Lockdowns reviewed and revisited

WITH the rising cases of Covid-19 in the Philippines and Metro Manila, there is a renewed and heated debate on the country’s return to a more stringent lockdown and the need to find a better way if we are to return to a lighter quarantine after that for an extended period. The government’s decision to go for a stricter modified enhanced community quarantine for two weeks for greater Metro Manila is not what business wanted nor what the medical professionals asked for.

What no sane person can say is that the virus is under control. At least in Metro Manila or Mega Manila or whatever the new favored nomenclature is. I have read incredibly stupid posts saying a country like Vietnam is now having a phase 2 ( for them that meant that as of the time of writing, deaths went from 0 to a still incredible 6) so why should we copy them? Or a Breitbart video canard on the discredited malaria drug hydroxychloroquine as a Covid- 19 cure where one of the doctors quoted also believes in ( I am not joking look it up) demon sex, alien ( as in alien from outer space not another country) leaders, DNA and medicine. Or using as authority a fringe right- wing site that is looking for evidence or advocates for its unchanging view against lockdowns by ( to be kind) contorting and cherry- picking evidence and arguments. I do not quote or read fringe websites of dubious provenance who are pushing an ideology, tantrums or agenda versus those that are real news and opinion sources that are quoted, respected, reviewed and make a serious attempt at seeking answers rather than justifying unjustified positions they hold and refuse to change.

Given that, I reread an April 6 column in the NewYorkTimes titled “Lockdowns Can’t Last Forever. Here’s How to Lift It” by Gabriel Leung, an infectious disease epidemiologist and dean of medicine at the University of Hong Kong. Much of what was in that column was written in the relative peak of the first phase for most countries. It remains relevant and on point. Rereading it made me appreciate how well reasoned it was and, four months later, it seems to have presciently outlined what happened and is needed.

Suppress and lift

Here is the opening paragraph: “Lockdowns, quarantines and extreme forms of physical distancing work: they are curbing the spread of Covid-19. But they cannot last indefinitely, at least not without causing enormous damage to economies and compromising peoples’ goodwill and emotional well-being.”

Here are two more: “And so to see us through the next year or more, we must all prepare for several cycles of a ‘suppress

and lift’ policy — cycles during which restrictions are applied and relaxed, applied again and relaxed again, in ways that can keep the pandemic under control but at an acceptable economic and social cost.

“How best to do that will vary by country, depending on its means, its tolerance for disruption and its people’s collective will. In all cases, however, the challenge essentially is a three-way tug of war between combating the disease, protecting the economy and keeping society on an even keel.”

What is the key point about quarantines or lockdowns? They buy time. That is all.

They are not a solution, but they give you time to find a solution and framework for how to operate in the period in between the lockdown and the passing of the pandemic whether by herd immunity (though almost all agree that it too high a price to pay except for some fringe right-wing sites), the virus mutating away or most likely a vaccine or effective treatment.

If you are one of the fringe groups who think some quiet form of muddle through herd immunity is the way, I suppose you missed a critical component. Who will take care of the herd while building up immunity? The protest and heartfelt appeal of the medical frontliners made that clear. Think it is unbearable under general community quarantine? Wait for a mass pandemic while developing herd immunity. The United Kingdom found out the hard way and reversed quickly.

Buying time

First, why do we need to buy time? If unchecked, the virus could overwhelm the health care system and exacerbate the situation beyond what a society could tolerate. The same is true for a subsequent wave, which all but the ignorant or prejudiced warned about prior to a cure. We have to look at how the health care systems and infection and death rates have coped in the countries and places that did well ( New York State and New York City, Hong Kong, Vietnam and Germany to list a few from various continents) and those that did not (Florida, Brazil, South Africa and Sweden to list a few who are deemed failures).

Now what did those that are considered successes achieve besides buying time and not overwhelming their health care system after an initial surge? What did they do with the time the lockdowns gave them?

Well, let us start with what they did not do. They did not act like the lockdown was an end in itself and expect things to go back to some modified normal post bringing the case levels down. Also, they did not claim once it goes down, it would not recur or accelerate again.

Instead, they prepared themselves and their people and constituents in some way for the possibility of a recrudescence and for modified norms and restrictions until the virus is tamed. They warned that the cases could ebb and spike and laid out objective criteria on what would cause easing and lockdowns. They changed the criteria in the light of what was learned and worked. They also put things in place like more quarantine and testing centers, trained and hired enough contact tracers, and were open about what

they did not know.

I am also aware of many companies that drastically increased the capability of their work force to effectively work and collaborate from home. Those firms did not just give their employees laptops and high-speed internet but also the software and training to collaborate effectively even if remotely. This allowed for extended work from home or phased return to work. Very few banks in the United States or Hong Kong have all their employees return. Those that did generally have not resorted to a one day in or day out policy but a one or two week from home or office policy so there would be no lingering contaminants from one team to another and allow a deep cleaning in between teams alternating in addition to the daily cleaning. Not having more than 50 percent of your work force in the office allowed proper spacing and social distancing.

Curative and preventive

Back to governments. For example, in Hong Kong when they list their daily counts (after nearly two months with little or no locally sourced cases), they said where the cases were discovered and where the source was unknown. When they found that taxi drivers were a high-risk group, they added free but mandatory testing at set intervals and so on.

Basically, the steps taken were both curative and preventive. When they realized it caused too much hardship or were unworkable, they reversed. For example, a week ago, Hong Kong went from no dining in from 6 p.m. to 5 a.m. to no dining in all day to take effect on Wednesday. Before the end of two days they saw the ban was worse as many workers were eating on the street, parks and construction sites without the ability to social distance and with much hardship. On Thursday afternoon they said we realize this was a mistake, apologized and said starting Friday, the next day, they will revert to no dining only from 6 p.m. to 5 a.m. so people who needed to could dine in for lunch but asked those who could eat at their offices to do so. This is Hong Kong’s third wave and third time to add restrictions after easing up twice and each time suppressed and lifted in phases. The people understand and accept it as there have been results and the lockdown was eased each time.

What is the main difficulty with extended, draconian and inflexible lockdowns? It assumes constancy of enforcement and compliance. Even in the best of times, this is an unattainable premise and impossible to expect in the Philippines. Please read the last paragraph from the

article again on each country finding its way given its people and their means. South Korea, Taiwan and Vietnam are among the star performers. All took different ways that factored in their means, health system, infrastructure and most of all the character of their people. But all embraced robust and effective contact tracing and suppressandlift strategies. They also implemented measures to address the time between the initial quarantine and the arrival of a cure or the end of the pandemic.

The Philippines needs to catch up and learn and come up with a comprehensive way to address a suppress- and- lift strategy or we will address neither lives nor livelihoods effectively. Our leaders both political and business must feel like Michael Corleone in “The Godfather 3,” where he said: “Just when I thought I was out, they pull me back in.”