[OPINION] Perspectives on building the new health normal beyond the coronavirus

With the recent presidential announcement of the extension and relaxation of enhanced community quarantine (ECQ) in high-risk and low-risk areas respectively, the Philippines is abuzz with daily ruminations of existence – new COVID-19 cases, deaths, recoveries – questions of epidemiology – flattening the curve, doubling rate, second wave – and prospects for survival in the age of the new normal – physical distancing, social amelioration, stimulating the economy. We must brace ourselves for the worst, cooperate with authorities (so we were told) and do the best bayanihan that we can before the discovery of any definite vaccine and treatment to put a stop to this raging pandemic becomes a reality.

From a public health standpoint, lockdown measures, aside from imposition of stringent physical distancing measures are meant for us to buy more time to decrease the rate of transmission of the disease and improve further our health system capacity to be able to detect more cases, trace their contacts, quarantine potentials, and isolate and treat cases so we will have fewer deaths and more recoveries. Understandably, the collateral economic damage and social repercussions provide a solid counterpoint with which to balance these extreme but justified public health interventions. 

Faced with the immense challenges brought by this pandemic, one fundamental question begs to be asked: As a health issue among many others, how prepared is our health system to handle this? To answer this, it is helpful to deconstruct the Philippine health system before COVID-19 and point out areas for strengthening that can be used to influence strategies now to manage COVID-19, and other pandemics and health threats in the future. (READ: DOH admits PH health care system ‘challenged’ by virus testing demand)

The Philippines, thanks to advances in science and health research development and increasing spending, had seen an improving trend in health outcomes. However, the health system remains to be defined by health inequality and inequity across the rich-poor and urban-rural spectra. This is compounded by a fragmented healthcare delivery system – public and private sectors – and a decentralized form of health governance – with national government setting policies and standards and regulating health services while local governments units implementing health programs and services for their localities. 

A science-based response to COVID-19 can be put forward but attainment of other health goals and outcomes maybe hurt as attention can easily be shifted and resources diverted to COVID-19 response. The disease will disproportionately affect the poor because they are vulnerable in social and economic terms. Access to COVID-19 services including testing, isolation, and specialized care may be limited in rural and geographically isolated and disadvantaged areas. Coordination between national and local, government and private are critical to the delivery of services both for COVID-19 and other conditions.  National policies should be clear and flexible enough to guide local actions. When an exceedingly high number of cases needing to be hospitalized overwhelm the capacity of hospitals, a good system of triaging, treatment, infection control, supplies management, coordination, and referral must be in place.

The Philippines is grappling with a triple burden of disease – communicable diseases, non-communicable diseases, and diseases due to health impacts of globalization, industrialization and urbanization like climate change and disasters. These will compete with COVID-19 so equal attention must also be given to non-COVID diseases. These same old health issues can cause cascading issues that can be far and wide. If not put in check, public health capabilities to prepare for and respond to bigger health threats especially pandemics can be challenged. These can have security implications as these can potentially cause devastating economic and sociopolitical consequences. (READ: How poor is the Philippine health system? Many hospitals not qualified to test for coronavirus)

Our current COVID-19 experience validates this. COVID-19 response in the country has become bigger than the Department of Health, bigger than the health sector. It has ceased to be a health issue. It is now a health, defense, economic, social, political, religious, even existential issue. The usual tools of medicine and public health are being used but with much inputs and expertise coming also from other sectors and disciplines. Resources from both public and private sectors, corporations and individuals have started to pour in. Suddenly, all of the pandemic planning principles that we have been drilled with (anticipatory planning, effective coordination, strategic communications) are becoming the norms now without which we are destined for failure.

It is imperative to strengthen health systems to anticipate, prevent, prepare and respond to traditional and emerging health risks, from the simple flu to a complex pandemic like COVID-19. Carrying the brand of universal health care, this can be done by improving financing, harnessing use of information for evidence-based decisions and actions, strengthening health governance, capacitating and motivating health human resources, investing on health infrastructure, equipment, and supplies, and optimizing the delivery of health services.

More than ever, these strategies are very important now in combatting COVID-19. The best time to strengthen the Philippine health system could have been before, but in light of our collective COVID-19 experience, the time is NOW. 

But HOW?  It would be helpful to distill unique lessons coming out from this pandemic using the acronym COVID. COVID-19 is a/an:

Complex problem that must be communicated clearly to all concerned.  This includes communicating what we know and what we don’t know yet – uncertainty. This brings everyone into the same page. When common understanding begins, half of the battle is already won.

Organizational challenge that requires a systems approach to address. It entails a range of strategies and the work of multiple people from multiple teams from different sectors, disciplines, locally and globally. It should answer the now and the future in the short, medium, and long terms.

Vicious enemy that is invisible but knows no boundaries and afflicts any one, regardless of socioeconomic status, nationality, religion, or occupation. Thus, aggressive and concerted strategies are needed and coming together in solidarity is not merely a call to action but may rather be the only offer of hope.

Individual (people)-centered experience that begets dignity, compassion, and respect. COVID-19 response apart from providing for the needs of people should also be involving people in the design and implementation of programs and projects capitalizing on their self-reliance.

Development issue that should be considered and addressed in the big sustainable development goals and plans of each country. When COVID-19 is over, we have to make sure the new normal puts Filipino’s lives in a much better position than they were before this disease.

With all of the Philippine society’s efforts, resources, hopes, and prayers put into COVID-19 response, we can confidently say to the world, to our worst critics, that we can at least put up a better fight with the next pandemic – that is, if all of us will be relentless and resilient enough to get out of 2020 unscathed. The next generation of Filipinos certainly deserves a brighter future. – Rappler.com

Ronald Law is the Chief of Preparedness of the Department of Health’s Emergency Management Bureau and is Professor of Public Health at the University of the Philippines-College of Public Health, Ateneo School of Medicine and Public Health, and the University of the East-Ramon Magsaysay Memorial Medical Center Graduate School.

He completed his Fulbright research fellowship on the topic of Health Security as US-ASEAN Visiting Scholar in the University of Washington last January of this year, when the threat of COVID-19 globally and domestically was already looming.