Rethinking to defeat the new COVID-19 surge

The government’s hospital hotline has been “overwhelmed with calls.” The mobile phones of hospital staff have been “ringing nonstop.” And “pop-up” hospitals are being installed. The healthcare system is being crushed by an unprecedented COVID-19 surge.

It is a no-brainer that a strict lockdown is necessary. The government’s decision to impose enhanced community quarantine (ECQ) from March 29 to April 4 is a forced move, a reactive move. It should have been done earlier, precisely to prevent the unprecedented surge.

At the onset of the new surge, the push was for reopening the economy. But as the virus further spread, the government introduced a “bubble,” which fellow columnist Diwa Guinigundo said “would hardly suffice.” The “bubble” in the form of a localized lockdown was inadequate because, in Diwa’s words, “we don’t have that luxury” of enforcing “a localized lockdown and selective easing of health protocols.”

In Vietnam, for example, says Diwa, “health authorities have the capability to trace the whereabouts of their citizens. In times of viral outbreaks, the health authorities could easily identify the specific areas of highest incidence and trace the relevant people.”

But in the Philippines, our lack of a centralized contact tracing system and the failure in coordination between local government units (LGUs) and between LGUs and the central government, inter alia, make granular lockdowns ineffective. Thus, the government has belatedly accepted having an ECQ.

In March 2020, Tomas Pueyo developed the “hammer and dance” strategy to manage the COVID-19 pandemic. According to Pueyo, most countries successful in containing the virus undergo two phases: the hammer and the dance.

The hammer phase entails strict lockdowns when cases rise, with the goal of getting the spread of the virus under control as quickly as possible, buying time to strengthen testing, contact tracing, and treatment infrastructure. The dance phase that follows is a period of gradually reopening the economy while keeping the virus’ reproduction number low through extensive testing, contact tracing, isolation, and quarantine. During the “dance,” the government should be open to the possibility of re-implementing lockdowns in case of new surges.

Although the hammer and dance are proven to be effective, our leaders seem more inclined to “dance and dance,” offbeat and with no lead dancer, at that. In February, the government loosened general community quarantine (GCQ) restrictions without putting in place measures necessary to safeguard people’s health and wellbeing. As a result, we continue to suffer from ineffective contact tracing, dysfunctional referral systems for patients, and substandard isolation facilities, to name a few.

With a record-high surge of almost 110,000 active cases and health systems in disarray, some leaders and opinion-makers were still reluctant to implement a strict lockdown.

The usual argument is that due to the high incidence of lockdown-induced hunger, unemployment, and non-COVID-19 illnesses, localized or granular lockdowns are our only option to contain the virus while protecting jobs and livelihoods.

Our view is that prematurely reopening the economy at a time that the virus threatens to overwhelm the healthcare system will have the perverse effect of further scarring the economy.

We need to struggle with a false dichotomy between health and the economy. One thing is for sure: The central task is flattening the curve and prioritizing public health. COVID-19 is our number one problem, and the economy is the collateral damage.

Even the rise of non-COVID-19 diseases and deaths is the indirect consequence of the pandemic. The health system and the healthcare workers are overburdened or over-exhausted, preventing them from attending to all COVID and non-COVID patients.

Patients postpone medical visits because they fear getting infected when they leave home. Doctors, too, close their clinics because they, too, fear the virus, or because the outpatients postpone their visits.

We can only facilitate economic recovery and address hunger, unemployment and illness by sharply lowering the virus’ infection rate through the appropriate and adaptive use of a range of instruments, medical and non-medical. In this manner, we are able to serve the total health of the people. In turn, this will renew people’s confidence or stimulate their “animal spirits.” Economic recovery will follow.

Countries (like China, New Zealand, and Vietnam) that have contained the virus have likewise been able to facilitate economic recovery. Lockdown restrictions per se are not the root cause of hunger, unemployment and illnesses. Regardless of quarantine policy, the people’s ability to work, feed their families, and seek treatment for illnesses is constrained by a high incidence of virus infection. Loss-aversion or risk-aversion will not go away as long as the virus remains threatening.

Consumer confidence was far from returning to pre-pandemic levels despite the relaxation of mobility restrictions in late 2020 and early 2021. Mobility data from Google showed that despite the loosening of quarantine restrictions, Filipinos mostly left their homes to work and buy essential goods in groceries and drugstores. They themselves have curtailed non-essential activities like going to restaurants and recreational facilities.

No number of pronouncements from government officials can encourage the public to go out if they do not feel protected from the virus or assured that the government has the capability to contain new outbreaks.

Lockdown remains as a tool to contain the virus, especially during a surge and in the absence of effective test-trace-treat systems. But of course, we all wish to avoid drastic lockdowns. They can only be temporary, and they have their limitations.

Our previous lockdowns failed because they were not done right. The timeout or respite that we gained from lockdowns did result in bringing down transmissions only for a short interval. But because the lockdowns were done improperly — the World Bank described our lockdowns as “super-draconian” and “porous,” the gains could not be sustained.

We interpret “super-draconian” measures as those that are punitive, militarized, and rigid. On the other hand, the lockdowns we had were “porous,” arising from among other things: inconsistent or contradicting policies, coordination failure, poor communications, non-compliance with rules by officials themselves.

What is central is to put in place the robust and sustainable interventions. The following reforms must be implemented soonest: consolidating contact tracing among local government units by having interoperability of different applications; establishing an efficient referral system for patients; providing adequate and safe public transport; and ensuring that workplaces follow minimum health protocols like proper ventilation.

Moreover, aggressive fiscal policy is vital to ensure financing for health and social amelioration, given that the economy creating jobs and incomes will not bounce back soon.

The worry over heavy borrowing is misplaced, as we have the capacity to repay.

Structural reforms, especially tax reforms, have been put in place. Low interest rates globally and nationally and the potential for high growth combine for sustainable debt servicing in the future. Furthermore, if we cut unnecessary items such as the counter-insurgency and intelligence funds, budget reallocation can provide additional spending.

Social protection for the vulnerable is the government’s responsibility. We cannot force people to make a daily choice between being stricken by the virus and dying of hunger.

The government cannot use the steep numbers of hungry and unemployed Filipinos to reopen the economy, while simultaneously refusing to provide them with relief. The opening of the economy, to repeat, cannot be willed. Control the virus first, to pave the way for the economy’s gradual reopening. While that is being done, the government must provide relief to the poor, the hungry and the unemployed.

One year into the pandemic, we clearly know the basics in flattening the curve. The problem is that the basics are being violated. We now have to rethink and overhaul governance, demand accountability, have good strategic communication, and ensure inclusiveness of all stakeholders in decision-making.

Winning the war against COVID-19 requires a reframing of the policy debate. We cannot allow ourselves to believe that health and economic policy objectives are mutually exclusive in fighting COVID-19. They go hand in hand, and containing the virus by smartly deploying the full panoply of instruments is the way to recovery.

Pia Rodrigo, Eddie Dorotan, And Filomeno S. Sta. Ana III are members of Action for Economic Reforms (AER). Ms. Rodrigo is AER’s communications officer, Dr. Dorotan is the convener of the COVID-19 Action Network, and Mr. Sta. Ana is AER’s coordinator.