Pandemic
FIRST PERSON - Alex Magno (The Philippine Star) - February 27, 2020 - 12:00am

By the latest count, the Covid-19 epidemic infected about 80,000 people worldwide. This is ten times more than the number of SARS infections.

The outbreak of infections in South Korea, Italy and Iran last week demonstrates the amazing speed this virus can be transferred from person to person.

In South Korea, a single virus carrier attending church service spread the infection to 893 others in a matter of a few days. The same rapid spread of the virus was seen in northern Italy where four towns are now on quarantine.

In Iran, the outbreak is centered in the city of Qom, south of Tehran. There is debate about how many are actually infected in this country given restrictions on information. At any rate, infections have spread to Kuwait, Bahrain, Oman, Afghanistan and Iraq – all attributed to persons who have been to Iran.

The nightmare scenario in this part of the world is that infections could happen in the crowded refugee camps of Yemen, Iraq and Syria. Should that happen, it could spread like wildfire.

The World Health Organization (WHO) has not declared a pandemic just yet, although its experts acknowledge that possibility given the rapidness of contamination associated with this virus. Covid-19 may be less lethal than SARS, but it seems able to spread out ten times as quickly.

Already, economists are expecting the global economy to take a substantial hit from this epidemic. The supply chains of many enterprises are linked to China, where contamination is far from contained. Last Monday, the US stock exchange dropped over a thousand points in a day, spooked by the possible dislocation attributable to this epidemic. On Tuesday, it fell further.

Chelsea Clinton, now a public health expert, wrote an influential critique of the seeming nonchalance of the Trump administration in the face of the rapid spread of Covid-19. The US health system, she argues, is woefully unprepared for an outbreak of the epidemic.

While Donald Trump may choose to downplay the possibility of such an outbreak, we have seen from the events in South Korea, Italy and Iran that no community is completely safe. The carriers are no longer people who have been to Wuhan.

Inferior

We have been fortunate so far.

Despite our proximity to China, the large number of Chinese tourists visiting and the repatriation of Filipinos from infected areas, we have not recorded a person-to-person transfer of Covid-19. The aging man from Wuhan infected with Covid-19 who died in one of our hospitals succumbed to pneumonia.

Although we have put hundreds of persons under observation for the disease, none tested positive so far. We are keeping our fingers crossed. Our public health system is holding ground. We observe all the standard protocols recommended by the WHO, including putting on two-week quarantine all health workers, airline crew and diplomatic personnel involved in the repatriation program.

Still, there are things we could still do to further improve our ability to combat the new virus.

From all that we know at this stage, people with other health problems, particularly relating to the respiratory system, are especially vulnerable to Covid-19 infection. The new virus attacks the respiratory system and persons with pneumonia are particularly vulnerable.

This throws the spotlight on the DOH’s decision to revert back to the use of PCV 10 in its vaccination program against pneumonia. Our health system has long before upgraded to PCV 13 that protects against a broader range of serotypes. The reason for the downgrade, according to the DOH, is to save a few pesos per dose.

But by saving a few pesos, we also limit the range of protection our people get. The experts disagree with the downgrade. House accounts committee chairman Michael Defensor has called for a public hearing on the issue. Former health secretary Janette Garin says the DOH’s decision is a “step backward” in preventing pneumonia among children aged five or below.

According to our health statistics, pneumonia is the biggest killer of children aged five and below. According to WHO, nearly one million children aged five and below died of pneumonia and pneumonia-related diseases in 2015 alone.

Dr. Jaime Santos, former president of the Pediatric Infectious Disease Society, and Dr. Rommel Lobo, a pediatric immunology specialist, also oppose the DOH decision to use cheaper vaccines. In a recent interview, both specialists argue that PCV 13 has a specific indication for “immunocompromised” patients.

The two doctors said the problem with antibiotic resistance is due to frequent use of antibiotics, usually for respiratory infections. Frequent use of antibiotics lead to mutations that make the bacteria more resistant. If we use an inferior vaccine, there will be more use of antibiotics to treat infections from bacteria that are outside the range of coverage.

They also point out infections among young children lead to infections of elder people, especially given or extended families. If an inferior vaccine is used, the possibility increases for more children, and hence more elderly, to fall prey to infection. PCV13 covers 13 types of bacteria while PCV10 covers only 10.

The latest word from the DOH is that the PCV 10 a new bidder has introduced would go through further study by the Health Technology Assessment Council. This, hopefully, means the downgrade is not yet final. Apart from testing the vaccine for efficacy, the authorities should also consider its role in a broader fight to prevent an epidemic causing respiratory complications.

At this time of Covid-19, it makes better sense to use a vaccine that protects against a wider range of infections.

DOH SARS
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