‘Household risk’ for COVID-19

Ask anyone who has caught COVID-19 in recent weeks about how they got it. They are likely to say “it entered my household.” They will also tell you that some had mild or no symptoms, and others in the family were incapacitated for a few days and continued to have symptoms way over the seven-day isolation.

We sighed with relief when we found out that Omicron BA.5 results in less severe symptoms compared to the other variants; however it is highly transmissible. While that sounded better, in reality what has happened is that people have been programmed to think less about what could happen to their families, and more about their individual risk.

Using the principle of “individual risk” is a Western notion in public health prevention. This is probably because Western societies are individualistic. Western public health prevention programs – that we tend to copy – focus on what “a person should do” to stay healthy. But in our context in Asia and the Pacific, prevention must be grounded in collective action and “taking care of each other” – rather than just “taking care of myself.” This is why approaches to public health prevention that rely on the principles of “individual behavior change” have not resulted in better public health outcomes for the public health challenges of the Philippines today.

Take tuberculosis for example. We have at least a million active cases every year, with about 70 deaths every day. We have gotten to this disastrous level of tuberculosis using an individual risk approach. When we diagnose one person with tuberculosis, shouldn’t our health teams check the whole family, look at household ventilation and nutrition, even check the workplace? No, we just treat the individual patients – and send them back to the conditions that made them sick in the first place.

Take hypertension as another example. A fourth of the adult population, possibly 17 million Filipinos, are hypertensive. This does not include 32 percent of those with hypertension who drop dead without knowing their blood pressure. Then there are the 5 million Filipinos who know they have hypertension, but take no medications. The yearly deaths from heart attacks are estimated at 100,000 that translate to roughly 274 deaths per day. When we have a death from a heart attack, shouldn’t we be taking everyone’s blood pressure in the family? Should we not be educating entire households about reducing salt and fat in the family meals? Should we not be encouraging household physical activity and recreation in groups?

Against this backdrop of co-morbidities from tuberculosis and hypertension – not to mention diabetes, asthma, cancer and the like – should we not be educating our people about household risk to COVID-19?

A big and resounding yes to minimum public health standards – mask wearing, social distancing, staying home when one is sick, handwashing. We already know that. But we need a household risk approach in our public health communication for Omicron BA.5 because of its high transmissibility.

Families need to understand their “household risk” and take care of each other, because of the co-morbidities that run into millions, and the presence of seniors in the home who are unvaccinated and at risk because of their age, and when there are children below the age of six – as Dr. John Wong of Epimetrics has recently reported – who have higher severe COVID and death rates compared to other age groups of children.

In 2021, WHO published guidelines on family approach; but in the context of Asia and the Pacific and its many informal settlements and poor housing conditions where multiple families live in under one roof, a household approach is more appropriate.

What are your household risks for COVID-19 when the variant is highly transmissible? The more of these you have in your living quarters, the greater your household risk: unvaccinated adults; unvaccinated children; seniors who refuse vaccination; adults who refuse boosters; a health worker who sees patients; an employee who uses public transportation; young adults who go to crowded areas; poorly ventilated house; cramped living conditions; working adults who refuse to stay home when they are sick; refusal to wear a mask at home when symptoms occur; household helpers who go home on weekends; anyone in the household who does not inform the others of possible exposure.

The way to survive this new wave of Omicron BA.5 is for the household to make sure that every eligible person is fully vaccinated and boosted. This has got to be a collective effort. We need to be responsible for each other – including the seniors who are refusing the shots. You are only as safe as the people you live with. If you answered yes to any of the above, it is time to have a household meeting and discuss your collective risk.

Omicron BA.5 is contagious and is notorious for “immune escape” – vaccination and previous infection is NOT a guarantee that you cannot get it. However, if you are fully vaccinated the likelihood of severe disease is minimal.

So why not just let everyone get infected and develop natural immunity? Well, the more this virus reproduces, the greater the chances it will mutate further. And who knows what the next mutation will be like?

I caught COVID-19 a few weeks ago from a household exposure. I’ve evaded this nasty bug in the community for more than two years through all the things an individual must do. But when it entered my household, there was very little I could do. I had fever, chills and vomiting. Couldn’t get up for a few days. Couldn’t eat. I have recovered well. But now into my fourth week, I occasionally feel a little weak and wonder what would have happened if I had not been fully vaccinated and fully boosted.

What WHO calls the “wall of immunity” has to start in your household. It is your responsibility to see to it that everyone is vaccinated and boosted and following minimum health standards. The consequences of continuing with an individual approach to risk are unthinkable – but we are headed in that direction unless we all reduce our household risk.

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Dr. Susan Mercado is co-chair of the National Panel of Technical Experts of the Climate Change Commission and adjunct faculty, National Institutes of Health, University of the Philippines, Manila.