Monster at the gates

With the COVID-19 variant B.1.617 spreading in India, breaking news that two overseas Filipino workers from Oman and the United Arab Emirates had tested positive for it was truly disturbing. They have apparently since recovered, but the question becomes more urgent: How is the Philippines preparing for another possible surge of the pandemic?

It was only late last month that the government banned the entry of travelers from India starting April 29 up to May 14, which is two days away. At the time of the announcement, as many as 73 Filipinos in India had tested positive for COVID-19 and were being assisted in their medical needs by the Philippine Embassy, per Ambassador Ramon Bagatsing Jr. (The number has since risen and one embassy officer has since died of the respiratory disease.) By then the vast South Asian country was struggling to cope with dramatic numbers of infections and deaths—a fresh wave of misery unleashed by the B.1.617 variant first detected there in October and, with its sublineages of varying mutations and characteristics, now listed as a variant of “global concern” by the World Health Organization.

Plainly put, B.1.617 is more transmissible, more deadly because able to elude vaccine protections, and thus more dangerous than the original strain.

What is the Inter-Agency Task Force for the Management of Emerging Infectious Diseases doing to reinforce the Philippines’ fragile health system? (Other countries, including New Zealand, Pakistan, the United States, and the United Kingdom, etc., were reported to have quickly moved to avert transmission by banning travelers from India even before the Philippines could bestir itself to do so.) On May 6, Inquirer health columnist Dr. Rafael Castillo raised the need for a contingency plan “for when the Indian variant hits us.” In an interview with Inquirer reporter Patricia Chiu, he wondered whether there was sufficient supply of oxygen for patients who would have no space in crowded hospitals, or “additional tents, in case cases go back to 15,000 to 20,000 in a single day.”

These are valid concerns for the people in charge of the nuts and bolts of the Philippine defense against the ever-mutating coronavirus. Castillo mentioned a narrow window of 45-60 days in which to prepare for what WHO chief scientist Soumya Swaminathan has described as the “extremely rapidly spreading” B.1.617 variant.

Castillo again raised the idea of targeted vaccination instead of mass vaccination—for example, inoculating residents of the National Capital Region and adjoining provinces Bulacan, Cavite, Laguna, and Rizal, or NCR Plus, but not those aged 20-40 years old for whom, he said in a recommendation he made as early as March 22, the risk of dying from COVID-19 is low. “It’s better to allow their system to develop natural, rather than vaccine-generated, immunity that can potentially weaken their innate immunity,” he wrote then.

In that early recommendation, Castillo noted the rate with which “escape mutations” were developing and called for a shift from a “vaccine-centric strategy” to “a more holistic multipronged approach” that included promoting the use of immune-system-boosting agents. “Let’s reserve the vaccination for the elderly and other high-risk persons…” he wrote.

It may or may not be an acknowledgment of Castillo’s pitch, but health officials are now employing “sectoral” vaccinations (health workers, people with comorbidities, senior citizens, or the most at risk of infection) and “geographic” vaccinations (NCR Plus, or economic centers nationwide), the idea being to make judicious use of the uneven supply of vaccines reaching our shores. And, of course, to help the prostrate economy recover.

But first, the monster at the gates. The WHO said last week that B.1.617 had been seen in over 1,200 sequences “from at least 17 countries.” At this writing, the number of deaths in India was pulling the overall toll past 240,000, with new infections increasing the total since the start of the pandemic to more than 22.3 million.

To address what the WHO called the “moral outrage” of the inequitable distribution of vaccines worldwide, the European Union called for an end to vaccine export limits and the United States backed waiving intellectual property protections for COVID-19 vaccines—acts of reassurance that will, however, produce yet distant results.

On May 7, Malacañang announced new guidelines, including two-week quarantine and strict swab tests, for Filipino and foreign travelers to the Philippines. It is hoped that logistics have also been fine-tuned and that it’s true, as the Palace mouthpiece claimed, that “we have foresight and we have learned what to do…”