Good data heals, bad data kills

In this health emergency, I gratefully cede my column space to Norman Dennis Marquez, MD, associate director of the health sciences program at Ateneo de Manila University and coordinator of the Learning Experience in Communities program at Ateneo de Manila School of Medicine and Public Health. He raises a fundamental question about the government response to the COVID-19 crisis:

I believe that the framing of the issues is important to how we as a people, not just the government, will respond to this evolving crisis.

My training in the sciences, including public health, leads me to recognize that clearly defining the problem is a practical and strategic first step in addressing an issue. I will not argue with the notion that two weekends ago, when the number of COVID-19 (+) patients jumped from 3 to 10, signaled the exponential spread of the virus. However, the first local transmission that prompted the government to raise the alert level to “code red sublevel 1” has provoked me to ask: “How much data do we need to significantly and confidently predict a clearly evolving pattern?”

I have followed the WHO situational reports on COVID-19 meticulously and cross-referenced reputable European and American journal updates to help me appreciate the nature and magnitude of the problem. I will withhold judgment on whether the red alert was premature or not. I believe, though, that the decisions surrounding the announcement of a state of calamity and the actions emanating from them required much more information to help formulate the primary issues and establish general objectives and specific goals. Only then could we have designed strategies and specific interventions to meet the corresponding objectives. It sounds easy enough, but many organizations and bureaucracies fail to reach their desired goal and waste resources because they miss this first and crucial step. From what I observed, the government may have focused too much on the need to do something, but did not clearly separate public perceptions from the substantial issues of the public health crisis.

As a teacher and a health professional, I have engaged students and patients in critical conversations about what they know, how they feel, and what needs to be known and understood, before we even talk about what they want to do. There are patients who would immediately ask for a prescription before we even have the chance to understand the pathophysiology of their symptoms, or if there is indeed “something wrong” with them.

While we cannot deny the fact that we are in imminent danger of a large-scale community transmission, I would like to understand how adequate and appropriate epidemiologic data from our current crisis defined the parameters of sustained local transmission—beginning with our index patients (those who “unknowingly imported” COVID-19 from China or elsewhere) and how the infection spread to different households in different communities. I do not expect the government to furnish us with all the details, but I hope that substantial data becomes available not just for transparency’s sake but also for the experts from different disciplines who may be able to participate strategically in managing the crisis at hand. As recommended in the WHO guidelines, accurate multi-source information increases the reliability of risk assessments necessary to design public health interventions.

There was probably a 2-6 week “data lag” between the first confirmed case and the declaration of the state of calamity. We now wonder what constraints, if any, confronted the contact tracers (those who investigated how the index patients may have infected others and how those without any history of travel contracted the disease), and how we can still assist them. However, at this late stage, we might have to shift from intensive contact tracing to quick and expanded identification and confirmation of COVID-19 (+) patients, as WHO also suggested.

The issue of limited testing kits will soon be addressed by the thousands of kits donated by China, but we now have to confront the needed capacity of national laboratories outside of the Research Institute for Tropical Medicine to run the confirmatory tests at an enhanced speed — something that is dependent not only on technology but also on the availability of medical technologists, laboratory engineers and technicians, medical specialists, et al.

Moreover, we face a depletion of frontliners and health professionals who have succumbed to COVID-19 or are now under threat themselves while faithfully performing their duties. This brings us to a necessary discussion: How much data was made available (including data gaps) to our health professionals for them to provide premium care to patients and to protect themselves?

I understand that we are in a state of emergency, and we do not have all the time to gather necessary data while the leadership is pressed to make quick decisions. But I believe that there is a difference between deciding and being decisive. The former may simply address the need for outputs, while the latter concerns itself with outcomes. That difference may determine who lives and who does not.

On Twitter: @jnery_newsstand, email: [email protected]