Pandemic management

In our third year with the pandemic, governments around the world are still struggling with how to manage it to produce the best protection of their people at the least disruption.

For instance, countries differ in how to approach international travelers. My son who lives in Singapore was in the United States during the holidays for our family reunion and returned home last Friday. After less than a day in a hotel, he is free to return to his family’s condo unit.

My wife and I also returned home last Friday, but we are required to quarantine for five days, take a PCR test on the fifth day, and may leave hotel quarantine if the test is negative. However, we must continue to home quarantine for two more days. The difference in policy makes one wonder since it is the same virus.

Normally paranoid myself, I understand the abundance of caution behind our approach. But isn’t there a science-based approach that transcends political borders? Apparently, none.

The good news is that our arrival experience at NAIA has been vastly improved. I was pleasantly surprised the process was now smooth and those involved were very courteous and helpful. The Coast Guard elements politely kept the flow of passengers moving.

We could have been out of the airport in less than 30 minutes. Unfortunately, the immigration officer processing arrivals in the senior citizen lane was slow and kept on consulting his supervisor. Probably a newbie.

I congratulated DOTr Secretary Art Tugade who is primarily responsible for the airport operations. He explained it was a joint effort of a number of agencies. Now that they have the system right, they can probably start increasing the number of allowed flights and passengers so the finances of our ailing airlines can be helped.

It should be clear to us by now that having the right approach to any country’s COVID response is not as simple as science vs economics.

Neither the scientists/doctors and the economists can claim their approaches are the right ones. Public health experts are still debating the best tests and masking. It is all a question of perspective.

An article in the New York Times, written by a physician who is also a public health specialist, called for an approach that underscores the public health interest rather than individual patients.

The problem, Dr. Aaron Carroll wrote, is that doctors who determine public health policies can’t seem to stop thinking of themselves primarily as physicians treating individual patients. “Caring for an individual and protecting a population require different priorities, practices, and ways of thinking,” Dr. Carroll wrote.

He said his frustration at the response to COVID is that too many officials in senior positions at the regulatory agencies like FDA and CDC seem to think that if something isn’t close to perfect or doesn’t maximize the safety of each individual person, it’s not worth it at all.

That also explains why our own DOH keeps on saying it is the RT-PCR test or nothing because it is the gold standard. Never mind that a person with the fast infecting Omicron variant gets to infect more people because PCR test results take days to confirm.

“Some of the greatest initial and continuing failures of public health policy have stemmed from this view,” Dr. Carroll says.

“Focusing on the individual can also lead to excessive fears of bad outcomes… Leaders can come to think that any risk of infections is unacceptable, leading to policies that close schools even though the danger that schools appear to pose is low.

“A population-level view,” he says, “focuses on reaching as many people as possible rather than perfection…”

He laments that “the FDA and the CDC have trouble recognizing the utility of at-home tests as a public health tool, as opposed to purely a clinically diagnostic one... More frequent imperfect testing may pick up more cases, even if we miss a few we might have caught with perfect tests. Getting many people to be somewhat safer might achieve more than getting fewer people to be really safe…

“Masks are another example. If you can have only the best, you’ll focus on N95 masks… tell most people they shouldn’t wear masks at all because only certain ones provide the best protection, and we have to save them for those at highest risk.

“A population-level view argues that cloth or surgical masks – which aren’t anywhere near as good as N95s, but were easier to get – would lower the risk for everyone when the pandemic was beginning, and therefore would be helpful. It took until April 2020 – many weeks into the pandemic – for the CDC to recommend mask wearing for the general public.”

Dr. Carroll also blames parents who might reason that the risk to their child from COVID (and other vaccine-preventable diseases) in the United State is very low, so why take on any risk of a vaccine at all?

“But from the perspective of the public health system, only with herd immunity, or something close to it, can we begin to see an end to this pandemic – and that requires near-universal vaccination.

“Overfocusing on encouraging people to vaccinate to protect themselves, which is what every chart comparing curves of hospitalization among the vaccinated and unvaccinated tries to do, misses opportunities to explain that the biggest reason to vaccinate is often to protect others, especially those who cannot protect themselves.

“If we’re trying to prevent COVID surges and end the pandemic, then we need to center the population in our thinking. Health authorities need to get tools like rapid tests and better masks to as many people as possible, especially those who are more likely to spread disease, even if they’re at low risk themselves.”

It is important that public health officials are able to shed their professional biases and learn from the past two years of experience with the virus. Outsmarting the virus requires taking a broader public health perspective. That’s not easy for doctors running health agencies, but are trained to focus on individual patients.

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