FASTLANES: Bukot og habol

CAGAYAN DE ORO (MindaNews / 15 October) – When I was a kid, I loved hearing my Lola talk about how they survived the Japanese invaders in World War II. Early in the war, every time they heard of an impending ‘huwis d’ kutsilyo,’ they would hide and if they had nowhere to hide, ‘magbukot nalang mi og habol’ (We hid under the blanket). Later on, she said there was resistance and the rest is history.

COVID-19 has the sent the world into confusion and panic. With so many unknowns, strict quarantines were imposed when the World Health Organization declared a pandemic in March. The reason for this was simple: Prepare for the fight.

Quarantine gave authorities time to prepare, upgrade and improve critical care capacity of health systems. Policy makers instituted measures to implement minimum health standards or non-pharmaceutical protocols. Measures that entail revisiting behavior change communication taught in good old Good Manners and Good Conduct classes – proper hygiene: cover your mouth when coughing or sneezing – wearing of face masks and face shields; have your hands clean always – frequent hand washing, and taking a bath regularly; physical distancing – hands forward, hands sideward exercises to avoid crowding in gatherings and order when walking in line.

The World Health Organization (WHO) also advises people to limit, if not, avoid going to places with one, two or all of the three CCCs – Closed, Crowded and Constricted.

Early on, we thought contracting the virus was a death sentence. But let us look at the latest data:

Of those who contracted COVID-19 in the Philippines, 84.2% were classified as mild, 10.6% asymptomatic, 1.7% severe and 3.4% critical. The COVID fatality rate globally is around 5%. Cagayan de Oro is hovering around 4% according to data from the City Health Office. COVID is most deadly if the patient has compromised immunity or co-morbidities like cardio vascular diseases, diabetes, cancer, etc. (Source: DOH)

Walang forever sa lockdown

Now that we do have a better understanding of the virus and are better prepared to deal with it, people and communities need to reclaim their lives by adapting to what is called the new normal.

While many thought that strict quarantine measures would redound to reduction of cases, the palpable effect of the world’s longest quarantine – the Philippines – are:  1) Sharp increase in cases. Remember the lockdowns was explained as necessary to prevent cases from reaching 75,000. Now we are approaching 350,000; 2) Economic recession: All-time high unemployment, record number of people getting hungry.

People pay the cost of lockdowns

COVID-19 response or any response to calamity is costly. But not all costs can be placed in a balance sheet, calculated and accounted.

The social cost or externalities cannot be reflected in the balance sheets but has to be paid directly by society – the people. A 2003 study by the European Commission for example has calculated that for every dollar of profit from the use of dirty, climate-changing fuels, the externality is three dollars. This comes in the form of lost income and opportunities, morbidities, reduced productive capacity of the natural environment, climate change, etc.

Implementing lockdown could be the easiest but a reactionary response to the pandemic. As a coercive measure, it breaks more than it cures. Its social cost is extremely high. Government can force people to stay in cramped squalid dwellings for a time, but not forever. Sooner, the social cost rears its ugly head, as people who lost their jobs and other opportunities go hungry and become more vulnerable to a cacophony of ailments. Peace and order could also be disturbed as poor and hungry people eventually get restive while many slide into anti-social behavior. Then a vicious cycle of using the coercive powers of the state to quell restiveness and to put in check the pervasiveness of anti-social behavior.

The social cost of lockdowns does not only aggravate the effect of the pandemic, but also makes it lingering and far-reaching.

This makes imperative the push for more interventions and public expenditures aimed at improving critical care capacity of the public health system; establishment of more isolation and temporary treatment facilities; improved medical testing capacity; pro-active community surveillance; contact tracing; focused or granular containment; and support for comprehensive behavioral change communication campaigns for the adaptation of the new normal, e.g. observance of minimum health standards.

These affirmative investments are not lost after the pandemic. It could very well be the much needed shot in the arm of our emaciated public health system.

Conscientious public officials make lockdowns as a last resort or only when no other better option is available.

That is my understanding of the strategic framework of officials like Cagayan de Oro Mayor Oscar S. Moreno. Why he is doing everything – putting up isolation beds, increasing testing capacity, improving ICU capacities, decongesting the regional COVID-19 hospital the NMMC by upping the capacities of the city government-owned JR Borja Hospital and over 30 rural health units that are accredited under PhilHealth’s Maternity Care Package.

At the onset of the medical emergency, Mayor Moreno refused to put the city of around a million people, one of the most economically competitive nationwide and the core of the 4th emerging metropolitan city in the country after Metro Cebu and Metro Davao, into hard lockdown or enhanced community quarantine. From March to July, the city kept its figures below 300 when others were already registering four and five digits. The most stringent it had was general community quarantine.

Now that cases have breached the thousand level, and exponential growth has been observed, the alarm bells for hard quarantine or lockdowns are again sounded. Although, the intentions of these calls are suspect, let me indulge you with empirical data.

Cagayan de Oro is not in a bubble. That is why it is imperative to assess its COVID data with other similarly situated localities. So far, among the top 10 highly urbanized cities, it is way way below at no. 9.

[Cases in top 10 highly urbanized cities as of 08 Oct. 2020 (lowest to highest): 1. General Santos 456; 2. Cagayan de Oro 984; 3. Baguio 1,246; 4. Zamboanga 1,896; 5. Davao 2,160; 6. Lapu-Lapu 2,385; 7. Mandaue 2,480; 8. Iloilo 2,935; 9. Bacolod 4,266 and 10. Cebu 10,061.]

As I have said above, there are no solid evidences solely linking hard quarantine to flattening of the curve or reduction of COVID cases. When Cebu City was placed in a second lockdown on June 15, their cumulative number was around 2,000. But its case doubling time way below the threshold and critical care utilization rate are approaching the danger zone.

Now Cebu City has over 10,000 cases. The difference however compared to June, is that critical care utilization rate has been pushed back to the safe zone at 23.5% (for the whole of Central Visayas from over 50%), again, due to improved critical care capacity: more isolation beds, ICU and mechanical ventilators.

Even if Cagayan de Oro’s cumulative rate had breached the thousand mark, CCUR is still in the safe zone. Its active cases, needing isolation and temporary care has been hovering at 300 cases since last month, out of an installed capacity of over a thousand beds. Keeping the number of persons in isolation and temporary care at manageable levels has largely been due to acquired RT-PCR testing capacity, active surveillance and contact-tracing, and focused containment. Instead of the 14-day quarantine, those required to go on quarantine are now tested on their fifth day at the isolation center. And when results come in a day or two, those with negative results are sent home and those positive but mild and asymptomatic are sent to the temporary treatment and monitoring facilities.

Even if Northern Mindanao has, of late, surpassed Davao Region in terms of cumulative numbers, it has still kept its CCUR in the safe zone at 24.31% — the lowest in Mindanao. In fact, the DOH in Region 11 had recently enjoined other local governments in the region to establish more isolation units and temporary care facilities as the CCUR of the Southern Philippine Medical Center, Region 11’s COVID referral hospital is reaching the danger zone. (https://www.mindanews.com/top-stories/2020/10/utilization-rate-of-beds-for-covid-at-spmc-reaches-danger-zone/)

Admittedly there are still gray areas that need urgent actions and improvements. Topmost is still the compliance to the minimum health standards. This behavioral challenge is not exclusive to CDO or Northern Mindanao.

The proactive interventions of Cagayan de Oro and the provincial governments of Bukidnon and Misamis Occidental have indubitably resulted in the region maintaining its CCUR at the safe zone.

The Provincial Government of Misamis Occidental and Bukidnon have respectively capacitated the Hilarion Ramiro Medical Center and Bukidnon Provincial Medical Center to handle COVID cases. Camiguin, as an island province, naturally has better border and quarantine controls, thus it has kept its cases low. Iligan has regained and shown better numbers after establishing more isolation, temporary care facilities and focused containment when it was reverted to moderate ECQ. Lanao del Norte has also invested in testing capacity so that it will not be dependent on DOH testing labs in CDO.

[As of Oct. 8, 2020, from lowest CCUR (average usage of ICU beds, Isolation beds and mechanical ventilators): 1. Northern Mindanao/ R-X 24.31%; 2. Western Mindanao/ R-IX 29.48%; 3. Central Mindanao/ R-XII 32.93%; Southern Mindanao/ RXI 54.24; and Caraga 56.95%. (Source: DOH COVID-19 Tracker)]

Perhaps, the weakest link in Region 10 is Misamis Oriental. It appears however that Misamis Oriental Governor Bambi Emano is more pre-occupied monitoring numbers in the city, he conveniently delegated the leadership of the Provincial Inter-Agency Task Force for COVID response to the provincial health officer.

And every time he expresses his misplaced concerns for CDO in regular, pre-arranged media interviews, paid radio blocktimers and socmed trolls go rahrah, misrepresenting facts and spreading falsities.

Let me ask: If Bukidnon has the BPMC and Misamis Occidental has HRMC as provincial COVID designated hospitals, what is the Covid designated hospital of Misamis Oriental? What has the Misamis Oriental government achieved in improving the critical care capacities of the province-owned hospitals in Gingoog, Magsaysay, Talisayan, Balingasag, Initao, Claveria, Alubijid and Manticao?

When the Bukidnon provincial government gave sacks of rice to residents across the province, over and above those given by municipal and component city governments when there was GCQ, MECQ and ECQ, what did the people of Misamis Oriental receive from the Capitol?

While the city-owned JR Borja Hospital decongested birthing cases of the NMMC, why is there a substantial increase in number of maternity cases from Misamis Oriental towns at the city-owned hospital?

Eight months hence, bukot lang gihapon og habol ?

(Disclosure: The writer is a former journalist. He is now into governance and environment advocacy as chairperson of the Pinoy Aksyon for Governance and the Environment (Pinoy Aksyon). FB: @NoypiAksyon; Twitter: @PAksyon)

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