Three lines of defense vs COVID-19

Fighting COVID-19 is like fighting a war against a virus that will not go away soon. To achieve victory, we should establish a strong defense against the enemy.

It has been a hundred years since the world faced a pandemic (the Spanish flu), so when COVID-19 descended on us, most countries were caught flat-footed, with generally tepid response.

But Taiwan, since the 2003 Severe acute respiratory syndrome pandemic, has been on constant alert, with a public health response which activates emergency measures, such as case identification, containment and resource allocation. They quickly established a command center, enhanced case detection, ramped-up production of face masks and personal protective equipment, initiated border control, started vaccine development, effectively communicated public health measures, etc. Unfortunately, most countries, including the Philippines, continue to struggle with the virus, and now face a resurgence. The United States, which accounts for a quarter of confirmed cases worldwide, just reached record levels of infection, hospitalization and deaths last year-end, after fighting the virus for about a year now. Viruses mutate, and CNN recently reported the US CDC has found some 50 cases of the UK variant in the United States, while some countries have raised similar warnings, albeit at much lower levels. Believed to be more contagious, there are no indications it is deadlier.

COVID-19 has battered economies worldwide, with many businesses going belly up or comatose, millions of jobs lost and poverty, governance corruption and incompetence exposed.

Some vaccines are already available in the United States and United Kingdom, but it is still a long way to desired inoculation levels, especially for developing countries. Many worry the vaccines being developed against COVID-19 may not have the same efficacy and safety on the new variants.

Prevent infection

The first line of defense against COVID-19 is “prevent infection.”

By now, the world is aware of the necessary public health measures to slow down the virus. Dr. Anthony Fauci, one of the world’s most respected immunologists, has consistently advocated basic health measures, such as wearing a face mask, social distancing, avoiding congregations, especially indoors, and washing hands. Following public health measures should be considered a patriotic duty to protect others until herd immunity is achieved. The virus is the enemy, not the people; therefore, enforcers should exercise maximum tolerance in dealing with related violations.

Control the spread

The second line of defense is “control the spread.”

Experts have not agreed on the best way to control the spread of the virus.

Two approaches have evolved, while a third is advocated:

1. “shotgun” approach, or lockdowns;

2. “targeted” approach, or mass testing, contact tracing and quarantine; and

3. frequent, affordable antigen tests.

A lockdown is easy and inexpensive to implement—simply immobilize the community to slowdown the virus. However, testing, contact tracing and quarantine are invariably inadequate, allowing the infected, especially the asymptomatic, to continue shedding the virus.

The longer the lockdown, the greater the damage to the economy. Like a shotgun, it is hit or miss with respect to isolating the virus. Sadly, once the lockdown is eased, the virus starts spreading again.

Targeted approach is more scientific, but tedious and expensive. Mass testing, contact tracing and quarantine simply require massive resources.

Assuming we are able to “put the virus in a box,” the rest can go back to work under the new normal, with less damage to the economy.

Dr. Michael Mina, assistant professor of epidemiology, Harvard TH Chan School of Public Health, advocates a third mode—frequent, affordable antigen tests at home, school or work.

He says frequency and speedy results, not absolute test sensitivity, should take center stage in public health screening program to stop outbreaks.

Dr. Mina explains antigen tests have 98 percent sensitivity in detecting the virus when most contagious. He added that paper-strip antigen tests are inexpensive ($1 to $5 per test compared to polymerase chain reaction tests at $50 to $150), simple to manufacture, give results in minutes and can be used at home, school or work. The Philippine National Red Cross, under chair Dick Gordon, is modelling the way with its proposed saliva test which they say is cheaper and has 99 percent detection rate in the United States.

Achieve herd immunity

The third line of defense is “achieve herd immunity.”

Herd immunity is indirect protection from infectious disease when a sufficient percentage of population has become immune through vaccination or previous infection.

The World Health Organization (WHO) reports that the fraction of the population that must be vaccinated against COVID-19 to induce herd immunity is not yet known. WHO chief Tedros Ghebreyesus also warned against deliberately allowing coronavirus to spread in the hope of achieving the so-called herd immunity, saying it is unethical. Philippine vaccine czar Carlito Galvez, Jr. said the government plans to inoculate around 25 million Filipinos initially, increasing to 35 million depending on availability of vaccines. He estimates achieving their inoculation goal by year-end, or possibly early 2022.Challenges abound as developing countries, like the Philippines, may have to wait until advanced countries get their share first, having preordered, or financed the development of the vaccines.

US Food and Drug Administration has given emergency approval to Pfizer vaccine at $20 per dose and Moderna vaccine at $30 per dose, while United Kingdom has approved AstraZeneca vaccine at $3 per dose. Assuming 75 million Filipinos need to be vaccinated, the total cost, excluding delivery and implementation costs, would be P75 billion for Pfizer, P112 billion for Moderna and P11 billion for AstraZenica. Vaccine supplies appear to be limited for now, so we may end up with blended supply.

Another concern is the speed of inoculation. The United States, with all its technology and resources, has so far vaccinated only six million against the target of 20 million last year-end. A significant number is also expected to resist vaccination.

In conclusion, we must establish the following lines of defense against COVID-19: first, “prevent infection” through public health measures like wearing of face masks, social distancing, etc.; second, “control the spread,” through mass testing, contact tracing and quarantine; and third, “achieve herd immunity” with an affordable and efficient vaccination program. We should not lower our guard until we have stopped the virus.

Finally, we should follow best practices, such as the need for trusted leadership; a viable, comprehensive, strategic plan; the nation acting as one, with one voice; fast and commensurate response to the virus; cooperation with other nations and institutions; and preparing for the next pandemic. 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 chair of OMNIPAY, INC.

He is a graduate of the Philippine Military Academy and the Asian Institute of Management, and formerly the President and CEO of the Social Security System or SSS. Feedback at [email protected].