ONE lesson from the severe acute respiratory syndrome epidemic of 2002-03 is that you cannot separate the right to health from the right to free speech. SARS was first detected in Guangdong province in China, and soon infected infected 8,096 people and killed 774 individuals in 37 countries all over the world. It felled its first victim, a farmer, in November 2002, but Chinese government officials?eager-beaver apparatchiks brown-nosing the local party chiefs?wouldn?t be the bearer of bad news, and restricted media coverage until February 2003. The international community would later castigate the People?s Republic of China for the undercounting of cases in its hospitals. The epidemic spread not for lack of doctors or medicine, but for lack of openness by the government, over-centralization and red tape, and state controls over the press.
Indeed, historically, the 1918 epidemic was nicknamed the ?Spanish Flu? although the first cases of the disease were registered in continental United States and the rest of Europe because Spain, a neutral country in World War I, did not censor news against the disease and its spread. Thus the most reliable news came from Spain, giving the false impression that Spain was the most?if not the only?affected zone.
We had a whiff of that dilemma recently, though much milder in scale and certainly less sinister. The Department of Health did not immediately inform the House of Representatives that the death of one of its staff members was due to the A(H1N1) virus. Health Secretary Francisco Duque III was quoted: ?[W]e couldn?t announce the identity beforehand because it?s our protocol, so the employees would not panic and so that we could do the contact tracing in an orderly manner? lest ?some [known contacts of victim] refuse to make a disclosure, or they would hide and avoid interviews.?
I can sympathize with the good secretary and wouldn?t place him in the same basket as the Guangdong commissars, but the case simply shows us that the epidemics are too important to be left to the doctors alone.
First, the figures can mislead. The World Health Organization?s latest figures report 21,449 infected persons in the United States, 6,457 in Canada, 2,905 in the United Kingdom, 2,857 in Australia, and 445 in the Philippines. The grand total of cases globally is 55,867; the epidemic has claimed 238 lives one of which came from the Philippines. The huge numbers for the First World countries may be due to their excellent monitoring and reporting systems?and in the case of the Commonwealth countries, to their public health insurance programs. The WHO itself has acknowledged: ?[W]e do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.?
Second, the sickness may also be in our heads. We are not guilty of underreporting a la the Orwellian Chinese but, on the contrary, of a reverse impulse so that no less than Education Secretary Jesli Lapus has used the newspaper headlines and appealed to schools not to suspend classes willy-nilly. It is a suspect fervor for a fever traceable to those who traveled abroad for their summer vacation. For your average ?Shallow Hal,? the virus is good for one?s reputation. Would they be ever so ready when the virus morphs into the Great Leveler and the sick glamour fades away? Lapus is correct: there are more calibrated measures available and, yes, the joy of the surprise school break must be tempered by the drudgery of make-up classes.
Third, for a virus that at this stage is contracted abroad, the true vulnerability of our country is not the business or vacation traveler but the overseas Filipino worker, especially our health professionals abroad. Already, our Riyadh embassy has identified an infected Filipina nurse in Saudi Arabia, and two other suspected cases of fellow nurses. Several other OFW centers have reported cases as well: Qatar, Hong Kong, Singapore, Kuala Lumpur, and Macau.
In the past century, epidemics typically took six to nine months to spread around the world, even during times when most international travel was by ship or rail. In 2003, the spread of SARS in Hong Kong was traced to just one mainland doctor who stayed at the 9th floor of a Kowloon hotel, infected 16 other hotel guests on that floor, who in turn traveled to Canada, Singapore, Taiwan and Vietnam. Comparatively the Philippines was barely hit by SARS. From a total of 8,273 infections and 775 deaths, the bulk of the cases came from China and neighboring ethnic Chinese communities. The Philippines had a mere 14 cases and two deaths.
Finally, we all hope that the special precautions contained in expert advisories will work. At the same time, I wonder: Will ?social distancing? work among a people who overdose on communal get-togethers and rituals? How realistic is it to counsel people to stay literally at an arm?s length from one another (have you taken the MRT at rush hour)? How do we maintain hand hygiene in school bathrooms that lack soap and water? How do we counsel ?respiratory etiquette? (covering one?s mouth when coughing and sneezing) when tissue paper is rationed by some, hoarded by others?
The Nobel laureate Amartya Sen has written that ?no substantial famine [or ?economic or social disaster?] has ever occurred in [a] democratic country with a relatively free press.? What makes the mutated virus worrisome is that it afflicts a mutated Philippine democracy where people speak softly while their government carries a big stick.
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