The endgame according to experts

When will this ever end? That is the perennial question of many people about the pandemic.

In reality, herd immunity is the only possible endgame of the COVID-19 pandemic, whether that be through vaccination, natural infection, or a mixture of the two. That is according to experts like Dr. Theodore Lytras and Dr. Sotirios Tsiodras in their commentary entitled “Lockdowns and the COVID-19 pandemic: What is the endgame?” published in the February 2021 issue of the Scandinavian Journal of Public Health.

Unlike Ebola and SARS-COV-1, SARS-COV-2 which causes COVID-19 is highly transmissible. And its transmission is mostly invisible due to the large degree of asymptomatic or mildly symptomatic cases. It’s a treacherous virus that spreads silently among people, with the number of severe cases large enough to overwhelm the healthcare system.

As a result, we have in our midst a double pandemic. The first one is the pandemic of COVID-19. The second one is the pandemic of untreated cardiovascular and other diseases which otherwise could be managed in normal times if not for an overwhelmed healthcare system. That is actually where all the worries about this pandemic come about. Until we have clear overall strategy for the management of the COVID-19 pandemic, we will all continue to be affected by the uncertainty of this pandemic.

So, is there an endgame? There is. But contrary to most expectations, the endgame is not the vaccine per se.

Allow me to digress with some recollection. Had China been transparent to the world and had acted quickly in containing the virus at its source in the early stages of the outbreak in Wuhan, we would not have gotten to this extreme situation. Had most countries followed the way of Taiwan and Vietnam which quickly closed their borders and set up contact tracing and testing protocols, we would not have this global crisis.

Had the Philippines, in particular, calculated the short-term cost of closing its borders and setting up a comprehensive contact tracing and testing regime early, as against the long-term cost of reacting only with lockdowns when the problem is already staring us in the face, the country would not have been the worst performer in COVID-19 response in Southeast Asia with a 9.6% GDP contraction in 2020.

Now that we have the vaccines against SARS-COV-2, it may already be too late for the vaccines to alter the course of the pandemic substantially, according to experts. That means vaccinations might have to be repeated in order to sustain immunity levels against new variants.

I’m not here to frighten you or dash your hopes for a solution to this crisis. My job is to help you with the right information from the right people whose painstaking works are helping us get through this crisis.

Among these people are the Healthcare Professionals Alliance against COVID-19 (HPAAC). The group called on the government to set up an integrated ICT infrastructure that will help in contact tracing and testing, and provide reliable data for the management of the crisis. HPAAC also suggested that we must not hold back on investments in testing, contact tracing, and providing social safety nets for the most vulnerable sectors.

When we lifted the lockdowns last year after it brought down infection rates to manageable levels, we should have had put in place already the infrastructure for large-scale testing and contact tracing. But that we failed to do.

We subsequently failed to control the infection because the virus transmission remained largely undetected. We increased testing capacity but testing can only be effective when combined with case isolation and exhaustive contact tracing. Digital contact tracing, like what they have been doing in Hong Kong, could have been a cheap and simple solution, but even that we couldn’t do right.

Our public transportation and public service systems are diametric contradictions to our call for people to observe physical distancing. Physical distancing measures remain largely in the realm of rhetoric.

Herd immunity through vaccination is the endgame of the pandemic. But we may not reach that point if variants of the virus keep on emerging because we failed to manage the infection to a low and stable rate. We must upscale contract tracing alongside laboratory testing capacity to cover those identified as risk areas during the contact tracing.

Knowing where the outbreaks are helps us bring the infection under control while we wait for the vaccination to put an end to the pandemic.