Whole of society

The President’s handling of the national response to COVID-19 has evoked a spectrum of commentary. Dealing with public health emergencies requires a “whole of government” approach – in this case, as per Senator Bong Go, whole of society (WOS) – for a more coherent, cross sector policy response. From the start of his administration, President Rodrigo Duterte has institutionalized the “whole of government” mode straddling the different portfolios of his governance infrastructure. Though he is more popularly known as a rule-by-fiat kind of king, behind the scenes it is the more integrated response that sustains the over-all success of his kingdom. 

It is no longer just the travelers, like the first victims, spreading this stealth virus. Transmissions are now community spread heightening the difficulty of tracing origins. Hence, Code Red Sub-Level 2. We have moved into a more obscure legal realm. 

One of the things that the Presidential announcements have clarified, at least for the Metro Manila area where infections are concentrated, is the way forward given the uncertainty of legal cover. At the meeting of Metro Manila Mayors last Tuesday, the clear intention was to not impose any sort of lockdown. Even Secretary Duque, just a day before, was emphatic in his position against metro wide quarantine which he termed “draconian.” LGUs, Sec. Duque acknowledged, had the call whether to take action in their respective jurisdictions. 

But the elevation to Sub-level 2 has changed all that. 

Meanings. Lockdown could mean different things to different people. Mass lockdowns are extremely rare in local and world history. No one really knows in advance if they’re workable before they’re imposed. There are no precedents before China and Italy.

The word lockdown doesn’t even appear as a technical or legal term in public health literature or in statutes or regulations. It may refer to the geographic quarantine of a community as now for Metro Manila; or to the lesser quarantine, self quarantine and non mandatory recommendations. 

Unfortunately, there is no clear understanding of what they contemplate. Travel shutdowns were immediately qualified by exceptions. We waited for the plans on cleaning up Metro Manila – the armed forces could be well suited to undertake this as a mass exercise. Anti-Dugyot, if you will. Notably missing was a reassurance on what to expect for and from the health sector as we mount a defense against the contagion. Hospitals and health centers are being overrun; options for the vulnerable are getting progressively dimmer. For the formal and informal working sector to be dislocated by the lockdown, what to do?

There ought to be a law. It is precisely this need for definitions that had Senator Francis Tolentino filing his Senate Bill 1408 expanding the Department of Health’s quarantine authority from its present travel based scope to one that allows quarantines as in the present community spread scenario. 

In the United States, the primary quarantine authority belongs to states and local governments. Let’s not add to the uncertainty that feeds the panic. Quarantine vs isolation are terms with distinct meanings though used interchangeably. Quarantine typically refers to the separation of individuals exposed but not yet ill from others not so exposed. The graver term Isolation refers to the separation of the infected from those not infected.

Public health authority derives from the grant of police power. In the Philippines, this is delegated to local governments through the general welfare clause (GWC). Aside from the GWC, the Local Government Code (Code) further vests each municipality, city, province with the direct power to “approve measures and adopt quarantine regulations to prevent the introduction and spread of diseases.” This is their actual quarantine power, by law.

Our Philippine Integrated Disease Surveillance and Response recognizes that primary quarantine authority is local within their jurisdictions. ”It is the primary responsibility of local government units to manage epidemic investigation and response. However, the next higher level will continue to exercise its technical oversight functions.”

The municipal/city health office can declare an epidemic if it has a functional surveillance system. Pursuant to the rules and regulations implementing the Code, the Department of Health (DOH) has the power to reverse or affirm any such declaration by LGUs. The DOH has sole authority to declare epidemics of national concern. 

Under existing law, the national government’s role is to arrest the indiscriminate spread of communicable diseases but the involvement of the LGUs at the frontlines is critical. PRRD, once a mayor, sees this relation very clearly. 

Keep calm. But overlaps and conflicting mandates should be handled. The Constitution and our laws continue to exist to serve as control measures for overreach. If government response should require emergency expropriation, for example, the eminent domain power is not suspended. Otherwise, there will be an outbreak of public loss of faith, just as worse. Panic is just one of its symptoms and the uncertainty will not help any in making us feel safe. 

It is essential also to avoid stigmatization. One of the areas where coherence is essential is in speaking with the same voice. This is one area where the DOH, the Philippine Medical Association, and the different private hospitals must get with the WOS program.

According to the WHO, stigma: drives people to hide the illness to avoid discrimination; prevents people from seeking health care immediately; discourages people from adopting healthy behaviors.

Good Optics. Four of the five most senior Senators, Vicente Sotto III, Franklin Drilon, Panfilo Lacson and Richard Gordon (Ralph Recto would have rounded out the group) trooped to the Supreme Court to file their petition questioning the Senate’s exclusion from the Visiting Forces Agreement abrogation. No high hopes for this Hail Mary as the Supreme Court can say that the Senate is just engaging in good optics rather than actually contesting the abrogation. There was no vote expressing a sense of the Senate against the abrogation. Rather, all they have in hand is a request that PRRD reconsider his action. No issue for the Court to resolve.