Four weeks after elections and the super spreader rallies and no Covid-19 surge has materialized.

CLINICAL MATTERS

Despite a slight uptick, Covid-19 cases remain under 200 new infections per day. Since we are outside the 14-day-long incubation period of Covid-19, it is safe to assume that the increased mobility and activity from the May 2022 elections have not resulted in a new wave of cases. Despite the detection of the new Omicron variants BA.4 and BA.2.12.1 entering the Philippines, there is little evidence that these are taking over or are driving a new outbreak. More encouraging is that daily deaths in May have remained in the single digits. Severe Covid-19 cases have, likewise, remained low.

In April 2022, the World Health Organization (WHO) predicted that we could see as many as 300,000 active cases in May if public health standards were loosened. This was in anticipation of the large rallies and the big crowds on election day. Both leading candidates’ miting de avance crowds topped a million participants. People lined up for an average of two to three hours in close quarters during the elections. Some voters stayed even longer as a result of malfunctioning vote-counting machines. While marshals and volunteers tried their best to enforce masking and physical distancing, there were numerous breaches. Both vaccinated and unvaccinated voters were allowed to cast their votes, adding another element of risk. Despite these activities, average daily new cases have remained low and manageable. Instead of 300,000 active cases, the actual number of active cases nationwide on May 31, 2022 was only 2,415. This number is less than one percent of the predicted total, a testament to how the different layers of protection—vaccination, boosting, masks, ventilation, physical distancing, and symptom screens—work very well if used correctly and consistently

Globally, overall Covid-19 cases are receding. A few countries, however, are still seeing high numbers of Covid-19. Early Covid-19 success stories such as Taiwan and Australia are reporting record numbers of cases in the tens of thousands. This may be due to the new Omicron variants breaking through vaccine protection, coupled with low hybrid immunity (vaccinated people who either previously had an infection and were then vaccinated or had a breakthrough infection) in their populations. Hybrid immunity seems to work better at preventing reinfection than infection-naïve vaccinated individuals. Deaths, however, remain low in either case since vaccine protection against severe Covid-19 is retained. Mortality trends are dropping despite the recent record numbers of Covid-19 cases. This is clear evidence that Covid-19 is no longer as deadly as it once was because of widespread vaccination.

With all these positive signs pointing toward endemicity, the WHO is likely to declare an end to the acute phase of the pandemic very soon. Barring the emergence of a truly awful new variant, the economic cost of continuing to treat Covid-19 as a pandemic despite its now decreased risk for death is unsustainable. Even Omicron sublineages BA.4 and BA.5 that were thought to be fueling a resurgence of cases in South Africa are already fizzling out. For many countries, locking down is no longer a part of their response since vaccines have enabled them to safely resume mobility without overwhelming their healthcare systems.

Recently, the IATF approved a resolution to relax pre-departure testing for returning Filipinos and foreign travelers entering the country. The previous policy required all incoming travelers, regardless of vaccination status, to undergo pre-departure testing prior to travel to the Philippines. The rationale for this policy is that some patients may be asymptomatic or be minimally symptomatic and might inadvertently bring in new Covid-19 variants. Either an RT-PCR taken 48 hours before the time of departure or a Covid-19 antigen supervised by a health professional within 24 hours before the time of departure was required. For fully vaccinated travelers, quarantine was no longer required. Unvaccinated or partially vaccinated travelers had to undergo facility-based quarantine and repeat testing on the fifth day of arrival.

Since vaccination plus boosting decreases the overall viral load and time of shedding of infectious virus, the Technical Advisory Group agreed that fully vaccinated adults with at least one booster dose can be allowed to enter the Philippines without pre-departure testing. While boosted adults can still have a breakthrough infection, the duration and degree of infectiousness are expected to be much lower than in unvaccinated or partially vaccinated persons. Studies have shown that the efficacy of primary vaccination without boosting has significantly decreased protection against hospitalization with Omicron compared to older variants. Since Omicron is the dominant variant globally, boosting is now considered essential to maintain protection against Covid-19. The new policy may also help convince more people to get boosted.

With a highly vaccinated population, the occasional breakthrough infections are unlikely to result in large spikes of cases. In addition, the continuing mask mandates and symptom screening serve as extra layers of protection. Protocols for quarantine, contact tracing, and isolation are all in place. Effective medicines are available, and hospital bed capacity is adequate. Relaxation of the pre-departure testing requirement is expected to boost tourism and make it easier for Filipinos to come home. In addition to fully boosted individuals, fully-vaccinated children without a booster from age 12 to 17 are also exempt from the pre-departure testing requirement. Children 11 years old and younger, regardless of vaccination status, will follow the requirements of the adults they are traveling with.

These gradual steps toward normalcy are much more prudent than the drastic relaxation of restrictions that many countries have done. The removal of mask mandates in the US has fueled a fifth wave with new cases reaching as high as 100,000 per day. Similar increases in Covid-19 cases have been seen in Canada and Europe because of relaxed mask mandates. Given the added risk of breakthrough infection from the newer Omicron sublineages, maintaining mask mandates is very rationale as an additional layer of protection against transmission. Moreover, decreasing the amount of virus that gets through even with breakthrough infection typically results in milder infections.

Masks will eventually become optional and further easing of restrictions will occur if Covid-19 continues to be well-controlled. But we must not forget how many times SARS-CoV-2 has surprised us and so protection should be relaxed methodically. Once WHO declares an end to the public health emergency of international concern, we can consider removing pre-departure testing entirely. Masks may then become optional outdoors and eventually indoors as well if there are no further increases or new threats. It is fortunate that Filipinos don’t seem to mind keeping their masks on, unlike in other countries. Protecting each other seems to be in accordance with the Filipino psyche. A cautious exit as we transition to endemicity is best. We survived these two years and we are now regaining our freedom. It is always better to be safe than sorry.