The grass is always greener

The Lancet, the world’s definitive peer-reviewed journal of the medical profession, has adjudged our COVID-19 performance to be in the “medium” rate of transmission category (30-50 new cases per million per day). This August, we averaged 37.5 daily infections per million. The list was released as part of the Lancet COVID-19 Commission statement on the occasion of the 75th session of the UN General Assembly. We are at 66th place out of 91 countries with “sufficient data” available.

The Lancet statement pointedly references President Duterte (with Presidents Donald Trump of the US and Jair Bolsonaro of Brazil) as case study of the “medical populism” style of political leadership. This purportedly accounts for a country’s failure to suppress the epidemic.

This denunciation has raised the hackles of presidential ppokesman Sec. Harry Roque. He ripostes that the COVID-19 response of the President and the IATF have been guided by science and hard data.

Between the lines. Like many who try to come to terms with our depressing numbers, I am not blind to the greener grass on the other side. We far outpace other ASEAN nations in infections. How and why has it come to this?

I reached out to my good friend, top vascular surgeon, professor and scientist Dr. Ricardo DT. Quintos to unravel the mystery. His hypotheses were numerous and profound. I struggled to keep pace with the scientific explanations. But one factoid he pointed out resonated with my own humble understanding. I remember discussing it here, as early as March 21, 2020, barely a week into the ECQ.

He agreed that, so far, the only real clue we have is population density. Not the number of people per se, but the number of people per square kilometer. Areas with very high population density show a high infection rate. We have high density not during work hours but after work, when we all go home. Coupled with stay at home rules honored more in the breach, community transmission happens at home from asymptomatic carriers rather than at workplaces. Anecdotally, this is what hospitals are seeing.

Other ASEAN nations may have high populations also. But they do not have the elevated population densities in certain regions as we do.

World’s densest. In this column space six months ago, I noted that a TIME magazine special report on the 10 fastest growing cities of tomorrow referred to Metro Manila as the “world’s most densely populated city.” Last 2019, a USA Today article identified Manila as one of the most densely populated cities in the world. United Nations data alternately places Manila as either No. 1 or No. 4 worldwide.

It is with this lens that I approach the comparison with the grass on the other side of the fence. Even a cursory search online will provide contrasts between our metropolitan capital and those of our ASEAN neighbors. Per the Philippine Statistics Authority (2015), the National Capital Region has a population density of  20,785 people per square kilometer (p/km2). Its densest city is Manila at 71,263 p/km2.

Contrast this with our neighbors’ numbers. The population density of Greater Kuala Lumpur is at 2,708 p/km2; Bangkok Metropolitan Area is at 5,578 p/km2; Hanoi, 2,300 p/km2; Phnom Penh, 5,344 p/km2; Vientiane, 5,250 p/km2; Yangon, 12,308 p/km2. Their countries – Malaysia, Thailand, Vietnam, Cambodia, Lao PDR, Myanmar – have suppressed the epidemic this past month. All are at five or fewer cases per million.

The metropolitan city that closest approximates Manila’s density is Jakarta at 14,464 p/km2. Indonesia, we know, has been paralleling our own “dismal” performance. For this month of September, Indonesia has even outpaced us and is within the Lancet medium range of transmission.

Starting from behind. The Philippines and Indonesia are handicapped by the disproportionately greater population density in their metropolitan areas relative to their closest neighbors. Of 2,180 new infections we recorded two days ago, 802 came from NCR.

We are two of the great archipelagic states of the world. This is a blessing as islands have a natural barrier to COVID-19 spread at the choke points of their port systems. Strict internal travel protocols should slap down any recalcitrant virus. Landlocked nations have more difficulty owing to their myriad points of entry. But the archipelagic shape is also a curse because once the virus gets in, the same topological considerations and strict protocols would operate to keep it contained to wreak havoc.

What now? Much remains to be done. Even on basic non pharmaceutical interventions like contact tracing, we are still in flux. The government has just announced that facility-based isolation shall now be required even for confirmed asymptomatic and mild COVID-19 cases.

From the discussion on density, we could use more input from the agencies responsible for building/housing safety. There appears to be no “unified” standard for building/housing safety against the virus. We just observe general guidelines. The different structures have their own respective ways of entry, temperature checks, workspace or home space sanitation. Businesses limit customer traffic but home density is not surveyed or inspected.

Urban density regulatory initiatives were, once upon a time, considered in connection with carrying capacity of basic services like water and power supply, traffic flow, garbage and sanitation, safety and security, etc. Urban density regulatory reform, national and local, is now all the more urgent as the pandemic portends survival connotations.

Out of the box. We hear decongestion proposals such as offering temporary relocation of overly dense living areas to less dense housing projects. Also, the support for travel and temporary stays in less dense home provinces. Senator Bong Go’s Balik Probinsiya program is a landmark effort in this direction.

We should also encourage outdoor activities for as long as physical distancing is observed. The “Boracay-ization” of Manila bay was a great idea with the intention to get people out in areas with lesser virus loads. There is still time to improve on the disastrous implementation of this white beach visiting policy.