We have only two scenarios as we approach the April 12 deadline of the Luzon Lockdown period.

It either gets extended a few weeks more or it gets lifted.

Either way, the bottom line is not only the human toll this pandemic is causing but the economic toll as well.

COVID-19 has changed the paradigm of what is the “new normal”. The millennials and the more recent “alphabet” Generations have never seen anything like this. Neither have we.

Two scenarios will play out as we go towards the end of the second week of being “locked down”.

Let’s be realistic. The number of new cases (and sadly new deaths) WILL NOT go down overnight. Or soon, for that matter. So let’s keep our expectations real. Locking down everyone for the next month will not make the statistics decline NOW. Remember, it took China in general and Hubei in particular almost 3 months to bring their numbers to where it is today. But they had a different model. And isolating Wuhan from the rest of China and the rest of the world took an economic toll on the country. But China will always be China. They are, after all, an economic powerhouse. They can build a hospital dedicated to managing SARS or COVID-19 in a matter of 10 days.

Keeping it real, the Philippines will always be the Philippines. The eternal beggar for donations. Let me call a spade a spade. We recognized this problem early in January. There was one death in three cases. From a foreigner who traveled from Wuhan, China to the Philippines via Cebu into Dumaguete and finally into Manila. He later passed away in a government hospital. That alone should have served as a red flag.

How we even got from that point to where we are today is a different story altogether. But the answer partially lies in what President Duterte said – The Kit is the Kit.

BEST CASE SCENARIO

The 4-week lockdown will hopefully slowly bring the number of positive cases down in the remaining 2 weeks. By “containing” everyone and presuming everyone is positive for the infection or are potential carriers (note: asymptomatic), we make the viral “infection” run its normal course. People within the same household who probably have mild to no infection will recover on their own. If enforced properly, this will curtail ongoing community transmission. Those that progress to being critically ill are then hospitalized, isolated and hopefully, recover with minimal sequelae.

The numbers should gradually slow down. The “curve” will flatten. The limited healthcare resources will not be usurped. And perhaps in another two months, life will breath new air.

WORST CASE SCENARIO

Then again, the success of a lockdown is a hypothetical presumption. It may work best for highly disciplined countries. Those with very few informal settlers. Those with better healthcare resources. And those with best economies because they have the means to feed and fend for its people. Like a zombie movie out of Netflix, the gated communities will probably be the last or least affected because they have the most resources.

How long do we lockdown and what are our grounds for endpoints? The anatomy of disappointment are expectations. As we near the date, are we seeing what we want to see? Why or why not? Should we extend the lockdown? If we do, how long do we extend?

Metro Manila is a highly dense city. We have more people here than Wuhan alone. More than 15% of people in the Philippines residing in Metro Manila. While there are many gated communities in the metro, they comprise only 1/3 of the population. Majority are informal settlers. How to quarantine a family of 10 that live in a 15 square meter area or a community whose homes are a thin plywood board apart with access alleys measuring 1 meter in width is a virtual nightmare.

So, yes. We need to get out of this lockdown in the next few weeks. Extending it is an option but a calculated risk on the economy of a third world nation like ours. As the poor would say, they will not die of Coronavirus but of hunger. We cannot keep giving them dole outs. Micro, small and medium enterprises will eventually crumble, with the smallest losing the most and most likely will be unable to recover at all. People will lose their jobs as these owners will need time to recuperate losses. Half of them will not be able to bounce back. The remaining half will struggle against the tide. There will be massive lay offs. Riots, violence, looting, unrest are worse case scenarios.

Is the lockdown the only solution?

No. And we need to get out of this rut quickly while taking into account the lessons learned from how other countries are managing their own crisis.

That’s why we need a plan B. This government should learn to shift gears now by appointing experts who understand crisis management and not rely on amateurs who only have political clout as the qualification for being appointed into public office. Sadly, some Filipino politicians use any form of crisis or disaster to be able to tap into government funds for their personal gain. Greed, power, and ambition are well entrenched in the DNA of corrupt politicians who run for public office because to them, it is a business enterprise. For a country like ours, it is a family affair.

As the various cities and provinces move into lockdown mode, the longer the time to relief, the more the economy will take the brunt of the pandemic. It has hurt more affluent nations already. Imagine the impact it will create in a small country like ours whose financial reserves are being depleted to sustain the fledgling business sector and the jobless.

The cash assistance program of the government IS THE WRONG solution to the current crisis. It is not a sustainable solution. The small patches being addressed include giving cash assistance to the informal settlers and those unemployed due to the crisis. Which I personally think is a bad idea. This is a problem that will last into Plan B. Which means that the government will need to sustain the micro, small and medium enterprises in a time of difficulty. They will need to give up more than just dole outs to the poor. The question is, are they willing to?

This would mean not collecting taxes, SSS, Pag-Ibig, Philhealth, GSIS and other contributions for an agreed period of time. This would also mean that losses can be claimed against taxes. Loan reprieve should not be voluntary but mandatory. All banks and other lending agencies should be mandated to require those who have existing loans if they wish to restructure their loans to lower rates. It is unfair that current lending rates have been lowered but not adjusted for those whose loans are locked in at a fixed rate at a time when they borrowed money from them. Those who are willing to hold off payment for say, 3 months, should be allowed to do so in order to recoup the financial losses of this lockdown. Local governments should be mandated to provide a reprieve to local businesses as well. Rebates in business permits can be given. For example, for those that pay quarterly instead of annually, the second quarter payments should be waived. While the business permit may be based on the gross income of the company in the year before, it should be able to assist the local business sector these unexpected extraordinary losses. In addition, it should be fair in next year’s assessment when paying for a mayors permit. (I am sure everyone knows that the LGUs turn a blind eye when it comes to the business permits. They will not believe the income tax statements you declare and insist their own computations.) Reprieve from rental of business establishments where the offices or stalls or stores in malls should be granted as per duration of the lockdown. In short, greed must be tempered from all sectors.

Sustaining the smaller and medium enterprises is essential. The aftermath of the pandemic will impact not only on health and lives of everyone but on the economic repercussions of the lockdowns. Let us face it, at the end of the day, it is those who have the least in life that suffer the most. If these small and medium enterprises close, there will no jobs to go back to. And everyone loses.

PLAN B

There are two models that can be used. The China experience (total lockdown) or the South Korea experience (no lockdown at all). The people in the government can integrate the experience of both countries and perhaps create a hybrid one for the Philippines. Using either of models (China or South Korea) ALONE will not work because our economic structure is fragile and poor.

The New York Times published an interesting article on “How South Korea Flattened the Curve” https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html. In a nutshell, Fisher and Sang-Hun point out the strategies on how to contain the coronavirus without shutting down the economy. The downside? It may not work abroad.

The article points that the lessons, “while hardly easy, appear relatively straightforward and affordable: swift action, widespread testing and contact tracing, and critical support from citizens.” The four lessons are:

Lesson 1: Intervene Fast, Before It’s a Crisis

We were there in the beginning of this war. Three cases all foreigners. One death among them. Then we were stumped. Too few testing kits were at our disposal. Even up to today, we’re stuck with the bureaucratic red tape and the parasites and opportunists who take advantage of their positions in government to overtake the queue or by-pass the algorithm on who we prioritize for testing.

We intervened ahead of the world. Our major mistake was the mixed messages being sent by various agencies. Basic epidemiology would have taught us that if there was 1 death in 3 cases, the overall case fatality rate is 33% for the country. A number far too high from the average case fatality rate of 4-5%. Which means we were not picking up the real numbers. To have one casualty from the virus, you needed to find at least 25 cases.

But the virus has arrived. And the traditional response may not be the solution here.

Lesson 2: Test Early, Often and Safely

Culled data as of March 20 shows how far behind we are when it comes to testing. As the kits came in last week, the numbers began to swell. Everyone wanted to get tested. Understanding testing is vital in the decision on whether we test those at risk, those exposed, those at highest risk and/or test everyone?

But should we test everyone?

No. That would be a waste of resources. And may provide a false sense of security.

Like any laboratory test – reliability and accuracy is crucial. The tests should be be done in a safe place by well trained people who pass accredited and quality standards. In a nutshell, the validity of a testing kit will need to get verified. Results can vary between 30-60% accuracy. Other reports include 10-30% pick up rate depending on what you use. And are dependent on the timing, how the specimen was obtained and transferred, the severity of illness, the viral load and of course the way the specimen is run in the laboratory. These factors alone will make testing in a country with 7,641 islands a strategic impossibility.

The model used in Korea is opening more testing centers. The question is – do we have enough testing centers that fulfill the requirements for biosafety in handling specimens for these tests – in the country? The answer is a NO. Even if we beef up capacity, it will take months before we can have enough accredited laboratories for testing along.

To show you the model of South Korea, here is what they did:

This is most unlikely easy to put up in the Philippines. Hygiene, the very basic tenet of infectious disease is difficult to enforce in a community that lacks water, basic toilet facilities, and garbage disposal. Ignorance is also important to manage, doctors included.

What can we do realizing these limitations?

After the curve sees some flattening (which won’t be anytime tomorrow), mitigating the spread is vital. The key is to do testing on EVERY SUSPECTED CASE (not on everyone). This way we can conserve resources. All patients who are positive, regardless of severity of symptoms should be admitted to a designated COVID facility. Since schools have been closed, public or private schools can be used as COVID facilities for those that DO NOT have severe symptoms that will require hospital care. Food, water, and isolation is all that is needed. Making them stay AT HOME in the community will place more people at risk. Knowing the Filipino mentality and culture, home quarantine will not work.

Lesson 3: Contact Tracing, Isolation, and Surveillance

The Department of Health through their Epidemiology Bureau does a lot of contact tracing. The challenge is the patient. Some (if not many) of whom are afraid to reveal they have come in contact with patients for fear of being positive for the virus and the idea of being isolated. In short, people must be willing to lose a part of their privacy as a necessary trade-off for the good of the community.

Here is the model used in South Korea:

For all the technological wizardry of this nation, and how socially connected Filipinos are with their gadgets and other platforms, creating an app similar to this is a walk in the park. Two large telcos – Globe and Smart – should be mandated to work with the government in providing free data to those who will eventually need to use this app during self-quarantine.

Lesson 4: Enlist the Public’s Help

And this is where it gets a bit tricky.

Our bayanihan spirit defines us as Filipino race. But sadly that same spirit isn’t a consistent one. When people do things in order to be recognized as heroes in the end, we all end up as losers. Finding recognition at the heart of an outbreak of this proportion is not a solution. It is a problem. While government needs to listen to suggestions from private sectors, the private sectors should be able to sit down and work with the government on various matters. For example, certain corporations can help at procurement of PPEs and face masks (eg. banks and other lending institutions), while others focus on their special fields (telecommunications, food manufacturing, etc). We don’t ALL have to donate food. Equipments, health facilities, testing kits, disinfectants, etc are at the core of lacking in support. Let’s segregate it. And it would be fantastic if we had only ONE keeper of funds for the private sector donations that would turn it over and do accounting with ONE recipient of funds from the government sector (perhaps the Department of Finance). This way, accountability is transparent.

LIGHT AT THE END OF THE TUNNEL

Either way, the virus will disappear slowly.

Will it ever go away?

Scientifically speaking – No.

At best, after the dust has settled, we will understand how to recognize early this disease, manage the infection and hopefully find a treatment, and discover a vaccine.

The next two weeks will be crucial. It will be a defining moment on whether we proceed to doing mop up operations after the war or prolong the war. This invisible enemy in our midst is so far winning the war. A measly virus that has claimed lives, disrupted economies, changed the normal way we live and breath and engage with families and friends has the upper hand now because we hid under the rug the red flag two months ago when a foreigner died of COVID19 in our country.

The perpetual beggar stance of our nation is disappointing. We have billions to spend on intelligence resources, private planes and foreign travel and yet we wait for donations for – THE KIT.

The next two weeks is crucial. We either have plan B or the virus continues to decimate us medically and economically.

This government can have its most defining moment now or be the ultimate lackey because no one will ever forget this pandemic that will forever be etched in the history of science and economics. Ever.

Yes. But with a price to pay.

Life in the metro, and in most parts of the world, has drastically changed in the past few days. As more new cases of the novel coronavirus are being reported, some people seem to be losing it. Literally, jumping the gun and going gaga over the additional cases that are being reported.

Epidemiologist, Adam Kucharski in his book “The Rules of Contagion: Why Things Spread and Why They Stop” proposes an interesting perspective on this topic during this lockdown period.

Flattening the curve: What does it mean?

Li, Pei, et al. in Science (16 March 2020) published an article https://science.sciencemag.org/content/early/2020/03/13/science.abb3221 analyzing the prevalence and contagiousness of UNDOCUMENTED novel coronavirus (SARS-CoV2) infections is “critical for understanding the overall prevalence and pandemic potential of this disease.” That publication (which serves as an interesting read) estimated that 86% of all infections were undocumented before travel restrictions were imposed in China on January 23, 2020. “Per person, the transmission rate of undocumented infections was 55% of documented infection, yet due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spreads of SARS-CoV2 and indicate containment of this virus will be particularly challenging.”

The study indicated that multiple factors including: identical and isolation of undocumented infections, awareness among health care providers, availability of viral identification assays, use of face masks, restricted travel, delayed school reopening and isolation of suspected persons can potentially slow the spread of the disease. Combination measures increase the reporting rates, reduce the proportion of undocumented infections and decrease the growth and spread of infection.

The lessons learned from the outbreak of the novel Coronavirus in Wuhan is a bitter pill to swallow for the global community. Experts in epidemiology talk about “flattening the curve” in order to primarily slow down the acceleration of number of cases. By slowing down the case rates, the burden and demands on various resources of the healthcare system is indirectly addressed. https://www.livescience.com/coronavirus-flatten-the-curve.html

A pandemic will take time to naturally “flatten” on its own. Because of the initial overwhelming burden on scarce resources of healthcare (especially in third world countries), the death toll will be much higher. Those at the forefront are primarily affected. If there are less healthcare workers to tend to more sick people, the mortality and morbidity rate increases. If there are more sick people that will need hospital beds and ventilators because of more severe COVID-19 infection, the already limited resources are usurped more quickly. Scales of outcomes then become dependent on financial capacity for better and more aggressive care.

In epidemiology, the idea of slowing a virus’ spread so that fewer people need to seek treatment at any given time is known as “flattening the curve”. It explains why so many countries are implementing “social distancing” guidelines.

Brandon Specktor, Coronavirus: What is ‘flattening the curve,’ and will it work?, LiveScience, March 17, 2020

In the above graph, as the number of people disproportionately increase and no precautions are placed, the health care capacity is exceeded, exhausted and fails. In order to maximize (not overwhelm) the health care capacity, there is a need to slow down the infection rate. Flattening the curve assumes that the same number of people ultimately get infected, but over a longer period of time.

Does it work?

In 1918, a global pandemic of Spanish flu was seen. Compare two U.S. cities – Philadelphia and St. Louis. Infectious disease experts warned of the flu spreading in communities. The reaction of both communities was different. A massive parade went as scheduled in Philadelphia, gathering hundreds of thousands of people together. In 2-3 days, thousands of people in the Philadelphia region started to die. At the end of six month, 16,000 deaths were recorded. In St. Louis on the other hand, the city officials implemented social isolation methods – schools were closed, travel was limited, personal hygiene and social distancing was encouraged. At the end of six months, 2,000 deaths were recorded – 1/8 the number in Philadelphia.

How long is this going to last?

That’s the question that’s begging for an answer.

Unlike 1918, we’re living in a different era. More than a century later, our tools at combatting infectious diseases are more rapid, accurate, and precise. But even cutting edge technology and digital advancement won’t solve this problem overnight. One avenue science has not caught up with is a contagion unknown by all. When the enemy is new, the learning curve is steep. Which means that it will take in casualties before we know how to deal with it.

This will not go away anytime soon. With appropriate mitigation measures – both medium- and long-term – we will be able to suppress this. We need to bring the number of reported cases down using ancient aggressive epidemiological tools – social distancing, quarantine, lockdown of high risk communities, and testing patients. Belligerent testing, case finding, contract tracing are vital to keep the cases declining. When the dust finally settles, the government should put into place an overlapping long-term plan on how to keep the numbers down. For example: (1) all people who travel should have mandatory quarantine of a minimum of 14 days upon arrival. (2) Everyone who comes in contact with a COVID-19 positive patient, should undergo testing, monitoring and self-quarantine regardless of test status (if any). (3) Social distancing should be norm for the next few month until this blows off. (4) Schools may need to get cancelled for the rest of the school year. (5) Vaccine-preventable diseases should be mandatory for all so that we are not taken aback when another outbreak (preventable at that) surprises us in the future. (6) Honesty is a direly lacking trait among Filipinos. For more personal reasons for that matter. (7) Sale and events that will entice a crowded group should be canceled up to the year end. But these are just examples and I am sure people will get upset to some degree.

Eradication is another story altogether.

Someone asked me if this will ever go away. The answer is no. I don’t think so. One strategy to making this vanish is to develop a vaccine at best. But like any new drug, this isn’t like some Avenger movie where a vaccine is developed in a couple of hours, needle plunged into the arm, and presto – we’re immune! This will take quite awhile because whatever is developed out there needs to get tested for safety and efficacy. How long will it protect you? Do you need added doses? What’s the immune response to the vaccine? What are the short and long-term side effects? We all want to be guinea pigs during a crisis.

Let me end this by saying that it’s okay to be disappointed with what’s happening. Sadly, we still have a lot to learn about this virus. And how it will play out. The worst will spare many of us. But only resilience will make us survive this pandemic. Yup. The pandemic will end. As it did with the Spanish Flu of 1918, it ended in 1920. With the novel coronavirus, “what we don’t yet know is when.”

Lockdown. Quarantine. Isolation. Containment.

These are words that are unheard of in the last century in democratic countries.

In the context of a health setting, these words were last used in a flu pandemic in 1918. More than a century ago.

A hundred years later, who would have ever imagined that another pandemic would arise? Yet it did. The virus is called SARS-COV-2. The disease – COVID-19.

The coronavirus outbreak has harmed communities and disrupted economic activity in many countries

The New York Times 3.16.2020

The evolution of digital technology, social media and the internet has undoubtedly changed the way we live in the 21st century. Everything is now readily accessed by our fingertips. Mobile devices and other accessory gadgets have created wonders at how staying connected we can still be in spite this health crisis we’re experiencing. All these have cemented the fact that human beings are social creatures. It has become our core DNA.

However, when social distancing becomes the rule, our norms are perturbed. Daily habits get changed. Schools are closed. Mobility is restricted. Travel bans and vacations are at a standstill. Work is muddled. Deadlines and targets affected. Economies are tested. Finances are disrupted. Those that have the least in life, end up suffering the most.

Life is at pause mode.

In societies where life plays out on the street or in the cafe, where friends are greeted with kisses on the cheeks, the outbreak is creating fear and fragmentation.

Steven Erlanger, The New York Times, 3.16.2020

While the novel coronavirus gains steam outside of China and at a pace much faster than its spread in Wuhan, the doubling rates in the rest of the world has become a major concern.

In the above table it shows that aggressive testing is proportional to the doubling rate. The more aggressive we test on a broader scale, the longer the period to doubling time. Below is the Philippines data.

That doubling time is why we react the way we do now. The number of deaths has disproportionally risen. In one of my blog posts https://wordpress.com/block-editor/post/relativejoyforyou.wordpress.com/6568, there’s a daily track on the status of the pandemic. The stance of the World Health Organization at the beginning of this COVID-19 outbreak was a feeble one. That’s how we got to where we are today. The reactionary attitude of individual nations is rationalized. Albeit a bit late, they’re doing all they can to bring this pandemic to its knees.

So I’m writing this blog on a day off from the hospital because I am heeding the call of the government – stay home, stay safe.

Yet I cannot help but think about the other people outside my gated community. 90% of those that own businesses in Metro Manila are micro enterprises (not even small or medium). They invest their hard earned money in tiny businesses inside malls. With the shut down of malls or other places of business, they have nothing at all. Suffering an economic loss is an understatement. 80% of employees depend on the flailing public transportation system of the metro. No matter how difficult life is, how far they live, they will trek to their place of work because they have mouths to feed and bills to pay. The disruption in daily life is most lamentable among those who have the least in life. And so yeah, I’m not all rah-rah about the total expanded community quarantine, a.k.a, lockdown. That’s because the government forgot to think about the larger group of people affected by this lockdown. And when you have government officials who tell you to just shut up and shove it, well that’s the kind of empathy you get from people who have water for brains. We silently concurred with government people who were out-of-touch with reality because we have the means to sit back, relax and watch how this eventually evolves.

Then there are my colleagues who are at the forefront of the battle against this pandemic continue to tend to patients who flock to the Emergency Room demanding for tests because of paranoia or probably real COVID-19 illness. And those of us who still get up in the day and see sick and well patients because we are morally and ethically bound by the responsibility of our profession. The whole health force at risk, tired, undermanned and yet end up unappreciated by others who have nothing better to say or do because all they care about are their personal bravados.

I would least care for the generation that thrives on bars, crowds and parties. Upending the lives of these social animals have no bearing at all on how this pandemic is addressed. If they take a reality check, they will realize that when the dust settles, unlike the 80% of the lower socioeconomic working class, they will be back to their spoiled, privileged daily lives sipping designer coffees and hanging out at bars or other forms of reckless or blissful living. Their whining is annoying. Someone should slap them to reality.

Finally, there are the opportunists who take advantage of the gullible and/or the vulnerable. Those heartless businessmen who hoard medical supplies and sell them at extravagant prices, or peddle equipments, tools, medicines, medical devices that have no scientific value or at best useless for diagnosing or treating COVID-19 should be punished for economic sabotage. Sadly, some of them have direct connections with government officials who are accomplices to criminal acts of deception. The vermins who take advantage of a crisis for personal economic gain and thrive on disasters for financial remuneration will have their comeuppance.

Growing up in the metro, I remember seeing only deserted streets during the Holy Week, especially Good Friday. That’s the best day of the year for me. When the daily rush of work is placed to a one day pause, it’s a wonderful feeling to breath for a day. The past few days has been a quiet one. One of solitude and peace. It has allowed me (and hopefully all of us) to reflect on life at a time of a pandemic.

As each day evolves, we get to see the good in humanity. Those selfless people who give more of themselves than you would expect. The extraordinary heroes during unprecedented times. Those who think out of the box in order to share our Filipino bayanihan spirit. Not having to think about what we can do about ourselves, but sharing whatever we can and have because we care more about our neighbors. Symbolically, the season of lent did not come at a better time to symbolize the strength, resiliency and sacrifice during this time of crisis.

Then there are the wolves. I am lost for words at describing the decrepit people who walk among us. They will forever be a symbol of evil lurking among good. They will remind us that the battle of the novel coronavirus is not between science and the virus, but a representation of the fight between good and evil. The struggle is real but that should remind us that in both good and bad times, we will survive this.

Sit back. Breath. Appreciate your family and friends. Enjoy the new found freedom from the humdrum of work. Go for a walk. Listen to music. Finish a book. Binge on Netflix. Break up with your boyfriend or girlfriend. Connect with yourself and sit down and contemplate on the life you’ve really wanted.

There are a million things you can do. And should do. Those things and tasks you’ve sidelined can be addressed now.

Perhaps the coronavirus outbreak is a gentle reminder to us that life will show its beautiful side in the midst of being ugly. That life is fleeting. That life is a gift and should be celebrated. Everything else that happens around us is just a bonus or noise.

Stay safe. Stay home. Good luck!

EVERYTHING GETS WORSE BEFORE IT GETS BETTER

So yeah. Coronavirus and all its relatives will go down in science and history as one of mankind’s greatest adversary.

Over a decade, it has caused deadly diseases -SARS (severe acute respiratory syndrome) and MERS-COV (Middle East respiratory disease from coronavirus). Now, its cousin called COVID19 is spewing another flu-like disease that’s causing disproportionate global panic, confusion and havoc. Unlike its earlier cousins SARS and MERS which have more severe outcomes, the chaos generated by COVID19 is taking a greater toll on health, travel, business, and the global economy. It has upended the “way of life” in the 21st century.

SOCIAL MEDIA PLATFORMS AND QUACKS

In an era where social media and influencers dictate what is shared, liked or believable, the gullible are taking the war to a new level. The pandemic of infodemic is real. From conspiracy stories about the virus being manmade to a bioterrorist nightmare, pseudo-experts are frantically banging on their keyboards dishing out “opinions” not in their field of expertise. Their objectives are unclear. Perhaps one borne out of the need for attention and a shot, albeit a temporary one, at popularity? The age of being technologically connected knows no boundaries. For sure, someone will always add hysteria in order to twist a story. Consternation and a sense for foreboding, after all, will always be a bestseller.

There’s a fictional book by Dean Koontz, “The Eyes of Darkness”, published in 1981 that refers to supposedly Wuhan-400 as a bioterrorism weapon in the city of Wuhan and predicting that in 2020, a severe pneumonia-like illness will spread throughout the globe and will suddenly disappear and return. This reference in a Nostradamus-like novel has been alluded to as well.

But this is where it gets weird. I don’t know if people actually know that the original book did not refer to this as Wuhan-400 but as Gorki-400. Let’s look at snopes.com and how they unravel the fake in this spread.

The animals that thrive in this infodemic spectrum are what I call the opportunists. They’re the kind of critters that spread “false” information on preventive measures and cures – peddling megadoses of multivitamins to devouring bushels of garlic and onions in order to apparently strengthen or insulate the immune system from viruses. With social media as a weapon, all the other propositions range anywhere from animal excrements to licensed drugs that are off label in use in the frantic search to place a stop to the outbreak. This act of desperation is human nature. We’re living in 2020 – a time of plenty, of travel, where social distancing is unheard of, where medical science is at its most advanced stage, and where miracles don’t happen anymore because we have an answer to every question. After all, it upended our normal day to day living in the 21st century.

The major difference between the influenza pandemic in 1918 and the infectious outbreaks of the 21st century is not only in the way the disease manifests itself. Social media platforms play a diverse, crucial and at the same time, deadly role in spreading either correct or wrong information. Suddenly, everyone is an expert – from the lowly troll keeper to the bored housewife to every Tom, Dick and Harry who is untrained and unable to discern with accuracy on what materials should be shared by Dr. Google. Search engines are churning out information that can simply be copied, pasted, shared, and the credulous person – like the coronavirus – simply spreads all these unverified data to the hapless ignoramus.

In the event of widespread illness, we’ll need to rely on accurate, vetted information to keep us safe. While the internet has made distribution easier than ever before, the democratization of information has created platforms and advertising economies built to reward misinformation.

Charlie Warzel, “Coronavirus will test our way of life” The New York Times, March 2, 2020

WHERE ARE WE NOW AND WHAT DO WE KNOW?

As the coronavirus seems to be getting a relief in Hubei in particular and China in general, the rest of the world is in highest alert as the numbers have spread outside of China and have amassed significantly in other parts of the world, particularly in Europe (where Italy is hardest hit).

The rapid global spread of the coronavirus has not only spread the disease but of racism and blame. Borders have been closed. Economies have been badly damaged. Governments have been criticized. Religion has bended back on traditional practice. One virus alone has brought the world to its knees. They say that the real human nature of a person is revealed during the worst of times. This is it.

What we now know is that the virus is being spread through local transmission with some people having no known contact or history of travel to China alone.

Like any viral respiratory disease (eg influenza), asymptomatic patients are difficult to identify. While adults and the elderly are at highest risk, children who have come in contact with family members who may be sick are not routinely being tested or isolated, or worst off, quarantined. “Super spreaders” can actually emanate from anyone who significantly move around sans conditional restraint. Daegu in South Korea was most affected because of a “super spreader” from a church group who continuously participated in activities and continued to proselytize in the community.

Like flu, COVID-19 presents with cough, colds, fever and other nonspecific symptoms. While they may be transmitted by similar routes, COVID-19 may be spread by the airborne route. We also know that the incubation period of COVID-19 seems to be much longer than influenza. The latter makes it more challenging to identify who are exposed and at risk. In addition, there are antiviral medications for the treatment of influenza and vaccine to prevent it. There is none for SARS-COV-2.

The varicella virus that causes chickenpox is a perfect example of a virus with a long incubation period. Patients are infective 3 days before and up to 5 days after the rashes appear. Meaning if your child has not had chickenpox and gets exposed to a classmate diagnosed yesterday to have the disease because the parents noted rashes only yesterday, most likely your child has been infected because the most infective period are 3 days prior to appearance of the rash up to 5 days after all the rash/vesicles have appeared. Because of the long incubation period, your child will most likely have chicken pox in the next 2-3 weeks.

QUO VADIS CORONAVIRUS?

Social distancing, isolation, quarantine, cancelled events and flights, lockdowns are interventions and measures used to control outbreaks in infectious diseases, particularly for those where we still have no treatment and no answers to more questions. YET.

What’s upsetting and causing the panic and hysteria is that as a people, we cannot accept the fact that in the past three months since the spread of this virus, it has finally landed home. Personal lives are now affected. In short, we simply cannot accept that there are just some things that we will need to give up for awhile while the medical community finds a solution as to how we can approach this novel respiratory virus with the limited resources we have.

Banging on the keyboards and instigating fear and worry is not helping anyone. It’s not like this is an easy puzzle to solve. You don’t know how much effort doctors and scientists are putting into this outbreak. How many of us are risking our own lives by attending to and pacifying a lynch mob who are desperate to get their lives back to what they used to be. We too, have our families who will grieve when we are gone. But we do what we do because we’re the only miracle workers left during times like these.

We are all on the same boat. Let’s not tilt too much on one side because it will sink if we do. Sit back. Relax. The waves will eventually die down. And if we all work together at addressing the problem in a calm manner, we will not overwhelm the limited health system. Overwhelming the current health care system affects efficiency and outcome of the critically ill and those who will require intensive care more than others.

Let’s try to be more socially and morally responsible in the kind of information that we share because the same shared spaces on social media with friends and family are multiply contagious as well.

I was telling a few friends the other day that if there is one Tagalog word that best describes the Filipino, it is the word “BASTA“.

It’s an apt description where the person thinks of himself and when cornered for an answer as to why they do what they do, the answer is BASTA.

It would help if we shoved that up our pride filled ass for awhile. This is not the time to care less. Only then can things get better…