Living with COVID

Countries can’t be on lockdowns and restricted travel forever. Many governments have decided to recalibrate their pandemic policies so that they can safely live with COVID.

For one, wearing masks and social distancing will be necessary for a long while. Crowding, such as what happened at the dolomite beach, must not be allowed. Public buildings must be required to install hepa filters to clean the air and prevent aerosol transmission of the virus.

The use of rapid antigen tests to quickly determine infected persons must be more widespread. From the latest pronouncement from DOH, it seems they are not updated on the use of rapid antigen tests in our new era of living with COVID.

A Harvard epidemiologist points out that “If the goal is to detect people who are infectious, a rapid antigen test is highly sensitive and specific for this. PCR is not specific for this objective. It will read positive even when not infectious. So it is less accurate for the public health question: Am I infectious?”

I understand that many private entities are now using rapid tests to help them get their businesses back on track. Unless DOH updates itself, it will be increasingly ignored in the new normal.

Governments must also have stocks of newly developed anti-COVID therapeutics or allow the private sector to maintain their own stocks.

There are new drugs to treat COVID. Soon we can deal with COVID, as we deal with the flu, by prescribing a pill at the first sign of trouble.

One new treatment for early onset of COVID is monoclonal antibodies. The website of the US Department of Health and Human Services explains how it works:

“Monoclonal antibodies are made in a laboratory and are given to patients directly with an infusion. The antibodies work to block the virus that causes COVID-19 from attaching to human cells, making it more difficult for the virus to reproduce and cause harm.”

CNN reports that at a White House briefing at the end of August, Dr. Anthony Fauci, President Biden’s senior medical adviser, noted that they can reduce the risk of COVID-19 hospitalization or death by 70 to 85 percent.

The US FDA has issued emergency use authorization (EUA) to monoclonal antibody drugs made by three pharmaceutical companies – Regeneron, Eli Lilly, and GSK. The US government purchased the drugs, which are free to patients and delivered intravenously or at other times by shots.

CNN noted that “monoclonal antibodies can be used preventively after exposure to the virus and also to prevent worsening of symptoms once people get sick.”

A promising antiviral drug, molnupiravir, has also been recently announced. The new drug from Merck and Ridgeback Biotherapeutics is awaiting regulatory approval.

“With the virus continuing to circulate widely, and because therapeutic options currently available are infused and/or require access to a healthcare facility, antiviral treatments that can be taken at home to keep people with COVID-19 out of the hospital are critically needed,” said Wendy Holman, chief executive officer of Ridgeback Biotherapeutics.

Merck expects to produce 10 million courses of treatment by the end of 2021, with more doses expected to be produced in 2022.

Merck has entered into a procurement agreement with the US government, under which Merck will supply approximately 1.7 million courses of molnupiravir to the US government upon EUA or approval from the US FDA.

In its press release, Merck revealed plans to implement a tiered pricing approach based on World Bank country income criteria to reflect countries’ relative ability to finance their health response to the pandemic.

Merck had previously announced that the company has entered into non-exclusive voluntary licensing agreements for molnupiravir with established generic manufacturers to accelerate availability of molnupiravir in more than 100 low- and middle-income countries…”

Molnupiravir is also being evaluated for post-exposure prophylaxis in preventing the spread of COVID-19 within households.

I understand part of the clinical trial for molnupiravir was done in the Philippines, probably making it easier to get EUA from our FDA. CNN Philippines reports that the first shipment of the drug is arriving next month. It is expected to cost around P100 to P150 each. A five-day treatment would require around 40 capsules.

The importation will be under a compassionate use permit for four hospitals authorized by the FDA last month.

This new drug is important because it can be taken at home at the first sign of symptoms and may prevent need for hospitalization. Monoclonal antibodies require infusion in a hospital.

Another area of normalization is international travel. Philippine Airlines is proposing to pilot test a “no facility quarantine protocol” for fully vaccinated passengers from North America. This will ease travel requirements for Filipinos returning home.

Among the suggestions to make this happen are the frontloading of the testing process before passengers arrive in the country, which is what many countries including the US, are doing. Also proposed is the expansion of international gateways to ease the load on the NAIA terminals.

OCTA Research fellow Fr. Nicanor Austriaco showed data indicating that new infections in the Philippines cannot be attributed to international arrivals. According to Fr. Austriaco, arriving international passengers account for only 1.8 cases of the average 6,000 new cases at this time.

PAL’s tracking observed that positivity rates among inbound passengers from North America have been relatively low, and that 90 percent of their North America passengers are vaccinated.

Presidential adviser Joey Concepcion called for reciprocity with the US, which only requires a negative RT PCR test and proof of vaccination status as travel requirements. “We need to extend the same privilege to America,” Concepcion said.

It is good to note that the officials who discussed the proposal with PAL and OCTA appear to see the logic in the proposal. Let us see how the IATF and Duterte reacts.

There are viable ways of living with COVID. But our bureaucracy must be up to date with international developments and not insist on measures that no longer apply to current conditions.

Boo Chanco’s e-mail address is [email protected]. Follow him on Twitter @boochanco