What the Philippines should do to arrest the COVID-19 contagion

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Truthfully, our problem in terms of governance management is our lack of faith in data. We are quite accustomed to acting based on gut feel and creating policies based on populist feedback. Data thru modeling had shown the necessity of closing our borders early on, but we did not do it out of political and diplomatic considerations. What is the basis of converting our “community quarantine” measure into “enhanced community quarantine”? You guessed right–when our policy makers saw pockets of people still doing their business inspite of the President himself ordering such quarantine.

And now, the administration faces a dilemma–the lifting of the enhanced community quarantine declaration simply on the basis of its earlier declaration of a 30-day lockdown. The question is— is that 30-day period sufficient for our health authorities to say that we already contained the contagion and we now know how it behaves and we have already gone past the peak period? This is the question in everyone’s mind.

When that time comes, expect a political decision rather than a decision based on empirical findings.

Cabinet secretary Nograles allayed fears of an extension of the enhanced community quarantine of Luzon. The Duterte administration pegged April 12 as the last day of the enhanced community quarantine. Many are hopeful that the administration is forthwith with us in saying that all of these measures are to be lifted by then.

The thing is, the artificial slowdown of the economy was undertaken without too much thinking. You only cause a slowdown of economic activities based on solid evidence that you can manage it, and the economy would not go down into what others call now as a “deep freeze.” Before I proceed, let me clarify the terms I am using here.

First, lockdowns such as the one we are experiencing right now, are not medical measures. They are political. It is the government which determines a lockdown or what this administration calls an enhanced community quarantine. It is political because, from a medical perspective, you only initiate a complete lockdown or quarantine if the empirical data shows you need to do it or if you have a strong proof based on modeling projections that such measures are necessary to stop the spread of the virus.

President Duterte decided for that measure because the Department of Health (DOH) itself gave him a chilling projection based on World Health Organization (WHO), which relied on data given to them by us. The processed data were never questioned– it was relied and given credence upon by the government because it serves a political agenda–it justifies a possible availment of a political measure called “lockdown.” Government knows the effects of spreading this information of the possible 75,000 infestation–it creates a climate of fear which would make people pliable to any suggestion, including, you guessed, employment of measures which will limit the exercise of civil rights.

As we now stand, the Department of Health (DOH) has just relied on World Health Organization (WHO) modeling which has not been totally verified. For one, our health experts has not yet identified Patient Zero. What we know is when the human-to-human transmission occurred and from there we made several assumptions and possibly created some modeling projections. The thing is, these modeling projections are, as the thing is, projections. It depends on the accuracy of data, and the choice of variables. I don’t question the mathematics of such models especially if the DOH and WHO used the modified SIR model. I would presume though that the data they used are really as close to what is happening on the ground rather than based on other modeling presumptions.

Since our health authorities do not have sufficient evidence of the rate of diffusion this pandemic disease had caused in our country, obviously, they would surely recommend what DILG secretary Ano described as “draconian” measures to contain the virus. Our authorities looked outside and found China and Italy and made them as examples of best practices. They shunned Japan and South Korea because quite frankly, these two states and don’t forget Singapore have sufficient medical equipment to initiate wide testings whereas we don’t.

LET’S ADMIT THAT THIS ADMINISTRATION IS NOT PREPARED FOR THIS. The initial action should have been shutting down our ports. We did not do that simply out of bravado, corruption at the immigration side and DOLE, and fears of possible diplomatic reprisals from China, which was at that time, the epicenter of the pandemic. Take note that this is a political decision, not medical. Health secretary Francisco Duque had already given sufficient evidence of a possible crisis situation as early as January. Had the political leadership did the right thing, this would not have happened.

What is the basis of my previous statement? Well, we did well with SARS, the Ebola virus outbreak and even with SARS-COV 1. We were firm in deciding to close our borders. Our administration decided to close our borders at a later date when the first COVID-19 infected individual had since arrived here and had already covered a wide latitude to spread and cause human-to-human transmission. Why was that during previous administrations, we were able to safeguard our borders from foreign infestation? Why is it that this administration failed to effect such a simple yet previous known effective mitigation measure?

Second, politicization of this health crisis. Instead of really minding the needs of medical front-liners such as finding solutions to bottlenecks in the supply chain and creating more effective ways on how government assistance would spill over the very bottom of the socio-economic chain, our government focused its attention on deployment of military units on the ground. Our government even thought of using this occasion to finally get what the President wanted since 2016–emergency powers. We know that pandemics are not short-lived affairs. They are not your usual crisis situations which last for two even 3 weeks. There are many imponderables when it comes to pandemics such as this one caused by a new and more virulent strain. The first consideration should have been preparing the frontliners. We should have procured the necessary medical equipment necessary for our frontliners to at least have the fighting chance against this virus. We instead went to the easiest route–shortcut through the use of police power. This leads us to the third issue, which is power struggle.

Government itself led a communication campaign which focused on the morbidity aspect of the virus instead of calling for community cohesion and preparing families and individuals against contracting this disease. Government peppered the communication networks with how lethal this virus is and how important giving the President emergency powers to deal with it. Our government communication teams overdid it and it caused what we are now seeing on ground— pockets of chaos in several areas. Our desire to address top level supply chain problems left us unable to address low-level supply chain issues because we undertook highly political moves in a devolved or decentralized environment.

Now that we are into this, what is the best solution this government must undertake in these times?

First, use data mining in constructing a model that would calculate the rate of transmission and create a map which would provide policy-makers information on virus behavior. We cannot proceed even with testing if we don’t know the areas of severe infestation and those which haven’t registered even one infected individual. Unlike Italy, which is a contiguous area, we are archipelagic hence, our geography alone is proof that no viral infestation would last a long time and infect every nook and cranny of this country. The best way is for us to determine exactly where these areas are so that we can very well, decide for other areas least or not infected to resume normal economic activities.

Second, ensure that everything that our health frontliners need are already here and ready for deployment and use. We don’t want to see our frontliners dropping one by one due to infestation. It would be interesting to see out of the numbers of PUI’s we have, how many of them are frontliners themselves. We need to ensure first that our frontliners would not be the ones transmitting the virus themselves and the only way we can do that is equip them with the necessary tools to address the situation.

Third, undertake selective testing and health surveillance. We don’t have enough testing kits and the reason is quite obvious—there is global demand for such things and the rate of manufacturing these are low. Like other countries, the Philippines is scrambling to get its allocation. We just have to do the best that we can with what we have.

This is where effective communication comes in quite handy. Our government should encourage the LGU’s to assist the DOH and the RITM in getting ground information, including samples of infected and non-infected individuals. A survey should be undertaken, if possible per barangay. Those living in the subdivisions and exclusive villages should be encouraged to take part in the comprehensive surveys online. Results of these field surveillance surveys are instructive and may even be used by government as policy research for other health concerns.

Fourth, data gathered should be processed by our best mathematicians and statisticians to create a highly reliable picture of the landscape. Medical experts who know the modified or enhanced SIR model should get access of these data and create modeling projections. Those projections would now be the basis of government action. These will determine the best possible action moving forward.

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