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[ANALYSIS] Expectations for the ECQ in the NCR

What should we expect for the ECQ that had just begun in the NCR?

As Malacañang has finally acknowledged, this second surge is being driven by new virus variants that are significantly more transmissible than the ancestral strain. Therefore, it is difficult to rely on our experience of the first surge in August to help us manage our expectations.

Therefore, we need to examine the recent and ongoing lockdown experiences of countries in Europe that are also struggling to contain surges driven primarily by the B117 variant. I chose five countries that are smaller in size than the NCR for our analysis. I have also noted the mobility change triggered by the lockdown, because no two lockdowns are the same. I rely here on mobility data from Apple, though a comparable analysis using Google and Waze data reveals the same trends. 

This analysis reveals trends that should help us manage our expectations for ECQ in the NCR. Most significantly, not every lockdown is able to shut down the spread of a pandemic surge. Indeed, lockdowns that do not significantly decrease mobility of the population – and it appears that lockdowns must lower population mobility to below 50% below baseline to have a significant effect – do not shut down a surge quickly.

The Czech Republic was able to decrease daily cases by 15% with a week-long lockdown that lowered population mobility to 62% below baseline. With an ECQ that lowers mobility to 75% to 85% below baseline – and we expect this decrease based on our experience of the first ECQ last year – we should also be able to decrease daily cases in the NCR by at least that much. This should decrease daily cases in the NCR to around 4,250 cases. If we decrease it by 25%, then cases should fall to around 3,750 after one week. 

Additionally, we need to observe the behavior of reproduction number R for the surge. We expect that this R will begin to plummet 3-5 days after the beginning of the ECQ because it will take several days for the effects to be noted in DOH data. Ideally, this R should drop to below 1 within a week because of the dramatic effects of an ECQ. The number of daily cases will decrease precisely because the R is dropping. Once the R is below 1, we would have to work to keep it below that critical threshold until the vaccination campaign is successfully rolled out. 

How should we expect the hospital utilization (HCUR) to behave? Notably, changes in the number of hospitalized lag behind changes in the number of daily cases by 5-7 days, because it takes up to a week for someone who has been infected to become sick enough to seek hospital help. What this means is that our hospitals will still be logging increasing numbers of admissions for at least one week after the beginning of the ECQ.

Furthermore, the average length of stay in a COVID-19 ward, based on data from the PGH, is about 27 days. We therefore expect our hospitals to be at critical capacity for many weeks as they deal with the hospitalizations from the explosive first weeks of the second surge. However, they should expect admission rates to begin dropping about two to three weeks from the beginning of the ECQ, around April 14, 2021. 

How should we expect death rates to behave? Death also lags behind daily cases because it takes a long time for someone who is infected to get sick, to become hospitalized, and to die from COVID-19. Data from the PGH suggests that someone who dies in hospital stays in the hospital for about 10 days. This means that we expect death rates to begin to increase between two to three weeks after the surge begins and to continue to rise until two to three weeks after the ECQ begins. Therefore, we should not be surprised as the number of Filipinos who die from COVID-19 continues to increase until it peaks about three weeks from now. The next few weeks will be difficult for many Filipino families. 

Finally, for how long should we maintain an ECQ? The purpose of any quarantine or lockdown is to starve the virus. We know that it takes 14 days for us to completely starve SARS-CoV2. As I described in an earlier essay published in Rappler, according to modeling done by the CDC of the United States, a one-week quarantine period will allow 10.7% of the viruses to escape the lockdown. If not contained, they will trigger a third surge of COVID-19 in the NCR. A lockdown of ten days would decrease this risk of a leaky quarantine to 1.4%. Therefore, I strongly urge the national government to consider an ECQ of at least ten days. 

An additional week for a total of 14 days in ECQ followed by an MECQ would be ideal because it would starve the virus completely and allow us to safely leave lockdown. It would also tell the government to complete building additional facilities for isolation and quarantine to buffer hospital admissions that will be increasing for several more weeks. This would prevent our hospitals and our front iners from being overwhelmed. It would also give our LGUs in the NCR a few extra days to supplement their contact tracing capacities.

As we exit the ECQ, we will need substantially more contact tracers to manage the still large – but decreasing numbers – of daily cases in the capital. Contact tracing, now supplemented with antigen testing, should prevent a third surge in the capital. 

We have already endured a significant sacrifice. Let us spend a few more days in hardship with sufficient ayuda for our poor to eradicate these new variants from the capital and from our beloved country. –

Reverend Fr. Nicanor Austriaco, OP is Visiting Professor of Biological Sciences at the University of Santo Tomas, and an OCTA Research Fellow.