29/04/2020
Scenario after the ECQ is lifted on May 15
(From Dr. Robert Dennis Garcia
Infectious Disease consultant
Makati Medical Center)
April 27, 2020
Dear friends and policy-makers,
The Phl lockdown has been quite successful. What should we expect when the lockdown is lifted on May 15?
We had 7,579 cases as of yesterday, with 285 new cases. The U.S. has 965,910 cases & 30,000 new cases/day. The U.S. had one case on Jan. 23, & as their lockdown was not uniformly done across the 50 states, they have done disproportionately much worse than we have, considering that the U.S. population is only three times ours. Indeed, our 200 cases/day for a country of 110M is already very low; we can not realistically achieve an actual figure of zero.
The reason why the government has extended the lockdown to May 15 is mostly because the LGUs, hospitals, healthcare system & the continuing education of our people, are still far from ideal.
We need to continue to educate everyone that the COVID-19 virus has high infectivity (ability to invade those infected), high pathogenicity (power to cause overt disease in those infected), & high virulence (ability to produce serious disease & death) in the setting of a propagative pandemic, where the population has no preexisting immunity. The feared polio virus, for example, has high infectivity, but has low pathogenicity & low virulence; only a small fraction develop paralytic disease. Furthermore, for polio, a big proportion of the Phl population has immunity, a vaccine exists, & we continue to vaccinate; immunity & a vaccine are not present for COVID-19.
What happens after May 15, when the enhanced community quarantine is lifted in Metro Manila? Take a look at what happens if a city like Pasig has 20 infected & contagious people on that date, & these people go out of their homes without masks & do not practice physical distancing, with the accompanying assumptions:
1. COVID-19 median incubation period = 6 days
2. COVID-19 Reproduction no. = no. of secondary cases arising from one index case = 2.5 people
3. COVID disease manifestations (Chinese data): 80% will be mildly ill; 20% will need hospitalization; 7% will die (Phl data).
4. For example: Pasig has 20 people with active, contagious
COVID-19 on May 15. How will this no. grow over time?
May 15: 20 cases
May 21: 20 + 50 = 70 cases
May 27: 70 + 125 = 195 cases
June 3: 195 + 313 = 508 cases
June 9: 508 + 783 = 1,291 cases
June 15: 1,291 + 1,958 = 3,249 cases
June 21: 3,249 + 4,895 = 8,144 cases
June 27: 8,144 + 12,238 = 20,382 cases
July 3: 20,382 + 30,595 = 50,977 cases
5. If, of the 50,977 cases by July 3rd, 20% will need hospital care, this figure will be 10,195 by July 3, for Pasig City alone.
No Phl city will have 10,000 beds to cater to such a demand over 6 weeks. The hospital system will collapse. The only way we can prevent the above scenario from happening, is if we, as a people, have the discipline to decrease the virus' spread when the lockdown is lifted.
Meanwhile, we have to make our best effort to prepare, equip, & boost the capabilities & capacities of our HC system. A new segment in this HC system is the need for & presence of quarantine facilities in each town & city, to serve as hospital extenders.
For all of us, after the lockdown is lifted, we have to have a mindset that:
1. Our home is our fortress.
2. Every time I leave my home, my & my loved ones' lives are placed at risk; as such, I have to have a good reason for leaving, and I have to be protected with a disinfectant in my bag, & I will wear a mask +/- eye shield while I am outside.
3. Anyone I encounter outside of my home may have asymptomatic COVID illness.
4. If I feel sick, I will not leave my home, & will promptly inform my workplace, & seek medical help for a proper evaluation & treatment.
To be ready, this is the HC bundle that each LGU has to have:
1. Test each person with COVID symptoms.
2. Have multiple COVID tracking teams to account for all suspected, probable & confirmed COVID people, & contacts.
3. Quarantine facilities are operational, to contain people in no. 2 who well enough not to be hospitalized. This is how the propagation of Pasig cases can be stopped in the example.
4. The quarantine facilities are supported with LGU-private sector cooperation.
5. The LGU has identified, & helped beef up with staff, equipment & meds, the govt & private hospitals which will take in the very sick COVID patients.
6. Only the mod-severely ill suspected, probable & confirmed COVID patients are admitted to these designated hospitals.
7. The govt helps protect HCWs with PPEs.
8. The govt supports private hospitals.
9. The local DOH has an active surveillance system to monitor further disease spread & clusters, & coordinate with COVID tracking teams.
If we are not disciplined & our HC system is not properly set up when the lockdown is lifted, this is one probable scenario: infection rates sharply rise after 4-6 weeks, hospitals & quarantine facilities are unable to cope, people will die in large numbers, & the govt is forced to impose another lockdown. This open-close lockdown can go on in 3-4 cycles, until a vaccine is, hopefully, available in 1 1/2 years.
We are Asians. Let us be educated & disciplined like the Taiwanese & South Koreans. We do not have a HC system like these 2 countries though. It is our discipline, as a people, that will get us through. Each person, each town, each city, & each province should regard the other beside us as a collection of links - each link is dependent on the next. It is only if we work as one big family of Filipinos that we can hope to survive this crisis.
Robert Dennis Garcia
Infectious Disease Physician
