The Covid surge: How we got here? What next?

HOW did we get here, and where could this go? That was the opening question in the Whitsun Reef article last Thursday, and we have it again today, this time on the coronavirus disease 2019, or Covid-19, pandemic.

The roadmap into and hopefully out of the current surge in cases and deaths, now several times the level during the previous peak last August, was presented by Dr. John Q. Wong, an epidemiologist or infectious diseases expert who teaches at the Ateneo School of Medicine and Public Health, right next to The Medical City hospital in Pasig, and co-founder of the Epimetrics disease information AND ANALYSIS fiRM.

Dr. Wong was among several resource persons who presented online about the Covid crisis recently, and those who have time should watch the whole webinar lasting two and three-quarters hours (https://www.youtube.com/watch?app=desktop&v=jQusLZgOYac&%3Bfeature=share). Those with less time to spare, read on.

So, where are we now? After over a year of one of the longest Covid-19 lockdowns on the planet and several months of cases subsiding from the August peak, new daily infections are now more than twice that of the previous surge.

Deaths have also risen, noted Dr. Wong, and while they are not at record levels (the recent 401 body count included deaths from several days), the casualties have exceeded the 75 percentile, A significant barometer.

Moreover, in the months between the August and February surges, daily cases never stayed at about 500, which led the World Health Organization (WHO) country director for the Philippines to note recently that we are not actually suffering a second wave of infections, since the first one never ended.

The key figure, however, is the reproduction rate of transmission, or Rt. It should be kept below 1 to bring down infections. But in the current surge, Rt in Metro Manila hit about 2.

The University of the Philippines OCTA Research group monitoring the pandemic expect infections and Rt to drop in coming weeks, thanks to the two weeks of enhanced community quarantine, or ECQ, imposed on the NCR Plus area of the National Capital Region and nearby provinces of Bulacan, Cavite, Laguna and Rizal. But no one is claiming victory against the latest surge.

The road to Surge 2

Critics of the Duterte administration and its Inter-Agency Task Force for the Management of Emerging Infectious Diseases, or IATF-EID, tend to zero in on President Rodrigo Duterte and his team and policies for the pandemic. Dr. Wong sees several factors with his systems approach in dissecting the surge.

As the professor explains starting 37:49 minutes into the video, and those closely following the pandemic know, the spread of Covid-19 involves transmission from a tiny group of carriers to those exposed to them in homes, communities, schools, workplaces, public areas and transport.

Those with symptoms tend to spread the virus even more, but health protocols can limit exposure and illness. Of late, vaccination is making a small but growing number of people, now exceeding a million, less likely to get and transmit the illness.

Dr. Wong points out concerns at various transmission points in his system model. Health protocols can reduce infection risk by 80 percent or more — if widely and diligently practiced. That level of protection matches most vaccines.

While mask wearing is widespread enough to confer 65 to 70 percent protection populationwide, the low face shield compliance of about 30 percent brings down the combined mask-andshield population protection to less than 70 percent.

A second factor is the mobility of people, especially in enclosed areas and public transport. There was much more movement in groceries, retail recreation and parks at Christmas and Quiapo’s Traslacion religious event for the Black Nazarene statue in January, though not for Chinese New Year, or Valentine’s Day.

Result: Five to seven days after Christmas mobility, the reproduction number went up from well below 1 on December 29 to much higher than 1 by January 7. But there was no such increase after Traslacion, maybe because the Nazarene devotion was mostly an outdoor activity. Ventilation dissipates the virus and reduces infection risk.

A third factor is quarantine, or its delay or lack because carriers do not know they are infected. They are usually not in quarantine during the infectious period from two days before symptoms appear to five days after, partly due to delays in getting tested and obtaining results, plus leaky quarantine compliance.

Overall, most infection clusters are still in the community, spreading in and among households. But infections in hospitals, government offices, and workplaces are rising. From 1.5-2.8 in December 15 to January 31, risk of clusters in non-community places went to 4.7-6.7 in February 1 to 15. Ventilation would help curb transmission, but that’s taking a while to implement in workplaces and public areas.

Finally, testing: there’s not enough being done. We have 20 percent positivity with 50,000 tests a day. To achieve 5 percent positivity recommended by the who, we need to test 200,000 a day to find and quarantine carriers.

The way forward

Based on the August surge and its aftermath, daily cases now peaked 10 days into the current lockdown. But hospitalizations would keep rising for two weeks after the lockdown period, reflecting the time people get sick, go into hospital, and get well or, God forbid, succumb.

Variants increase transmissibility by 56 percent. The aim then is to bring the rate of transmission or Rt from 1.95 projected if variants become dominant to progressively lower levels till it falls below 1.

The must-do measures have been widely discussed: better compliance with health protocols, better ventilation, avoiding mass gatherings, especially in enclosed areas. There is also need for active case-finding, bringing testing to communities. And contact-tracing capacity must be restored, after being slashed for lack of funds.

But Dr. Wong also stressed the need for a rethink of strategy and goals. For instance, aiming for herd immunity through vaccination may not work, since it’s not clear how long immunization lasts or how effective they are in fighting mutated covid viruses. So, better to immunize everyone to protect them from serious illness and death.

And as this column has repeatedly urged, develop, test, validate and publicize remedies. Let’s save lives in every way, vaccines, protocols, medicines and prayer.