Losing track

New COVID case numbers may be going down, but foot traffic in many commercial centers remains low. And it may take time before many people venture out of their homes for anything other than essential errands and onsite work.

The reason is the uncertainty over the actual COVID situation in Metro Manila and the rest of the country. We are losing track of actual infections, recoveries and deaths.

Even the OCTA Research Group, which uses official government data in its consistently accurate projections, may soon find itself flying blind because of the insufficiency of relevant information.

People are self-testing, isolating at home and resorting to self-medication, without informing authorities about their health status. COVID deaths – which require immediate cremation of the remains, with the bereaved not even allowed to open the body bag – may no longer be reported as such to authorities.

If wakes are being held for those who succumbed to COVID, against public health safety protocols, there is also a strong likelihood that people who know they are infected but have only mild symptoms are no longer isolating, out of necessity or irresponsibility, and are mingling outdoors with the public.

So people including the fully vaccinated and boosted are staying home to avoid infection, waiting for the Omicron storm to blow over. And this won’t happen when the government says so, but when people stop seeing relatives and friends, and hearing of friends of friends, catching Omicron.

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Since the start of the month when Omicron put an end to the short-lived freedom of the 2021 holiday season, I have personally known at least 15 people who caught COVID, or who were forced to isolate as the virus raced through their households.

Those who got infected had three things in common. One, they were all fully vaccinated (with different brands), with several boosted. Two, all had symptoms that lasted for only about five to seven days and were mild enough to allow them to isolate at home.

And three, because the symptoms were mostly just like a bad cold or mild flu, they underwent antigen tests and saw no need, when they tested positive, to get confirmatory RT-PCR tests.

They simply isolated from the other members of the household and took common medications for their cold symptoms, slight fever and body aches, sore throat and cough – the symptoms generally associated with an Omicron infection. Some did tuob or steam inhalation; others took the Chinese medication for mild COVID cases, Lianhua Qingwen.

The only ones who underwent RT-PCR testing to get a negative result after their isolation were those who needed it to return to onsite work.

It’s uncertain if the RT-PCR laboratories reported them as COVID recoveries and were included in the report to the Department of Health. What’s certain is that their antigen test results, some of which were self-administered at home, were not reported to the DOH or to the barangay.

The persons I know mostly live in houses that allow home isolation and are responsible enough to remain under quarantine during the period prescribed by the DOH.

But what is the situation in cramped low-income households that are hit by the highly contagious Omicron variant?

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Breakthrough infections among the vaccinated tend to be mild, except for the elderly and those with serious comorbidities. If the symptoms are manageable, there is less urgency to be tested, whether through RT-PCR or antigen.

Even if the local government unit offers free testing, there are persons who worry about being forced to go on quarantine if they test positive, or to have one’s home placed under granular lockdown. Daily wage earners with no work-from-home arrangements worry about losing income for even one day. Several vaccination holdouts have cited this as their reason for not getting their jabs, along with their inability to register online.

Concerns about one’s residence being placed under lockdown deter people from reporting positive antigen test results, even if their houses or condominium units are spacious enough for home isolation.

For those who can’t afford to skip even a day’s work, mild symptoms may be brushed aside. Many offices and establishments now send home any employee who manifests even mild flu-like symptoms. But this is still not a universal practice, and there are no such rules in the informal sector.

With contact tracing nearly non-existent and with testing inadequate and underreported, the infected can freely mingle outdoors.

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Epidemiologists say Omicron symptoms can emerge as early as 33 hours to three days from infection, compared to the four days for Delta and five to seven days for the Wuhan original strain. The person is infectious two days before the Omicron symptoms emerge and three days after.

With Omicron now the dominant COVID variant of concern, infected persons can spread the virus before they decide to undergo testing and get the result. Those they have infected but are asymptomatic can continue their routines, taking public transport, going to work or to the wet market or supermarket.

By the time the infection is detected in the original patient, an entire household or office may have been been infected and may have to be temporarily shut down.

So those low or plateauing infection numbers may be way off the mark.

Health officials say the low hospitalization rates tend to bolster the deceleration of the contagion. Most mild and even moderate cases, however, are opting for home isolation, not only because it’s cheaper, but also because hospital confinement for COVID can be extremely distressing for the patient’s mental health.

So hospitalization rates may also not accurately reflect COVID prevalence. Some doctors are reporting a spike in pediatric COVID cases in their hospitals. Minors are still mostly unvaccinated, and Omicron, unlike the original Wuhan virus and previous variants, has shown a stronger capacity to infect children of all ages.

With worried parents confining their children at home (together with vulnerable lolos and lolas), business will remain slow, until people believe the government has a firm handle on the real COVID situation to safely ease restrictions.

Now that the Food and Drug Administration has approved two self-administered rapid antigen test kits for home use, their use is likely to increase. And more results are likely to elude the DOH radar.

The government cannot afford to lose track of the cases.