By RJ NIETO
The Imperial College COVID-19 Response Team released a 16 March 2020 paper entitled “Impact of Non-Pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand,” detailing the results of its epidemic modeling of the COVID-19 situation in the United Kingdom.
The paper lists down scenarios that the United Kingdom and the United States will face if the epidemic is allowed to progress without any interventions, along with the projected mitigating effects of specific Non-Pharmaceutical Interventions (NPI) or a combination of them.
The study said that last time the world encountered a pandemic of this scale and with no access to vaccines was during the 1918 Spanish Flu pandemic that killed over 50 million worldwide. With no drugs or vaccines for COVID-19, the world has nothing but NPIs to deal with it.
The primary gauge for the effectiveness of NPIs is R-nought. The Imperial College estimates that the reproduction number R-nought is 2.4, meaning an infected person will infect 2.4 other persons on the average if no NPI is introduced.
In the absence of NPIs, the study estimates 510,000 COVID-19 deaths in Great Britain (the UK minus Northern Ireland) and 2.2 million in the United States, strongly suggesting that NPIs are needed.
The paper enumerates two fundamental NPI strategies that center on minimizing R-nought – Mitigation and Suppression.
Mitigation means R-nought is made as low as possible. The number of infected may still rise, but the total number of infected at any given time may always be within the limits of the healthcare system. Meanwhile, suppression reverses epidemic growth, or reducing cases to very low numbers by bringing R-nought to below 1.
Antivirals would have solved this COVID-19 problem, but there are none yet, so we’re left with no other choice but NPIs.
The study analyzed the impact of five different NPI’s, namely:
Case Isolation (CI) – Symptomatic cases stay home for seven days with household contact reduced by 75% in this period.
Voluntary Home Quarantine (HQ) – Households remain home for 14 days after identification of a symptomatic case.
Social Distancing of the Older Population (SDO) – Involves all aged 70 years and up, considering that they exhibit the highest COVID-19 mortality rate.
Social Distancing of the Entire Population (SD) – Similar to the previous bullet, except it involves the entire country.
Closure of schools and universities (PC) – Closure of all schools except 25% of universities.
With no NPI in place, the study says COVID-19 cases will outnumber the UK’s Intensive Care Units (ICUs) in as early as the second week of April, and the demand will eventually peak to over 30 times ICU capacity.
However, the study said a combination of school closure, case isolation, household quarantine, and social distancing for the elderly (PC + CI + HQ + SDO) for three months can reduce ICU demand by at least 69% and total deaths by at least 29%.
How does this relate to the Philippines?
The situation in the United Kingdom has both similarities and differences with the Philippines. The Philippines has more people, has fewer ICU beds per capita, and a much higher population density, which makes us more vulnerable to COVID-19. On the flip side, we are more archipelagic so geography helps a bit and we have a much younger population so we’re more resistant to COVID-19.
Interestingly, none of the scenarios evaluated in the study include all five NPI’s (school closure, case isolation, household quarantine, and social distancing of the elderly and the rest of the country), as the incorporation of all NPIs suggest a suppression strategy.
The Luzon-wide community quarantine seems to be a suppression strategy. If we enforce the nationwide lockdown long enough, all undiagnosed COVID-19 patients will have exceeded the maximum 14-day incubation period, so those who will exhibit symptoms would have done so without infecting others.
However, realities on the ground suggest that it is something in between suppression and mitigation, as evidenced by NCR residents living in the slums who roam their community’s streets. Yes, Duterte’s COVID-19 suppression policy is suboptimal, but we have to make do with what we’ve got.
Moreover, the UK has tested over 50,000 people so far, or at least 25 times more than the 2,000 test kits donated by the World Health Organization to the Philippines. To make matters worse, Health Secretary Duque ordered test kits for the first time only on 10 March 2020, strongly suggesting criminal complacency on his part, and the under-testing of the Filipino population.
Such low domestic testing rates indicate that we may have far more COVID-19 cases than what we know today.
The key here is to minimize the spread of COVID-19 until a pharmaceutical solution becomes available. While the UK paper estimates 18 months before availability, Chinese authorities have already said Japan’s flu drug Favipiravir works well based on preliminary studies, and mass production has started in February 2020. Meanwhile, America’s Remdesivir is also on clinical trials right now.
Despite sporadic data about COVID-19, I believe it’s safe to conclude that our best course of action, for now, is to continue the nationwide lockdown for as long as possible, with the understanding that ending the lockdown prematurely may mean the deaths of hundreds of thousands of Filipinos.
Yes, there will be complaints, but if this is what it costs to save hundreds of thousands of Filipino lives, then we have to do it because we cannot have our cake and eat it too.
I don’t know how long the President can pull this off, but I wish he succeeds for everyone’s sake.