I totally agree with the suggestion of the Metropolitan Manila Development Authority and our National Capital Region (NCR) mayors that restrictions be eased for those who have been fully vaccinated. We need to start moving outside the fear. But there is yet another group of persons for whom restrictions can be eased. These are those able-bodied Filipinos who have gotten COVID-19 and survived, regardless of vaccine status.
In an ideal world, our country would have enough vaccines to serve all who should be vaccinated. We would be like the United States where vaccines can be availed of for free almost everywhere, in community pharmacies and even upon arrival at international terminals. No fuzz, no drama, no lines. But this is not the case for the Philippines and for much of the developing world. Hence, we need to think outside the box.
There are two ways for herd immunity to occur: vaccination and recovering from the infection. With the Delta variant being overwhelmingly dominant, we see clusters of infections where one household member transmits the virus to almost all members of the same household. Experience from the ground tells us that there is a gross underreporting of our cases, and that a great majority are either asymptomatic or mild. Science also tells us that those who have recovered from the infection already have immunity. But our government has no idea about the degree of immunity in our communities, not only because of the underreporting of cases, but also because we don’t strategically utilize other testing modalities available to us.
On-site swab rapid antigen tests combined with antibody tests at the correct point in time will help. Once people recover from COVID-19, it’s like they were vaccinated. Some studies even show that natural immunity from COVID-19 infection and recovery is stronger and longer-lasting than immunity from vaccination. Hence, vaccination doesn’t become an urgent need for those able-bodied individuals who have recovered from COVID-19. They may be vaccinated even eight months later, if necessary. The very limited supply of vaccines can be distributed to those who truly need them, the vulnerable and the unvaccinated who have never been infected. And those able-bodied persons who have recovered from COVID-19 can join the fully vaccinated in being given less restrictions so that they too can work and lessen our collective misery.
Areas with very high numbers of cases that warrant pocket lockdowns should use the lockdown time to test their communities. I know from personal experience that barangay health workers can do this as long as they are properly oriented and trained. Do on-site swab rapid antigen testing in households with sick members. Again, personal experience has shown that if one household member gets sick, almost the entire household gets infected. That’s how it is with Delta. And 96-97 percent are either mildly symptomatic or asymptomatic. These persons, once they recover from the infections, would have natural immunity.
With almost 60 percent vaccinated in the NCR, plus the gross underreporting of infections, we may be suffering needless draconian lockdowns coupled with economic disaster and misery when, in fact, majority of our NCR residents already have immunity, either natural or from vaccines.
It would be ideal to do antibody testing three weeks after the positive on-site antigen testing. We know that this is not practical. But even without this, natural immunity can be inferred. If limited but available, then antibody testing can be done for those who tested antigen negative in the household with infected members. I am certain we will find that many of those in the infected households who were antigen negative at the time of on-site testing also have developed antibodies. This is our experience on the ground, in the community.
Our national government should empower local government units (LGUs) by distributing vaccines expeditiously so that they can utilize them before they have surges. This, combined with proper instruction on how to maximize vaccines and testing modalities, is the way to go. We have a devolved heath system. Let’s work with it rather than against it. There are so many ways to do so.
The national government should not hoard or use vaccines for political patronage. Many vaccination sites in Metro Manila have excess vaccines, while so many provinces have yet to receive their supply. Why is this so? Do we have a dashboard of sorts to be able to balance supply with demand? What is the basis for giving an LGU its share of vaccines? Is there a logical reason? If it is because of political patronage, then it is the ugliest kind of politics. It is an additional crime to the many crimes already committed against us. “Aanhin pa ang damo kung patay na ang kabayo?”
Let’s think outside the box. Let’s shift our paradigm in dealing with those who have recovered from COVID-19. Rather than being stigmatized by misinformation, they can be considered warriors who have survived a major battle and who can gallantly do their part to help our country recover from this debacle. By setting aside financial interests, by being open to ideas from outside the limited confines of their usual advisers, and by foregoing ugly politics, our national government will be able to save more lives, open up the economy, and take us out of this dark tunnel into the light, sooner rather than later.
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Minguita Padilla is a clinical associate professor of the PGH-UP College of Medicine and a co-convener of Doctors for Truth and Public Welfare.