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.

Do not panic.

Do not panic.

Do not panic.

Chances are, the one who nervously warns against panicking might be the one wetting his pants. The mischievous Greek half-god, half-devil Pan would be laughing shrilly after bellowing loudly to frighten those who unfortunately found themselves lost in his forest lair. Demonic laughter rouses the adrenaline of fear and the cauldron bubbles in the ensuing pandemonium. (Note the “demon” in pan-demon-ium.) Fear is contagious. Pretty soon so many are caught in the contagion of fear — transmitted person to person or “airborne,” as in the ambience — and there is a pandemic. (Note the “pan” in pan-demic, where “Pan,” the god who strides both the upper and the lower worlds, has been made the prefix for things universal or worldwide.)

So much for etymology and the play of words. Sorry, there is the luxury of time and space in this “expanded community quarantine” (ECQ) for the idle mind. But wait, here’s yet more “double-speak” in the “New Now” of the novel coronavirus world experience:

The World Health Organization (WHO) had first issued a warning about the coronavirus, renamed “COVID-19” on Dec. 31, 2019.  It was declared to be a Public Health Emergency of International Concern (PHEIC) by the WHO on Jan. 30, which noticeably avoided calling it a pandemic, as other previous widespread contagions or plagues have been rationally labeled. Precisely, world pandemonium over a pandemic must be avoided. Do not panic, world leaders exhort their fearful people. The leaders are panicking, perhaps over bubbling cauldrons of other pandemics in politics, economics, and societies within and outside their countries.

While outwardly repeatedly preaching “Do not panic” to constituents, world leaders in their respective regimes must, for their own sakes and, of course, for their country and people, look at the confluence of effects of the world shutdown in this time of COVID-19. The feisty socialist Bulgarian President Roumen Radev called down his government, and with them, world leaders who have been in denial about the “parallel crisis” of survival during and after the coronavirus pandemic. Radev initially did not want emergency powers, but eventually agreed to the State of Emergency Measures bill, after refining the freedom of speech and profiteering clauses in the bill, according to the Sofia Globe of March 22. How different Radev has been, from some PR-seeking politicos who seem to have taken shameless advantage of the pandemic to take unto themselves “emergency powers” purportedly to handle the situation better, when their sworn duty to their people was simply to do their jobs, and do their jobs well.

As of yesterday morning, April 5, there were 1,201,591 total confirmed COVID-19 cases in the world, with 64,703 deaths and 246,198 total recoveries. The US still tops the list at 246,198 confirmed cases, 8,476 deaths and 14,694 recoveries; Spain follows with 126,168 cases, 11,947 deaths and 34,219 recoveries; and third is Italy with 34,219 cases, 15,362 deaths and 20,996 recoveries. The Philippines, according to the same Johns Hopkins Hospital tally, has 3,094 confirmed cases, 144 deaths and 37 recoveries. With the varying numbers of confirmed cases versus corresponding death and recovery percentages, it can be seen that the coronavirus cannot yet be contained and controlled, much less reasonably prevented, regardless of the economic standing of the country in the world, or its state of medical technology and skills.

The more technologically advanced countries, led by the US and China, are working feverishly to cool the COVID-19 fever, but no vaccine is yet in sight to give confidence to the world that it would be fully restored to economic and social freedom of movement and interaction quo ante to the pandemic. The panic is now for the lack of testing kits for even the PUIs (persons under investigation) and the PUMs (persons under monitoring) so that they can remain in quarantine while the uninfected can resume “normal” life with relaxed social-contact restrictions vis-à-vis the identified sources of infection. Then there is the overwhelming lack of facilities (hospitals, equipment, specially ventilators and PPEs — personal protection equipment like masks, gloves, and gowns) and medical staff (the brave front liners, some of whom have already succumbed to the virus).

The top three countries suffering most from COVID-19 — the US, Italy and Spain —  have bungled their handling most, according to doctors interviewed in the Atlantic Daily of March 25. They blamed the denial of the leaders of these countries, or maybe the ignorance that the coronavirus was stealthier and more virulent, more immediately fatal than any other coronavirus (like the 2003 SARs). The slow reaction and bad planning, exacerbated by the lack of hospital facilities brought the world to its knees before the taunting coronavirus.

The quarantines around the world might not be lifted by Easter Sunday, most Health Departments say. Lockdowns have been extended by governments tentatively until the end of April, and some until the end of May. Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases, said in the USA Today of March 16 that the outbreak will get worse before it gets better.

Meanwhile, the “parallel crisis” of world economics petulantly vies for attention. Those hopefully not infected by COVID-19, and those who would have survived the contamination must have the wherewithal to continue to live, with a quality of life above Maslovian survival.

“The global economy is already in a recession as the hit to economic activity from the coronavirus pandemic has become more widespread, according to economists polled by Reuters amid a raft of central bank stimulus actions this week,” Reuters reported on March 20. “The evolving news on COVID-19 has triggered ‘forecast leap frogging’ with economists and strategists repeatedly lowering their forecasts. Among the big three economies, the US and the Euro area will see negative growth, while Chinese growth is expected to come in at a paltry 1.5%,” Reuters reported.

“Recession” is a dirty word, a virtual virus that can cross-contaminate nations and cause a pandemic as life-threatening as the coronavirus. And perhaps technology, with its tempting fruit of information-sharing and high-speed accessibility has brought the world to this now unshakable togetherness of commerce and trade, even diplomacy, in globalization. What affects the countries of the world will affect the little developing country of the Philippines.

“The main downside risk to (Philippine) GDP (gross domestic product) growth in 2020 comes from COVID-19 and is therefore highly unpredictable. The impact on the economy will be larger than currently assumed if the global outbreak is prolonged beyond the first half, or if there is a sustained local transmission in the Philippines,” the ADB said in its Asian Development Outlook 2020 report. Luzon, home to half of 105 million+ Filipinos, locked down since March 24, accounts for more than 70% of national GDP and is the center of the COVID-19 outbreak.

 Ernesto Pernia, director general of the National Economic Development Authority (NEDA) now says, “Gross domestic product could register negative growth of 0.6% to an expansion of 4.3%, depending on how long the lockdown of Luzon will last (ABS-CBN News, March 24). “But we still hope to recover by fourth quarter this year,” Pernia said, indicating the possibility of ending just somewhere 1% below the target 6.7% before the Luzon lockdown.

In a phone interview by Cathy Yang of ANC yesterday morning, Bangko Sentral Governor Benjamin Diokno said we are OK, no need to panic about the economy. There have to be two successive quarters of negative GDP growth before a technical recession, and we were at 2.9% in January, 2.6% in February, and 3.25% in March. We have the fiscal space, with 40% public debt to GDP ratio, which we can even increase to 45%, Diokno said. Reserves are good for eight months. We have the $2 billion assistance from the World Bank and its affiliates. And we have the continuing stream of OFW remittances, increasing 2% this year, dampened only slightly by the world quarantines situation from the previous 3% expected growth.

No need to panic over the pandemic.

We are now into the third week since the lockdown, otherwise known as the enhanced community quarantine (ECQ). To be exact, we are on Day 20 of the lockdown since March 15, 2020.

To date, 136 people have died and 3,018 have been found to be COVID-19 positive. This is a 12-fold rise in deaths (from 11) and 21-fold rise in positive cases (from 140) in just 20 days.

Seventeen fellow doctors – many I personally know – have fallen. Nakakalungkot. (That is so sad.)

These figures are just the tip of the iceberg. In the following weeks, we will see more and more cases detected and more deaths. This can become a deeper disaster if we don’t get our acts together NOW.

In this time of great uncertainty brought about by the disruptive COVID-19, we need adaptive responses to the challenges that don’t have easy answers.

We recommend the following six-point action plan:

1. Don’t lift the lockdown until the number of cases go down.

This may last for another one to two months. We have to prevent the spread of the virus. Stay home. No mass gathering. Social distancing. Wear a mask. Wash your hands. But let the supply chain flow unhampered.

Consider the following criteria in lifting or modifying the ECQ:

•  A sharp reduction of cases as demonstrated by a consistent downward COVID-19 infection slope;
•  Increased capacity and ability of medical facilities to treat all patients, particularly those hospitalized, which means having adequate personal protective equipment (PPEs), ventilators, testing kits, and the like;
•  Testing of all people with COVID-19 symptoms;
•  Effective monitoring and contact tracing;
•  Receiving relevant information from local government units (LGUs), including those outside the Luzon ECQ, to anticipate and prevent new transmission epicenters.

2. Test Test Test!

We need to know where the enemy is. Testing is key! Given the limited availability of the testing kits, let us prioritize testing the symptomatics with co-morbidities, those in contact with positive case, and, frontline health workers

3. Heal the Sick

For those who test positive with moderate to severe COVID-19: admit them to dedicated COVID-19 hospitals.  Don’t mix COVID-19 with non-COVID-19 cases.

For those persons under monitoring (PUM), persons under investigation (PUI),  and those with mild COVID-19: they should go into home quarantine if they have enough safe space. For those without sufficient space at home, bring them to national government quarantine facilities (e.g. ULTRA, the Philippine International Convention Center, the World Trade Center) or to the community quarantine facilities of local government units (LGUs). Biosafety measures have to be in place.

4. Protect the Health Workers.

Many of our health workers get infected and die because they are not protected enough. Provide them with the necessary PPE like gowns, cover-alls, glasses, masks, and gloves. They are sacrificing their lives so that others may live. Support them with food and prayers, too.

5. Strengthen the front lines through improved community management.

Our first line of defense is not the hospital. It is our last defense. Our first line of defense is at the individual level, at our homes, in our communities and LGUs, with our barangay health workers, our city/municipal/provincial health workers at the front line.

We need to reorganize our health system from a patient-centered model of care to a community-system approach that offers solutions for the entire population, rich and poor, rural and urban.

6. Strengthen the front lines through improved community management.

The rich can take care of themselves during lockdown, but what about the poor, the unemployed, and the vulnerable sectors? Let us roll out cash transfers, food packages, health benefits, and others from all corners: national and local government, private sector and civil society. This is the time to take care more of our brothers and sisters who have less in life.

To do all of the above things, we need to unite, cooperate, and collaborate. Do not be distracted by petty ramblings, fake news, politicking. We are not the enemy. Our common enemy is the COVID-19!

To our national and local leaders: quickly implement the above recommendations simultaneously! Time is of the essence. If we act now, we will pass through this storm. If we implement these later, disaster will come. Listen also to the local government units and the cry of the people. Temper your grandstanding and greed. For once, be the real leaders you ought to be.

To our civil society: let us creatively collaborate with the national government and provide value added contributions in terms of giving sound policy directions and implementing innovative local initiatives.

To our people: have faith. The storm will surely pass but we need to be more patient, humble and kind.

It is now Lent. Let us all pray, and do simple acts of goodness and kindness with all humility.

If we all act in a unified, coordinated, and collaborative manner, we can weather the storm, prevent more deaths, and come out a better nation: more caring for one another.

Eddie Dorotan, a doctor of medicine and a three-time mayor of Irosin, Sorsogon, is a convener of the COVID-19 Action Network. He is also the executive director of the Galing Pook Foundation and a senior fellow of Action for Economic Reforms.