how exactly do we heal from this?

Part 1 of 2

CEBU CITY – As of this writing, it has exactly been 42 days from the date that the superfluously titled “Bayanihan to Heal as One Act” was signed into law. As we all know, the law gives the President “…powers necessary and proper…” to address the Covid-19 emergency. A dispassionate view of the law would lead one to conclude that while imperfect, it does provide all the necessary tools that the President, and by extension, the Executive Branch of government to fight this emergency. Overkill, some might say, but in a time like this you’d rather have more than what you need rather than less. The only thing you wish for is that those who have been granted these powers use them wisely and knowledgeably. On that last point, at best, you can say the jury is still out. At worst, it has been a bumbling exercise of administrative incompetence.

Before anything, nothing in our (the Philippine) context could have prepared us for dealing with this crisis. Some would argue SARs, MERs, etc. but those were just specks compared to COVID-19. Hindsight, as they say, is always 20/20. At the same time, it is too early at this point, to exercise hindsight on the totality of our fight against this virus as well as the entirety of the decisions that are made because a lot of these decisions still need to be made.

It is unfair to blame the entire national leadership for the early decisions that were made. You can, however, put blame squarely on the DoH secretary for the fumbled (i.e. pointing the finger at the airlines and his own people) contact tracing after the first cases of the infection in the country were suspected then confirmed. You can also put the blame squarely on him (and others) who took an overly gratuitous position of not banning flights from China. In response to a question about banning tourists, the good Secretary answered – “(C)ertainly that’s one of the possible options that we are looking at, but not at this very moment. The reason being, your honor, is we have to be very careful also of possible repercussions of doing this, in light of the fact that confirmed cases of the novel coronavirus are not limited to China.”. As late as March 4th, the good Secretary resisted recommending travel restrictions on other hard-hit countries by saying, “(A)ng IATF, matapos mabigyan ng health risk assessment results ng technical working group ng DoH, ang naging pasya ay hindi natin sila isasama I think nasa medium risk lang sila.“. You ask yourself, how many infected individuals does it take to cause an epidemic or in this case a pandemic? Yup – it doesn’t take rocket science that it only takes one person to cause a crisis like this. One. When it is that, you don’t take risks – high-risk, low-risk, medium risk, it doesn’t matter.

Since the beginning of this crisis, we have always been playing catch up. The combination of the lack of physical and top of mind preparedness coupled with less than competent high-level government expertise has meant that we have dug ourselves an ever deeper hole.

Missed opportunities

We already missed trying to keep this virus out of the country and we have failed to contain this at the first and second instance when it could have made more of a difference.

Having said that, despite an ill-executed start and its other imperfections, the lock-downs aka quarantines have undoubtedly helped.

Quarantines and “flattening the curve”

The stated intention of the quarantines was and continues to be the “flattening of the curve”. In epidemiology, “flattering the curve” is the idea of slowing a virus’ spread so that fewer people need to seek treatment at any given time. It bears mentioning that a flattening of the curve graph is that of NEW CASES and not total cases. This means that since we have no way to protect ourselves from the virus (i.e. we don’t have a vaccine), the next best step is to make sure that we do not have too many people getting sick at the same time to the point of overwhelming our healthcare system. This entails, among others, the social distancing measures that we have all come to know too well.

So while we continue to have new cases, it does not seem to have overwhelmed our healthcare system. Though probably incomplete, DoH data shows that on aggregate, our hospitals and other healthcare facilities have been able to manage. The utilization of hospital beds and mechanical ventilators as of May 4th has been below 50%. Even the supply of PPEs has caught up to reach adequate levels due to the early attention and action of government, the private sector and non-formal groups and individuals to address this problem. This, of course, is data on a national and aggregate basis. At certain points in time, geographic hotspots particularly in Metro Manila were close to their breaking points.

So, the question as I posed in a previous article is, are we ready to loosen up? To answer that question, it is useful to ask where exactly are we in the flattening of the curve?

In theory, the graph below shows how a flattening of the curve looks like:

This is what our graph looks like as of May 5th, 2020:

Testing

Does that look anything like the flattening for the curve? The truth is we are far from knowing whether we have flattened the curve. We have not tested enough people to know how many really have the virus. As of this writing, the Philippines has tested 119,774 individuals. Of these, 9,684 have tested positive (although there is also a significant (~2,000) number of test results which are still being validated).

People keep on insisting that we test, test, test. Every time I hear that, it becomes a little more maddening. The truth of the matter is, we cannot. At least not now nor in the foreseeable future. Why? We just do not have the capacity to ramp up testing for the more definitive RT-PCR tests. Our laboratories can only process a total of about 6,000 tests per day.

So what about those rapid test kits? At best, they may identify people who may have had the infection. The rapid test kits that are or will be used widely, essentially detect the presence of antibodies which our bodies produce to fight an infection. The problem is that these antibodies only appear a week, if not longer, after one has been infected. So in the case of Covid-19, an infected person may actually test negative in an antibody test leading to the danger where this person thinking he is negative starts to infect others. A false negative.

Second, these tests may detect antibodies which may have nothing to do with the Covid-19 virus but which are generated to combat another infection – a false positive, at least for Covid-19. A good rapid test should be sensitive enough to detect the antibodies and specific enough to identify the right antibodies  to Covid-19. There is not enough evidence to support the presence of such test kits which is why the World Health Organization dissuades the mass testing use of these rapid test kits for the determination of Covid-19 infection.

[To Be Continued in Part 2]