Fighting COVID-19: open the economy safely...•PNR study shows its combination achieves 99.6%...

Fighting COVID-19:

open the economy safely

Manuel M. Dayrit MD, MScAdjunct Professor and Former DeanAteneo School of Medicine and Public Health

SharePhil SummitWebinar, October 21, 2020

My talking points

• How do we open the economy while keeping COVID-19 under control?

• What do we know about the spread of infection in NCR and outside NCR in recent weeks?

• What is situation re the country’s response in the areas of testing, contact tracing, isolation; Bayanihan 2 Law

• What have been the challenges and lessons in the last 7 months?

2) ECQ ends on May 31, after 77 days

March 15100 cases

3) mECQ, Aug 4 112,000+ cases

1) ECQ bent the curve at Day 20

March 15100 cases

3) Oct 18, 217 days since March 15

1) The rising slope and positivity rates at 10% tell the story of propagating spread of COVID-19

2) New cases in NCR have been falling in the last 8-9 weeks. But cases in some provinces have been rising.

Thailand, Vietnam, Taiwan have been able to suppress transmission

What have been the challenges in

fighting COVID-19?

• Clarity in governance, local implementation• Building capacity to test, trace, treat fast and across the board• “Snakes and Ladders”• Data management – delayed, incomplete, now improved & improving • Human resources for health – illness, deaths, exhaustion, shortage • Financing (PhilHealth woes) – inadequate coverage, delays, scandal• Communicating to the public • Restoring public confidence• Reviving the economy• Opening Public transport

What lessons have we learned in

the last 6 months?

• Lockdowns slow viral spread but have not suppressed it.• We continue to improve pandemic interventions.• Keep improving data for effective control especially at local

government level• Government needs to communicate more effectively to the

public to raise consumer confidence.• Keep positive. We will have to live with trade-offs• Plan ahead. Plan for the procurement and delivery of a safe

and effective vaccine.• Invest wisely. Increase investment in our public health system

going forward to ensure a constant state of readiness.

Where is the Philippines now?

• In NCR, data shows negative growth of cases in the last 8-9 weeks; good time to open economy slowly

• Epidemic is spreading outside of NCR; a challenge to control spread and open economy (eg. tourism) given weak health system capacity in LGUs;

• Continue to build health system capacity in LGUs;• Government and private sector seek to build consumer

confidence which is at a low level at the moment• Bayanihan 2 Law stimulus package

Bayanihan 2 Law, signed Sept 11, 2020

• 165 B economic stimulus and relief package

• 140 B various emergency packages, 25 B stand by fund 13.5 B for emergency hiring of health care workers 5B for hiring of contact tracers 4.5 B for building quarantine and isolation facilities 3 B for purchase of personal protective equipment 10 B for testing of vaccines and purchase of vaccines and medicines 39 B for small and medium scale enterprises 9.5 B to assist the transport sector 6 B for social welfare programs 4 B for alternative learning programs for education 3 B for development of smart campus of state colleges and universities

Amber – supply chain capacityGreen – test capacityDark gray -- lab capacityLight Gray – isolation capacityPurple – contact tracing capacityNot shown – hospital bed capacity

Snakes and

Ladders

Source: Rajan, Cylus, McKee, Roy Soc Med 2020

Testing data from Sept 21 to Oct 18, 2020(dashboard on Oct 19

by Socio-economic category of Municipality, Aug-Sept 2020

How do we open the economy while

keeping COVID-19 under control?

• Coherent policies, budget, and implementation of COVID-19 control (Win at “Snakes and Ladders”).

• Everyone practices minimum health standards in public spaces, workplaces, and homes; 7 commandments in public transport.

• LGU Goals: 1) < 7 new cases per 100,000 population per day and 2) 2-week growth rate of new cases at < 0%

through effective implementation of pandemic functions: surveillance, prevent, test, trace, isolate, treat, recover.

• Institutions & business establishments to support above goals• Maintain surge capacity for critical care beds -- < 70% occupancy rate• Provide a safe and effective vaccine to the public in due course.

Increase Capacity Public Transport to Reduce Waiting Times and Congestion

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Average LRT1 ride is 10 mins Average waiting time is 2 hrs

Late breaker: On October 12, 2020, Cabinet approved 1-seat apart in public transport. Expansion of rail capacity to 30-50%

Recommendation: Enforce the 7 Commandments Strictly

7 Commandments

These recommended minimum health standards would be amongst the most comprehensive in the world.

We advocate strictly implementing what we call the 7

Commandments, for all public transportation:

1. Wearing of proper face masks

2. Wearing of face shields

3. No talking and no eating

4. Adequate ventilation

5. Frequent and proper disinfection

6. No symptomatic passengers

7. Appropriate physical distancing

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Late breaker: On, Oct 12, 2020, Cabinet approved 7 Commandments for implementation

• Mandatory masks and shields for all + No talking + No eating + Well-ventilated will further improve efficacy of “The 7 Commandments”• PNR study shows its combination achieves 99.6% efficacy (not yet peer reviewed, for validation)

Derek Chu, Elie Akl, Stephanie Duda, et al. Physical Distancing, face masks and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis (of 172 studies); Lancet (27 June 2020)

1)

2)

3)

0.3 Meter Distancing +Masks (1 person only) +Face Shields (1 person only)

1 Meter Distancing alone≥1)

2)

3)

1)

Our conclusion, subject to further monitoring and validation, is that combining them will be even more effective:

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The Lancet meta-analysis shows that distancing, masks and face shields are similarly effective independently

LGU Goals : (1) < 7 new cases per 100,000 population per day;

(2) 2-week growth rate < 0%

Source: DOH Data Analytics Technical Working Group, September 24, 2020 19

2-week growth rate: Sept 7 to Sept 20 vs. Sept 21 to Oct 4 Falling growth rates in Quezon City, Manila, Caloocan

2-week growth rate: municipalities of Pasig, Paranaque, CalambaSept 7 to Sept 20 vs. Sept 21 to Oct 4: Growth rate is falling

1-week growth rateSept 14 to Sept 20 vs. Sept 21 to Sept 27

Growth rates of Negros Occidental and Aklan are negative;

Growth rates of Iloilo, Capiz, Guimaras, Antique are positive;

Hospital bed occupancy for Region 6 is 47.1%

Build surge capacity for critical care beds

What are aspirations towards the

end of the year…

• Slope of curve of cumulative cases becomes flatter as current interventions are brought to scale (optimistic view);

• Economy opens at 75%; (optimistic view)• A safe and effective vaccine has completed trials by the end

of the year (optimistic view);

Thank you.