Latest / The SHEA Podcast / COVID-19: International Perspectives: Asia, 9/18

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COVID-19: International Perspectives: Asia, 9/18 · The SHEA Podcast

• 0:07
  SPEAKER_01: Welcome to the Rapid Response Podcast, brought to you by the Society of Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:21
  SPEAKER_01: I am Dr.
• 0:22
  SPEAKER_01: David Bannock from the University of Connecticut, and I will serve as today's podcast moderator.
• 0:26
  SPEAKER_01: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:35
  SPEAKER_01: Shay is excited to launch today's episode of the podcast, International Perspectives on COVID-19.
• 0:41
  SPEAKER_01: Our speaker today is Dr.
• 0:43
  SPEAKER_01: Paul Timbaya at the National University of Singapore Faculty of Medicine.
• 0:48
  SPEAKER_01: So thank you, Dr.
• 0:49
  SPEAKER_01: Timbaya, for joining.
• 0:50
  SPEAKER_01: Before we enter our moderated discussion, I'd like to turn it over to Dr.
• 0:54
  SPEAKER_01: Hanrahan to get us started with a news and guidance update for the week.
• 0:59
  SPEAKER_00: As of today, September 17, 2020, there are 29,679,284 cases of COVID-19 in the world and 936,521 deaths.
• 1:12
  SPEAKER_00: At a Senate hearing on September 16th, CDC Director Dr.
• 1:16
  SPEAKER_00: Robert Redfield reminded people that face masks work.
• 1:20
  SPEAKER_00: He stated, quote, we have clear scientific evidence they work.
• 1:23
  SPEAKER_00: I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine, because the immunogenicity may be 70%, and if I don't get an immune response, the vaccine's not going to protect me.
• 1:37
  SPEAKER_00: This face mask will.
• 1:39
  SPEAKER_00: He went on to say, quote, these face masks are the most important, powerful public health tool we have, and I will continue to appeal to all Americans to embrace these face mask coverings.
• 1:49
  SPEAKER_00: In a study published in JAMA Ophthalmology, authors described a study of patients in Hubei Province, China, at the beginning of the pandemic, in which they found that among 276 patients admitted to a hospital with COVID-19, the proportion of patients who reported routinely wearing eyeglasses more than eight hours a day was lower than in the general population.
• 2:08
  SPEAKER_00: The authors conclude that wearing eyeglasses more than eight hours per day may be protected against SARS-CoV-2 infection due to decreased frequency of touching eyes.
• 2:17
  SPEAKER_00: Dr.
• 2:17
  SPEAKER_00: Lisa Maragatis points out in a commentary on the study that although it is tempting to conclude from the study that everyone should wear eyeglasses, goggles, or a face shield in public to protect their eyes and themselves from COVID-19, from an epidemiological perspective, we must be careful to avoid inferring a causal relationship from a single observational study.
• 2:37
  SPEAKER_00: The study demonstrates an apparent inverse association between routinely wearing eyeglasses and the risk of subsequent COVID-19.
• 2:44
  SPEAKER_00: Observational studies such as this one have inherent limitations due to the possibility of various forms of bias in the study data.
• 2:51
  SPEAKER_00: Dr.
• 2:52
  SPEAKER_00: Marigakis goes on to say that the study raises the possibility that use of eye protection by the general public might offer some degree of protection and that more studies are needed to confirm the observed association and to determine whether there is any incremental benefit to wearing eyeglasses or other forms of eye protection in the public settings in addition to wearing a mask and physical distancing to reduce the risk of acquiring SARS-CoV-2.
• 3:16
  SPEAKER_00: A novel testing method for SARS-CoV-2 was described in the New England Journal of Medicine on September 16th.
• 3:22
  SPEAKER_00: This test uses a method known as SHERLOC, which is specific high-sensitivity enzymatic reporter unlocking in one pot.
• 3:30
  SPEAKER_00: It is a streamlined assay that combines simplified extraction of viral RNA with isothermal amplification and CRISPR-mediated detection.
• 3:39
  SPEAKER_00: This test can be performed at a single temperature with minimal equipment and has high sensitivity and specificity.
• 3:46
  SPEAKER_00: This method may be useful in low complexity clinical laboratories.
• 3:50
  SPEAKER_00: As schools have reopened, there have been concerns about transmission of COVID in schools.
• 3:54
  SPEAKER_00: The CDC released indicators to help schools make dynamic decisions about in-person learning as local conditions evolve throughout the pandemic.
• 4:02
  SPEAKER_00: When coupled with local data about community spread, these indicators can help local health officials, school administrators, and communities prepare, plan, and respond to COVID-19.
• 4:12
  SPEAKER_00: To make decisions about operational conditions like beginning, continuing, or pausing in-person learning, schools in cooperation with local health departments must be able to monitor the local spread of COVID-19 and assess their own ability to implement prevention and mitigation strategies for students, teachers, and staff.
• 4:28
  SPEAKER_00: This new resource includes core and secondary indicators to help local officials and school districts assess the risk for COVID-19 introductions into and spread within their schools.
• 4:38
  SPEAKER_00: The indicators reflect the mutually dependent relationship between schools and their surrounding communities.
• 4:43
  SPEAKER_00: They do not set strict cutoffs but should be used as guideposts.
• 4:47
  SPEAKER_00: The CDC also has a parental resource kit to help support parents and caregivers recognize children's and young adults' social, emotional, and mental health challenges during this pandemic and ensure their well-being.
• 4:58
  SPEAKER_00: And that's the news for this week.
• 5:00
  SPEAKER_01: Thank you, Dr.
• 5:01
  SPEAKER_01: Hanrahan, for providing that update.
• 5:03
  SPEAKER_01: Now we will begin the moderated discussion with Dr.
• 5:06
  SPEAKER_01: Tembaya.
• 5:07
  SPEAKER_01: So, Dr.
• 5:08
  SPEAKER_01: Tembaya, thank you very much for joining us.
• 5:11
  SPEAKER_01: You know, our Shea audience is really interested in what's happening globally.
• 5:14
  SPEAKER_01: You know, a lot of our discussions have focused primarily on the United States, but we're really excited to have you discuss your experience in Singapore and provide some additional perspectives.
• 5:23
  SPEAKER_01: So thanks for joining.
• 5:24
  SPEAKER_02: Thanks very much.
• 5:25
  SPEAKER_01: Can you kind of walk through sort of the overall state of COVID-19 in Singapore?
• 5:29
  SPEAKER_01: I mean, we'll go into some more details, but can you give us kind of an update as to where things stand as of September 16th?
• 5:36
  SPEAKER_02: Well, we get a lot of travel from China.
• 5:38
  SPEAKER_02: So we had our first documented imported case like the 25th of January, somewhere around that time.
• 5:44
  SPEAKER_02: And then of course we went on to have local cases with clusters, primarily in our religious gatherings like in Korea, as well as in bars and in family gatherings.
• 5:55
  SPEAKER_02: And then we had a lockdown in April.
• 5:57
  SPEAKER_02: And that essentially, when there were no more gatherings, you didn't get clusters over there.
• 6:03
  SPEAKER_02: But we had a huge spike in infections in the migrant worker dormitories because we have a substantial number of migrant workers from China, India, and Bangladesh who do a lot of the construction and shipbuilding and shipyard work in Singapore.
• 6:19
  SPEAKER_02: And they live in very crowded dormitory conditions, sometimes with 10 to 15 people per room.
• 6:25
  SPEAKER_02: And it's been really, really difficult to control the outbreaks in these dormitories.
• 6:30
  SPEAKER_02: And so that's where we are right now.
• 6:32
  SPEAKER_02: The lockdowns have been gradually eased, but within the dormitories, we're getting significant numbers of new cases every day.
• 6:39
  SPEAKER_01: That's interesting.
• 6:40
  SPEAKER_01: Yeah, you were all finding that congregate settings are particularly challenging, and it sounds like the migrant worker population in Singapore and their living environment created some challenges.
• 6:50
  SPEAKER_01: Now, can you talk in a little bit more detail as to what the lockdown looked like in Singapore in the United States?
• 6:57
  SPEAKER_01: We implemented lockdowns, and there's a lot of variability across the country.
• 7:00
  SPEAKER_01: But you know, we're interested in how other countries have approached the lockdown.
• 7:04
  SPEAKER_01: It may look a little bit different than what we experienced here in the US.
• 7:06
  SPEAKER_01: So can you share at least what the country's approach was to lockdown?
• 7:09
  SPEAKER_01: And you mentioned that it's been eased, how the country has approached easing those kinds of restrictions.
• 7:15
  SPEAKER_02: Yeah, so you know, Singapore is a very small, it's a city-state, and we're very heavily dependent on tourism, travel, trade, business.
• 7:24
  SPEAKER_02: So it was not an easy decision.
• 7:26
  SPEAKER_02: And in fact, uh it took a while before the lockdown was enforced.
• 7:29
  SPEAKER_02: And it was enforced in the first week of April, and it was like a total lockdown.
• 7:33
  SPEAKER_02: You couldn't go out of your home unless you were going for medical reasons or to get food.
• 7:38
  SPEAKER_02: So all the restaurants were closed, all businesses were closed, schools were closed, the university, all the exams were canceled, medical student rotations were severely curtailed.
• 7:52
  SPEAKER_02: So it was pretty draconian for two months.
• 7:54
  SPEAKER_02: And then in June, they began lifting the restrictions.
• 7:58
  SPEAKER_02: And one of the first things they did was to gradually allow kids back into school.
• 8:02
  SPEAKER_02: And it was like on an alternate day or alternate week system with the different grades.
• 8:08
  SPEAKER_02: And then after that, after a couple of weeks, when uh things didn't really get out of control, everybody's now back at school full time, at least as far as the school kids are concerned.
• 8:18
  SPEAKER_02: And then the restaurants started opening up.
• 8:20
  SPEAKER_02: The bars are still closed, except for those which have a food license.
• 8:25
  SPEAKER_02: So what's happening right now is that the bars which decided to apply for a food license are now celebrating that they can stay open, but they can only stay open until 10:30 at night.
• 8:36
  SPEAKER_02: They can only serve alcohol until 10:30 at night.
• 8:39
  SPEAKER_02: And groups are not larger than five people.
• 8:42
  SPEAKER_02: The other thing is the uh religious activities.
• 8:44
  SPEAKER_02: So churches, temples, and mosques were all closed, and then they all went online.
• 8:51
  SPEAKER_02: And then in June, when the lockdown was lifted, what they did was they allowed them to open for private worship.
• 8:58
  SPEAKER_02: Now they're open for up to 50 people, but these 50 people have to be pre-registered, and there are a lot of social distancing practices which have to be put in place.
• 9:09
  SPEAKER_02: It's somewhat arbitrary in that for churches, temples, and mosques for the regular weekly worship, it's 50 people.
• 9:16
  SPEAKER_02: For weddings, it went to 20 people and then 30 people, and funerals is at 30 people.
• 9:22
  SPEAKER_02: So, you know, they there are some very clever mathematicians who are doing all the modeling, and they come up with a number and that translates into policy.
• 9:31
  SPEAKER_02: And of course, there's monitoring that goes on at the same time.
• 9:35
  SPEAKER_01: It sounds like a very reasonable and data-driven approach, which I think uh, you know, we certainly appreciate.
• 9:41
  SPEAKER_01: You know, Singapore, it sounds like was able to unify as a country, and I think that's been one of the big challenges in the United States that a lot of these decisions about reopening and the strategies have been handled on a state-by-state basis, and there's been inconsistency and a lot of variability between states in their approach to using the kinds of restrictions that you were describing.
• 10:00
  SPEAKER_01: I think in general that there's a lot of similarities between the US and what you're describing, but uh I think the variability in the US has been a challenge.
• 10:08
  SPEAKER_01: So I I think that there's a lot of interest in how the public responds to lifting up uh restrictions.
• 10:15
  SPEAKER_01: You know, as as I mentioned, there's been a lot of variability in the United States, but I'm interested in hearing how the Singapore population has responded to processes for easing restrictions.
• 10:24
  SPEAKER_01: Can you share sort of what the public response has been like?
• 10:26
  SPEAKER_01: Even going back to the lockdown, but then transitioning into easing restrictions and what are some of the current issues that the public is raising moving forward.
• 10:35
  SPEAKER_02: Well, you know, Singapore is famous for this law enforcement and and you know the strict adherence to regulations.
• 10:42
  SPEAKER_02: And in fact, uh, what the lockdown has done is it turned a bunch of people into vigilantes, and so people are really paranoid about, for example, going out without a mask because you're afraid somebody's gonna take a picture and put it on Facebook or you know, put it on the police Facebook page, and and then you're gonna end up getting fined$50 for going out without a mask.
• 11:03
  SPEAKER_02: So there has been a little bit of that going on.
• 11:06
  SPEAKER_02: The regulations are in place, and of course it's impossible to enforce this kind of thing.
• 11:12
  SPEAKER_02: But if you're annoyed with your neighbor and you you hear, you know, what sounds like more than five people in their home, you know, there's a number you can call, and then somebody will show up, and then that guy will get fined$100.
• 11:24
  SPEAKER_02: So in fact, the latest one that came out in the news yesterday was there was a bar which had been caught serving beer in Chinese teapots to try and get around the restrictions.
• 11:35
  SPEAKER_02: So people are creative when it comes to getting around restrictions, but it's challenging.
• 11:41
  SPEAKER_02: I mean, when you try and impose a restriction, it's very difficult because at the beginning, you know, even before the lockdown, a lot of restaurants, people were canceling bookings and reservations because they just didn't want to go up.
• 11:53
  SPEAKER_02: So, in fact, what happened was the lockdown kind of formalized what was already starting to happen.
• 11:59
  SPEAKER_02: Because as cases were starting to go up in the community, people were just saying, you know, maybe it's better if I stay at home.
• 12:04
  SPEAKER_02: But the lockdown kind of forced the hand of everybody.
• 12:08
  SPEAKER_02: And uh and it brought out the best and the worst in people, I guess.
• 12:12
  SPEAKER_01: Yeah, I think uh, you know, we've seen similar challenges with the lockdown.
• 12:16
  SPEAKER_01: It sounds like the public was responding to the data that was being put out regarding the number of cases and uh acting consistent with the government lockdowns.
• 12:26
  SPEAKER_01: I'd also be interested in hearing the experience with masking.
• 12:29
  SPEAKER_01: That is was something that was very new to the United States.
• 12:32
  SPEAKER_01: Other countries and in the world had a little bit more experience using masks in public.
• 12:37
  SPEAKER_01: So can you share what the experience has been like in Singapore when masking became recommended?
• 12:42
  SPEAKER_01: What was the uptake like?
• 12:44
  SPEAKER_01: Uh, what the general response of the community?
• 12:46
  SPEAKER_02: Yeah, this is probably the most controversial part of the public health response in Singapore.
• 12:51
  SPEAKER_02: Because unlike other parts of primarily East Asia, like in Hong Kong or in Japan, you know, every flu season you see people walking around in the streets wearing masks.
• 13:01
  SPEAKER_02: Singapore is just too hot and it's uh masks are really uncomfortable.
• 13:05
  SPEAKER_02: So it's not part of the culture to wear masks, unlike you know, this the more subtropical parts of uh East Asia.
• 13:13
  SPEAKER_02: And when the cases started increasing in the community, this was actually a kind of a misstep in that there was a big fear, because Singapore doesn't man at that time it didn't manufacture masks, and we we depended on masks which were imported from Taiwan, from uh Malaysia, from Thailand.
• 13:30
  SPEAKER_02: And there was a big fear that there wouldn't be enough masks for healthcare workers.
• 13:34
  SPEAKER_02: So the message that went out from the health authorities was similar to what the WHO was saying, is that if you're well, you don't need to wear a mask, and that people who are ill should wear a mask to protect other people.
• 13:48
  SPEAKER_02: And there was a lot of pushback against that because people felt that, you know, masks were protecting themselves and they felt that there was rationing going on.
• 13:56
  SPEAKER_02: And then all of a sudden, when the lockdown in April came into place, there was a 180-degree turn, and that was related to the WHO talking about asymptomatic transmission.
• 14:07
  SPEAKER_02: And, you know, if the mask was supposed to prevent transmission from people who were infected, and you couldn't tell who was infected and who was not infected, then all of a sudden, you know, we had to do the switch to a universal masking policy.
• 14:22
  SPEAKER_02: So now we've got a universal masking, you can't leave your home without wearing a mask unless you're going jogging or you're less than two years old.
• 14:30
  SPEAKER_02: And people have taken to that.
• 14:32
  SPEAKER_02: You know, they're not prescriptive about the kind of mask.
• 14:34
  SPEAKER_02: So you've got designer masks and you've got, you know, people sewing their own masks and things like that.
• 14:40
  SPEAKER_02: But I do get people asking me, when do you think we can stop wearing masks?
• 14:44
  SPEAKER_02: So I think the messaging at the beginning was problematic.
• 14:48
  SPEAKER_02: And I felt, you know, if we were honest and we told people, look, you know, masks probably are helpful, but we are concerned that we may not have enough masks for healthcare workers.
• 14:57
  SPEAKER_02: People would have, you know, understood.
• 14:58
  SPEAKER_02: And because people are creative and resourceful, I mean, the minute that the mandatory mask use policy came into force, I asked my wife, I said, where did all our neighbors get all these masks from?
• 15:09
  SPEAKER_02: I mean, the pharmacies were running out of supplies, but you know, people are getting them in from Indonesia and and all kinds of places, or they were making their own.
• 15:17
  SPEAKER_02: So I think that's one of the things that we learned is that sometimes in communication you have to admit that you don't know all the answers right away, and things are going to change.
• 15:27
  SPEAKER_01: I think that's a really important point.
• 15:28
  SPEAKER_01: Something that has been a struggle here in the US, you know, making these kinds of recommendations with limited evidence.
• 15:35
  SPEAKER_01: And, you know, fortunately, there's been more and more evidence to support the utility of universal masking and preventing spread from asymptomatic individuals by masking.
• 15:44
  SPEAKER_01: You know, the mandatory nature has been variable in the US and handled at a state-by-state basis, and some of the states have been more enforcing of uh universal masking and mandating that than others.
• 15:56
  SPEAKER_01: Um, so that inconsistency, I think, is something that we've seen throughout the uh experience in the response.
• 16:00
  SPEAKER_01: So you did mention some of the concerns about limiting PPE supplies to healthcare workers.
• 16:06
  SPEAKER_01: I do want to talk a little bit about healthcare before we wrap up.
• 16:08
  SPEAKER_01: So, can you talk about PPE more broadly in Singapore?
• 16:12
  SPEAKER_01: You know, in the United States, we've been fraught with shortages, particularly with N95 respirators and even other items.
• 16:18
  SPEAKER_01: But can you share how things have been in terms of protecting healthcare workers in Singapore?
• 16:23
  SPEAKER_02: Yeah, you know, we had the experience of SARS uh 17 years ago.
• 16:27
  SPEAKER_02: And, you know, I I'm not a huge believer in airborne transmission of coronaviruses except in aerosol generating procedures.
• 16:35
  SPEAKER_02: So during SARS, you know, everybody's wearing N95 masks all over the hospital.
• 16:39
  SPEAKER_02: And fortunately, with the COVID pandemic, N95 masks are primarily used for highly suspect or confirmed uh COVID patients.
• 16:49
  SPEAKER_02: And right now, what's happening is that people are using a mask through a N95 respirator through a whole shift and they carry around these little ziploc bags, and everybody's been taught how to avoid contaminating themselves with the front of the mask.
• 17:02
  SPEAKER_02: Most of the time we're using these surgical masks, and those are relatively easy to get.
• 17:07
  SPEAKER_02: So that hasn't been an issue.
• 17:08
  SPEAKER_02: Again, the the concern was Singapore was not a manufacturer at the beginning of the pandemic.
• 17:13
  SPEAKER_02: Now we've started local production of surgical masks, not yet N95s, but you know, with the Chinese supply coming online, financially Singapore is not short of funds.
• 17:24
  SPEAKER_02: So they've been able to resource the hospitals and healthcare facilities.
• 17:30
  SPEAKER_02: It's just been a matter of getting hold of supplies from China before any of the other countries in Southeast Asia do.
• 17:35
  SPEAKER_02: And that seems to have worked out.
• 17:37
  SPEAKER_02: And that's been a huge part of building healthcare worker confidence.
• 17:41
  SPEAKER_02: You know, if if they know that there's access to PPE, then you know they're they're not going to be so anxious or nervous about the whole thing.
• 17:48
  SPEAKER_02: And in fact, uh, we have fewer healthcare workers staying away from their families than we had during SARS, although that's also partly due to the differences in the viruses.
• 17:58
  SPEAKER_02: I mean, we've had a ton of cab drivers getting infected, but you know, hardly any healthcare workers getting infected in the course of their work.
• 18:06
  SPEAKER_01: Yeah, that's very interesting.
• 18:07
  SPEAKER_01: I agree with the importance of PPE and supporting, you know, the healthcare workers and providing them with confidence in uh taking care of patients.
• 18:15
  SPEAKER_01: And I think when we came across PPE shortages in the United States, I think that really hampered our ability to provide the confidence that you know our employees, our frontline providers really need.
• 18:25
  SPEAKER_01: So I'm glad to hear that those challenges that we saw here in the US weren't necessarily reflected in Singapore.
• 18:31
  SPEAKER_01: So we'll have to wrap up soon, but I just want to ask, can you give us a sense as to how hospitals have been faring in terms of patients with COVID-19 throughout the pandemic and have things lessened a bit?
• 18:41
  SPEAKER_01: Um and then of course at the end I do want to hear about what you're thinking uh as far as the future in Singapore.
• 18:46
  SPEAKER_02: Yeah, so you know what we did at the peak in April-May, you see, what we did in Singapore was we we hospitalized everyone who was positive regardless of how symptomatic they were.
• 18:58
  SPEAKER_02: So we had a bunch of people who were really well, and they were uh and at the beginning we we made them stay in hospital until they had two negative swabs.
• 19:06
  SPEAKER_02: And that was just eating up, you know, hospital beds.
• 19:09
  SPEAKER_02: We canceled all elective surgeries and people with fractured ankles were sitting in the emergency department waiting overnight.
• 19:17
  SPEAKER_02: But when we realized that that was just not feasible, um they opened up a lot of facilities in the community.
• 19:24
  SPEAKER_02: So they converted a couple of convention centers into sort of makeshift hospitals where those who were stable were just kept in isolation.
• 19:34
  SPEAKER_02: And so the hospitals were able to pick up the slack.
• 19:37
  SPEAKER_02: I think in the last few weeks, I was talking to a couple of surgeon friends and they finally got back a full list, and that's uh a few months after the uh uh the lockdown was actually eased.
• 19:48
  SPEAKER_02: Looking to the future, we've got various contracts out with vaccine manufacturing companies.
• 19:53
  SPEAKER_02: So there's an anticipation that Singapore will get access to vaccine, even though we don't make any of it.
• 20:00
  SPEAKER_02: And I think the structures have been put in place for testing, for uh we don't do routine screening, for example, of pre-operative patients, you know, except for ENT and IBF, interestingly enough.
• 20:12
  SPEAKER_02: But I think you know, we've kind of reached a sort of understanding in how we're going to deal with this for now.
• 20:18
  SPEAKER_01: Thanks for sharing that.
• 20:19
  SPEAKER_01: And then, you know, the last thing I wanted to ask you was about uh reflection on your own experience.
• 20:24
  SPEAKER_01: You know, reflecting on the experience in Singapore, can you give our listeners who are in other countries, including the United States, some reflection on something you think that worked particularly well in seeing the COVID response and that other countries may be able to learn from moving forward?
• 20:38
  SPEAKER_02: Yeah, you know what I think worked really well was right at the beginning of the pandemic.
• 20:43
  SPEAKER_02: And Singapore had essentially redid what we did in SAS, which was basic epidemiology, identification of cases, contact tracing, which was primarily manual with some input from technology, cell phones and stuff like that, and use of electronic resources.
• 21:00
  SPEAKER_02: But that allowed us to identify all the contacts, to do uh screening, to do testing, to quarantine those who needed to be quarantined.
• 21:10
  SPEAKER_02: And until the outbreak reached the migrant worker dormitories, we were doing really well.
• 21:15
  SPEAKER_02: And unfortunately, once it got into the dormitories where you've got you know large numbers of people sharing a room or sharing a 30, 40 people sharing a one bathroom facility, then it's just really, really hard to keep under control.
• 21:29
  SPEAKER_02: So I think the two lessons we learned are one, good epidemiology works, and now of course we've got molecular epidemiology to supplement it.
• 21:37
  SPEAKER_02: And the second thing is that you really got to pay attention to everybody, including the marginalized individuals within your community, because these are the individuals who are probably the most vulnerable.
• 21:48
  SPEAKER_02: We are fortunate that most of them were healthy young men, so we had relatively few complications.
• 21:53
  SPEAKER_02: We had a few uh thrombotic complications, uh, young strokes, young MIs, but by and large, very few severe pneumonias in uh in the young migrant workers who who are infected.
• 22:05
  SPEAKER_02: So, two things good epidemiology works.
• 22:07
  SPEAKER_02: Uh, second thing is make sure you cover all the bases and take good care of the marginalized people in in your society.
• 22:14
  SPEAKER_01: So thanks.
• 22:15
  SPEAKER_01: I think that's uh terrific advice and something that we all need to be thinking about as we move forward and reflect on each other's successes.
• 22:22
  SPEAKER_01: And I really appreciate you joining the podcast.
• 22:24
  SPEAKER_01: So thank you again for joining.
• 22:26
  SPEAKER_02: Thank you.
• 22:27
  SPEAKER_01: Thank you very much to our speaker, Dr.
• 22:29
  SPEAKER_01: Timbaya, for sharing your perspective and experiences, and a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 22:38
  SPEAKER_01: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program.
• 22:44
  SPEAKER_01: You'll also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAY COVID-19 town halls.
• 22:52
  SPEAKER_01: Additional resources available on Learning CE pertinent to this pandemic include the SHA CDC Outbreak Response Training Program, or RTP, and the Prevention Course in HAI Knowledge and Control Prevention Check.
• 23:04
  SPEAKER_01: You can now receive 75% off SHA membership for the remainder of 2020 using the coupon code podcast during checkout.
• 23:12
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 23:15
  SPEAKER_01: Thank you for tuning in.