Almost exactly one year ago, on 16 March 2020, Luzon entered enhanced community quarantine (ECQ), the most stringent of the four quarantine frames developed to address the COVID-19 epidemic.
As we mark one year of living with COVID-19 and quarantine, we are dealing with a second wave of infections, with reported new cases on 16 March at 5,404, up from 2,885 just five days prior (10 March). The 7-day rolling average of new cases at 4,167. This seven-day rolling average approximates the 7-day rolling average in August of 2020, the peak of the first wave.
Where are we now? What have we learned and what should we be doing?
What we have learned
A year ago, we knew much less about COVID-19 than we know today.
At the time, the consensus was that COVID-19 could only be transmitted through droplets and hence, transmission could occur from direct contact with the virus in droplets caused by sneezing or coughing of an infectious person or direct contact with an infectious surface. At the time, it was thought that COVID-19 was not capable of airborne transmission. What this means is that we thought that the virus did not remain infectious in air for a long time or over long distances. Today, we know that the COVID-19 virus is capable of airborne transmission. In fact, many of the earliest cases of airborne transmission occurred in hospitals during treatment of COVID-19 when health care workers were not yet adequately protected. Airborne transmission requires much more stringent requirements to control transmission. This explains current policy concerning face masks, face shields, social distancing and hygiene.
In the early days, the belief was that the patients became infectious when symptoms began. Now, we know that patients are infectious even before symptoms begin and are in fact most infectious in the early stages before and on the first day of symptoms.
In the early days, we knew that the average incubation was about 5 days. What we did not appreciate and what we understand better now is how variable incubation was. This explains the 14-day isolation period for travelers.
One year ago, estimates of case fatality rate (CFR) or mortality ranged from 2% to 4%. Current global and Philippine data indicates a 2% CFR. While this mortality rate is lower than other serious flus (60% for avian flu, 34.3% for MERS, and 9.6% for SARS), it is certainly much higher than the 0.1% mortality for the common flu.
One year ago, we were not aware of the existence of long COVID-19 and the potential long-term debilitating effects of COVID, including permanent damage to the lungs or heart. One year ago, we thought that children were relatively safe fromCOVID-19, that they could catch the disease but would likely only get mild symptoms. Now we know that COVID-19 can cause multiple organ shock and failure in young children.
In essence, we have learned that COVID-19 poses a much more difficult medical problem than we had originally believed. Most importantly, controlling transmission is job number one and that involves a few basic rules: the wearing of protective equipment, especially faces masks and shields; distancing of between 1 and 2 meters depending on the situation; limiting close contact to 30 minutes; and hygiene (hand washing and disinfection of surfaces).
What we have achieved
As of 15 March, total global COVID-19 cases are about 119.6 million, 1.5 percent of the global population. The Philippine numbers are at 626,000, 0.5 percent of the population. The Philippines reports 12.837 deaths from COVID-19. 1.2 deaths per ten thousand population. The global number is 2.6 million, about 3.4 per ten thousand population.
It is easy to look at the current surge in the country and the continued global epidemic and believe that we have accomplished nothing. That is not true. The COVID statistics, both worldwide and in the country, could have been much, much worse. They are not catastrophic simply because governments instituted safety measures.
The difference between Avian Flu and COVID-19 is that Avian flu kills most of the people it infects. That means these people have far less ability to infect others. Without non-pharmaceutical measures such as protective equipment and social distancing, COVID-19 can infect more people. Why? It is not just that the virus is airborne. Patients are infectious before they are symptomatic and the overwhelming majority (80 percent) of patients have only mild symptoms. Incubation periods can last up to 2 weeks and in rare cases, even more. This probably explains how the virus spread internationally so quickly.
What experts have always tried to explain is that quarantine can only control transmission and that truly eliminating the virus was a matter of herd immunity.
What the various lockdowns and social distancing measures have achieved is to buy time. Time not just to learn about the disease but time to develop a vaccine. There is currently no vaccine for avian flu, or SARS, or MERS. There are, however, now many COVID-19 vaccines.
What this pandemic has taught us is how much can be achieved when nations, companies, and scientists work together. Information on any new strain of the virus is made available to the global scientific community within days of discovery. Government and private sector have worked together. Companies have worked together across national borders. These vaccines have been made available to the public at what, under normal circumstances, would be considered blinding speed.
Where we are and what we should do
A second wave of the disease began making its way in Europe and other parts of the world in the latter part of 2020. This second wave was fueled by newer strains that proved more contagious than the original strain of the virus.
In the Philippines, we are experiencing our second wave today. What we need to do now is to use what we have learned. We can flatten this new curve. We have in the past and we can do so again.
We must continue social distancing and limit contacts. We should stay home, except for unavoidable activities.
The vaccines are coming. We must wait for them. Even more importantly, we must remember there is not yet a vaccine for children. If you engage in dangerous behavior, you are putting our children at risk. Please don’t.
Keep safe. Keep everyone else safe.
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