Time to shift COVID-19 strategy?

Are we in transition from pandemic to endemic? Consensus is rapidly building around that idea and time (and data) will soon give us a clearer picture. Meanwhile, let’s reflect on what our COVID-19 response journey has been over the last two years and develop a strategic shift in direction.

Rewinding back to January-February 2020, we had our first cases of “imported” COVID-19 from international travelers. Within a few weeks, community transmission had started and by mid-March the country went into a lockdown.

From the outset, the planning framework was built around test, trace, and treat (hence the establishment of Task Force T3 in the private sector). We focused mostly on ramping up RT-PCR testing capacity (we started the year with one lab) and on building up the capacity of the health care system through the One Hospital Command. Many attempts were made at contact tracing but with little or mixed success.

In the second half of 2020, we focused on developing the vaccine portfolio and on public and private procurement of vaccines. By March 2021, we started vaccinating people, kicking off with health care frontliners. By year-end, we had administered over 100 million doses and opened vaccinations for 12-to-17 years old and launched a booster program.

We can sum up our approach in four categories: (1) vaccination/medication; (2) testing; (3) hospital capacity/treatment); and (4) case management. As we entered 2022, conditions have changed. Omicron has overtaken Delta. Transmission is higher and faster but, thankfully, most cases are milder. There are far fewer severe cases and less deaths. This is especially true for the vaccinated. We are also much better off with vaccinations versus a year ago. But while we’ve made headway, we still have a lot of unvaccinated people as well as people in need of boosters. We are also realizing how difficult it is to sustain vaccination at this scale over a prolonged period.

What shifts should we think about starting 2022? For vaccinations and medication, in 2021 our primary focus was on procuring, providing logistics, and administering first and second doses. This included the use of large-scale mega vax sites. For 2022, we should focus on boosters and vaccinations for younger populations (e.g., 5-11 years old). We’ll also have to think about adjusting our vaccine site location strategy from mega vax sites to distributed micro-sites (think drug stores, small clinics, rural health centers, even mobile bus sites) to make them more accessible to people. We also need to think of the use of therapeutics and medicines. In the future, vaccines will likely be used for the most vulnerable and the elderly (like influenza shots) while the rest of the population ride out an infection or take medicines. This, of course, assumes that any new variant causes mild cases.

For testing, while we concentrated on RT-PCR tests before, we need to consider more affordable pricing for these tests plus introduce use of at-home antigen self-tests. This is in wide use already but is unreported because the government only records RT-PCR test results. Many people take antigen tests to get quicker results at lower cost. This also enables them to take tests more frequently. Though clinical purists may argue that antigen tests are not as accurate as RT-PCR tests, there’s no doubt that they influence the behavior of people who take them.

For hospital capacity, we used to focus on building up functional bed capacity because so many cases required admission. With Omicron fast spreading but mild, the trend now shifts to better hospital triaging, telemedicine consultation, and home care services and COVID-19 care kits. Many cases do not need hospitalization but nonetheless need care.

Finally, for case management, we used to rely heavily on lockdowns, building quarantine facilities, and contact tracing. Under these new conditions, it makes more sense to rely on vaccines, medication, and minimum health practices, and take a “life goes on” approach. COVID-19 is taking a pronounced endemic shift and the basic protocols are helping maintain the spread to a mild variant. After two years of an economic slowdown, we’ll need to refocus more attention in this direction.

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Guillermo M. Luz is chief resilience officer of the Philippine Disaster Resilience Foundation (pdrf.org).

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