Exit strategies

It’s almost 3 weeks since the lockdown in Luzon.

I’m sure we are already at the edge of each others nerves. And for good reasons. When the norms of daily life are perturbed, it gets crazy. An unseen enemy. Unknown cure. A race against time. The number of cases rising. The death toll insurmountable. The last century alone, all the gains and accolades of medical science wiped away with one virus. A microscopic pathogen indisputably eroding governments, economies, and lives.

The battlefield in the hospitals are at a different level. We’ve never been more fearful of a disease as this. Every front liner is fearful for their lives but still serve the sick. In our communities, paranoia and fear has hit the core of every family – from the gated villages to the informal settlers surrounding them. But let me say this for the record and with certainty – the informal settlers have the least to lose here in terms of health and wealth. It’s the middle and upper class that are panicking. The poor, well, they’re just worried about their day to day existence. Work for daily wages, food on their table, a house over their heads. They don’t have bank deposits or stocks and investments and businesses to worry about. They’re used to what they have. All they worry about is a tad of health care, their grumbling stomachs, somewhere to lie down on after a weary day. Day in. Day out.

So my readers asked me one good question.

Will (or should) the lockdown be extended?

My disclosure is that what I write are based on all the data I can cull available for public access. Other “unpublished” or unreported information are factors that may change the opinion later on.

So here we go.

The answer is YES.

It should, however, be modified because we have now seen its promises, and gaps.

As the number of new cases rise (and it will rise because we have more testing kits now), the number of daily deaths will be the predictor of whether the lockdown is working or not. Let’s remember, the number of new cases IS NOT a reliable predictor of whether the lockdown of a community works or not because when the lockdown was declared, the number of cases were already on the uptrend.

Figure 1
Figure 2

Figures 1 and 2 above show that the slope began toward the middle of March. I cannot overemphasize the fact the importance of testing here. It was an outbreak waiting to happen. We slept while the enemy was awake. Complacency and poor foresight. As long as we see those numbers go up for awhile, don’t expect the recoveries overnight. They won’t go down until 2-3 weeks from the time they went up. We started the steepest climb only last week. How steep will we go depends on multiple factors.

The good news is that if this lockdown did not happen, there would be more new cases and new deaths.

The bad news is that, as in all lockdowns, the lockdown came too late. By the time an outbreak has occurred or is recognized, the virus has already taken over a proportion of the population for it to spread. The R naught (R0) of SARS-COV2 is low. Scientists say it’s round 2-3. The R0 tells us the infectivity. For every case, 2-3 patients probably get infected with the virus. Compared to the seasonal flu where the R0 is around 1.3 or chickenpox virus where the R0 is 10 or measles virus where the R0 is 15. https://www.livescience.com/new-coronavirus-compare-with-flu.html

Why do these numbers matter? Because they are part of the basis in decision making for our exit strategies.

What works?

  • 1. We know that physical distancing works. The less crowded the place is, the less infectivity rates are. That’s common sense.
  • 2. Unlike the World Health Organization, I disagree that masks should not be worn. The WHO has flip flopped several times on various recommendations or whatever it recommends. They are, a political organization. They are not a regulatory agency. What may be effective in Uganda or the Philippines may not necessarily apply to Japan or the United States. Every country has its own vulnerable spot. And ours is relying on the WHO for an opinion. Their observations are noted. Do we need to follow it? No.
  • Masks should be provided and worn outside of the home, in public, when tending and seeing patients. The proper mask is also essential. Those washable porous masks that have Dora or whoever character etched all over don’t work. Wearing a mask should be the norm now. I cannot overemphasize how much a highly useful preventive equipment it is for many respiratory pathogens. The mere fact that SARS-COV2 is a respiratory virus, protecting your face with a barrier is just common sense.
  • 3. The surge of OFWs returning home is scary. Not that we don’t want them home. We do. What do we do when they get here? More than anything, they must all be swabbed. Their absence of signs and symptoms, fever or other factors ARE NOT reliable. Majority of our patients do not reveal a history of travel. Travel has become a stigma suddenly. We learned that with the death of a doctor from a patient who lied. The patient had a travel history. Got sick. Got people infected. Didn’t tell the truth. And a doctor died. Where’s the fairness in that? Swab them all. Quarantine them for 21 days. For patients that are positive, they need to have 1-2 negative swabs depending on the clinical status of the patients on discharge. Patients that develop symptoms and are critically ill must have 2 negative swabs before being discharge. And its not only the OFWs. Even those that have arrived in the Philippines in the last 30 days should get swabbed. The Department of Foreign Affairs and the Bureau of Immigration surely has a list of all these people who have arrived. They should look for the travelers and swab and quarantine them until all results are available.
  • 4. PUIs with mild symptoms should be segregated and admitted to a facility only for PUIs. They must not be allowed to be part of the home or community. This is to make sure that they are not violating any quarantine measures. You know how ingenious the Filipinos are. Segregating them will minimize having a total lockdown in the communities.
  • 5. All PUMs should be monitored properly. There are many ways that the local governments and barangays can assist. The identities of these patients can be provided and the data privacy act can and should be waived under these extreme circumstances , otherwise we end up in a catastrophe. The barangay can monitor the household 2-3 x a day. Everyone in the household should isolate the PUM in one room dedicated for the patient. Protocols are in place for self-quarantine. For the informal settlers or those that have no dedicated room for PUMs, the government should be able to provide makeshift places for these. Tap the public and private schools which are currently closed. PUMs have no signs and symptoms and will need very little monitoring except for food, water, shelter and keeping them locked in a room for the next 14 days.
  • 6. Malls, stores, movie houses, bars, offices and restaurants should remain closed until May 3, 2020. We can reassess later the situation. Restaurants can serve take out food only but no dine in. Businesses that can work from home should be encouraged to work from home until May 3. Businesses that will need physical presence of workers should have a minimum work force or skeletal schedule so that it is not packed.
  • 7. Curfew should remain in place from 9pm-5am every single day. This will minimize movements in any community.
  • 8. Schools should remain closed until the end of May. The highest transmission of a virus will always be a crowded environment and believe me when I say that the physical distancing is least observed in pediatrics.
  • 9. All children and the elderly (> 60 or 65 years old) should stay at home as much as possible. Unnecessary travel should be avoided among this group.
  • 10. Public transportation should be limited. Jeepneys and Buses and Taxis can be allowed but the number of passengers should be limited. No tricycles or bike riding apps should be allowed. Trains and MRT/LRT should not be allowed until such time that we have seen flattening of the curve.
  • 11. Every region must have its own accredited testing center before you can even consider lifting or modifying the lockdown. We need to capacitate every region because the delayed results due to backlogs are deadly. Some patients will present in an unusual manner. By the time you get the results, some of them can end up infecting 2-3 patients who in turn have infected 2-3 more people and so on down the line depending on the day the results come out! Without this being in place, you cannot lift the lockdown OUTSIDE of the National Capital Region.
  • 12. The Bureau of Immigration and Department of Health need to work together and we cannot rely on patient information. Every patient that is a PUI, PUM, positive (dead or alive) should be verified with the BI for a travel history – when, where, and what aircraft? This is for documentation and contact tracing purposes. Contact tracing is much easier when the patients are truthful with their information.

These are all common sense. They will work. If our government officials can work together. It’s disappointing that there are government agencies that create issues that are divisive in times of crisis so that they can lick the ass of people in power. Hey – this pandemic is about all of us, not about your political future. Get a grip on reality! If and when we all get out of this alive in the next few months, believe me, it will be payback time. Accountability among the government officials shall be made. And those that stole, corrupted, abused, and conspired evil during this pandemic should be held responsible for the outcome.

So yes. The lockdown should stay unless these issues are addressed. Then we can work on a week to week basis on how we can go back to our “normal” lives. In the meantime, this will be our new normal.

Oh before I end, the kit is still the most important tool we have here. I started blogging about this virus way back in January. It started with one simple article entitled “Pandemonium”. The rest is history.

How we tell the story, who we listen to and how factual the information is, and how it impacts on peoples lives and futures – that’s what matters. Let’s hope and pray that this government has an exit plan. Not one out of ranting but one that is well thought of. Because you accepted the role to lead, you have no choice but to lead us out of this pandemic with the least casualties.

20 thoughts on “Exit strategies

  1. George Sorio April 3, 2020 / 9:12 am

    This is well written and a great word of Wisdom. We need to discuss futher now how we should exit lockdown and more in details. Yes gradually open essential factories and manufacturing with their supply chain. Gradually now open the Customs for importation and exportation. We should gradually focus on employments specially for the poor. Open gradually all agricultural industry and supply chain. The goverment should protect our farmers and fishermans, buy and sell all of their produce and subsidize them for now. They must have a guaranteed profit. Observe social distancing, mask and hand wask all the time. Focus on employing the poor because they are the most vulnerable or else the government will need to house them especially when to many will become malnourished. Those who can afford must stay at home to avoid crowding in anyplace. Penalty and jail must imposed the those that don’t abide the rules and emergency laws.

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  2. Justin April 3, 2020 / 3:46 pm

    Excellent article!

    Like

  3. Emma Malgapo April 3, 2020 / 9:27 pm

    Very enlightening, if only people understand and follow what is being said..I guess we can combat the unknown enemy, as we bombard the gates of heaven with prayers for guidance and help.

    Like

  4. Geri April 4, 2020 / 10:32 am

    very informative. Concise and straight to the point.
    Practical applications

    Laude to the writer

    Like

  5. Raffy Serrano jr. April 4, 2020 / 1:28 pm

    Yes i agree with all the above…Just want to Emphazise To the Oppositionist Senators anf other Traditional Politicians: Plesse STOP POLITICKING?It’s time for all of us to open our minds and hearts!Magtulungan na lang tayo at tigilan nyo na please yong CONTRA ng CONTRA sa kahit anong ginagawa ng present Government?Those who Doesn’t to Change?GO TO HELL✊👊✊👊

    Liked by 1 person

  6. Geraldine Ramirez April 4, 2020 / 3:10 pm

    Very knowledgeable writer and and well written article. I couldn’t agree more. Thanks!

    Like

  7. Dimjo April 4, 2020 / 8:04 pm

    If history can be used as an indicator, the last existential threat to the Philippines was around the events of the end of martial law.
    There are several different paths history could have gone down. We know which one it did.
    However, aside from the “exiled one”, I am not aware of a single person prosecuted, convicted, or imprisoned for the economic rape of the Philippines. They were “forgiven” and we moved on.
    If any “accountability” is brought up, it will be to scapegoat an individual or a small group in the DOH or similar scenario.
    Then…’we move on’….again.
    Those in positions of power and control will not allow the “accountability” to rise above a certain level.
    Nor will they allow competence and efficiency to improve above a certain level. For these threaten their position.

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  8. Gerard April 5, 2020 / 9:03 am

    Hello po. We are leading po in positive results per thousand tests. Can you expound on the implications of this po, especially on the current measures and protocols that are being implemented? Thanks po

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  9. Hermenegildo April 5, 2020 / 10:04 am

    Excellent.i just hope our goverments information agency can bring this message down to the grassroot level of our society,our brothers n sisters working in agriculture,d fishers n farmers,daily wage earners,stay at home moms n our kasambahays.thank u po for enlightening us!

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  10. Cristina wong April 5, 2020 / 11:29 am

    What you have written are all facts, and truth. We don’t seen the enemy. Only God can save us. Let’s continue to pray that God will give wisdom to our President to what’s is best to all of us. His in control, and still in His throne. God bless all of us.🙏🙏🙏

    Like

  11. Panching April 5, 2020 / 1:27 pm

    The recommendation of mask is not to protect the individual but to protect others. We do not know who among us are asymptomatic COVID (+). Use of a mask even a cloth can be a barrier to those droplets being spewed (breathing, talking, coughing, sneezing) contaminating other individuals or surfaces/items. Of course an emphasis is mask is not a substitute for social distance, handwash and the like to protect oneself.

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  12. Aurora Bauzon April 6, 2020 / 9:28 am

    I must congratulate you, Benji on this excellent article with its accurate facts, figures and well thought-out analysis and recommendations. And on the very good feedback and reactions. You hit the nail on its head!
    Maybe in your subsequent writings, you can add a little more of the trademark you are known for, to really get your message across to the ones calling the shots😊

    Liked by 1 person

  13. Rudolph Pascual April 6, 2020 / 11:09 am

    One should ask what is the end goal? Should we kill SARS-CoV 2 or learn to live with it?

    A local lockdown will not kill a virus that has gone global. What we have right now is not a total lockdown because our goal is not the total eradication of the virus. We are simply trying to slow down the rate of infection so as not to overwhelm our healthcare system. In the absence of a vaccine, our hope against the virus is to develop herd immunity naturally. It would be better to let the population be infected at a manageable rate.

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  14. Vilma April 6, 2020 / 12:50 pm

    Very good insight on the current crisis. It will require not only common sense, scientific, firm political will, thorough research and all other considerations …to strike a balance between starvation and economic deterioration. This is a herculean undertaking not only for the government…but take note…discipline should start from us, each of us to keep safe (stay at home, practice social distancing, use masks, alcohol, etc)….. to keep EVERYONE SAFE and to stop the travel of the dreaded virus!!!

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  15. Sylvia April 6, 2020 / 5:41 pm

    Great article! Can you also write a follow-up article talking about the progressive Covid recovery and mortality rates? the DOH and IATF regularly present the whole numbers of cases, deaths and recoveries. But they do not show the percentage of growth (or decline) in Recoveries or Deaths vs Covid Cases. A reporter once asked DOH about this and he/she was just told that the reporter’s computation was incorrect, Maybe if DOH and IATF are made aware that Filipinos are also looking at these percentages, they will present a clearer picture on where we are now and where we are headed in relation to programs they have to effectively manage this crisis.

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    • kidatheart April 6, 2020 / 7:56 pm

      I am trying to cull data on these and will see what I can do. The DoH is not eager to share more than what it provides. Unfortunately.

      Like

    • kidatheart April 6, 2020 / 7:57 pm

      You can refer to my article entitled The Brief. I think you may see what you’re looking for there. There are links in that article that should point you to other relevant resources. Thanks for reading and liking!

      Like

  16. belovedtess April 6, 2020 / 7:53 pm

    I’d been looking for a write-up that would give me the complete picture, current stats and status, that any layman would understand. One that presents the problems in detail while offering realistic and doable solutions. I’m grateful to my friend who shared your articles with me. I found what I was looking for. Worth sharing to many because the solutions are wise, doable and make sense.

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  17. DR. MA. LOURDES G. LAGUNILLA April 6, 2020 / 9:12 pm

    I believe an extension of a lockdown will be beneficial to the Philippines , including social distancing , testing as many as possible and the use of masks.

    Like

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