Paroxysms of fear of new COVID surges

It would be a fatal mistake for people to believe the fight against the coronavirus diseases 2019 (COVID-19) pandemic is over and done with. With many indoor and outdoor activities back to their usual ways, it would be sheer folly to throw caution out the window.

The COVID positivity rate started to climb to 5.9 percent on June 25. It breached the allowable positivity rate of five percent following the standards set by the World Health Organization (WHO). Subsequently, our Department of Health (DOH) reported on June 27 a 53 percent increase in COVID-19 cases in just one week. All these coincided with the finding that there have been community transmissions in certain parts of the Philippines of the more transmissible Omicron sub-variants.

To date, there have been over 3.7 million cases of COVID-19 infections in our country. If it is any consolation, our country still has less than one percent of the total number of casualties at over 60,500 COVID-related deaths. However, the economic impact to our country has been heavy as well. It is only just the past few months that we are seeing a turnaround of the Philippine economy.

If the number of new cases continues to rise in the next few days, there is a distinct possibility that Alert Levels might again be raised. It would indeed be to the detriment of us all if it should happen. What then?

We have to make sure we do not just move in a never-ending cycle of tightened and loosened restrictions. We have to make our recovery and growth resilient. While there may be a renewed rising number of COVID-19 cases, at least 70 percent of the country’s 110 million population has already met the so-called “herd immunity” target by the WHO standard.

During the national convention of the Philippine College of Chest Physicians that delved into “Innovating with the Speed of Need in COVID and Flu” held last March, doctors appealed early on against complacency and urged the government to aim for a more aggressive vaccination program to really get ahead of the virus. Pulmonary medicine specialist Dr. Ralph Villalobos of the University of the Philippines-Philippine General Hospital (UP-PGH) warned that COVID and influenza and its complications are here to stay. He called upon health authorities to manage respiratory infections as we return to normal life.

Dr. Jubert Benedicto, chairman of the Critical Care Unit Management Action Team and vice-chair for Patient Service, Department of Medicine, UP-PGH, also echoed the WHO warning on the co-circulation of COVID-19 and influenza viruses. This is especially tricky since the diseases can normally be present in a similar manner and only testing can distinguish between the two.

Similar to COVID-19, influenza (or more commonly known as flu) is a contagious viral infection that can cause mild to severe symptoms. Like COVID-19, severe case of flu might likewise result to life-threatening complications such as pneumonia. The best line of defense to prevent flu is also through annual vaccination. However, once the flu virus is acquired, the treatment of anti-viral medications can reduce the exacerbation of symptoms.

In that same medical convention, Dr. Rontgene Solante, chairman of the Adult Infectious Disease and Tropical Medicine Department and Fellowship Program at the San Lazaro Hospital, identified the various treatment options for influenza. Among these anti-viral medications recommended for influenza treatment, he enumerated, are oseltamivir, baloxavir, zanamivir and peramivir. They have no significant drug-to-drug interactions with COVID-19 drugs, especially with tocilizumab, remdesivir, or any drugs like steroids.

The baloxavir in particular has reportedly been proven effective and well tolerated in otherwise healthy patients. Based from published clinical studies, it is also found to be effective in high-risk patients in a Phase III trial conducted globally. It is associated with fewer complications.

For COVID, monoclonal antibodies available in local drugstores like generic medicines casirivimab and imdevimab were granted emergency use authorization (EUA) by the Food and Drug Administration (FDA) of the Philippines. The drug has been proven to prevent as high as 50-60% among patients from developing severe infections, Dr. Solante cited.

(Note: The drugs mentioned are prescription medications. Please consult your doctor for further information.)

As for the next possible surge in COVID-19 cases, Dr. Solante reiterated the need to get vaccinated, including getting jabbed with booster shots, to really significantly improve protection.

But what does a return to “normal” – or a new normal – really look like from a medical point of view?

Dr. Anna Ong-Lim, associate professor and attending pediatrician at the UP-PGH and current president of the Pediatric Infectious Disease Society of the Philippines mentioned that two conditions must be present. First, more people should be vaccinated. And second, the virus should “cooperate” and not mutate so that the protection we get from these vaccines would hold.

She cautioned anew the people from taking antibiotics at once if they experience flu-like symptoms. This is because a recurrent exposure and sub-optimal treatment can contribute to drug resistance, she explained. “This can lead to other health threats and be a contributor to the next pandemic,” she added. “We will shift from a pandemic emergency response to a mindset that thinks about COVID-19 as something that will stay and learning to live with it to the best extent possible,” she urged the public.

Malacanang announced last Monday that newly installed President Marcos decided to maintain for now the Inter-Agency Task Force on the Management of Emerging Infectious Diseases (IATF-MEID) while COVID-19 pandemic still lingers on.

So, on the question on whether we put on hold our lives again if the number of cases continues to climb in the next few days, most probably no. Only with an abundance of caution we can prevail over these paroxysms of fear over the recurrence of COVID surge.