Our economy might’ve taken a hit, but we have one of the lowest mortality rates in the world
CLINICAL MATTERS
At the start of the pandemic last year, each country had to make hard choices in terms of its response to an unknown virus that was spreading fast. The rapid propagation of what was then known as ncov or novel coronavirus and the subsequent hard lockdown of Wuhan in China sent mixed messages throughout the world. On one hand, the decisiveness and swiftness of the Chinese response showed that the virus could be controlled, and this could have given other nations a false sense of security. On the other hand, a totalitarian regime with vast resources having to shut down an entire city should have also set off alarm bells to the rest of the world that this was going to be a serious problem.
As country after country got their first cases of SARS-CoV-2, each one had to decide on the best way to mitigate the onslaught of COVID-19. The World Health Organization playbook turned out to be woefully inadequate to address the spread of disease. Initial advice on mask wearing only for symptomatic individuals allowed the virus to spread from those who had asymptomatic disease. It turned out that, unlike SARS, which is only contagious among symptomatic patients, a significant number of asymptomatic COVID-19 patients were transmitting to others. As case numbers increased, hospitals started to fill up and people started dying. The highest mortality rates were seen in the early days of the pandemic, when testing was inadequate, and treatment was largely unknown. Countries that hesitated to initiate a hard lockdown saw mortality rates as high as 10 percent among those infected, including a significant number of deaths among frontline healthcare workers. In hindsight, given the exponential growth of cases by the time community transmission was detected, the best response was an early and timely hard lockdown. Every single day counted, as shown by the disparity in deaths between the Philippines (40,221 deaths as of Oct. 14, 2021) and Mexico (283,193 deaths as of Oct. 14, 2021), which shut down a mere 10 days after the Philippines.
By most estimates, the early lockdown of Metro Manila saved at least 200,000 Filipino lives. This was not without controversy, as the economic managers of the country projected a severe impact on our country’s financial position. Up to the night of March 12, 2020 in Malacañang, there was intense debate about the necessity of the lockdown. Fortunately, the government elected to prioritize control of community spread. One major humanitarian concession was that it did not prevent Filipino repatriates from coming home, in stark contrast to other countries with similarly stringent lockdowns. This had the effect of letting some variants of concern into the country, though this was somewhat mitigated by facility-based quarantine protocols.
The Philippines hasn’t done so well in recent economic surveys as ranked by some financial publications. This is expected because of the government’s pivot towards minimizing deaths. The priority of the Technical Advisory Group (TAG), which gives science advice to the IATF, has always been to save lives. The early and stringent lockdowns were designed to give the healthcare system time to cope and adjust while waiting for the development of vaccines and effective treatments. Consequently, the population-adjusted death rate from COVID-19 in our country is 361 deaths per million at the time of this writing, which is 123rd in the world. This number is about six times less than that of much more advanced countries like the US (2,218 deaths per million, 18th), the UK (2,020 deaths per million, 25th) and France (1,790 deaths per million, 33rd).
One frequent question about our relatively low death rate is whether enough testing is being done. It is a valid question, given our recent high positivity rates. Taking into account the speed at which cases climbed last year, most countries undercounted deaths since many died of COVID-19 when hospitals were overwhelmed and many patients went untested. There is one relatively unbiased way to determine the magnitude of uncounted deaths from COVID-19 as well as excess deaths from other causes because of the crisis pandemic conditions. Excess mortality is calculated by comparing reported deaths from all causes during the pandemic period versus all-cause mortality in recent years. This is easy to graph at the Our World in Data website. Due to the delays in the release of the mortality data from the National Statistics Office, only excess deaths for the first year of the pandemic, from January 2020 to the end of March 2021 can be evaluated at this time. The graph looks like this:
It is apparent that the US and many other countries which decided not to adopt early and stringent lockdowns paid for it with lives of their citizens. Are more than 600,000 preventable deaths worth it for the US to stay open? That is difficult to answer because lost income and wages will also end up with more people hungry and that will also cause more deaths in the long run. Each country has its own threshold for locking down and for determining how many deaths directly due to COVID-19 it is willing to accept. In contrast, the number of excess deaths in the Philippines is low, which reflects the priority we put on saving lives.
What is an acceptable price for 200,000 Filipino lives that were saved by the lockdowns? Doctors do everything possible to save each patient every single day. Choosing lives over a more permissive approach prevalent in many developing countries comes naturally to many physicians. This was the choice we made for our country in the first year of the pandemic.
Fortunately, those choices no longer need to be made now that we have safe and effective vaccines that prevent severe disease and death. It is no longer health versus economy. It is now a choice of accepting vaccines that will protect everyone as we open our economy; or dying because people choose to listen to pseudoscience and antivaxxers. The choice should be clear. Widespread lockdowns can become a thing of the past now that we have vaccines. We can either choose to live in this new world protected from COVID-19, or needlessly die from a disease that has already cost us so much.