The struggle to save lives and to keep society functioning amid the coronavirus pandemic means hard choices lie ahead for our national leadership.
These are 3 possible strategies going forward:
First, allow the course of the epidemic to run unbridled.
COVID-19 has a basic reproductive number (R) between 2 to 2.5, which means each infected individual will, in the course of his/her illness, infect two others on average (using the lower estimate) at the beginning of the epidemic. (READ: FAQs: Ano-ano ang alam natin tungkol sa 2019 novel coronavirus?)
The infection spreads exponentially through the susceptible population until most people have been infected. The outbreak is contained when about 60% of the population has contracted the disease and the threshold for herd immunity* is reached. At this point, perhaps 6 months from the start of the epidemic, the R will decline to close to zero for the lack of susceptible hosts.
About 60 million Filipinos will contract the disease before the epidemic fizzles out on its own. In this scenario, the health care system will buckle and fail to cope with the deluge of cases, and many of those infected will be left untreated or receive suboptimal care. Conservatively, around 600,000 Filipinos will perish from the coronavirus.
*The concept of herd immunity against the coronavirus is that if the virus keeps spreading, eventually so many people will contract the disease and (if they survive) become immune, that the outbreak fizzles out as the pool of susceptible hosts dwindles. At this point, the virus will find it difficult to infect susceptible individuals as they are now cordoned off by a wall of immune individuals who have recovered from the disease.
Second, total suppression of the epidemic through a lockdown.
By bringing society to a stop, and shutting everyone in, the government is able to keep a lid on infections. But with the virus so widespread locally and with multiple foci around the world, the threat of subsequent waves of infections keeps society in an indefinite or repeated lockdown until a potent cocktail of anti-retrovirals or a vaccine becomes widely available. (READ: Luzon lockdown: What are the do’s and don’ts?)
A vaccine, if one works at all, would not likely be available in 18 months’ time. The economics of an indefinite or repeated lockdown would be catastrophic. The halt in production will lead to scarcity in food, medicines, and other necessities. Support systems will collapse.
Lockdowns carry heavy social and economic costs that will disproportionately be borne by the poor. Class struggle will come to fore as the masses, young, hungry, and unafraid of the virus, clamor for work against the wishes of the elite who wish to retreat behind their gated communities and their full cupboards. The government will struggle to maintain peace amid the ensuing unrest. Deprivation and violence will claim many lives.
Today, many countries are taking a leaf out of the Chinese experience in implementing Wuhan-style lockdowns on their population, unprecedented in peace time, in an effort to control the spread of the virus. This is misguided.
First, China is led by an authoritarian one-party regime which can marshall the full strength of the state in imposing the lockdown, in securing the supply chain, and in maintaining social order. No government other than the most repressive ones can realistically keep their society in a prolonged lockdown.
Second, it’s wrong to be tempted to think that the ongoing lockdown of Wuhan has worked. True, Chinese cases have come down dramatically, with imported cases allegedly exceeding cases from domestic transmission. But with the relaxation of restrictions, it is not far-fetched to imagine the epidemic roaring back in China.
Experts believe there was one transfer event that introduced the coronavirus to the human population. This worldwide pandemic started with a patient zero who unwittingly caught the virus from a yet to be identified animal source. One person is enough to spread a contagion. This illustrates the impossible task of containment/suppression. Let one asymptomatic case go undetected, and the epidemic will again rear its ugly head.
Third, a compromise between two extremes – disease mitigation
The epidemic is allowed to run its course, but its intensity is tempered by measures to promote physical distancing and to protect the most vulnerable in a society allowed to grind on. Physical distancing is the act of putting some distance between you and the people you interact with, or foregoing some of these interactions altogether. This serves to decrease the probability of disease transmission among individuals and thereby slows down the spread of the disease. (READ: PH coronavirus cases in maps and charts: What the data says)
By “flattening” the curve, the number of Filipinos who will eventually become infected with the coronavirus will not change (about 60 million), but the rate at which the population is infected will be brought down to a more manageable pace.
Compared to the situation where the epidemic was allowed to rampage unrestricted, more lives would be saved. This is because more infected individuals will be able to receive appropriate care extended by a health care system able to cope better, and the vulnerable like the elderly and the sick will be shielded from the worst of the epidemic.
Modeling by the Imperial College in London suggests, at least in developed economies, that imposing quarantines on infected people and their contacts, and protecting the elderly through physical distancing, cut the height of an epidemic’s peak by two-thirds and pushed it back for a month (a flattened curve). The model also suggests we can prevent half of all deaths.
Still, at best, we are looking at hundreds of thousands of deaths locally before the end of this worldwide pandemic with just these measures. Aggressive testing and meticulous contact tracing done by Singapore and South Korea, not modeled by the Imperial College in London, have helped their societies keep case loads down while not imposing the kind of sweeping restrictions against work done in Italy or China.
Truly, our national leadership is under tremendous pressure during this unprecedented crisis. They are presented with the agonizing choice of preserving the fabric of society at the cost of saving lives.
Soon, they won’t have a choice. The public has to wake up to the realization that this crisis will likely stretch on for months to years, and has to lose its expectation that the government can save everyone from the coronavirus. The virus is here to stay and many lives will be lost.
The present lockdown serves to distract the government from the real work – supporting frontliners while simultaneously building health care capacity, aggressively testing suspected cases, and doing exhaustive contact tracing. Quarantines must be strictly enforced on those infected and their contacts. We have to support and perhaps isolate the elderly and the sick until the outbreak is controlled or until the population develops herd immunity.
The public has to understand and cooperate with these measures. But life must be allowed to go on for the rest of us. – Rappler.com