The pandemic and the Philippine elections

Published May 17, 2022, 12:05 AM

by Dr. Edsel Salvana

How did candidates use the Covid pandemic in their discussions?

CLINICAL MATTERS

With an apparent landslide victory for former Senator Bongbong Marcos for president, the post-mortems have begun. One of the most important issues during the campaign was the pandemic and whether the Philippines did well against Covid-19.

The performance of the government against the Covid-19 pandemic was clearly a point of contention among the different candidates. With Covid-19 cases remaining low in the weeks leading up to the elections, the minimal risk status of the pandemic in our country enabled all political parties to safely mount large rallies despite the super spreader potential. An open economy also meant more jobs and the revival of tourism.

While performance across the two years of the pandemic was variable, the overall result was more than adequate. Comparing case counts, mortality and remaining restrictions, the Philippines’ numbers are much better than many first-world countries with stronger healthcare systems and vast resources at their disposal. Despite relatively high caseloads early on, the Philippines is currently fifth in Southeast Asia with total number of cases despite having the second biggest population. Active cases in the country at the time of this writing are in the 3,000 range while it is less than 1,000 for Metro Manila. It has been said that the pandemic response is a marathon, not a sprint. While our response may have lagged early on, we found our second wind and are leading in the race towards the final lap.

The overall science-based prioritization of interventions, with specific emphasis on vaccines over testing, has proven that the long-term plan for our country’s pandemic response was sound. This response was guided by a multitude of experts, who were featured in last week’s column (https://mb.com.ph/2022/05/10/experts-assemble/).

During the pandemic, there was a lot of criticism aimed at the government response. Among the shrillest issues that were brought up were the lack of “mass testing” and the mandatory use of face shields. As government advisers, we have been subject to rabid personal attacks on social media on these issues from lay persons and even doctors from other specialties.

A seminal article by epidemiologist Adam Kucharski who happens to be in my Senior TED Fellows cohort showed that mass testing hardly affects transmission, with an impact of about two percent (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30457-6/fulltext). In contrast, targeted testing and use of masks and face shields can decrease the risk of transmission by over 90 percent. With the severe shortage of test kits globally along with the low capacity of RT-PCR laboratories at the start of the pandemic, insisting on mass testing was used to score the inadequacies of government despite repeated explanations from experts that this was not a viable plan. When I met up with Adam in the TED 2022 conference in Vancouver, he affirmed these findings and stated that targeted testing, not mass testing, was the way to go.

Dr. Salvana with Senior TED Fellow and Epidemiologist Dr. Adam Kucharski.

An example of a country that did a lot of mass testing and diverted resources from other interventions was Vietnam. There was in fact an allegation of corruption in the testing program of the Vietnamese government. Moreover, the locally developed RT-PCR test kit they employed turned out to be unreliable upon assessment by the World Health Organization. While Vietnam had a model response early in the pandemic, these issues, among others, resulted in a severe Delta and Omicron spike which pushed Vietnam COVID-19 cases to over 10 million. This is three times more cases than the Philippines.

The scientific evidence backing the use of face shields have been tackled in another column (https://mb.com.ph/2021/11/09/whats-the-big-deal-about-face-shields/). This was further confounded by the issue of possible improper procurement of face shields by Pharmally. The scientific debate centered on face shields for the general public. This is supported by the preponderance of evidence especially during periods of high community transmission (https://www.psmid.org/face-shield-evidence-summary/). The Pharmally issue investigated overpricing of healthcare worker face shields but not face shields for the general public. There is no dispute that healthcare workers benefit from face shields. If there is impropriety and overpricing in the face shields that Pharmally provided for healthcare workers, then they should be held accountable. This controversy, however, has no bearing on the scientific evidence of the overall effectiveness of face shields, especially in healthcare workers and was used to unfortunately confound the debate.

Throughout the pandemic, President Duterte relied on expert scientific advice. We were summoned to Malacañang on many occasions to debrief him personally. He listens attentively and acts decisively. He followed the majority of our recommendations when there was clear evidence of the correct action.

PRRD with members of the IATF Taskforce on COVID-19 Variants

There were two executive decisions that I had misgivings with early on but I really appreciated over time. The first decision was that President Duterte did not want face to face classes to resume until we had effective vaccines. I felt that classes should be started even if the kids weren’t vaccinated since we had no idea how long it would take to develop vaccines. Given how contagious the later variants of concern (VOCs) were particularly Omicron and Delta, it was fortunate he insisted on this. The number of Filipino children who live with their grandparents and other vulnerable people would have caused many more deaths if we had started face-to-face classes prior to vaccinating children.

The second executive decision was allowing all Filipinos to return home without exception. Even in countries we classified as red, Filipino citizens wishing to be repatriated were accommodated with special flights. While the experts were concerned about the entry of VOCs, President Duterte asserted that he cannot say no to a Filipino who wanted to come home. Some VOCs did sneak through with the repatriates, but these were tempered with strict quarantine protocols which were shouldered by the government. As a doctor who has taken care of foreigners who were locked out of their own countries for more than two years, the humanitarian impact of this decision cannot be overstated.

Despite competing priorities to suppress the virus versus reviving the economy, a good balance was struck. In spite of the Omicron surge in January 2022, the economy still managed to outperform expectations for the quarter with a GDP growth of 8.3 percent. The combination of an efficient vaccine rollout and continued mask mandates even as restrictions were relaxed showed that a strategy of living with the virus was viable. With several weeks of low daily cases coming into the May 9 elections, even as COVID-19 cases spiked to record numbers across the region, it was clear that the Philippines had done well. This undermined the opposition narrative that the Philippine COVID-19 response was poor. This cast doubt on the objectivity of those who did not acknowledge the tremendous success of the government response and may have been a factor in voter’s decisions to vote for continuity.

As a government advisor who tries to stick to scientifically measurable outcomes, I try my best to remain objective. I did not vote for President Duterte in 2016 but I respected the electorate’s decision. I did not always agree with his policies, but when I was asked to help with the government pandemic response, I readily said yes. He is a duly elected president running the government. He listened to the science and did pretty much everything the experts recommended. Being a very popular president, the people followed those policies. We survived and we did ok. We did well against COVID-19 because our President, the government, and the people did their part. You may or may not like the outcome of the May 9 elections, but the people have made a choice. You are free to leave if it is too difficult to accept. But I hope you stay even if your candidate did not win. Helping your country despite your politics is never wrong. If we all do this, the Philippines will always win.

 

 
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