Lab Notes | Would granular lockdowns in Metro Manila work in the face of a Delta surge?

At a checkpoint in San Mateo/Batasan Road boundary. Police set up checkpoints to implement the lockdown order of the national government. (Photo by JL Burgos)
By TIMOTHY JAMES L. CIPRIANO
Bulatlat.com

The Philippines’ COVID-19 daily reported cases remain high with 26,303 new cases on September 11 – the highest to date. On the same day, the National Capital Region’s 9,061 cases broke record despite the region being under a supposedly strict quarantine protocol. The consensus is that the surge in COVID-19 cases is primarily driven by the more transmissible Delta variant.

Even the government admitted that these sweeping lockdown measures are no longer working, which necessitated a policy shift to targeted curbs to bring down COVID-19 infections. [1]

Granular data matters

Clear, timely, and accurate data is needed to inform policymaking and even improve the country’s pandemic response. Sadly, a year and a half into the pandemic, the Department of Health (DOH) still faces nagging issues with collection, reporting, and presentation of COVID-19 data. Many cases have missing information like residence at the city, municipality, and even barangay levels. [2]

Based on the September 13 data drop from DOH, of the 2,249,211 total reported cases in the country, 287,865 cases have no data on barangay residence (12.80 percent) and 60,271 cases have no data on city or municipality residence (2.68 percent).

Contact tracing is worsening in the country. Even tracing czar and Baguio City Mayor Benjamin Magalong admitted it. Current data from the Department of Interior and Local Government (DILG) showed that the contact tracing ratio at the national level is at 1:5. Practically, we are only tracing first generation of contacts of COVID positive cases, or only the members of a particular household [3].

Granular data is key in the success of any public health intervention, including the new targeted curb policy.

Making sense of the granular lockdowns

Local government units (LGUs) are empowered to impose granular lockdowns in areas with high level of infection (or critical zones) based on epidemiological parameters [4]. These measures can be imposed in areas not limited to houses, buildings, establishments, streets, puroks, and even barangays.

Granular lockdowns are nothing new in the government’s pandemic response, at least on paper. In fact, this is part of the second and third phases of the National Action Plan against COVID-19. Many LGUs in NCR have imposed these targeted curbs in the past, and it comes with different variants including the localized enhanced community quarantine, special concern lockdown (in the case of Quezon City), barangay hard lockdown, and the like. While this policy is nothing new, there are growing concerns over the capacity of some LGUs in the country to implement it.

Do our localized lockdowns really target the problem “at the source”?

Granular COVID-19 data and robust disease surveillance would help target the potential source of the outbreak. Current publicly available data from DOH shows COVID-19 cases based only on residence and not on workplace location.

Granular lockdowns are mostly targeted on communities, puroks, and barangays, although there are instances that establishments and workplaces are being locked down. Do our granular lockdowns really target the source of the disease outbreak?

Assuming that the areas under granular lockdown are identified as potential sources of infection, what interventions are being done to ensure the risk of transmission is mitigated or even bring down infections? How are tracing and testing protocols being implemented? In the case of indoor establishments and workplaces, what engineering and administrative controls are in place? In the context of airborne transmission of COVID-19, disinfections are simply not enough.

More emphasis on restrictions, intervention targets and metrics of success are lacking

It’s ridiculous that there are more emerging variants of community quarantine protocols in the country than of the virus itself, and it is leaving the public more confused. The government puts too much effort on policies to restrict movement rather than ensuring proper interventions are met in stemming COVID-19 transmission.

The Zoning Containment Strategy of NAP against COVID-19 provided for interventions that must be done in areas declared as critical zone. There was a recognition for massive testing and aggressive contact tracing in these areas. However, what are assurances that these interventions are carried out on the ground?

When a local chief executive places an area under granular lockdown, do all people in the critical zone get tested for free? Are all potential contacts until the third or even fourth generation of contacts traced within 24 to 48 hours? Based on their data, have they identified the potential source of the outbreak? Are there enough people to implement surveillance protocols in the area? What conditions are required to lift the granular lockdown in areas declared as critical zones? What data will be used to decide on this matter? While reporting and monitoring of all areas under granular lockdown are mandated among LGUs, criteria to evaluate the success of these interventions are conspicuously absent in the current guidelines.

Post-script: Delta as a critical juncture of our pandemic response?

Delta could change the face of our response efforts given its high transmissibility. Given the surge of this scale, it is not so much anymore on tracing infected people but on circumstances that could have led to the infection. It would be interesting to look at environmental factors such as the physical arrangement of the area, ventilation, and crowding of people.

The definition of close contacts must also be revisited in the context of the airborne transmission of the virus, regardless of the variant, especially when the infection occurs in an enclosed/indoor space with poor ventilation. In this scenario, anyone in the room could be infected.

More importantly, aggressive public health interventions, adequate social safety nets and economic protection for those affected by the lockdown, and expansion of healthcare system must be implemented alongside epidemiological interventions.

Policymakers must be reminded: They cannot just simply shotgun the implementation of granular lockdowns. It must follow the science or else it would be another failure. a href=”https://www.bulatlat.com”>(https://www.bulatlat.com)

About the Author Timothy James L. Cipriano is a graduate student of the UP Department of Geography. He is currently a research assistant for a disaster research project funded by the Water Center of the University of Pennsylvania, and a former researcher at the UP Resilience Institute and NOAH Center. He is also a member of the Alliance of STEM Graduate Students and Workers – UP Diliman and AGHAM Diliman Chapter. TJ is interested in studying hazards and disasters, environmental studies, and disease geographies.

Endnotes

[1] According to the DOH’s Epidemiology Bureau, 80 percent of total cases in Metro Manila are from around 11 to 30 percent of its barangays, which the government sees as a good opportunity to revive economic activities in areas with low to zero incidence of infection.

The Inter-agency Task Force on the Management of Emerging Infectious Diseases’s (IATF-MEID) targeted curb policy announced on September 9 defined a new community quarantine classification, called the alert level system, based on certain parameters and thresholds set by the IATF’s Sub-Technical Working Group on Data Analytics. For each alert level, public health and social measures are specified.

The targeted curb policy is enshrined in IATF-MEID Resolution No. 138, s. 2021, released on September 9, 2021, and IATF-MEID Guidelines on the Pilot Implementation of Alert Levels System for COVID-19 Response in the National Capital Region, released on September 13, 2021

[2] Granularity of data matters. The availability of good quality granular COVID-19 data would help provide a bigger picture of the outbreak’s extent, like how areas with higher infections will affect nearby areas. This is where inter-barangay and/or even inter-city and municipality cooperation in disease surveillance comes into play. Like in any disaster, “not-in-my-backyard” (NIMBY) policies amid the pandemic will not simply work given the porous borders within Metro Manila.

[3] National Task Force against COVID-19 Situational Report No. 530, September 13, 2021, NDRRMC.

[4] Stipulated in a memorandum circular issued by the National Task Force (NTF) against COVID-19 on June 15, 2020COVID-19 Memorandum Circular No. 2, June 15, 2020, or the Operational Guidelines on the Application of the Zoning Containment Strategy in the Localization of the National Action Plan against COVID-19 Response

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