UNDER THE MICROSCOPE

Now that the state of public health emergency has been lifted in the Philippines (a full two months after WHO declared an end to the Covid international health emergency), we can now heave a big sigh of relief. But not so fast, pardner! The next pandemic is just around the corner, so to speak. We’ve been hit with successive pandemics/epidemics that threatened to engulf the whole world. SARS caused universal panic in 2002, followed by H1N1 flu outbreaks (2007), Influenza A (2009), Ebola (2013-16), Zika (2015-2016),  and Ebola again (2018-present). These outbreaks, including SARS-CoV-2, caused millions of deaths and billions of dollars in economic losses and economic misery to a large swath of the population. Thus, we should be prepared for the next one. Preparedness should be an all-of-society approach. We don’t have the economic clout to develop vaccines yet, but we should have government policies, plans, and resources in place to deal with the next pandemic. The three key measures are prevention, detection, and containment. The best, of course, is prevention, but that’s easier said than done in the era of fast travel and overcrowded cities. A virus can travel undetected for thousands of miles and spread rapidly. Detection is the next best thing if we are to identify the enemy and characterize its virulence and transmissibility. We were caught flat-footed in 2020 when only the RITM could test for SARS-CoV-2 on a very limited basis. Now, we have hundreds of molecular laboratories that sprang up to test for Covid. The waning of the pandemic resulted in many labs closing down for lack of business. But it will be a mistake to allow the rest to follow suit. These labs should be allowed to conduct other testing in order  to keep them going. Alas, the DOH has been slow in transitioning these labs to keep our testing capacity on guard for the next pandemic. I’ve also written about the need for the government labs to start testing for other infectious diseases, if only to keep tabs on the next big thing, or even to track other infections like dengue, HIV, TB, polio, measles, and others that still ravage our population. Surveillance testing will enable us to push the alert button in case of a brewing epidemic, as South Korea has shown with its infectious disease surveillance system drawn from its experience with MERS in 2015. We have proposed that our Covid lab in the Philippine Childrens Medical Center (where the pooled testing research was conducted) be converted into a pediatric research laboratory that will assist our pediatricians to conduct state-of-the-art research with genomic sequencing and other techniques. This will also enable us to sequence and identify unknown pathogens and detect mutations in raging viral epidemics/pandemics. We were sorely short on this capacity during this pandemic. This endeavor faces an uphill battle unless we have assistance from the DOH. Containment is a two-edged sword, as what happened in 2020 and 2021. The massive lockdowns caused severe economic disruption from which we are still recovering. Fortunately, the economic sector  stepped in and cooperated with the government in managing the ill-effects of lockdowns. I must cite the valiant efforts of Go Negosyo, particularly Joey Concepcion who went all-out in helping with testing and vaccines, and in pushing for faster transitioning to a more relaxed regime of pandemic control. We will be forever grateful to Go Negosyo for its funding of our pooled testing research which will prove useful when the next pandemic strikes. We should also stockpile PPE, particularly face masks, which can be drawn on when we sense the start of a pandemic. Had we had enough face masks, coupled with a strong surveillance system, contact tracing, and isolation facilities, perhaps it wouldn’t have been necessary to resort to drastic and drawn-out lockdowns. True, we didn’t have any knowledge of how the SARS-CoV-2 virus behaves, and it showed in our initial overkill reactions with protective suits and face shields, as well as the deployment of plastic or plexiglass partitions. But as we progressed in our knowledge of the virus’s behavior, we should have realized soon enough that we overreacted and corrected the mistakes early on, since these measures had severe cost implications, aside from their possible harmful effects on both health and the environment. Another observation is that we tended to place undue pressure on ourselves in proving that the proposed mitigation measures like vaccines, testing kits, and drugs work in our setting, even as research in more advanced countries and approval by their regulatory agencies already showed that these measures work. Thus, a lot of time was wasted in validation of vaccines, drugs and test kits that should have been deployed much earlier. We hope we have learned our lessons well. Till the next pandemic.