The new normal for the world is that, until a vaccine is found, COVID-19 is here to stay. We had better learn how to live with it. That means new ways of managing businesses, even after the quarantine is lifted. We now know that, contrary to previous understanding, the virus is easily transmitted, that up to 50% have no symptoms but can be carriers, and that air-conditioned rooms (where most people work) can be risky venues as the droplets can linger in the air.
All of this means that frequent trips to the restroom to wash hands will be standard procedure in any business. And because the most recent research shows that masks were a major factor for flattening the curve in Japan, Hong Kong, Singapore, Taiwan, South Korea, and China, all employees will be working with masks on.
But frequent hand-washing and daily mask-wearing are not the only things businesses will need to adopt. Before we can even think of lifting quarantine, we need to do two things:
1. Continuously improve testing capacity
Between local kit production and the imported kits, there will be 250,000 available in the next month. What we lack is Polymerase Chain Reaction (PCR) processing capacity. Certification for laboratories has been slow. It might take one more week to get to 1,200 per day processing – and we’ll be almost at the end of the national lockdown. We need to get processing capacity up to 5,000 per day, so we don’t get a second wave when restrictions are relaxed. South Korea has already done 400,000 tests, and found that one out of 41 people had COVID-19. Japan’s test ratio shows that one person out of 28 tested positive. In our case, we did 4,000 tests in the past month, and got 2,100 positives for COVID-19 – the frightening ratio of one COVID-19 positive for every two persons tested is a function of not doing enough tests, rather than an indication of
COVID-19’s spread.
But let’s not put all our bets on these kits. Even if they are the gold standard, they are only 63% accurate. The doctor needs to examine you and, combined with other tests and diagnostics, make the final determination of your illness.
2. Protect and Provide for Health Care
Because doctors and the Health Care Workers (HCWs) that support them are an extremely limited resource, we need to protect and provide them with the tools they need to save more lives. The critical factors are Personal Protective Equipment (PPEs), ICU beds, and ventilators. Most critical for HCWs is the N95 mask, which can now be disinfected in a clean room with hydrogen peroxide. Re-usability brings costs down by 90% – full head-to-toe bio-containment suits can be washed and disinfected. Savings can then be passed on in compensation to our front-liners who deserve hazard pay.
Next are the ICU beds and ventilators. For a population of 110 million, we have 106,000 beds – 75,000 in Level 2 and 3 hospitals, which have a combined capacity of only 3,700 ICU beds. If two-thirds are used for COVID-19 patients, then notionally we can handle up to 50,000 COVID-19 cases of varying degrees of severity at any one time. The key constraint is ventilators. In Italy, 88% of all critically ill patients needed a ventilator. The Department of Health ordered 1,500 more ventilators to supplement the 1,500 currently in place. But that is good only for a maximum 50,000 cases – any significant number over this means we have to choose who will live or die due to the lack of ventilators.
GROUNDS FOR OPTIMISM
While the global situation continues to be grim, there is hope for us. We panic when we hear of Italy’s 12% case fatality rate. But of 110 million Filipinos, we have 90 million under the age of 50, 10 million between 50 and 60, and 10 million above 60. This demographic dividend helps us, because the fatality rate for those 50 and under is 0.1%, around the same as the seasonal flu. Additionally, some studies show that higher temperatures (15-30 degrees Celsius) lead to slower COVID-19 infection growth rates – and a hot summer is already upon us.
BUSINESS, AQ (AFTER QUARANTINE)
Like any recovering patient, our economy has to follow a prescription to ensure we all bounce back to health. We have to manage space better to control the spread of infection, to protect our senior citizens as they are most at risk, and to make sure (especially our politicians) that our hands are clean.
MANAGING SPACE
The recommended personal physical distance now is two meters. It used to be one, until studies showed a higher trajectory of virus droplets with a big sneeze. Previous best practices in business dictated packing in the most number of people in the least space, to manage rent costs. This may now have to be re-thought, given the need for continued social distancing.
The challenge of office space is nothing compared to the problem of crowded homes. Here, we will need a three-fold strategy:
1. The community must identify who has symptoms (dry cough, fever) immediately;
2. Ensure that the person, plus all those he or she has come into contact with, has enough space to quarantine; and,
3. If the person is over 60 or has a compromised lung, heart, kidney, or liver condition, send the person to the hospital right away for testing and treatment.
PROTECT OUR SENIOR CITIZENS
The initial outbreak of COVID-19 in the United States happened in nursing homes in Seattle: sick staff members infected the elderly, and 35 deaths were linked to one center alone. In Italy, there were 62 deaths in two nursing homes. Spain was also hard-hit.
Until the vaccine is found, our senior citizens should cut down on travel, even if just for mall visits. They should monitor their temperature regularly. Those who live with them should maintain a healthy physical distance, and be extra careful in social or workplace settings so that they don’t carry the virus home with them.
MAINTAIN COMMUNITY STANDARDS OF HYGIENE
Frequent hand-washing is just one standard of behavior that must be maintained. In a business setting, a community can be a factory, office building, or mall. In a residential one, it can be a subdivision or barangay. A rating system for hygiene, with regular monitoring, should be built and maintained by different private sector associations, or public sector agencies and LGUs.
For example, does a factory or office now have a workstation distance rule for sewers or call center agents? Are elevators marked off, with buttons pressed by elbows and not hands? Are building surfaces and bathrooms wiped down daily with a Clorox (bleach) and water solution? Are there more stringent standards for when employees should and should not come to work? Are more employees working from home, particularly seniors, so building occupancy is reduced? Does everyone wear a mask at the office?
Particular attention should be made to high-contact professions, like those that transport goods and people, maintain and clean buildings and facilities, and serve customers in stores and restaurants.
Similarly, does a city have enough spaces to handle outbreaks of COVID-19, so that the mildly symptomatic, PUIs, and PUMs are appropriately isolated? Is mask use being consistently enforced in public? Are there enough hospital beds within its radius for the severely symptomatic? Are the public markets managed for space? Do vendors there wash their hands regularly?
To help business and LGU get a better understanding of how they are handling COVID-19 in their workplace and communities, we are developing a data map — please click on this link: https://docs.google.com/forms/u/0/d/e/1FAIpQLSdDMyJxnla0G9H27GOjT_jROyfFe_vbARaO beomt-sqYFoNtg/formResponse to fill out a survey and that can help you understand what businesses and LGUs in your area are doing.
REDEFINE BORDER AND TRANSPORT MANAGEMENT
A whole industry was built around fighting terrorism after the 2001 World Trade Center attack. We now take a lot of the security norms at our airports for granted. Yet, since 2001, global travel expanded exponentially, with pauses in 2003 for SARS, 2009 for swine influenza, and 2015 for MERS. With COVID-19, this has come to a screeching halt. It need not.
Airplanes are the epitome of crowded spaces. The longer the flight the riskier the exposure. But our OFWs need to fly to their places of work, as they send $30 billion home. As we continue to find a safer way to fly, we need to keep our borders open to facilitate economic exchange. South Korea, Taiwan, Singapore. and Japan have kept their borders open. Their protocols are to screen for fever and test at the airport, and mandatorily quarantine anyone for 14 days who comes from abroad. Some use geo tracking on cellphone apps to ensure compliance.
The contact tracing network in Wuhan was composed of 1,600 five-person teams. Do we have a strong tracing network to enforce border control at our airports? Japan has 25 million more people than us. It has the world’s oldest population but currently the same number of COVID-19 cases as us. It has kept its subways open. Everyone there wears a mask. In addition, Japanese do not touch their skin, nor wear shoes at home, nor eat with their hands, nor speak in public transport. We must consider adopting this behavior here.
THE KEYS TO BEATING THE VIRUS: MODIFY BEHAVIOR, ACT AS ONE
Our East Asian neighbors have shown that countries can operate relatively normally, even with COVID-19. Before we lift the quarantine, we must ensure that testing continues to increase, that our healthcare system has ramped up, and that we are all prepared to accept the new norms of doing business. We will need to cooperate and adopt new standards of behavior, for our own good. The less legal intervention, the better. We did not need formal government to fight in World War 2. We only need ourselves, acting in an empowered way as one nation, to beat COVID-19.
Jose Xavier ‘Eckie’ Gonzales is the Chairman of The Medical City and concurrently the President and CEO of USSC, the largest agent of Western Union in the Philippines. He graduated magna cum laude from the University of the Philippines and holds an MBA from the Harvard Business School.
