By PETER CAYTON, Ph.D.
The latest IATF resolution released on Sunday lacks at least six policies that are crucial to addressing a worsening pandemic, especially when you are implementing a lockdown.
Even though the government never mentions lockdown and used instead a different term, a bubble, we see from the restrictions that it really is a lockdown of another name. Lockdown is an effective strategy in arresting a pandemic only if you implement specific policies that we find missing in the resolution.
Although it made clear that there will be no suspension of public transportation within Metro Manila, the resolution is focused mainly on restrictions of movement: restrictions in churches, in restaurants, and other places of gatherings.
1. Strengthening contact tracing
It is necessary in this kind of response that we strengthen contact tracing protocols. It should be done in a progressive and aggressive way. The current practice of only finding the first and second contacts is no longer enough. We should add a third layer, the third contacts, in order to catch up with the network of infections and transmissions, especially that there is a heightened transmission of cases and with the possibility of having the variants. What are the plans to achieve those kinds of progressive contact tracing? To achieve that in the areas of concern, the so-called “bubble”?
2. Implementing mass testing
Another critical policy that should be implemented alongside a lockdown is mass testing. The positivity rate is toxically high. It already reached and remains at the double digits for more than a week now, at the 14-15 percent range. In fact, the Department of Health (DoH) has revised the positivity rate maximum around a week ago when they made to 16 percent. These are urgent issues that need to be addressed if we want to really catch up with infections, with the speed of transmission of COVID-19, and the possibility of also catching up with the variants.
There should be a plan on how to achieve mass testing. Right now, with the current positivity rate, it might need to be at least 100,000 persons per day that should be tested by our laboratories.
How did we come up with this number? Let’s say we have 5,000 individuals who tested positive. You just have to divide it by 0.05 (or 5%), which is equivalent to multiplying the number of positive individuals by 20. Where does 5% come from? That is the WHO guidelines for concluding that we are able to catch up with transmission. But that is just the minimum requirement to a situation where you have a moderate level of transmission of COVID-19. To really be able to assess that you have a low transmission of COVID-19, the number is even lower, at 2% positivity rate based on new guidelines from WHO. So if we want to reach 2% positivity rate, the daily testing rate is even higher than 100,000. It could go to 250,000 heads tested per day.
The existing level in the Philippines is no longer sufficient to achieve this. We are just testing at the very maximum that our country have done at about 40,000 individuals per day. We have to literally double our efforts and then some more with regards to testing. How to achieve mass testing for much of the country that has to be included into the resolution plan, especially with Metro Manila which lags in contact tracing. How would contact tracing even help if the government does not test all contacts of positive individuals?
There should be also changes in classifications of who should be tested. Change the current standards where we only test the symptomatic ones. Whether the person is symptomatic or not, they should be tested if they were established through contact tracing. We know that asymptomatic cases can still transmit the disease and asymptomatic cases are very difficult to detect if we are not really going to do the appropriate testing. We do not know if an asymptomatic person has COVID-19 if we don’t test them. Remember that asymptomatic positive individuals still pass on the virus. We have to really expand testing and contact tracing.
3. Expansion of health care workers and economic protection for workers
Another missing policy in the resolution is in relation to treatment of COVID-19 patients. While the IATF resolution provides for an expansion of hospital bed capacity, it is silent on increasing the number of health care workers (HCWs) manning and monitoring the situation of people that occupy those beds. We have to really expand our hospital staffing.
Since our hospital staffs are the highest at risk to COVID-19, there should also be adequate compensation for those who would be taking care of our COVID-19 cases. Again, the resolution is silent on this aspect.
4. Social safety systems
The resolution is also lacking in terms of social safety network system. What are the ways to help those who lost their jobs? We think that we don’t have this. Or even if there is such system, the government did not specify in the resolution how workers can access it.
The government is also not improving its existing cash transfer programs. We don’t even have to talk about social amelioration program (SAP) since we already have such program even before the pandemic like, for example, the conditional cash transfer or 4Ps. It should be expanded since the pandemic has really increased, in a way, the incidence of poverty in the country, and we have an existing system to address it to some extent. We have to expand that in a way, besides the unemployment aid.
Another thing is that workers’ rights really have to be protected in this time of pandemic. What are the mechanisms that should be in place for us to protect our workers in the public and private sectors, when their employer or their business leader or the leaders in their offices might be placing them at risk by some level of negligence in terms of following the minimum health standards?
5. Specific vaccination plans in lockdown areas
Also missing in the resolution is with regards to the vaccination plan. How do we execute it under the existing conditions? We don’t see that in the IATF resolution. So you define these areas as of very high concern, but how would the vaccination be implemented now in these areas so that we could start curbing the speed of transmission by way of letting our population gain immunity through the vaccination? They should be outlining the plans on how they would be making vaccines that are high efficacy accessible to the people.
6. Steps in reviewing the effectiveness of lockdown
Finally, the resolution did not specify the criteria of evaluating the success of the intervention. The IATF has not yet said what would be the sufficient conditions whether to lift the lockdown in these areas of concerns after April 4. After April 4, what would be the review of data in order to decide if the GCQ in these areas be retained? What would be the steps forward from this lockdown based on the data, based on the science of it? These things are glaringly absent in the latest IATF resolution.
About the author: Peter Cayton is an Associate Professor at the School of Statistics in UP Diliman. He is a member of the UP COVID-19 Pandemic Response Team. He obtained his PhD in Statistics from Australian National University.
This article is a revised version of a transcription from a podcast by AGHAM found in: https://open.spotify.com/episode/59l7Xiza3fTMS4QEs9vKQl
Lab Notes: critical views and incisive analysis on issues in the Philippines, charting ways in making science and technology serve the people.