Mitigating the next big COVID surge | Lifestyle.INQ

OCTOBER 27, 2022

(First of a series)

In this series of commentaries, we’d like to highlight the following:

  • Preventing the Delta or Indian variant from spreading here is likely out of the question; mitigating its consequences is still possible.
  • We must educate the public on the tricky presentation of the Delta variant, which presents mainly as headache, sore throat and runny nose (colds), and less of the classical symptoms of fever, cough, loss of smell or taste, muscle pains and weakness.
  • Other mitigating measures include enhancing detection through biosurveillance or genomic sequencing of the virus (including water sewage surveillance), chemoprophylaxis or preventive treatment of those exposed, early treatment of even the asymptomatic and mildly symptomatic high-risk or vulnerable sectors, targeted vaccination of these high-risk sectors.
  • The Department of Health (DOH) and the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) should reserve whatever remaining stocks of the Pfizer, Moderna and AstraZeneca vaccines for the elderly and other high-risk or vulnerable sectors, since the other vaccines have not been shown to be effective against the Delta variant. If these vulnerable sectors could not be fully vaccinated in two months, other means of protection, such as by chemoprophylaxis (preventive drug treatments), should be provided to minimize the death toll.
  • When the elderly and vulnerable sectors are almost fully protected, the next sector at risk are children aged 12 years or younger because their immune systems are not as strong as adults yet. There may be a shift of new cases in this age group, which should be considered in the plan to resume face-to-face classes of schoolchildren.
  • With the rapidly emerging more infectious and possibly more virulent variants such as the Delta Plus variant that may be capable of totally escaping the vaccines, or may make all current vaccines suboptimally effective—plus the real-life constraints in our antipandemic responses—attaining “herd immunity” will just remain a pipe dream. But no worries, we can still aim for “herd protection” through chemoprophylaxis and other means.

Major concern

As we’ve written and been emphasizing since two months ago, the Delta variant is going to be a major concern here. Preventing it is most likely out of the question since it has already breached our borders. Many of the 17 detected so far to have this variant were hospitalized with a few staying in the intensive care unit and mechanically ventilated. This virus has a batting average of eight transmissions for every infected person.

With all due respect, the pronouncement that there is no community transmission yet of the variant is more aspirational, rather than realistic since we’re not testing enough and we’re not doing genomic sequences enough to ascertain there is no community transmission yet.

The good news, though, is that there is still a fair to good chance we could mitigate its serious consequences, and prevent a similar catastrophe it has caused in India.

Last month, we forecasted that it’s going to be the dominant variant causing COVID-19 in our country; and if the proper measures are not done, we’re likely to have another surge by August (earliest, late July and latest, September) of this year with around 30,000 new cases a day and deaths of around 500 daily.

We used a doubling time of 10 days instead of 14, which is shown in the United Kingdom and United States. But these countries have more than 60 percent of their respective populations fully vaccinated, whereas we have less than 5 percent of our population receiving two jabs as of latest report.

We’re also doing much less testing and genomic sequencing surveillance, so we can’t really tell how fast the new variant is spreading.

Preparation is key

This is not to sow fear or panic. On the contrary, we want everyone prepared so we can brace up for the ravaging effects of the virus, know what we can and should do, and, hopefully, just see it pass through without causing health-care exhaustion or killing many Filipinos.

Yes, we reiterate that it’s not a doomsday scenario, and that we can significantly mitigate its serious consequences. There’s even a possibility that with all preemptive measures the DOH/IATF will do, we can reduce the death toll.

We still have time to prepare, but the window is getting smaller.

Recommended mitigating measures:

Enhance detection: Close genomic biosurveillance is important. The DOH should report at least weekly the growth of the Delta variant. Five weeks ago (May 15), they reported that we had 12 identified cases, and on June 18, they reported that there was only one additional case.

Then came the pronouncement that we had successfully prevented the spread of the variant. I thought this was incredible! Hence, I wrote on my Facebook page on June 19 that we cannot rely on hunches alone. The DOH has to support it with concrete biosurveillance or genomic sequencing data.

This was my Facebook post:

“Although the new cases in (National Capital Region) Plus have markedly decreased and somehow stabilized, the marked increase in number of cases in other key areas in the country is still discomforting and cannot rule out the emergence of another fast-spreading variant such as the Delta variant.

“To reassure the public that the new variant is not the culprit causing the surge in cases in the provinces, the DOH should inform the public of its genomic biosurveillance monitoring which detects any alarming increase of any new variant.

“In March, for example, the DOH reported that the new variants then (UK, South African) were less than 3 percent of cases, and the local experts were confident it should not cause a major problem with the vaccination program already rolled out.

“Six weeks later, we had the big surge attributed to the new variants. In early May, less than two months after the first report on the identified new variants, the DOH reported that of 744 samples of genomically sequenced virus, 678 or 91 percent consisted of the new variants already.

“The Delta variant has been shown to be 60-percent more transmissible than the already highly infectious UK or South African variants. More than 10 cases have already been identified last month. Even with a conservative doubling time of 10 days, in 10 weeks from last month, the variant shall have reached a threshold point that can cause another surge. That could be in late July or early August.

“But if the DOH and its affiliated agencies have been dutifully doing its genomic biosurveillance, and their monitoring shows there is no increase in the cases of the Delta variant—allaying fears that it might be triggering the surges in the provinces—then that would be truly reassuring, and we can sleep soundly at night.

“This information on COVID biosurveillance can help guide our President and other officials on vital

decisions such as the resumption of face-to-face classes and opening of our business establishments.

“We can always plan and decide better if we’re guided by data and not only hunches.”

We should be doing more genomic sequencing of the virus. In the United Kingdom, with less than 70 percent of our population, they’re doing more than 8,000 genomic sequencing weekly. Here, we’re doing less than 800. I think we should spend some money improving our capacity to detect emerging variants early, rather than just spending all the borrowed money procuring vaccines.

As they say, an ounce of preparation is better than a pound of cure. If we can detect the growth and spread of new variants more efficiently and promptly, we can prepare better and we’ll need less resources for other preventive measures and treatment. So, we may be saving a lot of resources and a lot of lives in the end by investing in more genomic sequencing machines.

———Just as we were finishing the first installment of this series, news of the death of former President Benigno “Noynoy” Aquino III came out. He was just 61 years old, six years my junior. I didn’t know him personally and never had the privilege to meet him but I feel like I’ve lost someone close to me.

Although I was just one of the more than 100 million Filipinos he had faithfully and dutifully led when he was president, I feel like the one of a hundred million threads stitching an ordinary citizen to his leader was strong enough to forge a meaningful connection and make me really sad about his untimely passing.

His humility, aversion to the trappings of power, and strong passion to serve his country well sans fanfare make a lasting legacy for which history will fondly remember him. He gave so much of himself during his presidency that he didn’t leave much for himself anymore.

We convey our condolences to the Aquino-Cojuangco families, and may divine comfort be with you in this difficult time. INQ

To be continued