Social distancing or lockdown; clearly, those are the only choices

It has been said that “social norms are powerful motivators and getting in the way of people taking the right steps in response to the pandemic. To create a new social norm, human beings like to see behavior modeled. This serves as a signal that says, ‘Oh, someone else is doing it so I should do it also.’” Imagine if all of us in NCR practice social distancing.

Note: This column originally appeared in The Manila Times on March 17, 2020.

We are all person under monitoring because all of us have been exposed to the coronavirus disease 2019 (Covid-19). The sooner we accept this, the better for everyone. We wait and build up our immune systems as we complete the self- quarantine all of us need to do for 14 days. Why 14 days? Because that is the incubation period of Covid-19.

We hope we do not graduate as PUIs or persons under investigation. The data being reported is inherently deflated because it does not reflect what is on the ground. What do we do then? We plan for the worst and that is the problem with irrational people commenting about President Rodrigo Roa Duterte’s (PRRD) plan. Their conclusion is, there is no plan.

PRRD has been blamed for coming out with an incoherent and, at the same time, draconian plan to battle Covid-19. Much has been said about how ill-prepared that address to the nation was; even the optics was bad because it had officials of the Armed Forces of the Philippines as the backdrop. True, it was not good, but if you mean business and you want order, that was the best signaling one could have. Is the national emergency not a public order issue? I have not seen a national emergency not treated as such. As to the demeanor of PRRD, those who have not accepted his style will never understand what he wants done. Style is not substance. When hard decisions need to be made, style does not figure in the frame. But yes, PRRD has to make a more forthright national address as father of the nation than what we saw last week.

Wuhan, China went on lockdown after roughly 400 cases were identified and they had access to testing kits. Italy confirmed the first cases on Jan. 30, 2020 and a third case on February 7, and the number increased to 16 by February 21, hence a lockdown was called.

PRRD acted at 24 positive Covid-19 cases and issued Resolution 10 last March 9. By March 15, the total number of cases in the country was 140. And the eternal debate was if we are under martial law. Seriously? If we need to do so for everyone to remain in their homes, we should because each of us, yes, the 12,877,253 population of the National Capital Region (NCR) are both carriers and at risk. We are all carriers waiting to explode; imagine what it will cause in terms of straining our limited health facilities and supplies. No local government unit (LGU) in NCR can do test, trace and isolate protocols because there are no testing kits. So, there is lag time from PUI to isolation.

Can the medical facilities and existing supply inventory respond to 10 percent of the total population of NCR being infected? That’s 1.3 million. No combined NCR hospitals, facilities, supplies and frontliners can handle such number. If we do not do social distancing today, what would the numbers be 30 days after?

So, questions were aplenty on why two PUIs would mean community quarantine as suggested in the proclamation. Why limit the declaration of a national emergency to 30 days? Those markers refer to an urgency that the national government seems unable to articulate so as not to panic everyone. Consequently, at a single PUI, an LGU will have to prepare for a community quarantine call already. Thirty days is due to the fact that we have only this period to “flatten the curve” in order to protect the rest of the country. NCR has become the modelling test, the baseline on how to respond if Covid-19 spills beyond NCR. NCR is the wall!

Apart from test, trace and isolate protocols, an LGU in NCR would need to put together a full process flow of contain, delay, mitigate, stimulate and recover if we are to build fast after the war with Covid-19. We need to stimulate the local economy and recover since if we go the path of recession, more people will be out of jobs. The big companies can take care of themselves, but the small enterprises will be wiped out. Both the national and local governments will have to agree on a set of stimulus packages.

It has been said that “social norms are powerful motivators and getting in the way of people taking the right steps in response to the pandemic. To create a new social norm, human beings like to see behavior modeled. This serves as a signal that says, ‘Oh, someone else is doing it so I should do it also.’” Imagine if all of us in NCR practice social distancing.

An American mathematician said, “…as a society, we are accustomed to having access to the best medical care available. Our medical system will be overwhelmed unless we practice social distancing at scale.”

The medical teams in Italy are seeing an alarming number of cases from people in their 40s and 50s. “Triage tents are already going up in the parking lots at many hospitals close to the epicenters in the United States. Spreading the virus puts those in the high-risk category at much greater risk. This is the moral argument. It’s a strong argument because there are only two ways, as of today, that the virus can be stopped: let it run its course and infect hundreds of millions of people, or social distancing. The risk of infection is increasing exponentially, because the quantity of infected people, most whom will not show symptoms, is doubling every three days.”

What do we know is that we are up against an exponential enemy — it typically takes approximately five days to start showing any symptoms; for every known case, there is approximately 50 unknown cases; and the total count of infected people doubles every three days.

People should look at actual cases and not confirmed Covid-19 because “the virus only kills a small percentage of those afflicted. The flu kills tens of thousands of people annually. Yes, 80 percent of people will experience lightweight symptoms with Covid-19. The mortality rate of Covid-19 is relatively low (1 to 2 percent). All of these are true, but immaterial.” They are the wrong numbers to focus on because the “nature of exponential math is that the infection rates start slowly and then goes off like a bomb and overwhelms the hospitals.”

In our country, the mortality rate is high and that should signal clearly to you that our hospitals and supplies are not enough to respond to the crisis. We can’t even do proper screening tests because we don’t have the test kits. Reports are coming in that even top private hospitals are overwhelmed. What more with public hospitals? If we become overwhelmed, we will have a much greater mortality rate because we won’t be able to adequately care for the sick. To be sick does not refer to only coronavirus patients.

What is the big problem? “Too many patients, not enough beds and a serious shortage of ventilators (the biggest problem) if we don’t immediately begin social distancing.” Clearly, for the freedom-loving Filipinos and their extended family ties, the options are not good: lockdown or social distancing?

With community quarantine, the LGU that is able to do this effectively will be able to address the problem of limited health indicators. The jurisdictional approach is good because LGUs have their own supply chain protocols. Yes, a local lockdown is necessary if people insist on engaging in social activities. Curfew is necessary. The needs of the LGU should be augmented by the national government and they should be allowed to be innovative in their ways of addressing the crisis, including using test kits with pending approval by the Bureau of Food and Drugs, as well as sauna baths and the like. The LGUs in turn should plan for the worst — an order of magnitude greater than the reported cases. The same American mathematician concluded that “if we don’t stop the virus from spreading, in 30 days we will have 2 to the 10th power more cases of infected people because the infection count doubles every three days (the virus doubles every three days and there are 10 three-day periods in 30 days).”

China, Norway, Italy and now France reacted with “shut everything down.” Countries that do not respond well will pay a much larger, catastrophic price. Let’s make the hard decisions now and stop the bomb or we suffer a wipe-out because leaders didn’t have the balls to make the hardest decision in their term.

After Covid-19, let’s fix our broken hospital system because devolving health without the funds in 1992 created the present state we are in today. Then LGUs must have their crisis management manual and drill their bureaucracy just like what the private sector has been doing. Meanwhile, start social distancing.

About the Author
Malou Tiqiua is the Founder/General Manager of PUBLiCUS Asia Inc. A noted political management expert in the Philippines and Asia, she brings over 20 years of professional experience in public, private and the academe combined. Author of the comprehensive book on electoral campaigns in the Philippines, "Campaign Politics", Malou is a graduate of the University of the Philippines with a Political Science degree and a Master of Public Administration. She completed her second master's degree (MA in Political Management) from the Graduate School of Political Management, George Washington University.
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