Duterte and prudential judgment

The thing is: absolutely no one really knows where we are and what’s going to happen as far as this pandemic is concerned. There’s data available but even numbers by themselves can’t give the exact picture. Also, subtle differences in context can lead to hugely different implications.

Take, for example, the test kits everyone is relying on to spot a person infected with the new coronavirus. Diagnostically, such are immensely helpful in treating an infected person. But for data purposes, that’s another story. A test could only tell if a person is infected — at that time — but what it can’t do is predict the condition of that person’s health later. Add to that the problems with false negatives, which can happen if a person is tested too early, or — worse — false positives, which occurs due to possible cross reactivity with other medical conditions.

Even numbers that seem straightforward, such as the death rate, have complications. As Matthew Lee Anderson points out: “In Italy, about 10% of people known to be infected have died. In Iran and Spain, the case fatality rate is higher than 7%. But in South Korea and the US it’s less than 1.5%. And in Germany, the figure is close to 0.5%.”

“So what gives? The answer involves how many people are tested, the age of an infected population and factors such as whether the healthcare system is overwhelmed.” It can even happen that “the numbers may look different even if the actual situation is the same.”

Then there are the conflicting expert reports. Imperial College’s study, upon which the United Kingdom based its early “herd immunity” strategy, forecast a possible 500,000 deaths within the UK. This was seemingly (“seemingly” because, as commentators contend,

Imperial College did lay caveats) contradicted later by an Oxford study, ironically released a day after the UK abandoned its “herd immunity” strategy for a lockdown. Oxford offered the possibility that half of the British population is already infected, implying the virus has far less lethality (forecasted deaths at 20,000 or less, with a UK population of around 68 million).

This leads to the question of the probable situation in the Philippines. As of this writing, the Department of Health (DoH) announced 2,084 people infected. But the fact is, that doesn’t mean 2,084 people are infected. It only means the DoH tested X number of people out of 110 million Filipinos and found 2,084 infected as of that date.

Hence, if the Oxford study is applicable, millions of Filipinos have already been infected, are walking around freely or in their homes, asymptomatic or exhibiting mild or tolerable symptoms. It also offers the possibility of the pandemic’s peak being earlier. Notably, just this week, The Lancet published a study claiming a much lower death rate: .66%.

Then, there’s the heat: which doctors say expands the virus and slows transmission. Currently, Philippine temperature is at 35°C. Wuhan’s was 10°C in February 2020, Italy 16°C last March.

The virus reportedly also has a more negative effect on older people or those with underlying health problems. And indeed, our data shows 75% of deaths are those 60 years old and above. With that, our demographics gain significance: 53% of our population is 0-24 years, 0-54 is 90%. Our median age is 23.7. Compare that with Italy’s 47.3 (23% of residents 65 or older), the US’ 38.3, and China’s 38.4. Looking at our neighbors with almost similar weather and circumstances, Indonesia’s infected to population rate (to date) seems to be at .0008%, Thailand .002%, and Malaysia logging badly at .005%. The Philippines (as of March 31) is .0019%. Italy, worst hit worldwide so far, hasn’t breached 1%.

If we assume Malaysia’s current numbers, then we likely have a peak of 8,800 infected, with 616 deaths (assuming 7%). If we use however Malaysia’s own assumption of peak infections at .02% of the population, then we’re looking at 22,000 infected for the Philippines. Assuming a high range death rate, 7% (currently ours stands at 4%), we are looking at 1,540 deaths. If The Lancet is correct, then 145 deaths (using 22,000 infected as base).

For context, there are annually 580,000 deaths in the Philippines, with flu or pneumonia accounting for 76,000 (or 12%) per year.

Which leads us to the concept of “prudential judgment,” defined (Wiki) as “one where the circumstances must be weighed to determine the correct action. Generally, it applies to situations where two people could weigh the circumstances differently and ethically come to different conclusions.” It is “the application of moral principles to a particular case… [recognizing] that we live in an imperfect world, in which achieving pure goodness is not always possible.”

Prudential judgment recognizes that we obviously are without the luxury of hindsight, that data can be interpreted in various ways, and people of good faith working on similar information can still disagree on the conclusions.

Prudential judgment is now in play because President Rodrigo Duterte, amidst all the uncertainty, conflicting opinions, and unimaginably difficult trade-offs, is confronted with a stark (not necessarily binary) choice: lift the Enhanced Community Quarantine as scheduled (on April 15) or keep going for a longer period (perhaps even indefinitely).

Either option comes at considerable costs.

Definitely, every single life is valuable, and the abovementioned 145 to 1,540 deaths are not mere numbers but actual people. On the other hand, it’s palpable that the population is under considerable physical, psychological, and financial strain. As usual, the worst hit are the poor. People must realize: one can get sick or die from the virus but a broken economy or the stress of being locked-up or unemployed can also sicken or kill people, perhaps even on a worse scale.

First Things’ RR Reno, writing about this monumentally tortuous choice faced not only by the Philippines but other nations as well, reminds us somberly that: “Alexander Solzhenitsyn resolutely rejected the materialist principle of ‘survival at any price.’; It strips us of our humanity. This holds true for a judgment about the fate of others as much as it does for ourselves. We must reject the specious moralism that places fear of death at the center of life.”

So everything now rests on President Duterte’s judgment.

“Executive power shall be vested in the president,” says Article VII of the Constitution.

Not the Congress or the Supreme Court. Not even the Executive Branch. The president. Our constitutional system was so designed that in times of crisis, decisions are to rest with one individual for “speed, flexibility, unity, and dispatch.”

It’s overwhelming to think that such a huge decision rests with one man but there it is. That is the system we’ve chosen.

All things considered, this column believes reasonable effort should be made to consider lifting the lockdown by Easter Sunday, with flexibility of deciding otherwise depending on events or circumstances on the ground.

Thus, it’s suggested here that the best course of action is to open businesses, transportation (domestic land, sea, air), and then, a week later, open classes. With the following maintained:

Strict health and social distancing policies in all public or work places;

Apply random testing for data gathering and monitoring;

Mass testing through schools, offices, parishes, or Barangay centers;

Continued quarantine for those 65-above, and those with chronic illnesses;

Continue indefinitely the travel ban for tourist and non-essential travel, with two week quarantines for those coming from abroad;

Stop POGO operations completely; Transfer all coronavirus testing and treatment to specially designated medical centers, away from other public and private hospitals;

Allow religious services but discourage larger public gatherings;

Close theaters, restaurants, and bars by 10 p.m. for one more month; and

Focus medical attention, monitoring, and care for those 55-64 years old (6% of population), above 64 (4%), and those with chronic illnesses.

Also suggested are further citizen assistance, through the president’s additional powers or by Congress itself, including:

Income tax holiday for Metro Manila/ Calabarzon employee salaries from March-June;

Income tax holiday for vital industries (including medical and academic institutions) and Metro Manila/Calabarzon SME’s, to the 3rd quarter;

Near zero interest on and continued availability of bank credit or loans for individuals and SME’s;

Waive Metro Manila/Calabarzon electric and water bills for March-June.

Studying other countries’ experience and actions may be helpful but, in the end, the Philippines, with our own particular circumstances and conditions, must decide on its own path.

Example: it’s misleading to think “lockdowns” are uniformly applied everywhere, even if the same terminology is used. The nature of a US lockdown (the extent usually decided at the State level) or Italy (with a continually operating transportation system) is different from here where masses of people live utterly close to each other and where food supplies are reportedly hampered due to varying local government checkpoints.

Ultimately, for us, it all boils down to one man. Let’s hope, for everyone’s sake, that President Duterte’s prudential judgment decides correctly for the Philippines.

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