Covid-19 pandemic preparedness and response

By Nestor C. Punay, MD

WHEN the Covid-19 pandemic is contained, there would be recriminations and investigations whether this could have been prevented by governments in the world. Certainly, there would be plenty of blame to go around. For sure, questions will be asked whether their respected leaders were aware of the danger. There will be investigations on when the government leaders knew and when the responses were made. From what we could glean from the events that unfolded since this pandemic started, most countries were ill-prepared and many did not act immediately.

I am not aware of any country in the world that is actively monitoring the world for a potential outbreak of a pandemic except for the United States that used to have a pandemic team in the National Security Council. From what we know, President George Bush was obsessed with the possibility of a pandemic. He pushed for the reforms for the United States to prepare for a pandemic. President Barack Obama after dealing with Ebola and the H1N1 outbreak subsequently created the Global Health Security and Biodefense Unit directorate under the National Security Council. The United States had allocated $200 million to train and prepare including other countries for a pandemic. This budget allocation and a pandemic team based in China, however, were reportedly nonexistent as of 2019. But of course, the intelligence service for every country likely had seen this pandemic coming.

This would explain the report the president of the United States was warned about this pandemic starting January 2020 in his daily intelligence briefing. What matters most is what President Trump, for that matter any leader in each country, did with the information they were handed. The actions or inactions on the information ultimately determined the outcome in the Covid-19 fight in their country.

As of today, it is clear the rapidity and decisiveness of the responses of government officials determine the spread of the virus. There is no question now that prompt community lockdown is very effective in controlling the spread of covid-19. A very good example of this is New Zealand which reported only one death and has successfully controlled the spread. Even when the outbreak is uncontrolled, a strict and complete lockdown or quarantine still is effective as was the case of China which locked down Wuhan completely. As a result, China contained the pandemic almost exclusively in Wuhan and now began to open its economy.

Since there is hardly any country well prepared for this pandemic, the argument in the future would then be centered on when someone knew about it and what they did about it. Dr. Fauci admitted that the United States would have prevented what is happening now by an early implementation of mitigation measures. This can easily be proven by the differences in the outcome between the United States and South Korea. Both got their first case on the same day in January 2020. After the first case was diagnosed, South Korea immediately went to work. The South Koreans implemented strict social distancing, carried out massive testing and contact tracings and isolations. As a result, the South Koreans managed to control the Covid-19 spread faster and more effectively than the United States even without complete lockdowns.

South Korea started massive testing for Covid-19 in January. The United States, in contrast, sent out their first testing kits mid-February 2020. The initial testing kits were faulty which hampered the testing further. When the South Koreans were testing 20,000 per day the United States had tested a total of fewer than 10,000 Americans in March. Even to this date, there is no widespread testing done in the United States despite the pronouncement from the president. The most glaring difference in the responses between the South Koreans and Americans were the timing of implementation of mitigation measures. Dr. Fauci in an interview grudgingly admitted that the number of cases and deaths in the United States would have been lower had these measures been implemented earlier. The United States does not have a federally mandated and uniform mitigation measures nationwide. Each state implemented its measures at different timing and varying degrees. As of today, seven states had refused to implement statewide stay in place orders as the covid-19 cases near 600,000 and more than 25,000 deaths.

In most countries, mitigation measures are coordinated and implemented nationally. This would be logical as the failure of one part of the country to contain covid-19 transmission will affect the success of the entire country.

The Philippines implemented a nationwide lockdown and prohibition of travel to and from China relatively early compared to other countries. President Duterte effectively locked down the entire country on March 17, 2020, when he stopped air, sea and land travel from one island to another. Of course, social distancing measures were coordinated and implemented nationwide early on as well. Unfortunately, there is poor compliance in some areas in the Philippines. Also, not all local government units have implemented strict mitigation measures. Thus, this may explain the continued increase in the cases of covid-19 in the Philippines. A case in point was the cluster of cases due to the reported derby held in Davao.

For a country that has a very dense population, the number of covid-19 cases in the Philippines is surprisingly low at this point. This may have been due to the early implementation of measures. The archipelagic geography of the Philippines may also be a factor. The absence of inter-island travel prevents the spread of the virus from island to island. Many cases in the Philippines can be traced to Manila travel where the local transmission in the Philippines was first established.

The bad outcome of a late implementation of mitigation measures is not in doubt. Italy, Spain and the United States are the poster countries for this. These 3 countries have the highest number of covid-19 cases and deaths in the entire world. We can also see from the experience in these countries what happens when the healthcare infrastructure is overwhelmed. This is exemplified by Italy and New York City where most covid-19 cases and deaths are. But again, we can see in the experience of Italy, Spain and New York what strict mitigation measures will do to the Covid-19 pandemic when finally implemented.

Considering there is no clear way that most countries can be truly prepared for this pandemic, it is obvious that the rapidity, decisiveness, and compliance to the response is critical to the success or failure of the containment of the covid-19 pandemic. Lessons are learned from the successes and failures of the countries. The world will not be the same after this pandemic. The question that remains is whether there will be more unity and cooperation worldwide to keep humanity safe and protected. Will there be a move by world leaders to implement united and coordinated measures to prevent such a pandemic to get out of hand in the future? Or will there be an increased isolationist, ultra-nationalistic and xenophobic measures by countries worldwide? Humanity’s survival may depend on the path chosen by countries after this pandemic is over.

(The author is a phyisician from Cagayan de Oro who is now based in the US.)