Are we there yet?
DEMAND AND SUPPLY - Boo Chanco (The Philippine Star) - March 27, 2020 - 12:00am

Two weeks into the lockdown and many of us are asking if we are there yet. This sounds like my second grader grandson in Anaheim who keeps asking that question in the course of an eight-hour drive to San Francisco.

I can’t blame the kid for being anxious. He probably feels constricted all buckled up in his kiddy seat and he is normally so full of energy running around the house.

Our anxiety over the lockdown is understandable too. Our lives as we know it vanished in an instant and we are confined to our homes.

But to answer the question, no we are nowhere near there yet. The April 14 target of government to lift the lockdown is a mere hopeful guess. Simulations now indicate most of the world may have to be in some form of restriction on social movement for the next 18 months or so.

A study made by the Imperial College of London also says millions would die and that health systems would be overwhelmed. To mitigate the disaster new measures would need to go into place immediately.

In our case, it seems we have barely begun. We have done a mere 15 tests per million population. That’s really nothing. The Secretary of Health finally admitted that DOH could be missing half of the actual total COVID-19 cases due to limited testing.

We should expect a sharp rise in the number of cases following the experience of China, Italy and Iran. That means our health infrastructure will be overwhelmed.

As it is now, the big private hospitals have given up and are no longer accepting new COVID 19 cases. Their frontline health workers are getting infected and being quarantined. Yet, simulations and actual experiences in other countries show we have seen nothing yet.

The strategy called for, according to experts, is for countries to try very hard to flatten the curve. That is, keep the number of cases from rising too fast.

How do you do that? By testing to find out who has the virus; isolating those who test positive; trace the contacts to test and isolate them too. That’s how to slow down the speed of viral infection to flatten the curve.

As the Washington Post puts it, “the grim harbinger of how bad things could get lies right in Europe’s midst, as Italy’s death toll leaps by hundreds each day. Doctors there are struggling to keep more than 2,800 people in intensive care alive, an effort that requires staff, beds and a constant supply of protective equipment.”

This is why our government must plan for an upsurge of cases.

What should we do? Government must build temporary hospitals quickly, the way China did. So far, only Quezon City’s local government and Pasig City’s are doing that.

Now for some bit of good news from a friend on the Board of DMCI. The construction team from DMCI (constructing the UPCM Medical Sciences Building) has accepted the work to convert Wards 1 and 3 of PGH into a “negative pressure area”.

They have mobilized their workforce from UPCM to work in PGH and finish the project by today as promised by Director Gap Legaspi to the country. There will also be an external elevator outside of ward 3 which will be exclusively for COVID patients.

The national government should immediately fix the buildings at Quezon Institute to take in the overflow of COVID-19 patients. It is a good isolated place with plenty of open space. It had been designed to take care of tuberculosis patients which at that time needed to be isolated.

Peter Angliongto, a businessman and a friend commented on Facebook that we need look forward to opening an instant facility for COVID 19 patients.

“I’ve been saying DOH should be studying converting PICC or Philippine Arena… we can probably put up a 500 bed facility if need be within a week or two. Planning forward and thinking out of the box.”

Supreme Court Associate Justice Marvic Leonen suggested using the casinos to take in an overflow of patients. Soldiers in Germany, France and Spain have been deployed to help build similar temporary facilities for thousands of patients.

Then we need to acquire more ventilators. In Italy, doctors are making life and death decisions on who can use a ventilator.

Eckie Gonzales, chairman of Medical City, said we need mechanical ventilators for the 20 percent of cases that requires assistance in breathing, even intubation. “The largest and most well-equipped government hospital has only 22, about the same number as the largest private hospital.”

Elon Musk said in a Facebook post that he acquired a lot of ventilators from China because there is an oversupply there and therefore cheap. Now is the time for China-lover Duterte to call his overlords in China to send here a few thousands of those ventilators.

A number of experimental drugs and a drug used for malaria are now being tested abroad. DOH should make arrangements with governments and drug companies to stock some of those drugs here. If a patient is between life and death, using these drugs, which anecdotally worked on some patients abroad, is a good risk to take.

To address shortages, the Washington Post reports, Spanish clothes manufacturers are turning their lines to making medical masks, and Parisian perfumers are producing hand sanitizer in an effort that harks back to wartime. The British government asked automakers like Jaguar to try to quickly manufacture ventilators. The NHS wants 20,000 to 30,000 more.

The Imperial College simulations suggest that “optimistic projections about life returning to normal and the economy getting back on track appear to be unrealistic…

“However, the authors of the report noted that four interventions: social distancing, case isolation, household quarantine and school closures would have the largest impact ‘short of a complete lockdown which prevents people going to work.’”

Dr Raul Jara

I just want to condole with the family of my cardiologist, Dr Raul Jara.

Dr Jara died fighting the COVID-19 virus. He no longer needed to be in the frontline, being a senior consultant in cardiology, but he was true to his oath as a physician. He was committed to his patients to the end.

A pillar in the local medical profession, Dr Jara will definitely be missed.

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter @boochanco.

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