The extension

In a dazzling (dizzying) display of desperation (?), a visibly confused rambling of frustration on how to control the novel coronavirus pandemic and how it was affecting the dire economic resources of the Philippines was seen in the face of the president over a live announcement last night.

He didn’t mince words.

Behind all the garbles on afterthoughts from his trip to the toilet to urinate, asking the secretary of finance to generate money whether he steals or borrows, telling the people that there is a limit to what the government can offer and offering to sell Dewey Boulevard (so retro), asking for patience (which I am sure has run out of especially for the daily wage earners) because the virus has torn the very frail economy of this nation, and finally ending with the vast unknowns…I could understand his annoyance at the circumstances he’s in.

Huwag ka mahawa. Huwag ka lumabas ng bahay. Paano pagkain namin? Maghanap ka ng paraan.

Hindi ko alam kung [hanggang] kailan ko kayo sabihan. “bahay lang kayo”.

Hindi ko alam kung kailan ako makapaghatid ng pagkain sa lahat.

Hindi ko alam saan ako magkuha ng pera.

Hindi ko alam kung ano ang ipagbili ko. Kung may magbibili.

Hindi ito trabaho ng abogado. Trabaho ito ng medical experts, scientists. I just happened to be here. To my chagrin, bakit sa panahon ko tumama.

I end this with a prayer. Whatever be the correction – ang anomaly sa mundo. He created the world. And if God wants it ended, so be it. Salamat po.

The live telecast surely didn’t sit well with the audience.

It was not surprising then that after that exasperated moment, the announcement came this morning – the lockdown would be extended. Period.

The objective for extending it till the end of the month?

According to Secretary Nograles, it was necessary “in order for the government to determine the impact of the ECQ and further increase health capacity in Luzon and other areas, including ramping up COVID-19 testing to 8,000 to 10,000 tests per day with a turnaround time of 24 hours.” https://www.gmanetwork.com/news/news/nation/732935/iatf-recommends-extension-of-luzon-wide-quarantine-to-april-30/story/

Let’s give people credit where credit is due. I actually see how hard the IATF (Inter Agency Task Force) is working trying to complete the arduous task of containing this global pandemic among our islands. As I’ve said in the past, in pandemic, some things will require decisive action immediately. Waiting for tomorrow is another day wasted.

And that’s what happened with the first ECQ and the night before the extension. The first lockdown sent people into a frenzy. Panic buying for the those who could afford. For those who had less in life, it was just pure panic. An exodus for the unemployed. A wait and see for those that are still holding on to jobs, which probably some will have none to return to when this crisis ends. The last three weeks was spent in prayer and hope. That life would be what it used to be on April 14.

I am sure that most (if not all of us) are glued to the daily numbers – new cases, new deaths, new recoveries. Media are quick to draw conclusions or confusions to the numerical values that are being churned out by the Department of Health. If you ask any grade school student to draw a graph based on the numbers culled the past 3 weeks, they’d tell you that there’s no consistency. And that’s probably because of the backlog in reports. The death of a 7 year old in the Ilocos region is a glaring example of how long it took for the results to come back. Five days after her death. And that’s just one case. How many more cases have had dismal reporting timelines? This is important because the management of patients (from treatment to contact tracing and quarantine measures of exposed individuals) highly matters on how quickly (and accurately) we get back the results and the number of people tested based on the released report. Moreover, accurate and timely data provides us the best picture on whether the lockdown is “flattening the curve”.

https://www.worldometers.info/coronavirus/country/philippines/

I understand the frustration of the president. I, too, share his frustration. And I’m a doctor already! When you can’t make heads or tails of the data, the frustration is real.

The first lockdown has shown us how much more work there is to do, and how unprepared we are at crisis management in a pandemic. Let’s face it, the only way this virus will ever go away is sadly – probably never. Even with the availability of vaccines for flu or any other disease, we’ve hardly eradicated many vaccine-preventable diseases except for smallpox in the last century. The search for a cure or treatment is at best for now, a trial and error method. A lot of theories and anecdotes, with little science (robust clinical trials) to back up various treatment regimens.

As a people, it’s only when we accept our shortcomings can we realize that there’s much more we don’t know. There are few short-term plans plotted out but a dire lack in medium- and long-term plans.

Those short-term plans are panned out at providing measly change for the poorest of the poor. The people who work in government are better taken care than those in the private sector. After all, no one will lose a job when you’re with the government unless there is no more government. How does the government plan to assist the private sector with respect to repayment and restructuring debts particularly for the micro, small and medium enterprises? Supplies purchased from large companies should be given a longer term grace period for payment rather than the original payment dates. But many multinational companies will not agree to this because they have employees to pay and their own needs to fill. While people in government are willing to take a cutback in salaries, are the people in the private sector willing to negotiate a 90 days payment option instead of 30 days for various goods? Mall tenants and other stall/store owners are in a similar situation. How many landlords are willing to forego rent to tenants who did not use the rented spaces due to the lockdown? These are just examples of incongruence in the “bayanihan” spirit of the Filipino people. The irony here is that it’s mostly these same people who provide donations in times of disaster as public relations promotions that are in disguise of being concerned with the poorest of the poor but take from the small and medium entrepreneurs. That is why I am not a believer of these corporations who give out “donations” yet don’t look after the smaller companies that keep them afloat. This domino effect, trickles down to the vendors and consumers in the end. And as the pandemic deepens, the economy will continue to falter to the point of collapse.

Then there’s the medium- and long-term goal. The idea of having designated centers for COVID cases in every local government is both doable and a good one. Remember, isolating infectious diseases and waiting out the course of illness until the patients recover on their own is the oldest method of containing an infection. Before the end of this week, every local government unit must be able to put up one. There are many unused edifices in the local government and placing their city health office in charge of such centers will free up the communities from having the cases monitored where they reside as well as the hospitals in having PUIs and PUMs occupy the necessary space for the hospital to operate regularly once more. People don’t know that there are more patients sick with other acute and chronic diseases who will require hospital care than COVID19 patients. Segregating the COVID19, PUIs and PUMs is vital in reducing the spread of the virus and thereby restoring some sense of normalcy in the community. It will also allow other sick patients without COVID19 to get better healthcare, and hopefully be at less risk or when they do get infected with SARSCOV2, be immunologically stronger at combatting this virus. Comorbidities that are well controlled have better outcomes than those that are not.

The real problem I see are actually the local government units. They’re like little kingdoms. There are those who have best practices. Then there are those who are a bit off not only in science but common sense as well. And that’s where the difficulty lies. There is no consistency in the implementation of recommendations. When the mantra is “every kingdom for itself”, it will be difficult to curb a pandemic of this proportion.

A long-term plan should also be discussed today. Not a week from now. Not after April 30. As the president mentioned, this is after all a battle. And a prolonged drawn out battle it will be. At the end of the war, only one will emerge victorious. Our fate depends on the strategist who put this plan together.

What do we do on April 30, 2020?

Is another extension in the horizon? And that’s the question that’s begging for an answer. I hope and pray not.

But I guess that depends on whether we’ve gotten our act together or not. At the rate we’re going, the plans the IATF have put forth should be strengthened and every LGU should abide by the general guidelines (if any) of the IATF. Additional local strategies must be in congruence with the general guidance provided by the IATF. Any local plan that deviates from the IATF should not be allowed. There should only be ONE agency responsible for the success OR failure of the mitigation efforts during the next 2 weeks extension period.

Allow some flexibility in mobility. We need to mobilize not only frontline workers but some other essential business establishments vital to the economy of Luzon (where the lockdown is limited to). Some form of public transportation should be restarted with conditions on how many to accommodate and the practice of social distancing. Trains and MRTs should not be operational yet. There should be no crowded places or events for quite awhile. Schools will be out probably till the upcoming school year but that’s the least of our problem because the kids will get their wish – long vacation – at last. To keep the crowd down, malls and bars and other recreational facilities should remain closed until such time that we have actually reached the lowest part of the flattened curve. Nonessential travel (both in and out of the country) should be avoided in the meantime.

We must set the expectations early on as we approach the deadline and prioritize the economy while taking into consideration the general health of our people (not only COVID19). Both the economy and health are inseparable in the equation of a healthy nation, with each of them being dependent on each other. We cannot care only for the COVID cases. There is a greater majority of patients who are sick with cancer, hypertension, diabetes, measles, dengue, hyperthyroidism, cardiovascular problems, COPD, etc. yet one case of COVID overwhelms a whole community and healthcare system.

In the spirit of transparency that there was a well-thought plan to begin with, the public should know the basis or criteria on when the lockdown can be lifted, the restrictions that remain after the lifting, and when and what to expect as we monitor the lifting in the next year or so.

Sadly, this is one virus that will never go away. It will have its peaks and troughs all year round. As doctors, we will probably look at every fever, sore throat, cough or colds and diarrhea in a different light from now on. The general public will not forget this pandemic for awhile. But for everyone’s sake (physically and mentally), we will need to get back to some sense of normalcy. That’s why we need to sing the song in the same tune now. And get our acts together in how to deal with this invisible invincible enemy in our midst.

One thought on “The extension

  1. Dr_Lagunilla MD April 7, 2020 / 4:22 pm

    My … its well said and analyzed … it is a huge viral pandemic but also a socio economic and even religious issues and concerns. Thank you, Dr. Ma Lourdes G. Lagunilla

    Sent from my iPhone

    >

    Like

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