A humanistic and adaptive approach

The conflict between Cebu Province and the Interagency Task Force on Emerging Infectious Diseases (IATF) on testing and quarantine protocols for returning overseas Filipinos has been going on for weeks already.

From a scientific and teleological point of view, it is hard to debunk the effectiveness of a mandatory 14-day quarantine for overseas returnees. The protocol is based on the science of how the coronavirus spreads. It is very possible that a returning passenger may have been exposed to someone with COVID-19 at the airport of origin or on the plane.

While all know that science over politics or whatever else should dictate our policies on the pandemic, there may be other ways of looking at the solutions to this crisis. In the words of Marcus Foth, Glenda Amayo Caldwell, and Joel Fredericks, “the positivist, global, and clinical approach must be tempered with realism and the experiential.” Their work entitled “A COVID-19 Horizon Scan Looking for Post-Pandemic Implications for Design” was documented in the Proceedings of Cumulus Roma 2021 – Design Culture(s).

This, I think, is where Cebu Province is coming from. The province has passed an ordinance mandating a swab-upon-arrival policy where the 14-day quarantine may be continued at the returnee’s home or locality if he or she is found negative of the virus after one or two days. It cements Executive Order (EO) No. 17 issued by Cebu Governor Gwen Garcia last March 30. The EO considers as impractical and too expensive the IATF requirement of holding up returning overseas Filipinos in designated hotels and swabbing them only on the fifth day after their arrival.

Indeed, a more effective pandemic response must consider the local context and adaptations in order for health directives and strategies to work in the long term. Without a solid understanding of how to tailor and adapt to local nuances and specificities, health directives and control measures are at risk of failure, wrote Foth, Caldwell, and Fredericks. “Science and the humanities disciplines together can make a difference and beat this pandemic.”

Cebu-based infectious disease specialist Dr. Bryan Albert Lim has a more practical elucidation of this perspective. I follow Dr. Lim’s posts on social media because of his science-based perspective with a humanities angle.

In his June 9 post, Dr. Lim said that the border control issue is a good example of trade-offs and risk mitigation. While the IATF policy is able to capture more strictly possible COVID-19 cases, such policy can be quite costly to all parties at a time when the economy is also in crisis. Mental health issues can also arise especially in less-than-conducive facilities. The policy likewise ignores humanitarian emergencies involving sick relatives and other urgent family matters.

Some of these concerns can be addressed through mitigation strategies like preparing the quarantine facilities so that these settings are not only clean and safe, but also are strictly monitored for any violations. However, some issues remain unresolved like the high cost of the program.

On the other hand, the Cebu Province strategy of test upon arrival has its advantages too. “Wait for the results in a hotel, and if negative, continue quarantine at home, and repeat RT-PCR on Day 7, and if negative, still complete 10 days home quarantine.” This is cheaper for the government or the returning overseas Filipino. Mentally, it is also good for the returnee because he or she is already at home and can attend to concerns remotely. However, it’s possible that home quarantine may not be strictly observed. Vulnerable family members can get infected. “If more infectious variants are present, this can easily lead to outbreaks,” Dr. Lim said.

So in this scenario, we must strengthen community-based response. “The barangay captains must be held accountable for any breaks in home quarantine. There should be a means to monitor compliance to home quarantine. There should be a working, efficient, and responsive Emergency Operation Center (EOC),” Dr. Lim said. If there are potential leaks in the system, the EOC must be able to trace and isolate efficiently. “Without the EOC, it can be disastrous. This should only be applicable to returning residents and not for those entering just for transit.”

“Regardless of what strategy is chosen, our leaders must acknowledge the risk and MUST ensure that the mitigation measures are ready and monitored to manage the inherent risks,” Dr. Lim said.