A patient who had been having fever and cough for several days felt like the roof of the emergency room caved in when he was informed of his positive swab test, findings of pneumonia on both sides of his lungs on X-ray and a slightly decreased oxygen level in his blood (hypoxemia).

“Doctor, what’s happening to our country?” he asked me on the phone. He cited the assessment of former health secretary, Dr. Espie Cabral, that we’re not only back to square one in our fight against COVID-19, but 10 squares backward.

A passionate traveler, he was hoping to get back on the road this year after a whole year of being sidelined and home-quarantined by the pandemic. Not only were his traveling plans dashed, but he now has to wrestle in close combat with the virus, with his survival hanging in the balance.

I just listened to my patient’s sentiments without giving any of my own. I guess the general to whom a similar question was asked by a top official, who was shot mercilessly by unidentified killers, grappled with the same poverty for words when he struggled to give an acceptable answer. All the general could do was give the top official a sympathetic gaze as he was wheeled into the operating room for emergency surgery.

Similarly, the virus is mercilessly killing thousands of our countrymen; our economy is in the ICU (intensive care unit); our social lives are impoverished; our health-care is recurrently nearing exhaustion.

So, is this surge of COVID-19 we’re currently experiencing alarming enough for us to lose hope? Are we nearing tipping point?

Still big enough

Alarming, yes, but not hopelessly so. Our golden window to keep COVID-19 at bay may have narrowed, but it’s still big enough to let us out of this pandemic rut. We’re still far from tipping point, but our margin for error is now much smaller. We need to be more precise, and adapt or adjust quickly to real-life developments, which have not gone as planned.

This pandemic has crumpled our conventional box of doing things. So, it’s futile to stick to conventional hand-me-down strategies from abroad, or from international agencies. We have to think outside the box, and stop following the leader.

Just because the affluent countries say mass vaccination is the key answer to the pandemic doesn’t mean we should take that hook, line and sinker.

We have to locally attune, improvise and calibrate our strategies.

The pandemic has outrun our availability of effective vaccines, with all the new variants showing up making currently available vaccines less effective.

Thinking that mass vaccination will solve our pandemic woes and restore normalcy in our lives limits our discernment of what could be more suitable for our country.

Mass vaccination for the young and old may no longer be the best solution at this point. I propose a targeted vaccination of the elderly and other high-risk patients in COVID-19 hotbeds like Metro Manila for now, and consider deferring it in the young who may just turn into asymptomatic superspreaders between the first and second doses of their vaccination. In other areas which are not infection hotbeds, we may proceed with the vaccination as planned.

Preventive intervention

Mass vaccination is an excellent preventive intervention that may help control the COVID-19 cases six months or a year from now, but not in the next several months in areas with markedly increased new cases.

It can still be part of our long-term anti-COVID strategy, but not for the current year in these hotbed areas. We must control first the transmission of the virus, then resume mass vaccination in Metro Manila and other hotbed areas later on.

Vaccination benefits will be seen in the midterm to long-term but not now, this month, next month, and the month after next. In fact, mass vaccination at this point when we’re actually under siege by the virus may have its downside which our experts must closely look into. We need to think of more pragmatic solutions at this stage of the pandemic for Metro Manila and other areas under similar viral siege.

Those who received the first vaccine dose remain vulnerable, and may even become a breeding and training ground for the virus to enable itself to mutate and upgrade to a variant that will be resistant to the vaccine. So, even those who have received the first dose need to protect themselves adequately until the beneficial effects of the virus kicks in after the second dose.

We’re all mesmerized by the vaccination silver bullet that we seem to forget that it is preventive, and not therapeutic. It can protect us from future infection, when our body has produced enough antibodies to fight and kill the virus, but it cannot protect us adequately for several months until we get the second dose. Meanwhile, the virus is on an infecting and killing spree.

It’s like we have powerful artillery that can annihilate the enemy troops from afar. But when the enemies are within a few feet from us, our potent weapon is useless and cannot protect us.

What will really be effective at this point when the virus is right in our midst is to ensure that our natural resistance or innate immunity is optimal to engage the virus in hand-to-hand combat.

Multipronged paradigm

My recommendation is to get out of a predominantly vaccine-centric strategy to a more holistic, multipronged paradigm aimed at enhancing the natural immune system with readily available drugs like melatonin, ivermectin and other supplements.

We still maintain our prescribed safeguards (mask, face shield, distancing, hygiene), but we should not spend practically 80 percent of our borrowed resources to keep on procuring vaccines at this point when we’re in the eye of the pandemic storm. We should allocate some of these anti-COVID funds in subsidizing the distribution of these agents that can boost the natural immune system.

Another concern now, and we urgently ask our experts to advise us on it, is what happens if one is already an asymptomatic COVID-infected patient when one gets vaccinated?

We advise that one should wait at least two weeks after an infection before getting vaccinated because there can be adverse effects of vaccinating those with acute infection. But the asymptomatic don’t know they have the infection. Quite an increasing number, especially in young people, are symptom-free, or they have very mild, vague symptoms which they don’t associate with COVID-19. Are we exposing these people to some risk? This is one reason we should probably defer vaccinating young people in hotbed areas.

The important thing is for our government officials managing the pandemic to realize that it can’t be business as usual or as planned. We need to reassess the situation and definitely make some changes.