Preparing for the next one

This pandemic is far from over, and yet talk already abounds about the next one.

For the Philippines, confronting the devastation of COVID-19 has been more of a paralyzing shock, not having any first hand experience of pandemics for more than a century. Our collective memories are just illuminated by scant readings of what happened during the Spanish Flu of 1918 caused by an H1N1 virus, with genes confirmed to be of avian origin. By historical records, a conservative number of 80,000 Filipinos died then.

After the Spanish Flu, though, the Philippines has largely avoided any confrontations with a virus that has become an epidemic or pandemic. Our closest brush with one was with the human immunodeficiency virus (HIV), believed developed from a chimpanzee virus that transferred to humans in West Africa in 1920. We do have Filipinos who have contracted HIV, but the spread has largely been controlled today.

The Philippines has even been spared of the Asian Flu, a virus from birds, that originated in China and spread rapidly to Singapore, Hong Kong, and the US in 1957.

Still, disease outbreaks, epidemics and pandemics, notably from animals, have become more prevalent. In the first two decades of this century alone, the global scientific community had already identified several. The severe acute respiratory syndrome (SARS) from civets and bats broke out in 2003; the H1N1 swine flu pandemic in 2009; the Ebola epidemic of 2014 from bats; the Zika epidemic of 2015 from mosquitoes; and the current novel coronavirus pandemic that started in 2019, believed to have come from bats.

More spillovers

Zoonotic disease spillovers or animal-to-human disease transmissions have been flagged since the early part of last century as increasingly potential causes of pandemics. Since the 1940s, about three-fourths of the 350 identified emerging infectious diseases were of zoonotic origins.

The global health community, with the World Health Organization, continues to come up with more initiatives and measures to counter a pandemic that could have worldwide crippling effects since seven decades ago; COVID-19 apparently escaped them.

In the midst of all the issues that come with battling this pandemic, scientists are reviewing current protocols and drawing up lessons that will provide better answers to hopefully prevent the next one from becoming as disruptive as COVID-19.

The Philippines can no longer ignore the risk that come with zoonotic disease spillovers in a world with more porous trading borders, man’s growing preference for meat products, importations from other countries, and even a rising pet ownership trend.

We need to strengthen our network of scientists to pay more attention to what the global health professionals are tuned in to gain more knowledge about handling zoonosis, and preferably on how to prevent it from reaching our shores.

Impartial assessment

Before election concerns swallow our governance machinery, it’s time to think long-term about establishing a more permanent body that would provide the necessary guidelines in meeting head-on the effects of a future epidemic or pandemic.

An impartial assessment of failings in how we handled the spread of COVID-19 and its cost to the economy, as well as unique learning points, if any, should come to light. Clearly, we could have done better in many aspects.

One reader who wishes anonymity sent a letter that appropriately fits today’s column. Here are excerpts:

“The University of the Philippines has a College of Public Health. It is the SEAMEO Center for this discipline, and for this reason, a number of experts in Southeast Asia are trained there. Most of the students are medical doctors who are specializing in the control of pandemics.

“The fields of specialization covers epidemiology and biostatistics, policies and planning, microbiology, hospital management, environmental and occupational health or the core specialization in an epidemic such as what we have today.

“I am just wondering why they are not at the forefront in the control of the current COVID pandemic, with other disciplines filling the gap. Just to establish some public confidence, the experts from that college should be at the forefront at the national level.

“As of now, economic statisticians, cardiologists, cancer specialist, etc. are filling the vacuum on biostatistics, criminology for epidemiology, etc. Is it politics? Is it the dire need for pogi points for the next election?

Vaccine, natural immunity, and serology

“Serological studies are often done after an annual disease season such as flu to determine the extent of infection in the general population, the mortality, morbidity, and seriousness of the diseases. For example in the 2019 flu season, some 35.5 million Americans had flu antibodies, but only 16 million went to see a health care provider, 400,000 had to be hospitalized, and 34,000 died.

“Antibodies (not antigen) are generated by the body after the infection, as part of the natural defense mechanism. Vaccines are artificial substances that stimulate the production of anti-bodies and prevent or minimize infection.

“Since COVID-19 has been around for more than a year now, a serology study would be very helpful to determine the extent of the infection in the general population, the morbidity, and mortality rates. Considering the recovery dates, it would also give an indication as to how long the anti-bodies stay in the system. Is it six months, it is a year, etc.?

“Just like a vaccine, antibodies do not guarantee freedom from infection or reinfection, even if the antibodies are present. It would certainly be higher than vaccines that are only 50 to 60 percent effective. Sometimes it is difficult to understand why a recovered patient needs vaccination if he has sufficient antibodies.”

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