Needed: A roadmap to reopening

It must be very hard for President Duterte to find himself having to make a decision on an issue where the slightest miscalculation could lead to catastrophic consequences, and with no one to blame. Like autocrats whose experience at ruling has mostly been carved in premodern settings, Mr. Duterte trusts too much in his own instincts. He has shown little patience for the kind of systematic thinking and rational decision-making that underpins modern statecraft.

In a rare admission of fallibility, he said in his latest public appearance that he has turned to prayer for some guidance on what to do. I suspect that, deep down, Mr. Duterte is terrorized by the thought of being remembered as the president who failed to protect his people from the ravages of a vicious disease.

Newly-reinstated presidential spokesperson Harry Roque earnestly opened the briefing with a summary of the decision, which extended the existing enhanced community quarantine (ECQ) in the National Capital Region and much of Luzon to May 15, and modified it into a general community quarantine (GCQ) in areas that have posted significant declines in the number of new coronavirus infections.

That would have made for a concise and straightforward presentation. But the President could not control his need to say something after every report by a member of the Inter-Agency Task Force. He saw every pause as an opportunity to launch another rambling and repetitive monologue on a pet issue, sometimes to the point of losing his breath in the middle of unrestrained cursing and threats to declare his “own” brand of martial law. These interruptions are the main reason for the general incoherence of these briefings.

If he is supposed to be the representative of the expert community during this crisis, Health Secretary Francisco Duque III has been nothing but a pathetic presence. His fawning behavior before the President is without parallel. Nothing in what he says mirrors the independent viewpoint of science or of one with any functional expertise.

On a previous occasion, in what seemed like an after-the-fact nod to science, UP professor Mahar Lagmay was called to the podium to share the findings from the modelling studies that his team from the university had been conducting. This took place after the main briefing led by the President had ended.

I don’t quite understand how these things are arranged. But I’m sure Dr. Lagmay would have gladly yielded the microphone to an epidemiologist or a public health specialist, if there was one in the room. He is, after all, an earth scientist, and, in the mass media, he is better known as an expert on geological hazards.

Be that as it may, the projections of his group, like those of another research team from the UP scientific community, carried a caveat. These projections are premised on the presumed accuracy of the Department of Health’s daily reports of the number of confirmed infections and number of deaths from COVID-19.

Here, precisely, is where the crux of the problem lies. These numbers are highly dependent on many factors, not the least of which are: (1) the readiness of people to report their symptoms to the health authorities, and (2) the availability of the tests to those who require them. Since testing for the virus has been largely confined to symptomatic persons with a history of travel to infection hotspots or of contact with known cases, the likelihood that the actual number of infections is grossly understated cannot be ignored. If testing were made available to people with mild or moderate symptoms, or to those who have had contact but show no symptoms, the scale of the infection could be much worse than the current figures indicate.

The numbers for COVID-19 deaths, at first glance, may seem unproblematic. But that is assuming that a proper diagnosis of death from COVID-19 is made and is duly reported to the DOH in every instance, no matter where it happens. I understand that the DOH subjects these reports to a validation process. Where neither a test nor a clinical diagnosis nor an autopsy is performed, it would not be easy to arrive at a clear determination of the cause of death. This leaves plenty of room for error in the number of case fatalities ascribed to COVID-19.

Some say that, ideally, at least a third of the population should be tested in order to arrive at a confident measure of the extent of the outbreak. That would be about 35 million in our case—a figure that we cannot begin to contemplate given the government’s modest target of 8,000-10,000 tests per day.

Given the inherent complexity of gauging the real magnitude of the outbreak and the course it takes over a period, responsive governments have premised the loosening of quarantine measures on attaining certain targets other than the flattening of the curve that everyone talks about.

One such plan comes from the American Enterprise Institute (AEI), a neoconservative think-tank that has a strong interest in the eventual reopening of the US economy. Interestingly, the AEI regards the current insistence on physical distancing as the chief barrier to a renormalization of economic activity. To lift this barrier, it argues, it would be necessary to put in place a better public health surveillance system for early outbreak identification and containment, and adequate treatment facilities. Without a vaccine, there is simply no way of returning to the world we knew.

This is a very modest roadmap as it is. We expect nothing less from a government that is supposed to base its decisions on more than one person’s instincts.

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