Raising the bar

SEARCH FOR TRUTH - Ernesto P. Maceda Jr. (The Philippine Star) - May 23, 2020 - 12:00am

Our health workers COVID-19 infection rate is one of the highest in the world. In our region, WHO-Western Pacific comprising 37 nations (including China), the average is two to three percent. The Philippines tops it at 17.2 percent as of May 21. Of our 13,434 recorded total infections, 2,315 were of health workers. 

The IATF/DOH announcement that a lesser number are getting infected because of distribution of PPEs is silver lining spin. Only one health worker death this month of May yet the Alliance of Health Workers continues to dispute the DOH data. They note that last April 8, there were only 252 infected.

For whom the bell tolls. As the WHO expressed, this trend is “very worrisome.” It is alarming for at least two reasons. First, we’ve taken to lionizing them as heroes for manning the line. Thus, every health worker downed is a gap in our defenses. Second, and more importantly, the protection we give them is emblematic of our capacity to protect everyone else. In this, we’ve been weighed and found wanting. WHO calls this is “an indicator of what lies ahead for the country’s healthcare system.”

Our ECQ, one of the longest worldwide, was intended to buy time; the opportunity to pay extra attention to improving capacities. Raising the bar in this context means supporting these men and women who serve above and beyond the call of duty. Guarantee them the best chance to safely do their jobs. Attend to their issues of lack of protective gear, inadequate testing, stretched schedules, non-observance of conditions of employment and access to mental wellness resources, and capacity building. Health workers’ health is the metric that, above all, should rouse decision makers to action. 

Politics, per Laswell, is who gets what, when and how. Economics is concerned  with the efficient allocation of scarce resources. When you can’t please them all, the operative word is prioritize. 

Prioritize also testing as a strategy. To test or not to test has been the week’s narrative. Both public (represented by Congress) and private sectors (everyone else) are clamoring for mass testing and explanations on our lag. A “whole of society” audit, if you will.

No mass, no mass. But the official line per Presidential Spokesman Sec. Harry Roque and the DOH is that it is not cost effective to do mass testing. The goal is to test up to two percent (around 2.2 million) of the population only, selectively. For epicenters like Metro Manila, the target is up to 10 percent (around 1.3 million).

Rep. Stella Quimbo supplies the best perspective in riposte: testing around 10 million Filipinos would cost the government P9 billion compared to the country losing P18 billion per day of lockdown. “It’s never about the budget. A cost-benefit analysis informs a budget decision. But the budget itself is never a parameter in a cost-benefit analysis. In other words, if there is an activity, like mass testing, which is not costly but the benefits are huge, then you find the budget for that.” 

MVP move, Rep. Quimbo. The Last Dance Michael Jordan documentary, for all its virtues, resonated for gifting my generation with the chance to bond with our sons over sport metaphors and sport as metaphor. MJ’s work ethic and leadership style allowed him to compete on the highest stage and to consistently dominate. This proactive find-a-way-to-win attitude is manifestly Jordanian and exactly the raise the bar mentality we need to prioritize and respond better.

Race to trace. Sec. Harry was also right. No country can afford to test all the citizens, all the time. The method of targeted or expanded testing, rather than the madness of blindly casting fishnets, is the only realistic approach. The standard is risk-based. Test only those with: symptoms, exposure, travel. But for all these categories, we should trace all contacts and test them, too.

Contact tracing and testing is the fastest way to identify and isolate asymptomatic positives, far better than systems that wait for symptoms to develop. Properly pursued, this helps keep much of the infection out of the general population. 

Tracking down everyone is a fantasy just like social distancing in a prison. Ultimately, the proportion of the population requiring isolation will make testing and tracing unmanageable and inutile in keeping pace with the contagion. However, the record attests that countries with sustained tracing and testing programs still have lower mortality rates. Every life saved means at least one less in the last count.

I want you. DOF is hiring an army for contact tracing. All hands on deck. Tracers work with positive patients to help them recall contacts: who and when. Then monitor accordingly.  

It won’t be easy. As is normal, most is done virtually, through calls or texts. The ideal hire would be those with backgrounds in customer service, public health, medicine, data entry, and interviewing skills. The Associated Press tags them: detective, nurse, confidant. Webinars and online learning platforms will be the way forward for certification. Already, the DOH and the UP College of Nursing have developed online courses for LGU capacity building in contract tracing.

Cautionary co-morbidity. Diabetes is in the lineup of existing illnesses that diminish your chances against the virus. The blood of a diabetic has been likened to Treacle (or Molasses). High blood sugar levels slow the immune system’s defense in responding to COVID-19. 

Dr. Hajira Dhamba Miller paints the scenario: ‘Physically, it’s harder for the immune system to get to the virus. The virus bugs do a lot of damage before the immune system even realizes it’s there. When the body does kick in, it won’t work as it should do. The immune cells are damaged because they’ve been saturated in sugar for years and don’t work the way they should.’

Testing dashboard. As of May 18, we hit 11,127 swab tests in a day. According to the IATF, we’re now supposed to be at 14,500. Let’s raise the bar and hit the 30,000 daily count by May 31.

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