China’s successful response to COVID-19

Despite the headwinds China has faced this year—COVID-19, the trade war with the US, and the recent tensions at the South China Sea—the Chinese economy appears to be bouncing back.

The World Street Journal (WSJ) recently reported, “China’s Economy, Bouncing Back, Gains on the US.” It further noted that China is the only major economy expected to grow this year, with JP Morgan boosting its 2020 China GDP (gross domestic product) forecast to 2.5 percent.

A confidential source added that domestic tourism is back, as domestic flights resume. International tourism will follow, with Thailand as first-tier destination, and others, including the Philippines, at lower tier, depending on their ability to control the virus.

So, what accounts for China’s turnaround?

An article recently published in Dubai Medical Journal, “China’s Response to the COVID-19 Outbreak: A Model for Epidemic Preparedness and Management,” by Nourah S. Altakarli of Dubai Health Authority, attributes China’s success to the following:

1. Epidemic response capacity. Since the 2003 SARS outbreak, China has been strengthening and improving their epidemic response capacity for future outbreaks.

2. Case identification and large-scale surveillance. A community-wide temperature screening was implemented, and thousands of quarantine stations were established in airports, railway stations, bus stations and ferry terminals. The government invested in a mobile tracking application that categorizes individuals into color groups according to health status and travel history, enabling quarantine if warranted.

3. National reporting system. As soon as a COVID-19 case is diagnosed, the responsible doctor is required to report electronically. Each province is required to submit daily reports with epidemiological curves, with data used to focus on areas with more cases and requiring further measures.

4. Health-care facilities and medical team preparations. Anticipating hospitals could be overwhelmed, they built additional facilities nationwide to accommodate all patients.

5. City lockdown and social distancing. Large-scale quarantine and social distancing were imposed, locking millions of people at huge human and economic costs.

6. Improvements. With all the measures taken and the people’s commitment, a decline in the new cases and deaths was observed thereafter.

7. Removal of lockdown. In April, lockdown and travel restrictions on Wuhan were lifted. They restarted the economy but warned of possible resurgence as the pandemic continues in other countries and 80 percent of infected cases, with mild to moderate symptoms, are still infectious.

So what are we doing wrong? Why has the Philippines become the hot spot of COVID-19 in Southeast Asia despite the fact we seem to be following the same measures?

First, our national strategy of continuing cycle of general lockdowns or CQs—MECQ, ECQ, GCQ, MGCQ—has failed to control the beast.

To allow some economic activities so as not to further devastate the economy, we are shifting to granular instead of general lockdowns, but this would be effective only if we have controlled the virus. Sadly, we have not.

To control the beast, we have to change course and change horses.

Some say it is not good to change horses midstream.

Well, during the early stages of the civil war in America, when the Confederates were consistently beating the Union forces, Abraham wisely replaced the head of the Union Army, Gen. George McClellan, with Gen. Ulysses Grant who eventually won the war.

The government cannot hack it alone. Tapping the private sector resources and talent and fighting as one nation will help.

The IATF (Inter-Agency Task Force for the Management of Emerging Infectious Diseases), with private sector representation, should be cochaired by energetic, competent and decisive public health expert and country’s economic czar to win the war against two fronts – the health and economic crises.

Second, we seem to be obsessed with PCR (polymerase chain reaction) tests.

For diagnostics and treatment of COVID-19 patients, the PCR test, tried and tested with very high sensitivity and specificity, is, no doubt, the gold standard.

But what we need is a speedy, affordable surveillance test to separate the infected (symptomatic, asymptomatic, or presymptomatic) from the rest of the population.

To start with, there is no perfect test, PCR notwithstanding.

Besides being expensive (P5,000 per test or higher), its results are delayed by days, even weeks. Bill Gates said any test result after 48 hours is garbage, meaning, the horse is already out of the stable.

For another, some experts say the PCR is too sensitive and gives positive results even if the viral load is low and the person is no longer contagious.

A health surveillance test must be done frequently, as one could test negative one day and positive the next.

Most importantly, the results must be known in the first 24 hours when the virus is most infectious, so the patient can immediately be isolated to avoid infecting others.

Johns Hopkins recently published a study by a group of scientists, notably Dr. Michael Mina, MD, PhD of Harvard TH Chan School of Public Health, which postulates, “Test Sensitivity is Secondary to Frequency and Turnaround Time for COVID-19 Surveillance.”

Their findings: Testing daily, or every three days with effective isolation after positive results, reduced the effective reproduction number below one regardless of the test sensitivity, and as long as results were returned in fewer than two days.

Dr. Mina says an inexpensive paper strip test (about P50 to P100 per test) is already available, with saliva sample and result in 15 minutes, that can be taken in schools, offices, factories, and homes.

Third, our contact tracing is nil.

Our contact tracing czar, Mayor Benjie Magalong, reported that only 1 percent of our LGUs (local government units) are ready for contact tracing, which incidentally is manual, tedious, slow and expensive.

We need an effective mobile contact-tracing application that respects privacy and many are available, practically for free. Former Acting Information and Communications Technology Secretary Eliseo Rio Jr. commented that the IATF-accredited mobile application does not respect privacy, let alone do the job.

The participants should be anonymous and surveillance should be mandated only for the infected. As soon as the infection is over, data must be erased.

Fourth, daily, timely, accurate and comparable reports should use easily understandable charts and graphs for confirmed cases, new cases, deaths, tests, contact tracing, etc.

Finally, we need “first aid” teams to assist, not arrest, the infected, once identified for immediate isolation. 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 OMNIPAY, INC. He is a graduate of the Philippine Military Academy and formerly the President and CEO of the Social Security System or SSS. Feedback at [email protected].)