After two weeks, what?

In another late night appearance, the President once again revealed what’s bothering the government and him (not necessarily the same things). The pushback from barangay officials seems to have been felt at the top; the President, after sidelining the barangay, said mayors and barangays would have a chance to rectify the national lists on which relief and other assistance is being based. He did grumble that people seem to be claiming relief in multiple jurisdictions. He gave way to his Secretary of Foreign Affairs even though he sympathizes with members of the Cabinet who wanted to ban Filipino medical workers from seizing the opportunity for fast-track entry to the United States. He issued a warning to people harassing medical frontliners and to hospitals refusing treatment to patients.The President’s remarks show he’s been made aware of the thing people increasingly fear, which is a second or third wave of infections once current quarantine policies are lifted or relaxed. More controversially, he revealed he’d heard an “antibody” has been developed, though he didn’t say by whom. More to the point, he said he was inclined to keep the metropolis on lockdown until an antibody comes along, presumably meaning a vaccine.

Dr. Leachon, one of the scientific advisers of the government, says that in two weeks, government actually has three options: 1) another 15-day extension; 2) gradual reopening (restarting of economy); 3) status quo.

Bill Gates, in a recent April 12 BBC Breakfast interview, pointed out we can’t even consider returning to some sort of normality until a vaccine is developed, which, at best, will take 12 to 18 months (but if the fast-track methods being explored fail, it will take years longer). In his Monday press conference, New York State governor Andrew Cuomo laid out what returning to the new normal would be like: 1. Controlling the spread; 2. Declaring the worst is over; 3. Starting on the way back to normality; 4. Some businesses reopening; 5. A medical treatment if one gets COVID-19 is available; 6. A vaccine exists to prevent an infection.

Note that in Cuomo’s list of milestones, a vaccine, number 6, is a year to a year and half away; and the milestone before that, a treatment regimen, is only now being discussed and has yet to emerge from the pandemic (some possibilities: using antibodies from previously sick people, the use of antimalaria drug, etc.). In Germany, the emerging national federal plan is that people who survived, underwent quarantine after exposure, and/or who will show exposure in an antibody test would receive certificates, and this would allow them to return to work. In the US, a similar strategy is being proposed and discussed. This is to prevent a second or even third wave (the 1918 influenza pandemic, for example, had three waves; the second wave was most lethal). So we should not assume that after the lockdown is lifted, everyone can or should go back to work/school.

Which goes to show what other countries are discussing but we’re not. Basically, it’s a top-down (lockdown for all, to severely limit the ability of the infected to make others sick) and bottom-up (testing and contact tracing, to find out where infections are, and to isolate and treat the infected) approach that will “flatten the curve,” allowing the medical system to itself survive. But after that, massive testing is still needed: testing for infection (plus contact tracing), and antibody testing to see who may have had it, but never showed symptoms though they recovered. It’s the people who recovered after hospitalization/quarantine, and those who have undergone antibody testing showing they were exposed, who will be able to return to work. Those not yet exposed might still have to stay in quarantine until a vaccine is ready by next year.

Oxford University’s Our World in Data COVID-19 Testing dataset points out that there are two types of tests for Covid-19: those that test for the presence of the virus, aiming to establish whether an individual is currently infected; and those that test for the presence of antibodies, aiming to establish whether an individual has been infected at some point in the past. The tests we hear about in the news are the first kind: They tell you if someone is infected or not. The second type—known as serological tests—is still being developed, but these tests will be the basis for how most governments will plan to move past the lockdown era.

So what is “massive testing”? Well, during the epidemic to flatten the curve, it’s not testing everyone, but taking representative samples to get an idea where infection hotspots are, etc. We are, some medical experts claim, getting to that point now. But there will have to be testing of everyone, or nearly everyone, to see who has antibodies; only then can the true scale of the infection, from a population point of view, be seen. In case you’re curious about this, there’s a layman-friendly discussion of this concept by Dr. John Campbell on YouTube (pay attention to his April 10 episode on Germany; near the end, he reviews official Philippines testing numbers).

The Our World in Data summary of our official data says that as of April 11, we have 0.03 tests per 1,000 people. South Korea, which is very targeted and smart in applying testing, has a rate of 10.1 tests per 1,000 people. One medical commentator said last April 10: Because of “tightly populated urban areas… I am pessimistic, sad to say, about the Philippines. I expect there to be a huge spread in the Philippines.”

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