Coronavirus: Doctors expect rise in acute respiratory infection cases after dip during circuit breaker

Doctors urged people with symptoms of acute respiratory infection to get checked, even if it means that they will get swabbed. ST PHOTO: LIM YAOHUI

SINGAPORE - Doctors here say they expect more cases of acute respiratory infection (ARI) as Singapore's economy continues to reopen, following a drop in the number of such cases during the circuit breaker period.

Healthcare professionals The Straits Times spoke to said there were a number of possible reasons for the fewer cases.

Dr Edwin Chng, medical director of Parkway Shenton, said the chain's 42 Public Health Preparedness Clinics saw an 80 per cent drop in ARI cases since the start of the circuit breaker, with each clinics seeing fewer than 20 such cases a day.

"This is probably because of the effective measures imposed by the Government during the circuit breaker," he told ST on Monday (June 29).

Dr Tan Liat Leng, a general practitioner (GP) at EH Medical Clinic, posited an alternate explanation.

"It could be because they're working from home and feel that a medical certificate won't make much of a difference, or because their symptoms are so mild, they prefer to treat it themselves," he said.

But a third possibility is that patients are afraid of the potential consequences of visiting a clinic while they have an ARI, said family physician Aziz Noordin.

Dr Aziz, who practices at Tampines Family Medicine Clinic, said many of his ARI patients told him they were hesitant to get checked up because they were worried about having to be tested for Covid-19.

"There's always a question of what happens if I'm positive, what happens to my family, my kids," he said, adding that such concerns need to be addressed.

Family physician Quah Soon Wee of Crossroads Family Clinic, which saw a 50 per cent drop in ARI patients over the circuit breaker period, shared the same theory.

"They may be afraid to get swab tested, or of having to take five day's medical leave," he said.

Patients with ARI have been the focus of Covid-19 swab testing as part of efforts to contain the spread of the disease here.

On June 2, it was announced that all students above the age of 12 and school staff with ARI would be tested upon seeing a doctor. On June 19, this was expanded to include those aged 45 and above.

Finally, on June 25, the Ministry of Health (MOH) said anyone aged 13 and up with ARI would be tested from July 1.

Since March, about 600 of Parkway Shenton's patients were swabbed for the coronavirus as a result of having an ARI. Thirty of these tests returned positive, said Dr Chng.

Northeast Medical Group's medical director, Dr Tan Teck Jack, said the group's nine clinics had also been swabbing about 20 such patients a day before phase two of Singapore's reopening, with very few of these tests coming back positive.

Since the reopening and activities started to pick up, his clinic has seen a 30 to 40 per cent increase in the number of patients with ARI.

"It appears that more people are mixing and getting an ARI because of increased human-to-human contact... This reflects the social nature of this disease," he said.

The doctors said that while the Health Ministry has set out general symptoms of ARI as being cough, sore throat, runny nose and loss of sense of smell, determining if one of these symptoms is due to an ARI and not something else is up to the individual doctor.

Dr Tan Liat Leng said that as GPs deal with ARIs most of the time, they are experienced enough to tell the difference.

He said: "It's about judgment calls and good history taking... We do exercise discretion in diagnosing an ARI as we understand that unduly diagnosing ARI when there's none might cause inconvenience to the patients - not only because of the swabbing, but the anxiety of waiting for the next few days for the test results."

He added: "If you have a cough, it's usually the case that you have an ARI. However, if it goes for very long with no fever, it could be due to something else, like an allergic reaction...

"To err on the side of caution, if there are more serious symptoms like fever or body aches, we will treat it as an ARI."

Other reasons for having ARI-like symptoms could include underlying conditions such as asthma or allergies, or a patient being a smoker, said Dr Quah.

However, he advised against patients self-diagnosing. He said: "The tricky thing about Covid is that a lot of patients present with very mild symptoms, so even a slight cough could be due to Covid. It's hard for patients to tell on their own, so it's recommended that they see us."

His sentiment was shared by Dr Aziz, who said some patients come in convinced that their runny nose is a result of them cleaning the house, or that their sore throat is due to eating too much durian.

"There are things that those with no medical background may not piece together. You may have eaten durian, but you may also have bought that durian from a supermarket at the same time an infected person was there," he said.

The doctors urged people with ARI symptoms to get checked, even if it means that they will get swabbed.

They all assured that the test is quick and relatively painless.

Dr Chng said: "Patients should not worry because Covid-19 testing is very quick and easy to do. In addition, anyone who is unwell should get tested for public health reasons. This will also allow him or her to receive the appropriate treatment needed and stop the spread to loved ones if tested positive."

Said Dr Tan Teck Jack: "If we have a second circuit breaker, it'd be very expensive and disruptive to the community. So it's socially responsible for you to present yourself to a doctor once you have a cough or cold, and let them decide."

Added Dr Tan Liat Leng: "Covid's danger is the fact that it tends to have complications at the late stage of the disease... So it's better to be diagnosed at an early stage, when you can be put under monitoring or isolation, rather than letting your infection fester."

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