Doctors have become the experts of the moment, especially those that dive deep into the daily battle of treating COVID-19 patients in our hospitals. We’ve encountered quite many of them in the past weeks — albeit through online messaging mostly — and their words not only inform our stories but have been the reassuring and comforting rubs on the back we need in these times. Their statements are backed by years of study and experience, and the way they dispense of advice and information are always sober and calming.
One of the doctors whose ideas we, along with our government, should listen to is Dr. Benjamin Co whose blog post we recently chanced upon. According to his CV, Dr. Co is an active consultant in pediatrics with subspecialty in infectious diseases and clinical pharmacology. He holds clinics in the UST Hospital, Asian Hospital and Medical Center, and Cardinal Santos Medical Center. But he tells us we can just say he’s “a physician, educator, professor, speaker, scientist, researcher, administrator, mathematician, writer and yes, a part-time blogger.”
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In his blog post currently making the rounds of Viber groups, he talks about his views on the lockdown and if an extended one is the advisable option. Below is a major chunk of that post entitled “Exit Strategy.”
So my readers asked me one good question: Will (or should) the lockdown be extended?
What I will write is based on all the data I can cull available for public access. Other “unpublished” or unreported information are factors that may change the opinion later on.
So here we go.
The answer is YES.
It should, however, be modified because we have now seen its promises, and gaps.
As the number of new cases rise — and it will rise because we have more testing kits now — the number of daily deaths will be the predictor of whether the lockdown is working or not. Let’s remember: the number of new cases IS NOT a reliable predictor of whether the lockdown of a community works or not, because when the lockdown was declared, the number of cases were already on the uptrend.
Figures 1 and 2 above show that the slope began toward the middle of March. I cannot overemphasize the importance of testing here. It was an outbreak waiting to happen. We slept while the enemy was awake. Complacency and poor foresight. As long as we see those numbers go up for awhile, don’t expect the recoveries overnight. They won’t go down until 2-3 weeks from the time they went up. We started the steepest climb only last week. How steep will we go depends on multiple factors.
The good news is that if this lockdown did not happen, there would be more new cases and new deaths.
The bad news is, as in all lockdowns, this came too late. By the time an outbreak has occurred or is recognized, the virus has already taken over a proportion of the population for it to spread. The R naught (R0) of SARS-COV2 is low. Scientists say it’s round 2-3. The R0 tells us the infectivity. For every case, 2-3 patients probably get infected with the virus. Compared to the seasonal flu where the R0 is around 1.3 or chickenpox virus where the R0 is 10 or measles virus where the R0 is 15.
Why do these numbers matter? Because they are part of the basis in decision making for our exit strategies.
1. We know that physical distancing works. The less crowded the place is, the less infectivity rates are. That’s common sense.
2. Unlike the World Health Organization, I disagree that masks should not be worn. The WHO has flip flopped several times on various recommendations or whatever it recommends. They are a political organization. They are not a regulatory agency. What may be effective in Uganda or the Philippines may not necessarily apply to Japan or the United States. Every country has its own vulnerable spot. And ours is relying on the WHO for an opinion. Their observations are noted. Do we need to follow it? No.
Masks should be provided and worn outside of the home, in public, when tending and seeing patients. The proper mask is also essential. Those washable porous masks that have Dora or whoever character etched all over — they don’t work. Wearing a mask should be the norm now. I cannot overemphasize how much a highly useful preventive equipment it is for many respiratory pathogens. The mere fact that SARS-COV2 is a respiratory virus, protecting your face with a barrier is just common sense.
3. The surge of OFWs returning home is scary. Not that we don’t want them home. We do. But what do we do when they get here? More than anything, they must all be swabbed. Their absence of signs and symptoms, fever or other factors ARE NOT reliable. Majority of our patients do not reveal a history of travel. Travel has become a stigma suddenly. We learned that with the death of a doctor from a patient who lied. The patient had a travel history. Got sick. Got people infected. Didn’t tell the truth. And a doctor died. Where’s the fairness in that?
Swab them all. Quarantine them for 21 days. For patients that are positive, they need to have 1-2 negative swabs depending on the clinical status of the patients on discharge. Patients that develop symptoms and are critically ill must have 2 negative swabs before being discharged.
And its not only the OFWs. Even those that have arrived in the Philippines in the last 30 days should get swabbed. The Department of Foreign Affairs and the Bureau of Immigration surely has a list of all these people who have arrived. They should look for the travelers and swab and quarantine them until all results are available.
4. PUIs with mild symptoms should be segregated and admitted to a facility only for PUIs. They must not be allowed to be part of the home or community. This is to make sure that they are not violating any quarantine measures. You know how ingenious the Filipinos are. Segregating them will minimize having a total lockdown in the communities.
5. All PUMs should be monitored properly. There are many ways that the local governments and barangays can assist. The identities of these patients can be provided and the data privacy act can and should be waived under these extreme circumstances, otherwise we end up in a catastrophe. The barangay can monitor the household 2 to 3 times a day. Everyone in the household should isolate the PUM in one room dedicated for the patient. Protocols are in place for self-quarantine. For the informal settlers or those that have no dedicated room for PUMs, the government should be able to provide makeshift places for these. Tap the public and private schools which are currently closed. PUMs have no signs and symptoms and will need very little monitoring except for food, water, shelter and keeping them locked in a room for the next 14 days.
6. Malls, stores, movie houses, bars, offices and restaurants should remain closed until May 3, 2020. We can reassess later the situation. Restaurants can serve take out food only but no dine in. Businesses that can work from home should be encouraged to work from home until May 3. Businesses that will need physical presence of workers should have a minimum work force or skeletal schedule.
7. Curfew should remain in place from 9pm-5am every single day. This will minimize movements in any community.
8. Schools should remain closed until the end of May. The highest transmission of a virus will always be a crowded environment and believe me when I say that the physical distancing is least observed in pediatrics.
9. All children and the elderly (60 or 65 years old) should stay at home as much as possible. Unnecessary travel should be avoided among this group.
10. Public transportation should be limited. Jeepneys and buses and taxis can be allowed but the number of passengers should be limited. No tricycles or bike riding apps should be allowed. Trains and MRT/LRT should not be allowed until such time that we have seen the flattening of the curve.
11. Every region must have its own accredited testing center before we can even consider lifting or modifying the lockdown. We need to capacitate every region because the delayed results due to backlogs are deadly. Some patients will present in an unusual manner. By the time you get the results, some of them can end up infecting 2-3 patients who in turn have infected 2-3 more people and so on down the line depending on the day the results come out! Without this being in place, you cannot lift the lockdown OUTSIDE of the National Capital Region.
12. The Bureau of Immigration and Department of Health need to work together and we cannot rely on patient information. Every patient that is a PUI, PUM, positive (dead or alive) should be verified with the BI for a travel history – when, where, and what aircraft? This is for documentation and contact tracing purposes. Contact tracing is much easier when the patients are truthful with their information.
These are all common sense. They will work. If our government officials can work together. It’s disappointing that there are government agencies that create issues that are divisive in times of crisis so that they can lick the ass of people in power. Hey, this pandemic is about all of us, not about your political future. Get a grip on reality! If and when we all get out of this alive in the next few months, believe me, it will be payback time. Accountability among the government officials shall be made. And those that stole, corrupted, abused, and conspired with evil during this pandemic should be held responsible for the outcome.
So yes, the lockdown should stay unless these issues are addressed. Then we can work on a week to week basis on how we can go back to our “normal” lives. In the meantime, this will be our new normal.
Oh before I end, the kit is still the most important tool we have here. I started blogging about this virus way back in January. It started with one simple article entitled “Pandemonium.” The rest is history.
How we tell the story, who we listen to and how factual the information is, and how it impacts on peoples lives and futures – that’s what matters. Let’s hope and pray that this government has an exit plan. Not one out of ranting but one that is well thought of. Because you accepted the role to lead, you have no choice but to lead us out of this pandemic with the least casualties.
Dr Benjamin Co is the Chief of the Pediatric Infectious Diseases Section at the UST Hospital.