Addressing our COVID-19 woes

We blew it.

The Philippines, like the United States, blew its first fight against COVID-19.

Yet, there are more battles to come—the next COVID-19 surge, possible hunger due to severe unemployment and most likely, an economic recession. All is not lost, we hope.

Why the poor results?

The Philippines and the United States are named among the most affected nations by the prestigious Johns Hopkins University and Medicine Coronavirus Resource Center, understandably due to relatively high levels of average daily confirmed cases, among others.

Worldometer reports the following disparities as of July 14:

(1) Total confirmed cases/million: United States: 10,514; Philippines: 525; South Korea: 264; Taiwan: 19; Vietnam: 4.

(2) Daily confirmed cases: United States: 614; Philippines: 634; South Korea: 33; Taiwan: 0; Vietnam: 1.

(3) Total deaths: United States: 138,273; Philippines: 1,603; South Korea: 289, Taiwan: 7; Vietnam; 0.

(4) Deaths/day: United States: 1,519; Philippines: 6; South Korea: 0; Taiwan: 0; Vietnam: 0.

(5) Total tests/million: United States: 130,564; Philippines: 9,284; South Korea: 27,708; Taiwan: 3,306; Vietnam: 2,864.

The following may have contributed to this dismal performance:

First, the responses of the United States and the Philippines were too little, too late. COVID-19’s transmission is exponential, if not immediately contained. Both are behind the curve in testing, contract tracing and isolating the infected. The asymptomatic persons, estimated by CDC (Centers for Disease Control and Prevention), the United States at 40 percent of total infected, still have to be contact traced, tested and isolated, if tested positive.

Second, no one is really in charge. The United States and the Philippines have each an interagency task force for coordination and policy. The United States has a coordinator, Dr. Deborah Birx, but implementation is left to the states. The Philippines has IATF (Inter-Agency Task Force for the Management of Emerging Infectious Diseases) chair Health Secretary Francisco Duque III whose “word is the law” according to President Duterte, but leaves the implementation to National Task Force commander Gen. Carlito Galvez Jr., who, in turn, defers to Secretary Duque.

Authority is dispersed. In the United States, the states complain of lack of guidance and support from the federal government, while the federal government blames the states for not doing enough. In the Philippines, we have too many czars.

Third, the plans, strategies and situation are not communicated well to the public; hence, the oft-repeated queries—what is the general plan, specific goals and accountabilities, strategies, who is really in charge, and what is going on?

The United States has three sources of information: the White House which paints a rosy picture, the task force which downplays the risks for fear of displeasing US President Donald Trump, and the research agencies and media whose reports are branded fake news by the White House. The consequence: confusion.

The Philippines has one voice, but reports are relatively incomplete, with no graphs (a picture paints a thousand words), bad news is avoided so as not to displease Mr. Duterte, and many wonder if the reports are reliable due to delayed, conflicting and “audited” Department of Health (DOH) data, which the DOH refuses to directly share with research agencies.

The bottom line: The United States politicizes COVID-19, with little regard to science; the Philippines polices the population, rather than focus on science.

Can the Philippines and the United States catch up?

Yes. Just follow the best practices of Germany, South Korea, Taiwan, Vietnam and other more successful states. Their principles are the same:

First, act swiftly and decisively as one nation. Involve the private sector which has a large pool of experts in epidemiology, data science, management and supply chain. Moreover, they have significant resources to contribute to the campaign.

Second, there must be an accountable chief executive officer who should direct all actions according to stated goals and strategies.

Third, reports must be transparent, trustworthy, real time, reliable and easily understood by the public.

Fourth, science must prevail over politics.

Albert Einstein reminds us: doing the same thing over and over again and expecting different results is insanity.

The solution? Put the virus in a box: pretest/test, contact trace, isolate. The steps are simple:

(1) Pretest symptomatic persons with antibody tests; then, confirmatory RT-PCR (reverse transcription-polymerase chain reaction) tests on those who test positive.

RT-PCR test is the gold standard only when done properly by trained personnel. If, for example, taking swab samples is not carefully done, there could be a lot of false negatives, meaning the test result is negative but the person is actually positive for the virus.

RT-PCR’s major disadvantage—each test takes 3-6 hours for chain reaction—and unless RT-PCR testing capacity is really relatively huge, which is too late and too expensive at this time, test results will invariably be delayed by a week or more.

There are already FDA (Food and Drug Administration)-approved antibody tests with very high sensitivity and specificity, with results obtained in 15 minutes or so, at 10-20 percent of RT-PCR test cost. Because it identifies antibodies instead of the virus, a confirmatory RT-PCR test is needed for diagnostics.

Saliva test is promisingly faster and cheaper, but it has to be approved yet by the FDA.

The solution: pretest with antibody tests first, then confirmatory RT-PCR tests for those who test positive.

(2) Contact trace those who may have been infected, most likely asymptomatic. If we take the CDC report that asympto­matic persons represent 40 percent of total infected, we have to contact trace and test 40 to 60 thousand persons more, and hire and train, at a ratio of 1:4, 10,000 to 15,000 contact tracers.

Mobile applications for contact tracing is a must. Manual contact tracing is too tedious and slow. The more mobile applications, the better, with a central database that protects privacy.

(3) Isolate immediately. Self-quarantine at home is recommended if a room is available for the patient; otherwise, he or she has to be transferred to a quarantine facility.

(4) To avoid any virus outbreak, a first aid team, as in Germany, to assist (not arrest) COVID-19 patients in the community. INQ

This article reflects the personal opinion of the author and does not reflect the official stand of the Management Association of the Philippines or the MAP. The author is a member of the MAP Inclusive Growth committee and the chair of the Omnipay Inc. He is graduate of the Philippine Military Academy and former resident and CEO of the Social Security System or SSS. Feedback at [email protected] . For previous articles, please visit map.org.ph.