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The blind leading the blind

the blind leading the blind 816x452 - The blind leading the blind

Covid19 cases - The blind leading the blind
There is now no denying the fact behind the desperate statement of doctors and other medical frontliners: we are losing the war on the coronavirus. Despite the world’s longest recorded COVID-19 lockdown — which has prostrated the economy in the worst recession in the post-Marcos era — the Philippines still managed to become the primary hotspot for the pandemic in all of East and Southeast Asia, averaging 4,356 confirmed cases every week (as of Aug. 6). Indonesia is a far second, with an average 1,777 weekly cases. (And if you prefer stock- instead of flow-figures, there are thus far 105.8 confirmed cases per 100,000 population here — only 42.7 per 100,000 in Indonesia.*)

The administration, its political supporters, and many voices in the business sector have rationalized the situation by attributing the rising case-count to the easing of the lockdown, an inevitable cost that must be tolerated in order to “open the economy.” Hence, the various noises being made to gradually reconcile the public to the fact: “the need to live with the virus for a long time,” how we must “strike a balance between public health and the economy,” and, more recently, how we must learn to “dance with the virus.” But leave it to a senator who always manages to put things starkly, if tactlessly: “Kung ‘di mamatay sa COVID, mamamatay sa gutom ang mga tao.” (If they don’t die of COVID, people will die of hunger.)

Actually, until the medical frontliners’ plea and despite the rising case-count, the administration’s choice already seemed clear. Duterte’s feigned hemming-and-hawing notwithstanding, the impending decision really was to further loosen restrictions and “reopen” the economy regardless of the pandemic consequences, with Metro Manila and environs expecting to transition out of “general community quarantine.” The consequences of the rising COVID-incidence would then be left to LGUs and the private sector to deal with.

These plans were stymied, however, by the frontliners’ very public call for relief, which could not be ignored, especially not through insensitive exhortations for them just to work harder (“pagbutihin nila trabaho nila”). This disruption of the administration’s plans from left field was the likely reason Duterte took sharp offense at the frontliners and accused them instead of fomenting “revolution” and subverting the established order.

The subsequent decision to revert to a “modified” lockdown for Metro Manila thus appears to be no more than a grudging concession to mollify a noisy but morally unimpeachable medical sector and prevent a threatened public relations disaster.

Fourteen days is obviously not enough to shift gears, formulate, and execute an alternative approach.

All it is meant to do is to sweep the past under the rug. Before that happens, two points need to be made.

First, contrary to the creeping fallacy being circulated, public health need not (and should not) be traded against reviving the economy. Indeed, the two must ultimately move together. Any premature “opening up” before a sustainable approach to managing the pandemic is put in place is only bound to be self-limiting. Imagine a situation where most or all COVID-related measures and restrictions were lifted overnight and all firms and industries were given free rein to operate at or near full capacity.

The natural expectation must be that the infection rate would rise precipitously. (The US and India are almost models in this respect.) Questions of the health system’s capacity aside, sales and aggregate demand are likely to remain depressed nonetheless, since customers would likely continue to stay away for fear of catching what will have become a more rampant disease. Investment would fare no better, given the sluggish and uncertain consumption demand. And don’t even mention the foreign trade sector, given the global nature of the current recession. Closures and bankruptcies would happen anyway. It is a specious argument, therefore, to say that measures to safeguard public health are an obstacle to opening the economy; on the contrary, they are the precondition.

The recent retreat (grudging as it is) into a tighter quarantine for the NCR and Calabarzon already illustrates the economic consequence of failing to put a proper system in place. In this case, it was healthcare personnel and the tertiary care capacity that threatened to give out. But it might as well have been the health of some other part of the labor force (e.g., transport workers, food-processing) that was in peril, or some large community outbreak that had occurred. In any of these cases, another “timeout” would have to be called — which illustrates the point that unless an entire system of response to the pandemic is in place, the economy can “revive” only in fits and starts — like a patient always on the verge of flatlining.

This brings up the second point. Before it is swept under the rug, it is vital to acknowledge that the government’s response to the pandemic has thus far been a failure.

That much will be evident to anyone who compares the country’s performance to that of others. The Figure provided illustrates three common patterns among countries that combated the pandemic through lockdowns then ultimately relaxed them. South Korea’s is an example of a response that was prompt and effective (a similar pattern is seen for Vietnam, New Zealand, Taiwan, Thailand, and others), one that managed to keep case-rates low (except for a small bump) from the beginning of its lockdown to its finish and after. Germany’s pattern on the other hand (which resembles that of Italy, Spain, and others that were badly hit) first shows a precipitous rise in case-rates that was ultimately tamed through drastic measures and then kept low even after quarantine ended.

What makes the Philippine curve remarkable is that despite the absence of any “bump” and the fact that infections plateaued during the strict lockdown period (mid-March to end-May), average case-rates have risen continuously thereafter with still no peak in sight. This pattern strongly suggests that the steady case-rate was a false spring and due solely to restrictions on physical movement during the lockdown — the only thing police and military were adept at anyway.

But little else by way of systems seems to have been put in place to prepare for what would come once restraints on movement were relaxed. In particular, the capacities for testing, tracing, and treatment were not built up. The scale and frequency of testing never reached the government’s own targets. Contact-tracing was never comprehensive or systematic (with e.g. Quezon City Mayor Joy Belmonte even now complains that many in the Department of Health (DoH) list of COVID-positive persons lack addresses). And only belatedly — after the frontliners’ manifesto and loud calls for Health Secretary Francisco Duque to resign — did it dawn on the DoH to augment health personnel through massive new recruitment and redeployment. In short, there does not seem to have been a firm plan in place beyond the lockdown; so it should surprise no one that the case-rate has ballooned since. The government’s failure and helplessness in the face of the new situation is evident in President Duterte’s newfound line that citizens should just endure the situation until a vaccine arrives from China. All this contrasts with the way other countries have used their lockdown periods to beef up their tracking and treatment capacities — which explains why their case-rates have remained under control even after restrictions were relaxed and they are better prepared to confront a second wave.

The Philippine experience thus far calls into question the quality of the leadership of those put in charge of the national response to this pandemic — and ultimately the prudence of the appointing power. Missing above all is the assurance that any strong scientific input is guiding the direction of policy. The British have their SAGE (Scientific Advisory Group for Emergencies); the German government defers to the Robert Koch Institute; and even Trump must struggle with a Dr. Anthony Fauci; most other countries have at least a chief scientific adviser that explains the whys and hows of things to the public.

Here at home, by contrast, people cannot even access the most basic information to guide their behavior. Figures on the daily progress of cases are distorted by large changes in statistical definition and delayed and unreconciled results. Nor are these disaggregated by useful geographical-political areas to help local governments monitor the success of their efforts. Complex but more useful data are even harder to come by: What is the effective reproduction number (Rt) on a weekly basis? What is it per city or province? What is the estimate of prevalence per city or province including non- or asymptomatics? What is excess mortality per city or province? Some of these data could have been obtained by properly guiding and mobilizing the private sector (yes, including the much-maligned antibody tests), but the business sector’s voluntary efforts have been vilified instead.

Filipinos — a fortunate race — do not have to concern themselves with science and statistics. Instead they must merely ponder the profound wisdom in the pronouncements emanating from this or the other ex-general — including installing plastic barriers on motorcycles for pillion riders, applying tokhang methods to flush out infectious cases (using “police instincts” and neighborhood gossip), or requiring face-shields to ride public transport (which is banned under MECQ anyway). Alternatively, of course, they can simply join their favorite mayor in his devout effort of “praying to God for a guiding light so that [the Chinese] can make the vaccine.”

No one can be blamed at this point for remembering Rizal’s quote of Schiller at the beginning of the Noli, which strikes a chord to this day:

Aber, ich bitte dich, Freund, was kann denn dieser Misere

Großes begegnen, was kann Großes denn durch sie geschehn?

(But, my good friend, pray tell me, what can such people e’er meet with

That can be truly called great? What that is great can they do?)

* Figures as of Aug. 6, 2020 from https://ourworldindata.org/coronavirus/country/philippines?country=~PHL

 

Emmanuel S. De Dios is professor emeritus at the University of the Philippines School of Economics. He does not want to start a revolution.

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