COVID-19 on the frontlines

"These measures amount to only half the solution."



Frontlines. An all-too-familiar term that we have used these recent weeks to refer to the doctors, nurses, medical laboratory scientists, pharmacists and other healthcare professionals who have been working round the clock to address the growing COVID-19 pandemic.

But it seems that bleak is the sight at the so-called frontlines of this battle against a ruthless invisible menace. Many of the major hospitals in the country’s capital city have announced that they are already operating beyond their available bed capacity and thus, they could no longer admit new patients. With more and more doctors succumbing to this dreaded disease, and many more healthcare workers in strict quarantine, it appears that we are now losing—at the frontlines.

If this is a war that we are fighting, what we need is a change in the order of battle. If we were to win against COVID-19, we cannot fight this war in the hospitals, our first line of defense should be on our streets and in our barangays.

It has been said many times in many ways—the virus cannot travel on its own. It needs carriers—unfortunately, that is, a human carrier. There are more than six billion of those “carriers” on this planet, almost one hundred million in this country. Close to ten million in Metro Manila alone.

If we want to defeat COVID-19, we need to prevent further spread of the disease. Therefore, the only way forward to win against COVID-19 is to make this enhanced community quarantine work. China, where this outbreak reportedly started, has proven that to effectively reverse the trend of COVID-19, shutting down a city of more than ten million people was an absolute and logical necessity. It was a decision made at huge human and economic cost, because imposing a quarantine at such enormous scale has simply not been done before.

The frontlines in this fight against COVID-19 must be on the streets.

First, we must empty the streets of all carriers—that means of the people who could cause the further spread of the virus.

It will be an unpopular choice, but as in any war, decisions have to be made at a huge cost. As long as carriers are on the move, possibly spreading infecting the rest of the population, more and more COVID-19 cases will pour into our already overwhelmed hospital system. Epidemiological models have already shown that if unabated, around 75 thousand Filipinos will be infected by the coronavirus, and 5 percent or around four thousand would be critically ill and would need to be in an intensive care unit.

Sad news—we only have a little more than a thousand ICUs in the country.

Clearly, a sustained influx of COVID-19 patients will cripple our hospital system.

If our hospitals were our frontlines, then we are at an even graver crisis.

President Rodrigo Roa Duterte has already placed Luzon under enhanced community quarantine. Local government executives in the Visayas and Mindanao have followed suit, imposing varying levels of community quarantine.

Public transportation in and out of the quarantined areas has been suspended. People have been asked to stay indoors, while providing exemptions for personal and medical emergencies. Schools at all levels have been closed. Work-from-home arrangements have been encouraged. Businesses have been shut, except for groceries, banks and pharmacies. Only one person per family is allowed to buy necessities. A curfew from eight in the evening to five in the morning has been imposed, wearing masks has been made obligatory, and temperature of anyone going through checkpoints is being monitored. Public gatherings have been prohibited. Everyone has been encouraged to strictly observe social distancing measures.

But clearly, these measures amount to only half the solution.

China took three months before they were able to effectively stop the spread of the virus. With the restrictions already imposed by the Philippine government, it might take us less that time to achieve the same results.

But we need sustained, focused and closely coordinated action.

It is important that Filipinos stay inside their homes, and if necessary, food and other necessities should simply be rationed to them, or at least a supply distribution chain should be in place in order to minimize the number of people going out of their houses. Remember, a lesser number of people in the streets means a lower chance of spreading the disease. This means a total lockdown for two to three weeks might be a logical solution. If the frontlines were on the streets, we must get rid of the enemy’s capability to advance.

This means strictly enforcing that people stay in their homes—even if this requires that the military and the police take charge.

Businesses should act in concert, ensuring that food supplies and other necessities would reach the people. While the government must ensure that the movement of goods must remain steady and unobstructed, business must acknowledge the fact that profit and competition need to take a step back and first consider the general welfare.

As a society, we must understand that what is at stake before us is not only the health of our people but the very existence of our social and economic order.

If we were to fail in containing COVID-19, the necessary step – in order to “flatten the curve” is to extend the enhanced community quarantine by another two to three month.

If that happens, our economy will take a bad hit. Our small and medium enterprises, which employ a majority of our people, will not survive. People will lose their jobs, and God knows what pandemonium will follow the pandemic. What is certain is that we are heading towards a record-setting global recession, and the sooner we address this crisis, the faster it would be for our economy to rebound.

Once we empty the streets of people, and keep the healthy inside their homes, we need to isolate the COVID-19 carriers under strict quarantine, no exemptions. At the soonest possible time, local governments should establish dedicated COVID-19 quarantine facilities where “persons under monitoring” or those showing mild symptoms should be strictly quarantined – rich or poor – no excuses. Their basic needs must be provided by the government, at no cost to the patients – and the facilities managed by a proportionate number of nursing staff.

Mass or even massive testing is an ideal tool to establish the baseline number of COVID-19 patients, and it must be pursued within the means available. However, we cannot wait for the test results to act accordingly. Health Secretary Francisco Duque is correct in saying that is best to assume that when showing COVID-19 symptoms or when one had exposure to an infected person, it is best to observe self-quarantine.

By keeping the people strictly in their homes, and separating the sick from the healthy for a period of two to three weeks, we prevent more people from getting the virus, and focus on curing those who have already been infected. About 80 percent of them will only exhibit mild symptoms and will recover in two weeks.

The remaining 20 percent – the elderly and those immunocompromised due to diabetes, hypertension, asthma or cancer – will need hospital care, and by “flattening the curve” we can drastically reduce the advance of the disease, to a level that corresponds to the capacity and capability of our hospital system. Consequently, we can focus the resources – both human and material – of our hospitals to care for their medical needs and ensure their full recovery.

In two to three weeks, if take strong measures to minimize the number of those who have COVID-19, those who already have the virus will either recover – or unfortunately, die.

Hospitals should not be the frontlines, and we should not put our healthcare workers in an even greater risk than what they already face. Rather hospitals should be our last line of defense in this fight against COVID-19. We must prevent the carriers from spreading the virus further, so that less people can be infected – and an even lesser number of patients will end up in our hospitals.

In order to achieve this, we need an enormous amount of resources and an even greater confidence in our government. Both the national government and local governments must get their act together, empowering the most basic level of governance – the barangays. The people must be willing to sacrifice and cooperate, because each day that this pandemic continues what is at stake is a matter of life and death.

We are all in this together.

Topics: Jude Acidre , coronavirus disease 2019 , COVID-19 , frontlines , health workers
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