Our early lockdown in March saved 200,000 lives, and continued vaccination is driving down infection numbers
CLINICAL MATTERS
Dr. Edsel Maurice T. Salvana
Last March 2020, the first community transmission of COVID-19 in the Philippines was recorded. Given the uncertainty surrounding the virus, the doctors of the Technical Advisory Group of the Department of Health recommended a lockdown. This early lockdown and subsequent ones saved more than 200,000 Filipino lives. While other countries saw horrific death rates, the Philippines somehow managed to temper its deaths with the early shutdown. Currently this number stands at just above 300 deaths per million, which is 118th in the world and five to 10 times fewer than that of many advanced European countries and the US. Lockdowns cost a lot, but in the early days of the pandemic, these were certainly worth it.
With the availability of highly effective COVID-19 vaccines, the equation has changed. Despite the decrease in clinical efficacy and transmission blocking properties of COVID-19 vaccines against the Delta variant, all current COVID-19 vaccines still bring down the risk of severe disease and death by over 90 percent. This enables us to reevaluate the best way forward for our country. As more and more nations realize that the old formula of lockdowns is no longer feasible against a variant that is as contagious as chicken pox, a paradigm shift is inevitable.
The biggest problem with COVID-19 is that it is about 10 to 20 times more fatal than the flu. For certain vulnerable populations like the elderly and those with comorbid conditions, it is 100 times more fatal than the flu.
To put this into perspective, the number of people in the US who got influenza from 2018 to 2019 was about 35.5 million. The number of deaths from the flu that year was about 34,200, or 0.1 percent. Tragic, but it did not entail shutting down society and changing the way people live. In contrast, COVID-19 numbers in the US from February 2020 to May 31, 2021 was 34 million cases with 610,000 deaths. If most of those people had gotten the vaccine against COVID-19, deaths would have decreased by up to 95 percent and it would have resulted in 30,000 deaths—nearly identical to the flu. Vaccination of as many eligible people in a population will result in turning COVID-19 into the flu, and we wouldn’t need to lock down anymore.
But what about kids? We can’t vaccinate them yet, right? The current mortality from COVID-19 in people younger than 20 years old is already at 0.1 percent, which is the same as the flu. We would still vaccinate them anyway once supplies catch up to further decrease this risk but this should not be a significant impediment to further opening up.
The groups that are still in significant danger despite vaccination are those people belonging to the vulnerable population, namely the elderly and those with comorbid conditions. With a baseline risk of dying from COVID-19 of 10 percent, vaccines modify this to about one percent. A one percent risk of dying from an infectious disease is still horrible. This is the same risk as a healthy non-elderly adult who is unvaccinated. The best way to mitigate this risk is to continue to protect the vulnerable population by wearing masks and PPE, and minimizing non-essential interactions. This won’t be forever as better vaccines with higher efficacy continue to be developed. Decreasing community transmission by getting more and more people vaccinated will decrease the risk further.
With these things in mind, how close are we to transitioning from being locked down to living with the virus? One of the things we constantly discuss during meetings of the IATF Data Analytics Subtechnical Working Group is how we are doing in terms of our case projections. Due to the extreme transmissibility of the Delta variant, new models had to be developed to see its impact on healthcare utilization and the volume of cases. This was the reason behind the pre-emptive ECQ in NCR from Aug. 6 to 20, 2021 as the FASSSTER (the DOST COVID-19 modeling platform) projections all showed overwhelming cases of COVID-19 if ECQ was not declared. Moreover, the ECQ would merely delay the rise and so a rapid vaccination program for NCR was needed in order to lessen the proportion of severe and critical cases when the large number of cases hit.
Just before the time of the downgrade from ECQ to MECQ in NCR on Aug. 20, the FASSSTER team presented updated scenarios and gave the numbers on how many active cases in NCR were expected by Aug. 31 and Sept. 30. These projections took into account the projected positivity rates as well as the increasing proportion of Delta among positive samples.
FASSSTER had models to predict what would happen with different scenarios, depending on the action chosen after Aug. 20. The numbers that follow depicting two of these scenarios were publicly released (https://mb.com.ph/2021/08/23/lower-active-cases-by-end-september-in-ncr-seen-under-6-week-mecq-with-improved-interventions-doh/):
- If an additional two-week ECQ after Aug. 20 followed by a four-week MECQ were to be done, then there would be 66,403 active cases in NCR by Aug. 31 and 269,694 by Sept. 30.
- If a six-week NCR MECQ were declared after Aug. 20 with intensified pandemic response and strategies, then there would be 83,921 active cases by Aug. 31 and 152,776 active cases by Sept. 30. The reason the Aug. 31 number would be higher is because intensified case finding would detect more cases, which if quickly isolated would result in fewer cases downstream.
The actual number of active cases for NCR as of Aug. 31, 2021 is 40,157. This is more than 20,000 active cases below what the models had predicted even if ECQ had been extended by two weeks. This is just short of a miracle because if even the 66,403 active cases had come to pass, we would have overshot healthcare capacity by a lot, resulting in many deaths.
Why did we do better than even the most conservative scenarios? The enhanced vaccination program had a lot to do with it. Another factor is that the NCR LGUs are outperforming the estimates of intensified pandemic response and strategies. In multiple MMDA meetings that I had the privilege of being part of, the NCR mayors and their constituents were proactive and united. Also, it seems people are getting used to the idea that Delta is at a whole different level of transmission and are using their PPE more consistently.
What are the next steps? The hospitals are still dangerously full because we continue to have high daily cases as a result of the higher transmissibility of Delta. Cases are expected to remain relatively high in the long term compared to previous baselines, because of the inherent R0 of 5 to 8 for Delta. With increasing vaccination, however, the percentage of severe and critical cases will go down and the burden on the healthcare system, with hope, will remain manageable. With nearly half of eligible people in NCR fully vaccinated, a transition from widespread lockdowns to less expensive localized lockdowns can be carefully attempted to see if we can further open up in order to revive the devastated economy.
Continuing to wear masks and face shields and adhering to public health standards for both vaccinated and unvaccinated people will further decrease the pressure on the healthcare system. More healthcare capacity needs to be added for future spikes, especially if another variant of concern develops. In the meantime, new vaccines are in the works, and new treatments are in phase 3 trials. We can live alongside the virus if we all continue to protect one another.