President Duterte has extended the enhanced community quarantine to May 15. Despite sentiments of some including LGUs and businessmen, he personally listened to experts, scientists, and former secretaries of health before he agreed with the IATF. In general, the public supported that decision, although many complained about not receiving the promised food and cash grants to help them tide over the quarantine period.
The appointment of former AFP chief of staff General Carlito Galvez and current presidential adviser on the peace process as chief implementer of the National Action Plan has been widely hailed. The National Resilience Council had a roundtable discussion via Zoom with 200 plus participants. Former Major General Restituto Padilla Jr., the spokesman of the National Action Plan (NAP) COVID-19, was the key note speaker. Padilla emphasized the need for a whole of society approach to addressing this crisis. Of particular significance was the four measures of success that the NAP had set for itself in fulfilling its mandate: 1) Reduction of new COVID cases. 2) Reduction of deaths. 3) Increase in recovered patients. And finally, 4) Normalization of the economy. These are clear and implementable metrics that the general public can understand and appreciate.
Heavy handed?
However, at the ground level though, there have been instances where overzealous implementation of the quarantine has led to blatant disregard for legal rights and privacy.
There was an incident at the Pacific Plaza Towers. The PNP stormed the condominium complex at the Bonifacio Global City in Taguig City on Sunday, April 19, and accosted residents who were at the open area of the condo.
Retired Supreme Court Justice Antonio Carpio said it was illegal for policemen to barge into the premises of a condominium. “The police needs a search or arrest warrant issued by a judge to enter a residential condominium building.”
The Taguig City Police said it was Mayor Lino Cayetano who ordered cops to go to the condo citing reports that residents were not observing physical distancing. Even with the mayor’s order, Carpio said the police still had no legal basis.
Retired Court Chief Justice Artemio Panganiban opined: The armed intrusion by policemen into the Pacific Plaza Towers in Taguig City, the “house” of the residents therein, may have violated the constitutional “right of the people to be secure in their persons, houses, papers and effects,” unless it can be factually shown that their acts were made in conjunction with, or were necessary incidents of, a valid warrantless arrest and search.
I am sure there are many similar cases of such confrontation that have gone unreported particularly in those areas where residents do not have the means to use social media to air their grievances. There are reports of homeless people, vendors and people who needed to go to work being arrested and detained for as long as two days when they should have been released after being booked.
It has also been reported that the DOLE labor official assigned in Taichung in Taiwan had arranged for the “deportation” of a caregiver with her employer and recruiter because she was critical of the Duterte administration’s handling of the pandemic crisis in her social media posts. This is a clear case of overreach and worse, forced a foreign government, who of course would not be a party to such action without a legal process being undertaken, to speak out. MECO resident representative Angelito Banayo subsequently disavowed the labor official’s actuations.
One tragic incident highlights fears that law enforcers may have taken at face value the President’s statement made in a press conference to shoot violators of the quarantine. Corporal Winston Ragos, retired from the Army for PTSD (Post Traumatic Stress Disorder) was unfortunate to run afoul of police forces manning a checkpoint in Quezon City. According to eyewitnesses, Ragos was complying with the police officers’ instructions, when he was shot as he reached for his bag, which his family says contained a bottle of water and documents attesting to his impaired mental health.
All of these incidents of heavy handedness raised the specter of martial law when a leaked Air Force memo spoke of getting ready for a martial law type of lockdown. The President himself threatened to declare one, thus, exacerbating the public’s concern.
US helping hand
Although the conversation between the President and US President Donald Trump on bilateral COVID-19 cooperation captured the media’s attention, what has not been given enough prominence is direct US assistance to our efforts to fight the pandemic. The US has, thus, far provided more than P470 million to support the Philippine’s COVID-19 response, in addition to 1,300 cots donated to the Office of Civil Defense and Philippine General Hospital. US assistance is also strengthening the capacity to detect, treat and defeat the virus. This complements nearly P30 billion in assistance the US has provided over the past 20 years to improve health care in the Philippines. This does not count the invaluable role that Filipino alumni of US educational grant programs are playing at the forefront of the country’s effort against the pandemic.
American companies in the Philippines are also doing their share in the fight against COVID. To cite a few examples, Ford is lending vehicles for medical use; UPS and FedEx are delivering critical supplies; Procter & Gamble and 3M are producing PPE; and Coca-Cola and Pepsi are supplying beverages for frontline workers. US companies CapitalOne, Marriot, Dow, Cargill, AIG, Google, Airbnb and Facebook are also providing assistance.
China
During WWII “Lebensraum” became the ideological principle of Germany providing justification for territorial expansion into Central and Eastern Europe. They justified it as necessary for their survival. There is an amazing similarity to China’s actuations in the Spratleys.
Lessons from the COVID-19 pandemic series: Tools for business continuity in the era of COVID-19: How could businesses prepare for reopening?
May 7, 2020 | 9:00 PM (GMT +8)
Background
Up to 80% of all investment in any given country is coming from the private sector. It is there critical that the private sector engages to make this investment risk-informed. The private sector is a critical participant in the creation of risk-resilient societies. By combining the intellectual (know-how) and capital assets of the private sector with the public sector and other stakeholders solutions will be developed and implemented to achieve the targets of the Sendai Framework by 2030.
At the same time, the COVID-19 situation reveals the challenges of managing health risks while reducing disaster risks. All countries face systemic risks, such as those associated with disease outbreaks, with the potential for very significant socio-economic impacts.
Objectives
The webinar aims to give business owners the tools to better prepare for and respond to such events. The webinar will share leadership strategies adopted by the private sector to continue business during the COVID-19 situation.
Speakers
Ms. Chloe Demrovsky-President and CEO of Disaster Recovery Institute International (DRI)
Ms. Liza B. Silerio-Vice President for Corporate Compliance Group, SM Prime Holdings Inc. Philippines
Mr. Jorge Noel Y. Wieneke III- President and founding member of the Association of Filipino Franchisors, Inc.
Metro Manila (CNN Philippines, March 26) – San Miguel Corporation beefed up its efforts in helping communities affected by the enhanced community quarantine due to COVID-19.
The Ramon Ang-led conglomerate announced on Thursday it will donate 560,000 kilos of rice as part of its relief efforts to assist communities that are vulnerable to the disease and the effects of the quarantine.
“Starting this week, we will also be adding rice to our food donations,” Ang said in a statement. “We have been able to source 560,000 kilos of rice. We plan to give 10 kilos per family and through this, we hope to be able to continue to help the most vulnerable among us – people who are out of work and families struggling to eat.”
Ang, who is the president and chief operating officer of SMC, also reported that their food donation drive has reached 126,000 families.
SMC provided 1.1 million pieces of canned goods, 695,000 sachets of coffee, 288,000 packs of biscuits, 21,630 servings of its version of “nutribun” and 24,338 servings of pandesal. It has also donated spreads, dairy milk drinks, and water.
SMC’s food donations are being coursed through various channels, including local government units, charitable groups, and church organizations. It has also made direct donations to hospitals and various communities all over Luzon.
LGUs that received food donations from San Miguel include Manila, Caloocan, Las Pinas, Malabon, Pateros, Mandaluyong, Navotas, Marikina, Paranaque, Makati, Pasay, Muntinlupa, Pasig, Quezon City, San Juan, Taguig, and Valenzuela.
Hospital beneficiaries include the Philippine General Hospital, The Medical City, Quirino Memorial Medical Center, Philippine Children’s Medical Center, Las Pinas General Hospital, and the Jose Reyes Memorial Medical Center.
Families under the care of SMC’s Better World Tondo, a food bank and learning facility established last year, were also beneficiaries of the food donations.
SMC also utilized its manufacturing facilities to produce 70% ethyl alcohol to address the shortage of hand sanitizers and disinfectants, and is also donating 13,000 units of its own Protect Plus Gold powdered disinfectant for the sanitation of hospitals and government and public facilities.
Ang stressed the company, through its San Miguel Foods business, is committed to continue providing food donations to those who need it the most.
Ang also assured the public that the company has the capacity to produce enough food for the country for the next six months.
“What we want is for food to be one less worry of vulnerable families, health workers, and front-liners against COVID-19,” he said.
Dr. Wang-Jun Lee (centre) with colleagues, who spoke at the UNDRR webinar on COVID-19
GENEVA, 25 March, 2020 – Trace, test and treat. That sums up the strategy pursued by the Republic of Korea since it detected its first case of COVID-19 on January 20 and its first death on February 20, without imposing a lockdown.
The country has managed to keep its mortality rate at 1.4% compared to a global mortality rate of 4.34% despite an outbreak triggered by the activities of a religious organization in Daegu, Gyungbuk, which contributed to a spike in confirmed cases in late February.
The highest recorded number of infections on a single day in Seoul where 25 million people live, was 75 compared to 735 on a single day in Daegu, population 2.5 million. To date, 85% of the confirmed cases can be traced to Daegu.
The strategy pursued by Korea was explained in some detail today to an online audience of 900 disaster management and health specialists from 105 countries, by Dr. Wang-Jun Lee, CEO and Chairman of Myoungi Hospital and Executive Chairman of the Korean Hospital Association in a webinar organized by the UN Office for Disaster Risk Reduction’s office in Incheon, Korea and the World Health Organization.
“As of today, total confirmed cases are 9,137 among them 3,730 were discharged after recovery and 126 died. So until now fully recovered patients percentage is 41% and mortality rate is 1.4%,” said Dr. Lee who went on to describe the three distinct phases of the epidemiological curve in Korea.
From January 20 until February 17, the number of new infections was low but during phase two from February 18 till March 11, the curve started to trend upwards with patient number 31 associated with the religious group in Daegu. The curve peaked at the end of February and started to level off.
“Phase three started from March 12 till now when we have seen a downward trend in new cases with sporadic new clusters of infections,” he said.
Dr. Lee pointed out that unlike in China, more women (61.4%) than men (38.6%) were infected and the most infected demographic is aged 20-39 recorded 2,419 infections. These unique statistics were linked to members of the religious organization in Daegu.
Nonetheless, as in China, most deaths were among older patients with underlying diseases with a mortality rate of 10% for people in their 80s.
Dr. Lee outlined the Government’s four main policies to prevent the spread of COVID-19.
The first policy is one of complete openness and transparency in sharing updated information on new infections through the Korean Centre for Disease Control, simultaneously with all stakeholders, including the media, on where, when and how the infections were discovered and investigated.
Dr. Lee said this was a key learning from the outbreak of MERS (Middle East Respiratory Syndrome) in 2015 and the result is that there is no confusion among the public about what needs to be done to avoid spreading the virus. No cities have been locked down, no transport closed, and international entry is still open.
The second policy is containment and mitigation. Containment was started after the first case was identified in China on December 30, 2019, and the focus is on identifying infected patients immediately and isolating them to interrupt transmission. “We track all suspected cases and trace all the confirmed cases,” he said.
Mitigation seeks to lower the peak of the outbreak to make it within Korea’s capacity to respond primarily through a social distancing campaign introduced just after the big outbreak in Daegu at the end of February.
It was also decided to close all schools and to recommend voluntary restrictions including no large gatherings and working from home.
“We are so proud of the promoted participation of the patients,” he said.
The third policy is the triage and treatment system developed as a result of the experience of the MERS outbreak. In any outbreak the biggest challenge is the overflow of the patients exceeding the capacity of the hospital staff, said Dr. Lee.
To overcome this, a triage system was created comprising five isolation hospitals to take care of 19% of cases designated critical and severe, while mild to moderate cases are handled by a network of public community hospitals. Bed spaces have also been created through revamped hotels, gyms and residential centres.
The fourth policy promotes massive screening and fast tracking of suspect cases, underpinned by the accelerated production of emergency diagnostic kits with a weekly diagnostic capability of 430,000. Dr. Lee said the main weapon is the diagnostic kits combined with drive-through and walk-through test centres.
Korea has more than 100 labs working round the clock with daily testing capacity of 20,000 and this has been crucial in keeping COVID-19 at bay.
In opening remarks, Dr. Stella Chungong, WHO Director, Health Security and Preparedness, said: “This webinar is timely as it is very important to learn and apply the lessons learnt and best practices in Covid Response, and to identify challenges in preparing for, and managing COVID-19 across the world.”
UN Office for Disaster Risk Reduction (UNDRR) head Mami Mizutori has been an advocate of a comprehensive approach to deal with disasters, backed by international collaboration. She explains this approach to Pradeep Thakur in the context of the Covid-19 outbreak:
The global attention on Covid-19 is unprecedented. Is this because the rich are more affected?
Like many disease outbreaks, Covid-19 does not distinguish between rich and poor. There is worldwide attention on it because it threatens every country regardless of development status. Disasters affect all, however disasters don’t affect everyone equally and in the case of Covid-19, it is also true. This is why, developed countries with more resources available to respond to the outbreak will need to attend first and foremost to the safety and well-being of their own citizens, but there also must be international support to low- and middle-income countries that are struggling to cope with the outbreak. Pandemics do not recognise borders so a united international response is vital under the leadership and guidance of the World Health Organization.
We have seen Ebola and bird flu. How different is Covid-19?
Covid-19 is not an epidemic confined to a few countries. It has been declared a pandemic by the WHO. There is a crucial difference. The list of countries reporting outbreaks is growing daily. There is no nation on Earth that can claim to be immune from the threat. Thousands have died and many more thousands are fighting for their lives in hospitals around the world. We are still in the early stages of the pandemic. It is urgent that countries which have yet to experience the full brunt of the disease should observe and learn from those who have been most impacted, notably China, Italy, Iran and the Republic of Korea. There are many lessons we can learn from these countries.
How can India effectively deal with risks arising out of disasters?
India has a very robust policy on disaster risk management, and this is evident from its zero tolerance approach to casualties in disaster events and its full embrace of the Sendai Framework. The Coalition for Disaster Resilient Infrastructure, launched by Prime Minister Narendra Modi at the UN Climate Action Summit in 2019, and supported by UNDRR emphasises the importance of public health infrastructure.
India does not see the Covid-19 outbreak as simply a health issue but has taken an all-of-government, all-of-society approach which is very much in the spirit of the Sendai Framework. The public health authorities are working closely with bodies such as the NDMA and government ministries responsible for civil aviation and shipping and the production of textiles including protective materials such as masks.
India is also using mobile technology in a smart way that could be adopted by other countries. Anyone making a mobile phone call must listen to a health message in the language of their choice before their call commences. This is a great way of communicating with a population of 1.3 billion people.
India is also showing leadership at the regional level. I understand also that while the number of cases currently is low, India is stepping up its response and surveillance capacity and mapping its resources. At the same time, it has made donations to a regional response fund and expressed its willingness to help other nations with their response. This is international solidarity of the highest order and I can only commend India for its approach.
Could Europe and the US have handled things better?
Hindsight is a great teacher. The Covid-19 outbreak is a step into the unknown. Nobody could reasonably claim to have been fully prepared for what is unfolding now across the globe. I would like to call attention to a critical observation about the changing nature of risk, which UNDRR highlighted in the Global Assessment of Risk report published in May 2019. GAR 2019 is very clear that risk is increasingly systemic. We are seeing this with Covid-19 rattling the global economy. The only way of fighting systemic risk is with a joined-up systemic prevention and response approach. This means that we cannot work in silos, we must map and model how risk cascades into other risks, and importantly we must be able to work trans-boundary, in a unified fashion and not take nationalistic stances to risks – which, as we very well know, are no respecters of borders.
Many countries have curtailed economic activities. How should governments mitigate the impact?
Poverty eradication is the No 1 sustainable development goal. In this current crisis it is important that provision is made for those who are especially vulnerable. This can take many forms including cash payments, emergency shelter and food distribution programmes. The most important thing is that the poor be consulted about their needs and be included in the response planning process.
In December 2019 the Chinese authorities notified the world that a virus was spreading through their communities. In the following months, it spread to other countries, with cases doubling within days. This virus is the “Severe acute respiratory syndrome-related coronavirus 2”, that causes the disease called COVID19, and that everyone simply calls Coronavirus.
What actually happens when it infects a human and what should we all do?
The Office of Civil Defense (OCD) led by the National Disaster Risk Reduction and Management Council (NDDRMC) Undersecretary Ricardo Jalad, activated the pre-agreement with United Nations Office of Disaster Risk Reduction (UNDRR) ARISE Philippines network and partner Nature Spring, with the 1st batch delivery of 43,000 SM Bottled Water to various frontliners in Metro Manila, dealing with the COVID-19 health emergency.
ARISE is the Private Sector Alliance for Disaster Resilient Societies, the DRR network of private sector entities in the Philippines. SM Prime is the UNDRR ARISE secretariat, headed by Hans T. Sy, Chairman of the Executive Committee, and its lead partner is the National Resilience Council (NRC). ARISE network pre-agreements are signed MOUs between members of the public and private sectors for immediate assistance with goods and services during times of calamity or crisis.
The Chief Data Scientist and top policy strategists of PUBLiCUS Asia, Inc. (PAI) have collaborated to publish Competitive Intelligence (CompIntel) Report No. 1, Series of 2020 titled “#FlattenTheCurve: Effects of Exposure Risk Reduction and Quarantine Policies on COVID-19 Local Transmission Rates in the Philippines”.
This CompIntel Report is PAI’s contribution to COVID-19 literature for consideration of Philippine decision-makers in the public and private sectors. It provides an epidemiological model of the spread of the infection in Metro Manila under various levels of Exposure Risk corresponding to the number of acts or interactions that could cause the virus to spread from one person to another.
The report finds that strict compliance with and strict implementation of severe, even draconian quarantine or lockdown policies for an extended period of time within Metro Manila, Luzon, and possibly the entire Philippines is the only feasible way to flatten the local transmission curve of COVID-19 before it strains the Philippine health care system to the point of complete collapse. The report also outlines specific policy recommendations to improve the implementation of the Enhanced Community Quarantine (ECQ) of Luzon.
PUBLiCUS Asia, Inc.Competitive Intelligence Report No. 1, s. 2020
#FlattenTheCurve:Effects of Exposure Risk Reduction and Quarantine Policieson COVID-19 Local Transmission Rates in the Philippines
David B. Yap II, PhD Ma. Lourdes N. Tiquia, MPA, MA Aureli C. Sinsuat
Introduction
The Coronavirus Disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has quickly become a global pandemic just months after the first reported infection in Wuhan, China. According to the March 17, 2020 situation report of the World Health Organization (WHO), there are 179,111 confirmed cases worldwide, including 7,426 deaths, spread across every continent except Antarctica. China (81,116 cases), Italy (27,980), Iran (14,991), Spain (9,191) and South Korea (8,320) are the five countries with the highest number of confirmed cases.[1]
The first COVID-19 case in the Philippines was recorded on January 30, 2020, with a second confirmed case and first fatality recorded on February 2. These were considered imported cases as they involved a pair of Chinese tourists traveling together from abroad. The first case of local transmission involving a 62-year old Filipino male from San Juan City, Metro Manila with no recent international travel history was confirmed by the Department of Health on March 7. Since then, the number of confirmed Philippine cases has risen exponentially. As of 12:00 noon on March 18, 2020, 202 cases of COVID-19 have been confirmed in the Philippines along with 17 deaths[2], resulting in a mortality rate of 8.4% – more than double the global mortality rate of 4.1% as of March 17.[3] Computed from March 17, 2020 WHO situation report (See Note 1).
Following the examples of China and Italy, the Philippine government has imposed aggressive community quarantine policies to arrest the accelerating rate of COVID-19 local transmission. Though styled as ‘quarantines’, these policies are essentially lockdowns. The theory behind this is that by significantly decrease opportunities for exposure to the virus through the imposition of strict limitations on movement and contact with other people, the number of recovered confirmed cases will begin to outpace new infections. This is commonly referred to as “flattening the transmission curve” or simply “flattening the curve”.
This report studies the quarantine policies adopted by the Philippine government through the lens of epidemiological modeling by comparing projected infection and active case numbers based on different levels of exposure risk. We argue that strict compliance with and strict implementation of severe, even draconian quarantine or lockdown policies for an extended period of time within Metro Manila, Luzon, and possibly the entire Philippines is the only feasible way to flatten the local transmission curve of COVID-19 before it strains the Philippine health care system to the point of complete collapse. Specific recommendations to the government and general public to optimize lockdown implementation and ensure higher efficacy in policy outcomes are also provided.
Philippine Quarantine Policies
Alarmed by the increasing number of COVID-19 cases in Metro Manila, the Philippine epijustify; of the pandemic, President Rodrigo Duterte announced on March 12, 2020 the implementation of a Community Quarantine of Metro Manila beginning March 15, 2020 and ending on April 14, 2020. Entry and exit from Metro Manila was restricted, classes at all levels and work in executive branch offices were suspended, mass gatherings were banned, and social distancing measures in public places were enforced. However, public transportation within Metro Manila continued to operate and private businesses were only encouraged to adopt work-from-home arrangements. Workers employed in Metro Manila but residing in surrounding provinces were also allowed to enter Metro Manila upon presenting a valid work ID.
After observing mixed results from the original partial lockdown, President Duterte imposed on March 16, 2020 an Enhanced Community Quarantine in the entire island of Luzon effective until April 12, 2020. Public transportation in Luzon ceased operations, and international and domestic travel to and from Luzon were severely restricted. Non-essential business establishments not providing basic goods or services such as food and medicine were shuttered. Residents of Luzon were confined to their homes for quarantine, except for limited trips outside to transact with essential businesses, seek medical attention, or travel to work at essential establishments. Curfews were also imposed via local ordinances to empty the streets from 8pm to 5am every night.
The Enhanced Community Quarantine (ECQ) of Luzon can be characterized, for all intents and purposes, as a lockdown which significantly reduces the risk of exposure to SARS-COV-2. However, it cannot be characterized as a total lockdown. Certain persons are still allowed to enter Luzon via international ports. Individuals are still allowed to leave their homes and come into contact with others, who may or may not already be carriers of the virus. Thus, the ECQ still does not provide the lowest possible exposure risk level, a concept which will be discussed later.
Susceptible-Infection Epidemiological Model
To illustrate the effects of quarantine and lockdown policies on disease prevalence (the cumulative number of infections within the population) and disease incidence (the number of people that may require medical treatment as a specific point in time), we ran the numbers using a susceptible-infection epidemiological model for Metro Manila with Day 1 corresponding to March 7, 2020, the date when local transmission was confirmed. This model is predicated on the following assumptions:
Population of 10 million with a single patient as starting point (March 7, 2020)
No recurrence of infection upon recovery
No inherent individual immunity to infection
Constant rate of infection at 5% (conservative), 10% (moderate), and 20% (aggressive)
FIGURE 1: DISEASE PREVALENCE OVER TIME AT VARIOUS EXPOSURE RISK LEVELS
(Moderate 10%)
Exposure Risk (ER) Levels 10 (LEFTMOST) TO 1 (RIGHTMOST)
Figure 1 provides a graphical overview of the progression of disease prevalence over time given various exposure risk (ER) and a moderate infection rate of 10%. Exposure risk levels correspond to the number of acts or interactions that could cause the virus to spread from one person to another. The leftmost graph representing ER 10, the highest level, would correspond to business-as-usual operations in Metro Manila without any restrictions on travel, work, school, and outings, along with a lack of deliberate social distancing. The exposure risk level decreases by 1 after every graph such that the rightmost graph corresponds to an exposure risk of 1. ER 1 would roughly correspond to a total lockdown situation with the most limited number of interactions, assuming complete compliance by the subjects of the lockdown.
ER 10 to ER 6 would allow the virus to spread throughout the population within 27 days or less than a month. ER levels 5 and 3 would require between five to eight weeks, and ER 2 would require 76 days. At ER 1, the spread of the disease would be almost nine times slower than ER 10 at 150 days or five months.
FIGURE 2: DISEASE INCIDENCE OVERTIME AT VARIOUS EXPOSURE RISK LEVELS
(Moderate 10%)
Figure 2 provides a graphical overview of the progression of disease incidence (the number of people that may require medical treatment) over time given various exposure risk levels and a moderate infection rate of 10%. Again, the bell curves are indexed by exposure risk (i.e. from 10 at the leftmost to 1 at the rightmost, each curve decreasing by exposure risk increments of 1).
The estimates suggest that the peak number of cases at exposure risk levels 2 to 10 could require as many as between 500,000 to 2.4 million hospital beds assuming 100% of cases were categorized as moderate to severe and required admission. Calculating based on the prevailing global estimated moderate-severe case rate of 20% (generally encompassing all symptomatic cases requiring in-patient treatment) this would equate to roughly 100,000 to 480,000 admitted cases. Meanwhile, ER 1 would require substantially fewer hospital beds and would distribute the strain on precious medical resources over a markedly longer period of time – almost seven and a half months from start to finish.
It must be noted that even the most conservative model at the lowest exposure risk level predicts a terrible strain on the Philippine healthcare system. The peak of the conservative disease incidence at the lowest exposure risk (ER 1) on Day 323 would require as many as 124,992 hospital beds with a 100% admitted case rate. Calculating again based on the 20% moderate-severe case rate, this would require 24,998 hospital beds in Metro Manila. The hospital bed capacity of Metro Manila is only 29,000 according to the Department of Health.
As discussed earlier, the current Enhanced Community Quarantine does not achieve the required level of isolation for Exposure Risk 1. Even going up just one notch to ER 2 would debilitate Metro Manila’s health care system by requiring an estimated 49,977 hospital beds on Day 162 based on the 20% moderate-severe case rate – almost double the actual bed capacity of all Metro Manila hospitals combined.
Interpretation of Models
The results above suggest that Metro Manila and perhaps even the entire Philippines – which has a national hospital bed capacity of only 106,000 – is headed towards a potentially debilitating overload of local and national health care systems as the rate of transmission of COVID-19 cases remains at a sharp upward trajectory. Therefore, it is evident that immediate action must be taken to reduce COVID-19 exposure risk by massive amounts. Insisting on a business-as-usual strategy would increase the rate of infection and increase the risk of overloading the medical system.
Unfortunately, the Philippines simply does not have the financial or technical capabilities to adopt the mass testing and individual isolation strategy employed by the Republic of Korea to flatten their country’s transmission curve. In that case, the most feasible and proven strategy available would be to implement widespread lockdown policies such as those implemented in Hubei, China and Italy. Thus, it is clear that strict compliance with and strict enforcement of the Luzon Enhanced Community Quarantine and any future quarantine or lockdown policies are essential to averting a public health disaster or even the complete collapse of the Philippine health care system.
It is not a question of whether or not the virus will spread. Rather, it is a question of how rapidly it will spread. The macro effects of the virus will be spread out over a longer period of time and become more manageable if exposure risk among the entire population is minimized as much as possible. This would allow the government more time to secure emergency funding, undertake emergency construction of medical facilities, procure medical supplies and personal protective equipment, coordinate with international and humanitarian actors for technical and financial assistance, and perform other essential tasks to keep the situation under control.
Recommendations
Based on the foregoing, the following recommendations are humbly submitted:
1. All persons subject to Enhanced Community Quarantine or any other quarantine protocol in Luzon or any part of the Philippines should strictly observe the prescribed quarantine protocols toward the end of bringing down their individual and household exposure risk levels down to 1 for extended periods of time.
2. Private enterprises employing no-work, no-pay employees for non-essential business purposes should commit to and immediately deliver wages equivalent to 30 days of work (excluding rest days) to incentivize these employees to stay home instead of attempting to work.
3. The Stimulus Package currently being formulated by the national government should focus on immediately disbursing funds in a way that would incentivize strict compliance with quarantine procedures by individuals and businesses.
Suggested programs include:
Identification of informal sector workers by DOLE, who would then receive payouts from DSWD, thus incentivizing informal workers to stay at home rather than plying their goods or trade outside;
Joint DTI-LGU Buy-Back Program where basic necessity goods will be procured from available stocks of micro-enterprises (sari-sari stores, etc.) and distributed to residents subject to quarantine by the respective LGUs;
DOH-LGU Frontline Health Workers Program to provide medical personnel and public health workers on duty with food, transportation, and other essential goods and services for the duration of the COVID-19 pandemic, thus reducing the need for health workers to come in contact with people outside of their clinics/hospitals;
The COVID-19 Inter-Agency Task Force (IATF) should create three sub-teams: a Policy Team, a Forecasting Team, and an Implementation Team, to streamline the tasks of the various officials and foster greater efficiency in operations.
4. IATF Implementation Team (ImT) must establish better coordination with LGUs, especially those outside of Luzon, to facilitate logistical concerns during these times and to answer in a timely manner questions of LGUs, AFP, and PNP on the implementation of the ECQ and other quarantines.
5. ImT should also adopt a National Supply Chain Protocol (NSCP) utilizing public and private land vehicles, airplanes, and ships to facilitate the speedy delivery of goods for distribution in quarantine areas. The NSCP should also include mechanisms for the speedy delivery of test kits to the National Institute of Tropical Medicine for confirmation of COVID-19 cases before the used test kits expire.
6. IATF Forecasting Team (FT) should regularly review all available data to forecast national and local trends in infections for the consideration of the President and the IATF Policy Team (PT).
7. PT should regularly review the implementation and forecast notes to make changes to the quarantine guidelines as necessary, most especially the severity, geographical coverage, and duration of ongoing and future quarantines.
8. IATF must adopt a Crisis Communications Protocol (CCP) to communicate necessary updates and information to the general public in a concise, timely, and easy-to-understand manner. IATF should also reduce the amount of officials authorized to speak to the media on its behalf or on behalf of its member departments and agencies, as well as the length of their press conferences. Information overload should be avoided at all costs.
ANNEX A: ADDITIONAL CHARTS
FIGURE 5: DISEASE PREVALENCE OVER TIME AT VARIOUS EXPOSURE RISK LEVELS
(Aggressive 20%)
FIGURE 6: DISEASE INCIDENCE OVER TIME AT VARIOUS EXPOSURE RISK LEVELS
(Aggressive 20%)
FIGURE 7: DISEASE PREVALENCE OVER TIME AT VARIOUS EXPOSURE RISK LEVELS
In an interview with Karen Davila for ANC’s Headstart, Former Department of Health Secretary, Manuel Dayrit is urging the government to ramp up its support for private and public hospitals. He notes how COVID-19 has become a bigger problem compared to previous outbreaks of SARS and MERS-Cov, with the new coronavirus having a higher contagion rate. He believes the community quarantine imposed on Metro Manila is appropriate to limit the build-up of cases and slow down the spread of the disease.
