An open letter to Mayor Moreno

By Nestor Punay, MD.

I AM writing on behalf of my fellow Cagayanons, my fellow physicians and my relatives who currently reside in the city including my mother and my daughter. Although I do not currently reside in the city, Cagayan de Oro is my hometown where someday I want to go home to. I grew up in the City of Golden Friendship and has deep roots there.

During this time of uncertainty and grave danger for all due to Covid-19 pandemic, I am confident that you want nothing else but the safety and good health of everyone. I am sure you are cognizant of the fact the very survival of everyone including that of your family and relatives and the millions of Cagayan de Oro residents are in your hands. Thousands of people, rich or poor, political foes or friends, men or women, young or old, depend on your ability to make the right choice to ensure they live and not die due to this pandemic. Thus, my purpose for writing you should not be construed as political in nature. I am writing to personally appeal to you to ensure the survival of everyone in Cagayan de Oro by implementing enhanced community quarantine (ECQ).

I am sure you are well counseled and likely had been briefed adequately about the virulent nature of Covid-19. I am confident as well that you are already fully aware of the nationwide guidelines on the measures necessary to fight this pandemic. It is not my intent to write to point out the legal basis for declaring an enhanced community quarantine in Cagayan de Oro. I am not a lawyer but I do understand from information I gathered you have the legal bases for this ECQ.

I am a physician, a graduate of Xavier University and Oklahoma University. I am at present practicing my specialty in Texas. Due to my training and medical knowledge, I am in a position to educate people about medical conditions and recommend measures to address such diseases. Covid-19 is one of them that I maybe able to recommend something, albeit unsolicited.

It is public knowledge that coronavirus disease 2019 started in Wuhan, China. This is a new disease with no known cure nor vaccine. It is highly contagious. Despite what some quarters want you to believe, Covid-19 is deadlier than the common flu. As of this writing, the case fatality rate of Covid-19 in the Philippines is at 4.5 percent.

To illustrate this in plain language that all may easily understand, for every thousand people that will get infected, about 45 patients will die. As I am writing this, there are 3,018 Covid-19 cases with 136 deaths in the Philippines.

This number of cases is likely just the tip of the iceberg. From all indications, there is active community transmission in certain parts of the country, if not the entire country now. The Philippines has limited resources, CDO is no exception to this. Thus, it should not be a surprise to anyone we do not have adequate test kits. Even worse, we do not have adequate PPEs to protect our frontliners. Thus, they are particularly at risks of contracting the disease and dying from it.

We cannot afford to lose our most valuable resource in this fight. It is obvious a surge of infected cases will magnify their risks of infection.

In Cagayan de Oro, the only center certified to handle Covid-19 cases is the Northern Mindanao Medical Center (NMMC). Unfortunately, this center handles all the Covid-19 cases from surrounding cities, municipalities and provinces. NMMC will be swamped and overwhelmed easily once the surge of cases starts. If you are unlucky enough to contract the disease and suffer respiratory failure, we do not have enough respirators to keep you alive. In this instance, your chances of dying are very high. We know now that Covid-19 affects mainly the respiratory system causing difficulty breathing, leading to respiratory failure and death. While it is true that ages 50 years old and those older have the highest number of deaths, recent reports indicate younger, healthy individuals are succumbing to the virus as well.

Since there is no cure and no vaccine, the mainstay of the fight against this pandemic is the implementation of mitigation measures especially social distancing measures and isolations.

Ideally, communities like Cagayan de Oro conduct surveillance testing to identify and isolate infected citizens to prevent further spread of Covid-19. The Philippines has to compensate for the lack of adequate testing kits and healthcare resources. The best option therefore is to implement early and aggressive mitigation measures (hand washing, social distancing, lockdowns or quarantines).

We all know that the saving grace of the Philippines so far had been the relative early implementation of nationwide social distancing measures and enhanced community quarantines when it became clear there is community spread in the Philippines. The goal is to limit the spread of the virus and to prevent a rapid rise in the number of the infected which would overwhelm our health care infrastructure.

To understand this scenario better, one can learn from the experience of Italy and New York. I am sure you are fully aware of the thousands of cases and thousands of deaths in these two areas. The common denominator of the overwhelming number of cases in Italy and New York was the late implementation of social distancing measures. In these two cities, the virus had spread in the community before strict measures were implemented.

Contrast this to the successes of Taiwan, Japan, South Korea and even Wuhan, China. Although thousands got infected in these areas, they were aggressive in their identification of cases. They were also very aggressive in implementing social distancing, isolations or quarantines. At the height of the pandemic in Wuhan, China, several millions were quarantined in the city. We even saw footages of doors being welded shut to prevent people from violating quarantine. The success in controlling the pandemic in Wuhan, China was the implementation of strict quarantines.

Although widespread testing ideally has to be coupled with strict social distancing, the latter is indispensable and is a must. Social distancing or isolations or quarantines have been shown to be the most effective in limiting the spread of Covid-19. The spread of Covid-19 can be stopped if we starve it by denying it of new hosts to infect. In the absence of surveillance testing, ECQ is our best hope of winning this fight.

Based on the experience of others, fighting this pandemic, early and aggressive implementation of strict social distancing, stay in place or enhanced community quarantine, successfully controlled the community spread of the virus and controlled the pandemic. For ECQ to be effective, it has to be implemented early and aggressively when there is no widespread infection in the community. A single Covid-19-infected person can infect thousands in a very short period, likely within a day or two.

The argument for an early implementation of ECQ has been made urgent due to the fact 25-50 percent of infected cases are asymptomatic, that is, no symptoms. The dearth of symptomatic cases in the community, may lull the local government unit officials into thinking there is no community spread. The next thing you know, there is an explosion of cases in the city which will overwhelm our infrastructure and will kill thousands of Cagayanons.

Based on our knowledge about Covid-19 to date, this is not a matter if it happens but when it would happen. The danger of a severe outbreak in the city is high especially if the people will not cooperate and will continue to violate social distancing and quarantine order. Everyone has to understand that a single person who does not cooperate may potentially cause the death of thousands of people, starting with people closes to him, that is, his family members. We have heard of stories of entire family being infected.

In similar manner, an ECQ in one city or province will not work if the neighboring city or province has not implemented ECQ. Thus, the ideal scenario would be an ECQ for the entire island of Mindanao. Because the Philippines is an archipelago, all citizens of Mindanao are in this fight together. Everyone has to stay home and to stay in place if everyone hopes to survive this pandemic.

In summary, I am appealing to our honorable Mayor Oscar Moreno and the local government officials to immediately order and implement enhanced community quarantine (ECQ) in the entire city of Cagayan de Oro. It is still not too late to implement this measure. This ECQ may be the only measure that will save thousands of lives in the city. The lives of the citizens of Cagayan de Oro, including that of your own and your family, depends on the implementation of ECQ. In this regard, I am also appealing to all local government units in Mindanao and in the Philippines for that matter to ensure social strict distancing is implemented, especially ECQ. ECQ can only be effective if everyone abides to it. May God help us and Bless us all in this hour of needs.

With my warm regards and sincere gratitude.