Anti-fragility and lessons in preventing another surge

In the news yesterday was that the Cebu City Emergency Operations Center (EOC) is getting ready for another possible surge in COVID-19 cases.

Councilor Joel Garganera, EOC’s deputy chief implementer, noted that for the past four days, the city’s average daily positivity rate is 6.12%, a rate higher than the 5% threshold of the World Health Organization. The city’s critical care occupancy rate has also gone up the past few days, with public hospitals now at 39.2% while private hospitals now at 21.3%.

The number of active COVID-19 cases has ebbed and flowed since the start of the pandemic. This shows that people tend to get complacent and slide back to risky behaviors when they hear or read less-alarming news about the pandemic.

We were able to stem a further surge last March after having new daily cases in triple digits almost every day for over two months. The next few days will show if we can again prevent another surge.

One thing is going for us though, and that is we may have learned from the shocking experience we had last year when Cebu was dubbed the epicenter of COVID-19 in the Philippines. Our hospitals nearly got overwhelmed and many of us heard of friends getting sick or whose family members have died because of the disease.

Since then, we have taken pride in our ability to bounce back after that bad experience. Judging by the heavy traffic on the roads, Cebu’s economy has turned. The people are not letting this virus get in the way of their determination to carry on.

If we can sustain in keeping our COVID-19 numbers under control while getting the economy running to almost pre-pandemic levels, I would say that Cebu fits the description of what Nassim Nicholas Taleb described in his 2012 book “Antifragile: Things that Gain from Disorder”.

Taleb describes something that does not merely withstand a shock but actually improves because of it as “anti-fragile”. According to him, some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, stressors, love adventure, risk, and uncertainty. “Let us call it anti-fragile. Anti-fragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the anti-fragile gets better," Taleb states.

I believe that Cebu is capable of fitting into the description of ‘anti-fragile’ for two reasons; one, it has already seen possibly the worst in this pandemic; and two, there is that entrepreneurial and unrelenting spirit of the Cebuanos.

We just need to learn from our experience, as well, from the lessons of other cities that faced their own COVID-19 challenge amid their low vaccination rate. Hong Kong, in particular, is one such city. In a report by CNBC International, it identified five factors that resulted in Hong Kong defeating COVID-19 while avoiding a lockdown.

The first factor is masking. As early as January 2020, people in Hong Kong were already wearing face masks in public places. People there learned the lessons from the 2003 SARS outbreak.

The second factor is decisive yet rational border controls. Hong Kong tests arriving people from abroad immediately upon arrival, and despite a negative result, the returnee is still required to undergo quarantine for 14 days at home. It has set up a system that ensures that no returnee ever violates the quarantine rules.

The third factor is extensive contact tracing. When the authorities know who you were in contact with and where you’ve been after your arrival from abroad, they can quickly trace the possible clusters of infection and stop it right in its tracks. Anybody who has had contact with a confirmed case is also instructed to self-isolate. They put the identified cases in a map which is posted in the public domain where everyone can be warned to take precautions or avoid certain possible cluster areas.

The fourth factor is local scope. It’s easier for government to monitor its population because of its relatively small scope in terms of population and geographic size. Hong Kong can be likened to a local government which knows its population very well and can easily establish protocols that fit well within its local context.

The fifth factor is cultural habits. The people of Hong Kong know that all of them are part of the reason why they have controlled their COVID-19 cases. As a result, there is a greater degree of community cooperation.