How 20 infectees can fast become 51,000
GOTCHA - Jarius Bondoc (The Philippine Star) - May 1, 2020 - 12:00am

A second wave of COVID-19 infections can ensue after lifting of the Luzon lockdown. Indiscipline and ill-preparedness can worsen epidemic. With hospitals unable to cope, healthcare will collapse. More will die. Other countries already are staggering from such resurgence.

By way of warning, infectious disease specialist Robert Dennis J. Garcia explains the numbers. Only 20 infectees can multiply to 51,000 in just one month in one city alone. Last week Dr. Garcia prescribed ten preparations for policymakers. Foremost, every province, city and town must build and fund a quarantine facility for mild asymptomatic cases, to free hospital beds for severe ones (see Gotcha, https://www.philstar.com/opinion/2020/04/24/2009410/filipino-health-workers-getting-infected-amid-ppe-shortage). In a second post this week Dr. Garcia illustrates the duty of each citizen as well.

A graduate of University of Santo Tomas School of Medicine-Manila, Dr. Garcia took fellowship at Massachusetts General Hospital-Harvard Medical School. Residency training: Georgetown University Medical Center and Howard University Hospital. He mastered in health services administration at George Washington University School of Business. He heads the pediatric infectious disease sections of Makati Medical Center and Cardinal Santos Medical Center. Condensed with permission:

“The Philippine lockdown has been quite successful. What should we expect when it is lifted on May 15?

“We had 7,579 cases as of Apr. 26; 285 new. The US had 965,910 cases; 30,000 new per day. The US had one case on Jan. 23, and as its lockdown was not across the 50 states, it did much worse than us, with its population three times ours. Our 200 cases per day of 110 million is very low; we cannot realistically achieve zero.

“The government extended the lockdown to May 15 because LGUs, hospitals, healthcare system, and education of people are far from ideal.

“We need to continue educating everyone that COVID-19 has high infectivity (ability to invade), high pathogenicity (causing overt disease), and high virulence (serious disease and death). Polio virus has high infectivity but low pathogenicity and virulence; only a fraction develop paralysis; a big proportion of our population has immunity; we continue to vaccinate. No immunity and vaccine for COVID-19.

“What happens after May 15, when enhanced community quarantine is lifted in Metro Manila? What happens if a city like Pasig has 20 contagious infectees that date and they go out without masks and physical distancing, given these data:

“(1) COVID-19 median incubation period = six days;

“(2) Reproduction, or number of secondary cases arising from one index case = 2.5 persons;

“(3) Manifestations: 80 percent mild, 20 percent will need hospitalization (China data); seven percent will die (Philippine data);

“(4) How will the 20 contagious infectees grow over time?

“May 15: 20 cases;

“May 21: 20 + 50 = 70;

“May 27: 70 + 125 = 195;

“June 3: 195 + 313 = 508;

“June 9: 508 + 783 = 1,291;

“June 15: 1,291 + 1,958 = 3,249;

“June 21: 3,249 + 4,895 = 8,144;

“June 27: 8,144 + 12,238 = 20,382;

“July 3: 20,382 + 30,595 = 50,977.

“(5) If, of 50,977 cases by July 3, 20 percent will need hospital care, that’s 10,195 for Pasig City alone.

“No Philippine city will have 10,000 beds for such demand over six weeks. The hospital system will collapse. Only way to prevent the above scenario is for us to have discipline to decrease the viral spread when lockdown is lifted. Best efforts, to prepare, equip, and boost capabilities. The healthcare system needs quarantine facilities in each town and city as hospital extensions.

“After the lockdown we must have a mindset that:

“(1) Our home is our fortress.

“(2) Every time I leave home, my and my loved ones’ lives are put at risk; I must have good reason to leave, and be protected: disinfectant in my bag, mask and eye shield.

“(3) Anyone I encounter may have asymptomatic COVID-19.

“(4) If I feel sick I will not leave, promptly inform my workplace, and seek medical evaluation and treatment.

“If we are undisciplined and healthcare is improperly set up on lockdown lifting, the scenario is: infection rates sharply rising after four to six weeks; hospitals and quarantine facilities unable to cope; deaths in large numbers; government is forced to relock down. Open-close lockdown can go on in three to four cycles, until a vaccine is available in one-and-a-half years.

“We are Asians. Let us be educated and disciplined like the Taiwanese and Koreans. Our healthcare is unlike theirs. Still discipline, as a people, will get us through. Each person, town, city, and province should regard the other as part of a chain – each link depends on the next. Only if we work as one family of Filipinos can we survive crisis.”

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Gratitude to Bloomberry/Solaire for more than 125,000 sets of personal protective equipment donated to public hospitals. PPEs are basic in shielding doctors, nurses, and lab technicians from infection as they handle COVID-19 patients and emergencies. Chairman Enrique K. Razon and vice chairman for construction and regulatory affairs Donato Almeda reserved a PPE shipment for Philippine Navy station hospitals. The Navy continues to guard territorial seas and maritime jurisdictions during the pandemic.

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Catch Sapol radio show, Saturdays, 8 to 10 a.m., DWIZ (882-AM).

My book “Exposés: Investigative Reporting for Clean Government” is available on Amazon: https://www.amazon.co.uk/Expos%C3%A9s-Investigative-Reporting-Clean-Government-ebook/dp/B00EPX01BG

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Gotcha archives: www.philstar.com/columns/134276/gotcha

COVID-19 ROBERT DENNIS J. GARCIA
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