The COVID-19 Action Network (CAN) is a network of organizations and individuals working to stop the spread of COVID-19 in the Philippines. It was organized in the first quarter of this year to harmonize primarily the efforts of the civil society and the private sector in responding to the coronavirus pandemic and provide the Philippine Government and local government units (LGUs) with evidence-based and sound recommendations.
Consistent with its commitment, the CAN offered seven recommendations, all of which have been considered by the Philippine Government. Translation to policies and implementation of these policies, however, usually vary depending on the perspectives of the leaders in charge and the realities on the ground. This makes a periodic review necessary.
With the recent developments, we therefore ask: Are we beating the coronavirus disease 2019 (COVID-19)?
After four months or 118 days of lockdown, what have we accomplished so far? And, what should still be done?
CAN’S RECOMMENDATIONS AND UPDATES
One of CAN’s recommendations was not to lift the lockdown until cases go down and the health system is prepared. Listening to this call, the government has extended the lockdown three times. Modifications, however, were done from enhanced community quarantine to general community quarantine.
Despite the lockdown, the number of COVID-19 cases increased from 140 on March 15 to 51,754 cases on July 9. In the past week, the average daily number of cases was 1,861 with the highest registered on July 8 at 2,539.
Whether or not the lockdown helped curtail the pandemic needs to be seriously reviewed. In a recently concluded survey, 60% of the CAN members find the situation uncertain as more studies need to be conducted and indicators of success need to be set first. The remaining 40% are divided, as 19% answered positively while 21% responded otherwise. Those who answered “yes” claimed that if the lockdown had not been not implemented, the number of cases and deaths from COVID-19 could be higher. This could be true based on the projections of statisticians and analysts and based on the situation in the United States as well as Sweden. Those who opposed, however, claim that the government failed to fully implement the lockdown and had some policy misgivings that cases later skyrocketed. Infection also spread from Metro Manila to the provinces thus creating new COVID-19 hotspots that include Cebu City and the provinces of Cebu, Samar, and Southern Leyte.
The government has relaxed quarantine policies. But this, however, was done to balance the negative effects of COVID-19 on the economy. Because of the lockdown, businesses closed, including companies shutting down totally. Both the temporary and permanent closures of business establishments led the economy to contract to -2% to -3%, with some economists projecting it at -7%.
The Philippine Statistics Authority notes that the closure of establishments has affected 7.3 million workers, thus increasing unemployment to 17.7%. The Bangsamoro Autonomous Region of Muslim Mindanao is badly hit, with its unemployment rate climbing to 29.8%. With this increase in unemployment, the poverty rate is also expected to increase by around 3.3% from 16.7% according to the World Bank.
The second recommendation of CAN is for the conduct of tests, tests, and tests. Though still insufficient, the government has improved a lot in this aspect with the help of the private sector. The number of testing centers increased from one to 78 accredited and licensed reverse transcription polymerase chain reaction (RT-PCR) testing laboratories. This significantly increased the number of RT-PCR tests conducted from 300 per day to 10,000 to 12,000 per day. On July 6, 22,672 samples were tested covering 21,654 individuals. The numbers though are still below the maximum capacity of 30,000 to 40,000 tests a day. Test backlogs are still high, and antibody tests are indiscriminately used and commercialized.
The third recommendation is to treat the sick. If the recoveries are an indicator, the Philippines was able to slow down the deaths due to COVID-19 to less than 10 cases a day starting June 15. This figure is lower compared to the 70 deaths daily due to tuberculosis. The majority of COVID-19 cases recover and the mortality rate is less than 1%.
The fourth recommendation is to protect the health workers. As of July 5, the Department of Health (DoH) recorded 3,513 health workers affected by COVID-19, 34 of whom died. And while there is a dynamic within the health department with regard to the benefits of the affected health workers, those who are not yet affected are still struggling on how to go to their places of work due to the limited transportation. We need more information regarding the adequacy of personal protective equipment (PPEs), and whether the used PPEs are recycled or dumped as hospital waste. Some government agencies have to be credited for issuing policies against discrimination of health workers. Further, reports of harassment or violence against the health workers have substantially decreased.
The fifth recommendation is to develop community management. Fortunately, we have good local government leaders on the ground. Our partners in CAN were able to document local government units and leaders that implement innovative responses against COVID-19 addressing not only the health aspect of the pandemic but also the socio-economic dimensions. The sad point is, there are only a few of them. In most cases, though, particularly in urban areas, adaptive responses are necessary rather than technical measures. These include addressing the issues such as how to implement social distancing in urban poor communities and how to promote hand-washing in areas with no or limited water supply.
CAN’s sixth recommendation is for the poor and the vulnerable to be protected and not be sidelined. But while the government implemented programs such as the Social Amelioration Program (SAP), questions continue to linger. Was SAP distributed to all targeted beneficiaries? Were the poorest of the poor (4Ps) given ample support? What about the persons with disabilities? Are other people sick of TB, renal disease, cancer, and the like being treated as well? Are mental health problems and domestic violence being addressed? What about the returning overseas Filipinos? Note that 2,720 of the 114,394 returning overseas Filipinos are COVID-19 positive (as of July 6).
Lastly, CAN recommends that transparency and accountability be alway exercised. Unfortunately, not only are the government’s budget and expenditures figures not readily available but some government agencies have not provided detailed data and information on COVID-19. Because of issues relating to governance, including political issues that affect the response to the pandemic, some CSOs are having second thoughts when it comes to extending hands to the government in the battle against COVID-19.
WHAT WE KNOW
It is difficult to fight a battle knowing nothing. For this, CAN has conducted research whenever possible and talked with experts whoever is available. The following is a summary of the data and information about COVID-19:
• COVID-19 is now more contagious but overall mortality is less than 1%.
• It can be transmitted through droplets and aerosol. Recently, some scientists have claimed that COVID-19 is airborne.
• Within two to 14 days after exposure, victims may experience fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting and diarrhea. The typical incubation period is about five days. About 97% of the people who get infected and develop symptoms will do so within 11 to 12 days, and about 99% will within 14 days.
• Transmission, however, may be decreased by 85% through the use of face masks, 80% by physical distancing by at least three feet, and 78% by using a face shield.
• COVID-19 has no cure yet but there are drugs that show a positive effect on patients. Dexamethasone, for instance, decreases risks of dying by 1/3 in COVID-19 patients on ventilators and by 1/5 in COVID-19 patients needing oxygen, while remdesivir decreases duration of hospitalization in those with severe cases of COVID-19.
• Previous pandemics lasted 12 to 36 months. Without a vaccine and cure, COVID-19 will be with us for some time.
COVID-19 also affects our social behavior. To minimize risks, we need to adapt to new norms like physical distancing, frequent hand-washing, wearing masks and avoiding large crowds, among others.
On the economy, expect poverty and joblessness to rise, and a delay in the Philippines becoming an upper middle-income country. The negative economic impact affects the whole. The World Bank forecasts that the world economy will contract by 5.5% this year and we will be experiencing the worst recession in 80 years. Around 70 million to 100 million people will also fall to extreme poverty due to the loss of jobs and closure of businesses.
There are a lot of things that we still do not know. When will a vaccine and treatment regimens be available? When and where outbreaks will occur? When will we be able to develop immunity? And, when will COVID-19 pass?
LESSONS LEARNED AND MOVING FORWARD
Government and experts cannot and will not be able to contain COVID-19 alone. The government and the people need a “massively distributed responsibility” to learn and adapt. In doing so, we need to face a two-fold challenge: How to contain COVID-19 and improve the health system; and, how to recover socio-economically towards a more equitable society.
To contain COVID-19, everybody should be responsible and be empowered to protect himself, his family and others — by wearing masks, physical distancing, maintaining personal hygiene, observing a healthy lifestyle and boosting our immune system. Likewise, everybody should continue helping others in any capacity — sharing facts not fake news, providing assistance to the needy (food, shelter, jobs, etc.).
The national government should provide the necessary conditions and incentives to encourage, not intimidate, the communities to cooperate and collaborate in the fight against COVID-19. It has to listen more (to the local governments, the private sector, and communities), be more honest and transparent, and communicate clearly. It has to improve its governance and public service delivery, including providing safe public transport and fast tracking the rollout of broadband and Internet connections.
The Department of Health can do more to share information and ensure data transparency. It should continue PCR testing as well as regulate the antibody tests, fine-tune the contract tracing strategy, and continue the universal health care implementation.
On socio-economic recovery, we should use the pandemic as an opportunity to expedite the implementation of programs that will build a more equitable society, anchored on the respect for human rights. The programs include providing fiscal and monetary stimulus that will benefit the micro-, small- and medium-enterprises, the farmers and workers, and the poor. This should be reinforced with appropriate and free education for all, sufficient infrastructure and road networks, and access to the digital highway.
Despite the increasing numbers of COVID-19 cases, we found out that there are gains in our fight against COVID-19. The war, however, is not yet over, and worse, it is even spreading. The government cannot fight it alone and everybody should help and step up to fight. All sectors need to be mobilized to contribute in a way that is democratic and empowering. The simultaneous task is to contain COVID-19 by improving the health system and enable socio-economic recovery towards a better and more equitable society.
Like any other pandemic, COVID-19 too shall pass. How and when will depend on our collective action now and in the coming months.
Eddie Dorotan, MD, MPA is the convenor of the COVID-19 Action Network, the executive director of Galing Pook Foundation, and a fellow of Action for Economic Reforms