"We still have so many questions."
Last April, immediately after the ECQ was imposed we reminded the Department of Health and the IATF not to forget the long established WHO protocol in the handling of pandemics: Test, Trace, Isolate and Protect or in that agency’s code—TTIP.
The reimposition of MECQ in Metro Manila and adjoining provinces 138 days after ECQ with its various easing arrangements brings us back to that standing protocol. Now there is even greater thoroughness, not merely toughness in its implementation, given our experience with battling this invisible enemy thus far.
In that regard it may do well for our implementers and the public at large to check out and learn from the experience of persons of interest in two of the most infected
First World countries, Britain and Australia. The narratives of Professor Carl Henegan, Director of Oxford University’s Center for Evidence Based Medicine (CEBM) and Cristian Benetto, a Melbourne based writer, are so appropriate to our situation it could very well describe what we are now into—laboring under the weight of a flurry of guidelines and restrictions in response to the outbreak.
Professor Henegan posits that the United Kingdom’s situation which ranked it among the top five countries in the number of infections may not be as bad as the data suggested. Studying the record as of July, he noted that it was very possible that there may have been inaccuracies in the data being churned out by the country’s National Health Service (NHS). Worse, there may have been poor interpretation of the said data leading to errors in the policies imposed on movements of people and goods.
He noted that the data for tests and results of those done in healthcare (hospital) settings and those done in the community (outside laboratories and community tests), showed there were no sudden jumps or exponential increases as the daily average stood at 250 cases per day. The question is: was the increase real or was just due to an increase in testing—the same question which the public has been asking our own officials specially after they reported that we now have increased testing capacity and are now testing more people. Henegan took note of the data inaccuracy attributable to false positives (people without the disease but test positive) which can drive numbers substantially. Thus he advised the need to standardize cases per test done and align the counts in different databases (hospitals vs community or outside hospitals) to provide the same numbers to better understand whether these are going down or not.
This, in our case, leads us to ask: Did more people really avail themselves of the testing? If so, how many and what kind of tests were conducted, where and when were these conducted? How many tested positive but did not actually have the virus?
These questions have to be truthfully answered so we could track the reported cases and the possible transmission given the time lag in the actual determination of infected, not just tested, persons. We have yet to come out with such answers as the DoH and the IATF have not been issuing standardized data but a variation of sorts with all kinds of interpretations every so often.
Given the mangling which the COVID-19 case data has gone through in the last four months, is it any wonder the public has been increasingly dismissive of all the assertions and assurances which the DoH and even the IATF have been issuing all along? As Henegan noted: “Inaccuracies in the data and poor interpretation will often lead to errors in decisions about imposing restrictions, particularly if these decisions are done in haste and the interpretation does not account for fluctuations in the rates of testing.”
The Melbourne experience is equally educational. As Cristian Bonetto reported, Australia’s toughest restrictions were meant to be “knocks on the heads of those defying the rules” and, equally important, a nudge on the implementers of the response plans to be as thorough as thorough can be in doing their rounds. Noting that the biggest driver of new infections were “asymptomatic locals heading out instead of staying at home,” she recounted the utter dismay of teams of implementers from the Australian Defense Force (yes, Sir, from the armed services) and the Department of Health and Human Services who knocked on doors found that a full quarter of those who tested positive for COVID-19 weren’t home. They were either at work or visiting friends and relatives and became super spreaders.
Then there was this man who in Bonetto’s view may have been “simply too bored or defiant to follow the rules, among them a ban on non-essential trips outside the metropolitan area” In this case, the guy drove out of the Melbourne area for 199 miles all the way up to the New South Wales border just to buy a Big Mac. Daily appeals from Victorian Premier Daniel Andrews to “stay home” recall a patient parent tested by misguided teens.
So, as we now go back to MECQ with this 15-day timeout, it is hoped that this problem of data gathering, recording and interpretation, along with the basic concerns raised by our health workers, will finally be resolved in time. Otherwise, we will never see our way out of this pandemic and suffer immeasurably for our follies. Thoroughness in all aspects of our COVID-19 response plan, not just toughness should be our abiding guide.
For the purpose, our COVID-19 response teams, national and local, may well appreciate a number of the best practices condensed out of the experience of Italy, the original epicenter of COVID cases in Europe, which is now slowly but surely getting back on its feet to face up to the challenges of a new normal. The Italian advisory borne out of their implementation of the established TTIP pandemic response protocol emphasized the need for a humane, integrated and collaborative approach: to prioritize people’s needs and invoke self discipline in combating this pandemic and future disease outbreaks.