No guesswork, please. We’re humans…
The endless cycle of idea and action, Endless invention, endless experiment, Brings knowledge of motion, but not of stillness; Knowledge of speech, but not of silence; Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?
— T.S. Eliot, The Rock, 1934
On the current viral pandemic, this column has been consistent. Public health policies must be founded on science and evidence. A lockdown was necessary in the beginning because of lack of data. There was no information on the pathogen and its trajectory. Our health care system was weak and there was great likelihood it could be overwhelmed. After more than two months of restrictions and great economic loss, very little has changed in our situation with a dearth of information and unfortified health institutions. The lockdown was not maximized to formulate policies that increase confidence.
The way this pandemic is being handled, there are no black swans. Reported scandals and blundering incompetence in the health sector are well known. The health secretary stupefied everyone by declaring that the virus is on its second wave — an assertion repudiated by at least two cabinet secretaries. At the beginning of this pandemic journey, the health secretary also opposed travel restrictions citing diplomatic concerns over public health risks. Thus, there is nothing unexpected as a tail event.
Despite two lockdown extensions, parameters for migration between and among “CQs” remain unclear. Until recently, massive testing was not actively pursued. Public procurement of medical supplies and equipment is struggling and beset by questions of cost.
Yet, Metro Manila mayors were reported to have voted unanimously to recommend a downgrade of NCR from MECQ to GCQ. Defense Secretary Delfin Lorenzana indicated that the IATF “would watch the coronavirus trend this week and then decide whether to downgrade the ‘MECQ’ in Metro Manila to ‘GCQ’.” Lorenzana cites indicators that will guide the IATF’s decision on lifting: confirmed cases not increasing, deaths occurring in single digits, and recoveries increasing.
If we rely solely on DOH statistics, there seems to be support for the second and third indicators. As of 25 May 2020, there were 5 new deaths aggregating 873 and 74 new recoveries adding up to a total of 3,323, a ratio of almost 1:4. However, 284 new cases were also recorded, bringing the total to 14,319. These new cases are not exactly “not increasing.”
Last Monday, in his weekly press conference with the IATF, President Duterte correctly appreciated the numbers. He asked if we have indeed succeeded in flattening the curve. We have the same curiousity.
Unfortunately, our testing capacities are unlike those of several countries. Theirs are enviable. They have some information on individual immunity, as well as on the trajectory of viral spread. If we had the same information, we could have better basis for ascertaining the cycle of the infection. There would be better grounding of policy decisions on whether travel across provincial and city borders could be allowed and which barangays should remain in hard lockdowns.
The day before, there was a cumulative total of 301,899 samples tested. These numbers indicate more than a million tests yet to be done. What is most revealing is that data on daily samples tested came out only on 8 April 2020 — three weeks into the lockdown. Thus, while our health macrodata compare favorably with other countries, the limited extent of the tests masks the magnitude of the viral challenge. It is useful to know that in Wuhan, health authorities have been reported to have conducted 6.5 million tests in two weeks.
LGUs are indispensable in expanding our health capacities. Instead of merely administering cash transfer and various forms of social protection, LGUs and national authorities could have used our isolation time to pool resources to intensify the conduct of tests, tracing and treating COVID-19 patients. We would be more confident in reopening business and resuming life in the new normal especially at local levels.
Mervyn King, former Bank of England governor and author of the pathbreaking “The End of Alchemy” (2016), observed that “the language of optimization is seductive.” When deciding how to use scarce resources, economic agents are assumed to optimize. But King argues that humans do not optimize. Rather, they cope. Humans cope in the face of “radical uncertainty” or “an uncertainty so profound that it is impossible to represent the future in terms of a knowable and exhaustive list of outcomes to which we can attach probabilities.”
In this pandemic, how do we cope?
King suggests that when coping, there are three elements: First, there is categorization of problems into those amenable to optimizing behavior, and those that are not. Second, a set of rules, or heuristics, is defined to cope with the latter class of problems.
And third, a narrative is crafted.
On the first element, we reiterate that we could optimize state finances by focusing on neutralizing the pandemic through massive testing and contact tracing. As we distributed the “ayuda” we could have done a simultaneous testing of the representatives of the 18 million targeted beneficiary families.
There is also scope for accelerating procurement of necessary medical supplies and equipment.
Beyond our limited data and information, is radical uncertainty. Our knowledge, if any on the geographic distribution of the virus, should be granular but it is not. Our basis for calibrating ECQ is not strong.
On the second element, beyond the information we currently tout, additional heuristics from the UP Resiliency Institute would be very useful. The R or the reproduction number of the viral infection shows a declining trend from April to May. If sustained, this is justification for some policy easing. Data on daily cases would be more meaningful if expressed per million of the population, whether on a national, provincial, or city basis. This is the risk level of each area in the Philippines. Those with R less than 1 and new cases less than 1 per million can be considered low risk and may be considered for delisting or for a downgrade.
On the third and final element of the narrative, if mathematical proof is not possible to forecast future infection, a qualitative narrative should suffice. Good narratives can convince people to own credible and intelligible policies.
We are all eager to resume life and activities like witnessing our children graduate and receive diplomas. We cannot wait for church and social activities to resume. We are even prepared to brave urban traffic for work and business. But people will find it difficult to understand lifting MECQ in the NCR if cabinet secretaries cannot even agree among themselves on which wave we are in. Over two months into the lockdown, procurement of PPEs is still in progress involving even the highest official of the land. Widespread outbreaks continue to be reported due to people’s failure to abide by the protocols. If the Senate minority can raise the issue of sufficient information to guide ECQ calibration because of lack of massive testing, the narrative remains weak.
We have yet to learn how to cope.
To those holding public trust, no guesswork, please. We’re humans…