is very low compared to our neighboring countries, ranging from 788 (Vietnam), 45 (Myanmar), 24 (Malaysia) and 12.5 (Singapore) tests per case. These numbers can mean two things: either COVID-19 cases are more abundant in Indonesia or too few tests have been performed. The latter was supported by more data from the same research, which showed the number of tests per 1000 citizens. Indonesia’s number was 0.22 tests per 1000 citizens. Again, compare this to Singapore (13.93), Malaysia (4.23) and Vietnam (2.17). If the number of tests is not enough, what about the asymptomatic positive cases unknown all over Indonesia?
Consequently, for us to stay safe, we have to be vigilant in keeping our distance, washing our hands frequently and wearing protective equipment in public. Wearing a mask can significantly increase the level of protection, including for other people. According to an article by a public health expert on John Hopkins Medicine, a mask provides protection by containing small droplets that come out of your mouth and/or nose when you talk, sneeze or cough. A face mask might especially reduce the chance of spreading COVID-19 to other people especially by asymptomatic patients. That’s why everyone should wear a mask. Face shields are usually used by health workers in handling patients. It is not necessary to wear a face shield when you keep a physical distance of 1.8 meters. Yet, some people might feel safer wearing a face shield and it is acceptable for additional protection. However, Centers for Disease Control and Prevention (CDC) warned the public that a face shield was not a substitute for a mask. If a face shield is used without a mask, it should extend below the chin and fully wrap around the sides of the wearer’s face.
A bigger hidden danger is the spread of false information or hoaxes. One widely spread claim said wearing a mask could decrease the level of oxygen we breathe, or increase the level of carbon dioxide in our body.
This has been proven to be false. A myth-buster article by the WHO said, “The prolonged use of medical masks does not lead to CO2 intoxication nor oxygen deficiency.” Surgeons wear masks and heavy protection equipment often for hours at a time, yet they never experience any harm. Many physicians have also spoken up, with one in a viral Facebook post going so far as to prove how her oxygen saturation levels stayed the same when she wore a simple surgical mask, an N95 mask and no mask at all. Masks are designed to be breathable, including heavy duty ones such as the N95 mask. Oxygen and carbon dioxide molecules are so much smaller than coronavirus particles and the masks are designed to let these molecules pass through.
So are the new normal protocols enough to keep us safe from COVID-19 in public places? The answer is yes, if we keep up with all the physical distancing, hand-washing and mask-wearing precautions. There is still the tiniest chance of danger, of course, when you forget to do all that. However, I can safely say that asymptomatic COVID-19 people who comply with health protocols are less dangerous than false information. So wear your mask, keep your distance, wash your hands and filter and re-confirm all information you receive about COVID-19. With this ammunition, we’re going head first into the new normal era. Godspeed. (wng)
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Maria Cellina Wijaya is a medical doctor from Airlangga University and a researcher in the COVID-19 Research Team in Clinical Research Unit, RSUD Dr. Soetomo, Surabaya.
