“How do you do it, Minguita? I mean, just reading all the updates makes me already feel and imagine I have the symptoms.”

This was a message sent to me in one of my many Viber groups recently. It is a very real problem nowadays. Last night I had to counsel someone who had a post-nasal drip and started to get light wheezing after she read about looting, holdups, and planned robberies that turned out to be fake news.

She calmed down when I reminded her that she and her family need to just follow the basic rules of the quarantine, as stated in the government guidelines, in order to stay safe. I also assured her that her post-nasal drip and occasional light wheezing were not signs of COVID-19. She has emotionally-induced asthma; something more and more people are experiencing lately due to all the anxiety and stress brought about by this pandemic. 

And so I would like to share some of the advice I gave my friends on how to keep sane and calm and centered during this worldwide crisis.  

1. Remember that more than 80% of COVID-19 cases are mild. Deaths occur in around 2.3% of cases and mostly in people above 70, especially those who have other underlying illnesses like hypertension and diabetes. In Korea, where testing is more vigorous, this death rate is less than 1%.

Just take care that our parents really stay home and eat properly and keep healthy habits. Our local death statistics, which are higher, are misleading and stem from the fact that we are not testing those with mild symptoms due to the lack of testing kits. 

2. Try to take a break from social media. A lot of the stress being experienced by many is because we are all glued to all things COVID-19. And social media is full of misinformation that can cause useless anxiety. 

3. Choose the Viber or WhatsApp groups that you will engage in and take seriously. Otherwise you will just become a nervous wreck; not just because of the panic they strike in your heart, but also because of all the false news that they spread and which you wish to correct all the time. If in doubt of any new and panic-causing info, check it first with the reliable, credible sources. (READ: LIST: Groups providing helpful information about the Luzon lockdown)

4. Keep the important numbers on hand, such as the nearest hospital, DOH hotline, at least one reliable doctor you can call, your barangay hotline, the PNP hotline to report crimes, and food delivery numbers. These are the basic numbers you need to survive.

5. Stop looking at the numbers of COVID-19 patients if they are causing you stress. There's nothing you can do about it anyway.

5. Avoid large family gatherings first, but try to keep bonded through Skype or Facetime. You can even have shared meals remotely. We plan to have our regular Sunday family lunches this way. We may be apart, but we will try to eat at the same time and chat like we were together. Our mother is 84 years old, and my husband and I are physicians still exposed to patients. We don’t want to take the risk of infecting her or any of our family. 

 6. Do things you like to do while at home. I intend to play the piano and cook more. These are two things I love to do but can't do on a regular basis due to my hectic work schedule. I might not even have this luxury soon once reservists have to man PGH. So I will do as much as I can today.

7. Think of people who may be suffering right now – an elderly or sick friend, a super anxious friend, someone who may be lonely and quarantined alone– and send them a loving message to make them know they are not alone. If you can help in feeding programs for the marginalized without breaking the rules of social distancing, then do so. There are many people who really need our help, and thinking about them will prevent any self-obsession. 

8. And finally, meditate, do deep breathing exercises through your nose, pray regularly, and know that God is in charge.  

There are positive changes happening amid all this turmoil and suffering. Some of us see them already while others don’t. But surely we see that people are kinder to each other. Our people have again realized the importance of our health care workers who are the frontliners in this world war. This is a far cry from the dangerous “smart shaming” and “expert bashing” we painfully witnessed in the recent past. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic)

Our country is rediscovering its true soul; something we had started to lose because rudeness and hate and anger had become vogue – propagated further by irresponsible trolls. Nowadays, these same trolls have largely kept quiet, and those who have tried to foment anger and hatred amid the pandemic were pummeled by the wrath of outraged netizens. 

The best, and perhaps the only way we can get through this crisis and emerge a better people and nation, is by thinking of others. It's the miracle of the “multiplication of the loaves” that we have to live and practice, both literally and figuratively – where food was enough to feed all, but where the miracle had to start with people willing to share what they had with those who had none. (READ: [OPINION] We need people power, not emergency power)

After we get through this together, in the right way, then we will see a better world.  But we need to stay sane and centered first. – Rappler.com

Dr. Ma. Dominga "Minguita” Padilla is a Clinical Associate Professor at the Philippine General Hospital-UPCM; an active consultant at the St. Luke’s Medical Center, Global City; and the Founder and President of the Eye Bank Foundation of the Philippines.

Being away from home at a time like this brings a lot of uncertainty and anxiety. For me, personally, it almost feels like having to go through the crisis two-fold, because I’m gathering and processing information about the situation in the Philippines and the UK simultaneously. With different strategies in place to contain the situation, directives from governments and health organizations changing at every turn, it’s hard to feel a sense of stability and peace of mind. (READ: Keep calm and cope: How to stay mentally healthy during coronavirus crisis)

The announcement of the community quarantine in NCR came over a week (almost two) ahead of any similar directive here in the UK. Since this wasn’t something we’d experienced before, naturally, the first line of thought that my family considered was to have me fly back to the Philippines temporarily. My medical history includes bronchial asthma and pulmonary health issues in the past, so my parents worried that I would be at risk. With a full-time job, no quarantine advice, or travel restrictions in place by the UK government at that time, much as I wanted, staying here in London felt like the logical choice. I was afraid that a long-haul flight would not only put my health at risk but possibly even risk exposure to my loved ones in the Philippines.

While the lockdown was imposed in the Philippines, health agencies and the media warned that Europe was now the epicenter of the pandemic. Though neighboring countries like Italy had enforced lockdown too, in the UK, life seemed pretty much business as usual. I tried to implement changes in my personal routine though, like practicing physical distancing, carrying a 500 ml bottle of Green Cross alcohol (yes, even here, love local pa rin!) to and from work every day, washing my hands more often with soap and water, and bringing disinfectant wipes everywhere I went. I guess for a while it humored people, especially when I would wipe down exercise equipment before and after use at my local gym. 

It was only a matter of time until the gravity of the situation had caught up with the rest of the Britons. In London, we saw a daily increase in confirmed cases shoot up from 100, 200, to nearly 700 cases within a 24-hour period. As the numbers escalated, so too did my anxiety. Not only for fear of the coronavirus itself, but more importantly because of the onslaught of racism and discrimination hurled against the Asian community. Having been based in the UK for a while, I never really felt like I had to look over my shoulder. But living through it myself and hearing stories from people close to me, allow me to say this. Asians are not to blame for the spread of coronavirus. (READ: Stay home for 3 months, UK tells 1.5 million most at risk)

I’m fortunate that even without the government’s imposition of a lockdown, my workplace was very supportive and flexible with working remotely. Because of this situation, a week ago, I decided to go on a self-imposed lockdown here in London, to avoid any risks of exposure, and to do my part in helping #FlattenTheCurve. Even then, I had an unsettling urge to do something more for my community back home in the Philippines. (READ: [OPINION] Staying sane and centered in the time of the coronavirus)

In the first week of my self-imposed lockdown, I managed to find a way to channel all the stress and anxiety into something more positive and productive. Despite all the uncertainty that we are facing today, know that there is still so much that you can do. Your voice matters. Wherever in the world you may be. – Rappler.com

Isabel is a London-based Marketing and PR professional who is passionate about elevating storytelling through creative experiences. She was born and raised in the Philippines and is an island girl at heart. 

Editor's note: A longer version of this article was first published on Medium on March 10, 2020. It is being reposted with the author's permission. Watch and read the transcript of Pueyo's interview with Rappler. 

READ: Part 1 | How many cases of COVID-19 will there be in your area?

The coronavirus is already here. It’s hidden, and it’s growing exponentially.

What will happen in our countries when it hits? It’s easy to know, because we already have several places where it’s happening. The best examples are Hubei and Italy.

Fatality rates

The World Health Organization (WHO) quotes 3.4% as the fatality rate (% of people who contract the coronavirus and then die). This number is out of context so let me explain it.

It really depends on the country and the moment: between 0.6% in South Korea and 4.4% in Iran. So what is it? We can use a trick to figure it out.

The two ways you can calculate the fatality rate is Deaths/Total Cases and Deaths/Closed Cases. The first one is likely to be an underestimate, because lots of open cases can still end up in death. The second is an overestimate, because it’s likely that deaths are closed quicker than recoveries.

What I did was look at how both evolve over time. Both of these numbers will converge at the same result once all cases are closed, so if you project past trends to the future, you can make a guess on what the final fatality rate will be.

This is what you see in the data. China’s fatality rate is now between 3.6% and 6.1%. If you project that in the future, it looks like it converges towards ~3.8%-4%. This is double the current estimate, and 30 times worse than the flu.

It is made up of two completely different realities though: Hubei and the rest of China.

Hubei’s fatality rate will probably converge towards 4.8%. Meanwhile, for the rest of China, it will likely converge to ~0.9%:

I also charted the numbers for Iran, Italy, and South Korea, the only countries with enough deaths to make this somewhat relevant.

Iran’s and Italy’s Deaths / Total Cases are both converging towards the 3%-4% range. My guess is their numbers will end up around that figure too.

South Korea is the most interesting example, because these two numbers are completely disconnected: deaths / total cases is only 0.6%, but deaths / closed cases is a whopping 48%. My take on it is that a few unique things are happening there.

First, they’re testing everybody (with so many open cases, the death rate seems low), and leaving the cases open for longer (so they close cases quickly when the patient is dead). Second, they have a lot of hospital beds (see chart 17.b). There might also be other reasons we don’t know. What is relevant is that deaths/cases has hovered around 0.5% since the beginning, suggesting it will stay there, likely heavily influenced by the healthcare system and crisis management.

The last relevant example is the Diamond Princess cruise: with 706 cases, 6 deaths and 100 recoveries, the fatality rate will be between 1% and 6.5%.

Note that the age distribution in each country will also have an impact: Since mortality is much higher for older people, countries with an aging population like Japan will be harder hit on average than younger countries like Nigeria. There are also weather factors, especially humidity and temperature, but it’s still unclear how this will impact transmission and fatality rates.

This is what you can conclude:

• Excluding these, countries that are prepared will see a fatality rate of ~0.5% (South Korea) to 0.9% (rest of China).
• Countries that are overwhelmed will have a fatality rate between ~3%-5%

Put in another way: Countries that act fast can reduce the number of deaths by a factor of ten. And that’s just counting the fatality rate. Acting fast also drastically reduces the cases, making this even more of a no-brainer.

So what does a country need to be prepared?

What will be the pressure on the system

Around 20% of cases require hospitalization, 5% of cases require the Intensive Care Unit (ICU), and around 2.5% require very intensive help, with items such as ventilators or ECMO (extra-corporeal oxygenation).

The problem is that items such as ventilators and ECMO can’t be produced or bought easily. A few years ago, the US had a total of 250 ECMO machines, for example.

So if you suddenly have 100,000 people infected, many of them will want to go get tested. Around 20,000 will require hospitalization, 5,000 will need the ICU, and 1,000 will need machines that we don’t have enough of today. And that’s just with 100,000 cases.

That is without taking into account issues such as masks. A country like the US has only 1% of the masks it needs to cover the needs of its healthcare workers (12M N95, 30M surgical vs. 3.5B needed). If a lot of cases appear at once, there will be masks for only two weeks.

Countries like Japan, South Korea, Hong Kong or Singapore, as well as Chinese regions outside of Hubei, have been prepared and given the care that patients need.

But the rest of Western countries are rather going in the direction of Hubei and Italy. So what is happening there?

What an overwhelmed healthcare system looks like

The stories that happened in Hubei and those in Italy are starting to become eerily similar. Hubei built two hospitals in 10 days, but even then, it was completely overwhelmed. Both complained that patients inundated their hospitals. They had to be taken care of anywhere: in hallways, in waiting rooms…

From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

— Jason Van Schoor (@jasonvanschoor) March 9, 2020

I heavily recommend this short Twitter thread. It paints a pretty stark picture of Italy today

Healthcare workers spend hours in a single piece of protective gear, because there’s not enough of them. As a result, they can’t leave the infected areas for hours. When they do, they crumble, dehydrated and exhausted. Shifts don’t exist anymore. People are driven back from retirement to cover needs. People who have no idea about nursing are trained overnight to fulfill critical roles. Everybody is on call, always.

Francesca Mangiatordi, an Italian nurse that crumbled in the middle of the war with the Coronavirus

That is, until they become sick. Which happens a lot, because they’re in constant exposure to the virus, without enough protective gear. When that happens, they need to be in quarantine for 14 days, during which they can’t help. Best case scenario, two weeks are lost. Worst case, they’re dead.

The worst is in the ICUs, when patients need to share ventilators or ECMOs. These are in fact impossible to share, so the healthcare workers must determine what patient will use it. That really means, which one lives and which one dies.

All of this is what drives a system to have a fatality rate of ~4% instead of ~0.5%. If you want your city or your country to be part of the 4%, don’t do anything today. – Rappler.com

*Tomas Pueyo is a Silicon Valley entrepreneur and behavioral psychologist who specializes in exponential growth. He wrote the Medium post, "Coronavirus: Why You Must Act Now," which was read by tens of millions of people around the world.

Suppose you had the choice between two health policies, A and B. Policy A would result in the death of a lot of elderly people. Policy B would result in the death of a lot of children, especially infants. Which would you choose?

Right now we are facing a choice between more or less drastic measures to slow the spread of COVID-19, a virus which, at time of writing, has yet to claim a life under 10, and claims very few lives under 30, with the risk rising exponentially with age. We are putting in place measures that will lead to malnutrition and starvation for millions of people, and for these horrors, children and especially infants are the most at risk. And very many of those infants are born, and will die, in Africa.

Yet there is little discussion of the consequences for human health of the measures we are taking. Nor is there discussion of how the major differences between Africa and America, Europe, and Asia might matter. The World Health Organization (WHO) website contains no technical guidance on how African governments should approach their considerably different contexts. The advice is the same globally, but the context is not.

Failure to recognize that one size does not fit all could have lethal consequences in this region, maybe even more lethal than those of the virus itself.

Social distancing may cost lives in Africa

In Africa, millions will starve if the global economy enters a protracted downturn. We must ask whether the number will be more than COVID-19 will kill in a region where only 6.09% of the population is over 65.

After the 2008 recession, 1 billion people were malnourished, and 5 million more children were hungry in 2010 than they would have been if the recession had not happened. We are only seeing the start of the economic disaster, and therefore the health disaster, that is going to engulf us as a consequence of social distancing measures.

And it’s not just the plunge of some abstract stock market. Tourism employs 1 in 23 employed South Africans. It has evaporated overnight. Bars and restaurants are empty, and, where they serve alcohol, must close early or limit numbers. Football has been shut for the season, and football clubs will go bust. And so on.

Unemployment in South Africa was already nearly 30% in the fourth quarter of 2019. The government lacks both the means and the competence to swiftly dish out grants to SMEs, such as the GBP10,000.00 (about South African R200,000.00) offered by the British government. South African SMEs are already vulnerable. Their employees mostly have no savings, no access to credit (creating hospitable waters for loan sharks), limited assets, and a support network consisting of people in the same boat. Mass unemployment means mass poverty, which means mass starvation.

The crunch question is this: what is the case fatality rate of social distancing in Africa? We have no idea; but that is the figure that should be considered when implementing social distancing measures. The scientific community, including both epidemiologists and economists working together, should be putting as much effort into estimating that case fatality rate as into estimating it for COVID-19.

Social distancing might not work in Africa

It’s not even clear that the social distancing measures will curb the spread of disease here. We know from award winning work on HIV transmission by South African epidemiologists that local social context can neuter a health intervention that is effective elsewhere. So it may be with social distancing.

In a South African township, living conditions are extremely crowded. Socializing is unavoidable. You might as well tell people to emigrate to Mars. In the bubonic plague, the aristocracy left London for the countryside; the poor of London could not isolate themselves, and so they died. This may be our situation.

It is similarly fantastical to expect people who cannot afford food – as will soon be the case for many more – to practice personal hygiene. You can’t eat soap. If you are starving, you won’t buy it.

Thus the major components of the recommended public health measures – social distancing and hygiene – are extremely difficult to implement effectively in much of Africa. The net effect of measures that seek to enforce social distancing may thus be to prevent people from working, without actually achieving the distancing that would slow the spread of the virus. If that is true, then we must consider whether we would be better off without them.

Not all these measures are the same, and nor are preventive measures an all-or-nothing measure. Some degree of social distancing may be possible. Elbow greetings may slow things down. But it’s a fantasy to suppose that the virus can be contained anywhere, and the cost of measures must be proportioned to their likely benefit. The cost of an elbow greeting is low, but the cost of shutting a school is huge.

But even if social distancing here will “flatten the curve,” will it make a difference? The logic of flattening the curve is to bring the peak of the pandemic (the highest number of sick at any one time) down to a manageable level. But this assumes access to healthcare in the first place.

In much of Africa, public healthcare is inaccessible to a huge proportion of the population. Without a miraculously fast overhaul of the continent’s healthcare provision, flattening the curve will make no difference to the majority. Cute as the meme is, its logic does not apply to much of Africa.

What about the children?

Children evoke strong emotions in most of us. Those with children may be worried about their welfare. But children are at very low direct risk from the virus, although of course they are at indirect risk from the economic consequences of pandemic and the death of elderly care-givers. And, in a famine, they are at very high risk of malnutrition and starvation.

We, personally, have elderly relatives whom we care about deeply. But would we actively move children who are otherwise at a minimal risk into a high risk situation, in an attempt to prolong the life of some of those elderly? Would we do so when the effectiveness of those measures is questionable, and the economic effects of those measures (famine) also puts the elderly themselves at risk?

We don’t know. It depends on the data. But we do believe that this is a conversation that we must be brave enough to have.

Many leaders are doubtless aware of their dilemma, but their ability to express this and their ability to make choices is restricted, as the treatment of British leadership shows. In Africa, it’s questionable whether leaders have a political choice, given intense pressure from an international community that isn’t thinking about the differences of the African context, and a WHO offering no region-specific technical advice.

Leaders need to be given the space to say shocking things, to be upfront about what might go wrong, to change their minds in the face of new evidence, and to pick the lesser of two evils.

Doctors face such choices every day, and they are horrible. But they are unavoidable. Without a proper estimation of the costs as well as the benefits of the measures currently being implemented, no rational assessment of their merit can be made. – Rappler.com

This article originally appeared in The Conversation.

Alex Broadbent is Director of the Institute for the Future of Knowledge and Professor of Philosophy at the University of Johannesburg.

Benjamin T H Smart is Associate Professor at the University of Johannesburg.

It’s only been a few days since the Duterte administration put all of us in the island of Luzon on lockdown due to this pandemic, and yet I already feel my anxiety going through the roof. It’s not the “normal” kind of anxiety that I’m used to: the rapid, sharp sensation that may persist throughout the day but eventually dies out. It’s the kind of anxiety that slowly wraps you in its claws, the creeping sense of dread similar to anticipating a jump scare at the end of a movie scene.

It’s a foreboding reminder that things are just going to get worse from here, or even worse, that things aren’t going to change.

“Makati nako. Text ko na lang kayo kung kelan ako uuwi. Ingat kayo” (I’m in Makati City. I’ll text you when I’m going home. Take care).

That was one of the last texts I sent before the first COVID-induced lockdown befell Metro Manila; a reminder to my parents in the bordering province of Cavite that I intend to continue my weekend visits home after all this is over. I normally send texts like these when I’m too lazy to leave my rented unit for the weekend, but this time it feels a little heavier. It almost feels apocalyptic knowing that my family, who should be at least two hours away, are suddenly impossible to reach due to the government’s military barriers and the virus’s invisible ones. Even though it’s just for a month, this lockdown made me realize what it really means to be alone. (READ: PODCAST: Battling depression and anxiety)

Shortly after the implementation of community quarantine and the 8 pm to 5 am curfew, public transport was banned. Now it’s really looking like a bad start to dystopia. I can’t take my nightly walks anymore, the restaurants are closed, and the streets are empty. People are doing the stuff I’m used to doing on a Friday night: browsing the web, reading, watching movies, staring at the ceiling. I’ve even mastered the whole work-from-home thing because I previously spent more than a year doing freelance work.

It feels surreal seeing everyone stuck in the sort of struggles I learned to live with growing up: staying at home, avoiding everyone, isolating. As someone with both anxiety and introversion, I grew up being told that I should put myself out there and that I should socialize more. Now, everyone is doing what I’ve been doing all these years not out of comfort but for safety. (READ: Dealing with depression and anxiety: My saving graces)

Instead of being comforted at the sight of my peers becoming like me, I feel uneasy. Because of COVID-19, I am reminded of how unnatural it is that I have few friends, that I prefer staying home to partying, that I don’t date, and that I tend to wander off and isolate no matter who I’m with.

I’m reminded that in order to survive in society’s rat race, some of us have to go out and protect whatever’s left in us with what little we have because we’re not privileged enough to have things handed to us.

As I write this, I get a text from my dad telling me to sleep in total darkness to increase the melatonin in my body. My dad’s a doctor, so I’m used to getting unsolicited health advice from him. I decided to keep reminding myself to take dad’s advice even though my roommates and I always sleep with the lights off. 

There’s darkness out there in the streets too, but the lights never go out. – Rappler.com

Andrea Rivera is a writer based in Makati City. Her Twitter handle is @andreyeaah.

Think about it. 

There would be a lot less flak being hurled at public officials if there was a stronger perception of focused leadership from the top. Hell, ANY kind of leadership from the top, rather than a slurred mix of policy vacillation, double standards, and petty threats. 

There would be a lot less dissing certain LGU heads if their peers weren't being so exemplary. It doesn't help that the targeting by the usual troll farms of perceived role models only angers a suddenly home-bound army of vigilant online citizenry.

There would be a lot less complaining if we knew that the frontliners against COVID-19– a line of medical professionals already worn thin – received enough logistical support and appreciation from this government. 

There would be a lot less fear if there was a sense of something to hold on to – hope, confidence, timetables of improvement, a reality better than this one. And we are not even speaking of sighs of relief from the privileged tired of Netflixing, but a genuine concern and initiative to help those who are more vulnerable, those who have no walled subdivisions to retreat to, no full refs to fall back on, no guaranteed income to receive whether they actually work or not. 

We are very grateful that there are so many efforts by individuals and corporations to help. Malls that will not collect rent from tenants, utilities and banks that are waiving or delaying collections and fees, and even motels that provide sleeping quarters for the staff of nearby hospitals.

There are people collecting donations to provide food, fundraising for buying supplies, even networks of private transportation to bring essential workers where they need to go. 

Perhaps it is ironic how the threat of a mysterious international disease can bring out so much unexpected altruism from even the smallest, quietest corners of human society. It is, after all, easier to milk the situation for popularity's sake, or to prepare for elections in 2022. It is easier to hoard than it is to share, to ignore rather than to assist.

It is so much easier to lash out at detractors, than to ask oneself, am I giving them a reason to do so?

The volume of social commentary, or if you want, the backlash against bullshit, is not driven by boredom. With our backs increasingly against the wall, the anger directed against those in government is very real, because it has to be. We cannot afford to be complacent anymore, business as usual, letting someone else worry, because COVID-19 gives us a hell of a reason to all be worried. 

I would like to think Filipinos are sometimes mature enough to show appreciation and admiration when it is deserved. I think Filipinos are sometimes mature enough to know when generosity is an act, and when it is real. 

More than concern, practice compassion. More than sympathy, show empathy. (READ: We need leadership, sanity during crisis)

Fewer childish tantrums, more accountability. Less fake news, more basic, badly needed truth. 

Amid all the calls to stop politicking and unite against a common enemy – stop behaving like you're also an enemy. 

If you're tired of being called indifferent, incompetent, and inefficient, then by all means, stop being so. – Rappler.com 

Jo-Ed K. Tirol, PhD, is an Assistant Professor of the Department of History, Ateneo de Manila University.

With the COVID-19 wave about to engulf us, our response needs to be nuanced to the huge disparities in this country. The enhanced community quarantine, while certainly warranted, has markedly different impacts depending on where we sit on the income ladder. There is no doubt we all suffer from these measures, but we suffer to a greatly different extent.  

For the 2.5 million people in Metro Manila who reside in crowded slums, or the 15.1 million poor households nationwide, community quarantining and social distancing have entirely different implications. Lost income from restricted movement matters greatly, not just to the income earner but also to the whole family dependent on those earnings. There are no savings to draw upon. Crowded in one room that may be 3 sqm, it is unrealistic to think that social distancing is possible. Collecting water or washing at communal points, walking through narrow alley ways, just stepping out to get some sunlight and less fetid air, or walking 3 hours to and from work because of the absence of public transport presents a whole set of risks. (READ: Thousands of Metro Manila’s poorest left out as deadly coronavirus spreads)

Certainly, efforts to suppress transmission with strict community quarantine measures need to be in place. But what are the complementary policies and programs for the poor? Can the Administration increase the amount and frequency of social safety net payments? Can we, as we would in the aftermath of a destructive typhoon, provide emergency water, sanitation, and food aid? These are preventative and alleviation measures. But there is also a looming crisis that requires a viable contingency plan. National epidemiologists are estimating that the number of people infected could rise to 75,000 within a few months (what about the projected fatality rate?) and that is likely a conservative figure. A significant proportion could be the poor living in crowded slums.  

Local governments will need to run the numbers and develop the worst-case scenarios for planning. Personal protective equipment for front line workers, testing kits (and the WHO tells us we must test, test, test), ventilators, sanitizers, ICU beds, and alternative bed space (for hospitals that may quickly reach their limits to house the sick), etc., will need to be provided and quickly. Much of this will be challenging given the huge demand on global supply. Health facilities will need to be accessible and ideally testing and health services taken directly to poor communities. Innovative approaches to tracing and isolation in crowded slums areas will need to be implemented. Assignment of health workers needs to be calibrated to where the greatest numbers are likely to be. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic)

The President is calling for a special session to pass a supplemental budget to manage the crisis and contend with its (social) and economic impact. (Editor's note: As of posting, Republic Act 11469 was already signed into law.) This stimulus is urgently required, as is an adjustment of existing programs. Spending the full budget allotment in any one year has been a problem, so a rapid review based on realistic projections of expenditure could be undertaken to realign savings to pro-poor interventions. 

This is now a matter of both the quantum and quality of expenditure. At all costs, we need to avoid the ethical dilemma of choosing whose life to save or care for. Income should certainly not be the defining factor. We are about to head into not only a health crisis but a humanitarian crisis. We need to act accordingly and leave no one behind. – Rappler.com

Titon Mitra is the Resident Representative of the United Nations Development Program-Philippines.

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair...”

– Charles Dickens, A Tale of Two Cities

At a time like this, either the world is about to end or a new one is about to begin. 

For several days, I have not slept well. Every day comes with worse news than the previous day. Cases exponentially increasing, doctors becoming patients, lives shut down abruptly, and the degree of separation clearly becoming smaller.

When news of local transmission came to light that evening of March 7, when a woman contracted the dreaded virus from a native with no travel history, I shuddered in fear. True enough, the days that followed chronicled unprecedented measures to contain the contagion. 

Statistics are supposed to reassure us that at best, this virus can just cause mild upper respiratory tract symptoms in most healthy individuals. But for someone who has studied medicine and epidemiology, science and mathematics have failed to assuage my fears this time. It could be any of my loved ones. It could be me next. Logic has flown out the window. In statistics, there are wrong assumptions, outliers, standard errors, and worst-case scenarios. 

This enemy has stripped humanity of its layers and brought out the best and worst in us. This virus shows us man’s selfish nature – hoarding months and months’ worth of food, alcohol, masks, without regard to other people who might be needing them. To each his own, these hoarders rationalize. (READ: On a roll: The psychology behind toilet paper panic)

The virus exposes man’s self-righteous behavior and intolerance. When a socialite repeatedly cursed at people who left their homes for work, people reprimanded and reminded her of her privilege. Judgment prevailed. 

This virus reveals a fragmented system without true leadership, the obvious cracks widening into a gaping hole. There was no voice that could calm a populace already beset by fear, a presence that could assure. This virus unmasked the true nature of those in power.

Nevertheless, this virus has shown us that when circumstances are down, we step up. In times of despair, we discover things in ourselves that we might never have discovered in times of prosperity. 

The less than ideal situation and scarcity of resources brought out the inventors and innovators in us by producing modified face shields made of acetate and empty water bottles, raincoats for protective gowns, plastic shower caps for surgical caps. 

These turbulent times also give rise to paintings that inspire, poetry that heals, and music that soothes. In Italy, the caged bird sings. 

Because of the collective madness, leaders emerged from the crowd. These leaders are not necessarily the elected ones. They could be doctors in hospitals called out to man the emergency rooms in the line of duty. They could be heads of companies who prioritize people over profit, sending employees home and compensating them appropriately. The present situation has also exposed proactive community leaders who display the necessary qualities at a time like this: quick in action, decisive, and empowering.

This situation brings out the bayanihan spirit inherent in Filipinos: this spirit of volunteerism that make us rise to the occasion when called for. Students creating makeshift masks in their spare time and giving them for free to frontline health personnel. Medical interns volunteering their services to man hospitals despite the risks of being exposed to danger. The spirit of bayanihan creates ripples: from free meals being provided to healthcare workers by eatery owners, to free rides given for workers in the midst of a lockdown. 

Physical distancing encourages people to be one meter apart to lower the risk of spread. Ironically, the physical distance that now separates us brought us closer to a state of solidarity. There is a united spirit, a spirit that remains hopeful and defiant that together, we can get through this. 

Wherever and whoever you are, as you read this, may you live to tell the tale. If the Lost Generation was defined after the bloodshed of World War I, may our generation be the Found Generation of our times, defined by our newfound humanity. – Rappler.com

Elvie Victonette B. Razon-Gonzalez is an internist-gastroenterologist and epidemiologist born and raised in Las Piñas, but now a resident of Iloilo City. She considers herself a woman of science but a lover of the arts.

We were not alone in underestimating the COVID-19 threat. With every country inextricably linked to China, where this disease started percolating, the rest of the world was similarly caught flat-footed. 

But while our health systems are not as advanced as other countries, we could have done a lot better. 

We Filipinos are no strangers to disasters. Regular exposure to various natural hazards have built innate resilience in our people.

What's different here is that the threat concerned – unlike in other crises – is invisible. But this is not the first time we have managed a threat like this either. We had experience with SARS in 2006. Health authorities did not do badly in containing that outbreak. 

So what went wrong? And how do we move on from here?

Comprehensive, holistic approach

The first thing we need to do is go back and review well-established workflows for disaster risk reduction and management: prevent, prepare, respond, recover. 

Looking at this problem from this comprehensive and holistic lens is critical because you want to avoid cures that are worse than the disease and you want to mitigate future vulnerability to this threat. 

The fact that our medical frontliners are forced to go to work without personal protection equipment and the lack of coordination in the way the quarantine or lockdown protocols were implemented shows just how much we failed with respect to the first two phases of this workflow.

To help us move forward, it is crucial to assess and acknowledge where we failed and provide a clear accounting of where the gaps are. Transparency and humility on the part of the political leadership is key to helping this country heal as one. It is also critical to enable everyone who can help to jump in and help out more effectively.

Let me go through some of the things that were missed one by one. 

Step 1: Assess risk vulnerability, prevent, mitigate

Disaster management experts will tell you that the first critical step to preventing a crisis is to assess the hazard (in this case a disease outbreak), determine level of exposure and vulnerabilities to the hazard, and plan ways to mitigate risks in relation to a particular threat or hazard.

The formula goes this way: risk = hazard x exposure x vulnerability.

They also stress this: every dollar spent on prevention and mitigation saves US$6 or more in losses. 

We failed in this critical part of the workflow when Philippine authorities failed to accurately assess potential exposure and vulnerability to COVID-19, even though we have been pivoting more closely towards China politically and economically in recent years. A red flag should have been raised when the first case, a tourist from Wuhan, was confirmed on January 30 this year. 

The fact that the first and second cases were able to go through various local airports undetected should have pushed the government to level up action. It was clear from that point that surveillance efforts were not enough and that the level of risk was significant. 

For instance, hiring more people to do contact tracing, and investing in mechanisms to strengthen quarantine measures would have prevented those with the disease from infecting others.  Instead of making sure that this is done, President Duterte dismissed the outbreak as "nothing to be scared about."

The health department recently did a callout for volunteer data gatherers to help with contact tracing. This might be too late for areas in Metro Manila where local transmission is evident but may still be helpful for areas in the country where cases reported involve travelers from other places.   

Here, effective risk communication is paramount. The Presidential Communications Operations Office (PCOO) should focus on communicating the nature of the threat and how local governments can prevent further exposure to it in their respective areas, instead of dismissing critics’ concerns. 

Step 2: Plan, test plans, prepare to respond

The first case was reported January 30. The first death from local transmission due to COVID-19 was confirmed March 9. The month in between these two dates could have been the golden window for what disaster managers call the preparedness for response phase. Having a checklist of needs and things to do helps at this point. 

Instead of patting themselves on the back, the Department of Health could have used this window to sound the alarm and ensure that local disaster managers were oriented on what’s unique about this threat and what needs to be done to manage it. Workflows and functional capabilities should have been assessed and tested at this stage.

Supplies needed for emergency response should have been procured. We could have ordered personnel protective equipment and ventilators at this point, given the amount of time it takes to get these manufactured and shipped out.  

Step 3: Respond, get people out of harm's way, help those in need

Given that local transmission is obviously happening already, it makes sense to make people stay at home in the meantime. With less people moving around, the likelihood of the virus spreading uncontrollably and exponentially beyond the capacity of the health system is minimized.

But what are indicators the quarantine is working? Lockdowns, according to the World Health Organization (WHO) are not enough to defeat the coronavirus. Finding those who are sick and isolating them, finding their contacts and isolating them, too, should be the focus.

Granular, up-to-date data on how the disease is spreading is critical to effective response. This is where a testing strategy helps, according to former health secretary Manuel Dayrit. Testing helps those fighting to stop the disease see how it is spreading.

Beyond counting the sick and the dead, we also need real-time tracking of needs on the ground such as PPEs, ventilators, hospital beds to protect frontliners and attend to those who are sick. This inventory of requirements is critical so groups who want to help can plug in where they are needed. 

In previous disasters, the National Disaster Risk Reduction and Management Council (NDRRMC) used to have a National Incident Management System that tracks needs and actions done. This is critical because it prevents bottlenecks in action and information flow, and allows needs to be addressed faster. 

The same setup at the national level is then echoed by local disaster management councils at the provincial, city, municipal, and  barangay levels. In this setup, citizens and the private sector are not seen as potential victims. Rather they play an active role in helping address the crisis as well. 

Step 4: Recover, improve resilience

Lockdowns and quarantines cannot be forever. We need to plan on how and when to get society moving again. 

The danger right now with the lockdowns, according to the WHO, is that the disease may jump back up when those movement restrictions and lockdowns are lifted. To prevent this, strong public health measures need to be put in place. 

The outbreak and the lockdown will have tremendous socio-political and economic effects. A number of excellent studies on how the Philippines can get back on its feet are worth examining. One worth looking into is a discussion paper written by noted economists from the University of the Philippines School of Economics.

Entitled, “A Philippine Social Protection and Economic Recovery Plan,” its recommendations include measures for social protection, preserving jobs and businesses, providing liquidity, and finally, ensuring transparency and accountability.

One key point that needs to be highlighted is the need for transparency and accountability.

To say that “Congress will exercise its power to check” is not enough. Establishing clear guidelines for distribution of scarce resources is critical. Putting up mechanisms that will help the public track and independently verify where funds went is crucial in building the trust and confidence of all sectors.

Leadership, connecting echo chambers, healing polarization

My final point here has to do with the kind of leadership we need in these trying times.

Managing a complex effort like containing the COVID-19 menace and getting people to work together as a collective so that the country can “heal as one” requires a leader and a manager who is conscious of the science, has experience managing crises, and can traverse the opposing ends of the political spectrum.

For the Philippines to "heal as one,” we need to heal the wounds of polarization that continue to plague this land. Leaders should be humble enough to acknowledge what they do not know and what inputs they need from others.

Make no mistake, if not handled right, this crisis could ruin political careers. Whether or not he deserved it, politicians should remember the experience of Mar Roxas during Yolanda. Hindi ito panahon ng pagpapa-guwapo. (This is not the time for politicians to make themselves look good.) 

People are grieving. Trouble is simmering. People are angry, and rightfully so. People are frustrated, and rightfully so.

Leaders need to start listening and acting fast. – Rappler.com

The human dimensions of the COVID-19 pandemic reach far beyond the critical health response. All aspects of our future will be affected – economic, social and developmental. Our response must be urgent, coordinated and on a global scale, and should immediately deliver help to those most in need.

From workplaces, to enterprises, to national and global economies, getting this right is predicated on social dialogue between governments and those on the front line – the employers and workers. So that the 2020s don’t become a re-run of the 1930s.

International Labor Organization (ILO) estimates are that as many as 25 million people could become unemployed, with a loss of workers’ income of as much as $3.4 trillion. However, it is already becoming clear that these numbers may underestimate the magnitude of the impact.

This pandemic has mercilessly exposed the deep fault lines in our labor markets. Enterprises of all sizes have already stopped operations, cut working hours and laid off staff. Many are teetering on the brink of collapse as shops and restaurants close, flights and hotel bookings are cancelled, and businesses shift to remote working.

Often the first to lose their jobs are those whose employment was already precarious – sales clerks, waiters, kitchen staff, baggage handlers and cleaners.

In a world where only one in 5 people are eligible for unemployment benefits, layoffs spell catastrophe for millions of families. Because paid sick leave is not available to many carers and delivery workers – those we all now rely on – they are often under pressure to continue working even if they are ill.

In the developing world, piece-rate workers, day laborers and informal traders may be similarly pressured by the need to put food on the table. We will all suffer because of this. It will not only increase the spread of the virus but in the longer-term dramatically amplify cycles of poverty and inequality.

Expansionary policies

We have a chance to save millions of jobs and enterprises, if governments act decisively to ensure business continuity, prevent layoffs and protect vulnerable workers. We should have no doubt that the decisions they take today will determine the health of our societies and economies for years to come.

Unprecedented, expansionary fiscal and monetary policies are essential to prevent the current headlong downturn from becoming a prolonged recession. We must make sure that people have enough money in their pockets to make it to the end of the week – and the next.

This means ensuring that enterprises – the source of income for millions of workers – can remain afloat during the sharp downturn and so are positioned to restart as soon as conditions allow. In particular, tailored measures will be needed for the most vulnerable workers, including the self-employed, part-time workers and those in temporary employment, who may not qualify for unemployment or health insurance and who are harder to reach.  

As governments try to flatten the upward curve of infection, we need special measures to protect the millions of health and care workers (most of them women) who risk their own health for us every day. 

Truckers and seafarers, who deliver medical equipment and other essentials, must be adequately protected. Teleworking offers new opportunities for workers to keep working, and employers to continue their businesses through the crisis. However, workers must be able to negotiate these arrangements so that they retain balance with other responsibilities, such as caring for children, the sick or the elderly, and of course themselves.

Working with employers, workers

Many countries have already introduced unprecedented stimulus packages to protect their societies and economies and keep cash flowing to workers and businesses. To maximize the effectiveness of those measures it is essential for governments to work with employers’ organizations and trade unions to come up with practical solutions, which keep people safe and to protect jobs.

These measures include income support, wage subsidies and temporary layoff grants for those in more formal jobs, tax credits for the self-employed, and financial support for businesses.

But as well as strong domestic measures, decisive multilateral action must be a key stone of a global response to a global enemy. The G20’s virtual Extraordinary Summit on the Covid-19 response on 26 March is an opportunity to get this coordinated response going.

In these most difficult of times, I recall a principle set out in the ILO’s Constitution: Poverty anywhere remains a threat to prosperity everywhere. 

It reminds us that, in years to come, the effectiveness of our response to this existential threat may be judged not just by the scale and speed of the cash injections, or whether the recovery curve is flat or steep, but by what we did for the most vulnerable among us. – Rappler.com 

Guy Ryder is Director-General of the International Labor Organization.

The Philippine economy needs to pull a Han Solo. 

If you’ve ever watched Star Wars: The Empire Strikes Back, one of the most iconic scenes is the “carbon-freezing” of Han Solo (played by Harrison Ford).

He was flash-frozen and encased in a substance called carbonite, such that he still lived and his vitals were kept intact. He was later thawed and brought back to life at another side of the galaxy.

In the time of COVID-19, economists argue the economy also needs a similar freezing.

To stop the coronavirus in its tracks, everything needs to be shut down – except the bare necessities for society to function. Later, once this nightmarish epidemic is over, we can similarly thaw the economy and stimulate it no end.

Such an economic hibernation, as you might expect, is extremely costly. Thousands of businesses might close shop, and even more workers will be thrown out of work, save those lucky enough to work from home. Millions could go broke and hungry.

To prevent widespread despair and chaos, government must pull out all the stops and provide billions worth of financial assistance to almost everyone in the economy – at least until this pandemic ends.

But what kinds of financial assistance should the Duterte government provide? How large should these be? Are they forthcoming? Do we have the money? 

Menu of assistance

Financial relief could come in many forms.

Workers. Government must ensure that workers can still pay their bills – and buy groceries, medicines, and other necessities – even if they can’t show up at work.

One way to do this is by subsidizing and expanding paid leaves or directly handing them unconditional cash transfers.

To avoid a wave of defaults and foreclosures throughout the economy, zero-interest personal loans, interest waivers, and loan and rent payment extensions could help.

Not every worker will stay on the payroll. For those who will be laid off or forced to work fewer hours, unemployment insurance – equivalent to their full salaries and lasting several months – could tide them over.

Businesses. As people hunker down at their homes, lots of businesses will lose cash flow. With bills to pay, many businesses might be forced to fold.

Some suggest billions worth of corporate grants or bailouts. But the last thing we need right now is to needlessly line the pockets of big corporations and their shareholders. Economists prefer instead zero-interest business loans: at least taxpayers can get their money back once business resumes as usual.

Another way to help businesses is by extending tax payments and the filing of tax returns. Government might also consider tax relief and tax credits for firms that, say, promise they won’t lay off any of their workers.

The poor. Most of all, government must look after the welfare of millions of poor Filipinos, as well as workers in the informal sector – vendors, street sweepers, tricycle drivers – for whom no amount of paid leaves or unemployment insurance will help. 

Handing out money to the poor should be relatively straightforward because there’s an infrastructure in place, thanks to programs like the Pantawid Pamilyang Pilipino Program (4Ps).

But even more simple is a temporary universal basic income (UBI) which involves giving every Filipino (or Filipino household) a fixed amount of money to help tide them over.

'Bayanihan to Heal as One'

To its credit, the Duterte government has already incorporated a number of these financial remedies in the “Bayanihan to Heal as One Act” signed by Duterte in the wee hours of March 25 (read the full text here).

For instance, for two months, government promises to give 18 million of the poorest households an “emergency subsidy” ranging from P5,000 to P8,000 a month.

The Bayanihan law also expands and enhances 4Ps to include households not currently enrolled in it.

The law also mandates a 30-day grace period for the payment of rents and loans. It also postpones the payment of taxes and filing of tax returns.

To ensure the availability of credit, the law also provides for the lowering of interest rates and the reserve requirements of banks (although the Bangko Sentral ng Pilipinas or BSP already did these over the past week).

Finally, under the law Duterte could also “reprogram, reallocate, and realign” savings from other budget items of the executive to help communities and industries affected by COVID-19.

Not enough 

Although a good start, the Bayanihan law is not enough.

First, will the emergency subsidy of P5,000 to P8,000 enough for a family of, say, five, to replace lost income and survive this shuttered economy?

Recall that a few years back people were outraged by suggestions supposedly coming from government that P10,000 will suffice for a “decent life.” What more now?

Second, the Bayanihan law fails to provide a specific amount of financial assistance to businesses, especially small ones.

Congress needs to pass a separate spending bill for this, like the P108-billion package crafted by Marikina Representative Stella Quimbo which includes P50 billion worth of loan packages and subsidies for micro, small, and medium enterprises.

Unfortunately, Congress might not tackle a proper “stimulus” package until May – by which time many businesses may already have gone bankrupt.

Third, the law seems to underestimate the magnitude of the economic problem.

A group of economists from the University of the Philippines recently estimated the government needs anywhere from P100 billion to P300 billion to “protect our people, avert a recession, and arrest the misery” wrought by the coronavirus. 

In a much-awaited report, meanwhile, the National Economic and Development Authority (NEDA) estimated our economic losses could fall somewhere between P429 billion and P1.36 trillion.

By itself, the emergency subsidy for poor households already costs about P270 billion (assuming a mean payoff of P7,500 per household per month).

Can Duterte raise such sums just by shifting around savings from existing projects?

At any rate, the whopping P300 billion liquidity infusion of the BSP should give the national government some financial leg room. Finance Secretary Carlos Dominguez III is also scouring for loans from multilateral agencies amounting to $1 billion-$2 billion.

Fourth, there’s the issue of transparency and accountability.

The Bayanihan law requires Duterte to report every Monday all uses of funds and how he realigned savings for the COVID-19 effort.

But I pointed out weeks ago that the Duterte government has been fiscally irresponsible of late. (READ: How the budget deficit exploded under Duterte’s watch)

With billions of additional funds soon at Duterte’s disposal – and a spotty track record of transparency and accountability – we should all watch the money trail closer than ever.

Can we pull through?

For the first time since 1998, the Philippine economy could shrink. But it’s a necessary shrinkage: we have no choice but to “carbon-freeze” our economy and put it in hibernation until we rein in COVID-19.

Spoiler alert: Han Solo did eventually survive and recover from forced hibernation.

Will Duterte’s Bayanihan law allow the Philippine economy to pull through as well? – Rappler.com

The author is a PhD candidate and teaching fellow at the UP School of Economics. His views are independent of the views of his affiliations. Follow JC on Twitter (@jcpunongbayan) and Usapang Econ (usapangecon.com).

It is apparent that the coronavirus pandemic is trouble for every individual. But there is a caveat to this.

Sociologist C. Wright Mills proposes that our personal troubles should be understood in light of public issues. More often than not, we do not link our personal troubles with the issues of society as a whole. We might think that our personal troubles – in this case, safety from the virus – can be solved through our individual coping mechanisms alone. But one thing is certain: the coronavirus is a public issue.

But the mere recognition of the issue as a public concern is just the beginning. Making sense of this phenomenon is another task. German sociologist Ulrich Beck’s notion of “risk society” will be helpful here.

He describes the contemporary world as one where people, governments, and corporations are increasingly mindful of the experience of risk in different aspect of our lives, including health. He says that in the event of any world catastrophe, the impact would be damaging and difficult to contain. We see this social reality in the increasing number of deaths worldwide and in the different measures, rules, and regulations imposed by different states. 

How, then, should we deal with the phenomenon of the coronavirus as a public issue and a global risk?

There are 3 main responses to risks that Beck mentions – denial, apathy, or transformation. By denial, we behave as if the risk does not exist. By being apathetic, one may acknowledge the risk without responding to it. Given the reality and gravity of the situation, neither of those two can save us. This leaves us with transformation. By this, he meant taking collective, global action. (READ: Volunteer your skills during the lockdown through these initiatives)

How exactly can we realize this collective action if we are under quarantine and our actions are limited in the spaces of our own homes? At the surface, it may seem that our individual efforts are purely private, personal, and not at par with that of volunteer groups, businesses, and the state. But when we stay at home as advised by the medical experts; when we stop spreading fake news about the virus that fosters fear and confusion; when we control ourselves from flaunting our lavish lifestyles on social media while others are in peril; and when we are being vigilant about the actions of our leaders to ensure accountability, we are doing a huge favor not just for ourselves but for other people as well. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic)

As different sectors of society make adjustments amid this pandemic, so should every Filipino family. Indeed, the safety of our loved ones is our immediate concern, which in no way should be undermined. And although the coronavirus is a global risk phenomenon, this should not lull us into thinking that our individual efforts are insignificant. Rather, we must begin with the kind of mind that links our personal circumstances with the public experience. Ultimately, the only way to face the present threat is through collective and transformative actions. – Rappler.com

Prince Kennex R. Aldama is an assistant professor of sociology at the Department of Social Sciences, UP Los Baños.

One week has passed since Manila was placed under "enhanced community quarantine." That first night, I didn’t sleep well. I stayed awake trying to comprehend the incomprehensible announcement made by our President and fearing the consequences of a mandate so poorly communicated and implemented. I must have dozed off trying to make sense of it all, but woke shortly after midnight to the sound of sirens blaring in the distance. I couldn't distinguish if it belonged to an ambulance or a police vehicle, but either was equally unnerving as it signaled a life that needed saving or one unable to be saved. In silence, I prayed that all sirens I heard and continue to hear were for lives saved. (READ: Luzon lockdown: What are the do's and don'ts?)

On the morning of March 16th, the world around me fell silent: no more sound of cars, of dogs barking, of the family in the neighboring house sharing meals or watching TV. Overnight, the sound of normalcy disappeared and was replaced by the eerie silence of uncertainty and fear. It was deafening. 

Only the sirens resonated distinctly, and frequently. I hear them more often than the hourly church bells. With the rising number of COVID-19 cases and the rising death toll, I can't help but contemplate: "Today, for whom does the bell toll? Today, for whom does the siren sing?" As the poem concludes, it’s beside the point to know for whom – because it tolls for all of us. Any person's death is mankind’s loss, especially now, when a mistake in sanitation or a misused test kit could seriously endanger others. 

I never imagined that social distancing would deprive us not only of physical touch, but also of the sounds of togetherness: laughter around the dining table, hugs with a comforting pat on the back, and the tender whisper of kisses. Sounds I never thought I would miss. It’s nothing like being deaf, although it comes close when you realize you can still hear, but what was taken away were the sounds you loved most. Like the voice of a loved one lost to the virus. 

Silence is a double-edged sword that magnifies its harm and help. It's harmful when used as a response to the community's most pressing questions. It's harmful when one keeps silent about his or her travel history, or the truth about being exposed to a PUM/PUI. It’s harmful when we keep silent about injustice. These days, silence kills more than ever. (READ: Makati Med denounces Pimentel's 'irresponsible, reckless' protocol breach)

But silence can also be a saving grace and even a privilege. For those of us who are comfortably quarantined at home, cherish the silence of social distancing. Use it to reflect on how you can help, even without stepping outside. A heartfelt prayer will find its way through walls, and up to Heaven. 

As I write this, my thoughts and prayers are with our health care workers. I can only imagine what it's like for them to constantly hear people beg for help, to be bombarded with the earsplitting alarm of a Code Blue or the shrill beep of someone flatlining, to hear the dying ask for their loved ones. Can you imagine what it feels like to hear yourself respond with "I'm sorry?" Or what it's like to hear someone's dying breath? Indeed, quiet moments are quite a privilege. 

Seemingly, it’s a privilege that several politicians refuse to enjoy. The usual suspects are quick to speak boisterously (except our mumbling Mr. President) and callously, without empathy or logic. Perhaps if they spent more time in silence and thought, we would have a more rigorous plan to contain this virus and help the vulnerable. Perhaps, if they were placed under mandatory isolation regardless of the results of formal testing, then they could have the space to think logically, plan properly, and communicate thoughtfully to citizens. Perhaps this would also allow the test kits to go to those who truly need it. 

Sirens and silence are the defining sounds of this pandemic. But recently, another is being amplified: the song of birds; representing hope that we will defeat this disease if we all do our part. Already we're hearing good news about containing the virus: countries with little to no new cases, increasing recoveries especially among the elderly, more test and PPE kits distributed, heightened compliance with social distancing, petitions for mass testing, and people helping even from the confines of their homes. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic)

In the weeks to come, I pray that we hear more good news such as thorough plans and accountability from our government. I hope we hear about significant progress in vaccine development and aid given to frontliners. I pray that we hear fewer sirens, and more birdsong.

And I pray that soon, we can all hear the words, "A cure has been found." – Rappler.com

Therese Joson is a Business Economics graduate from the University of the Philippines and currently specializes in Business Development for start-up companies in the technology and innovation space, specifically companies geared towards social impact.

She and her family are actively facilitating donations and aid to health care frontliners, some of whom are friends falling victim to COVID-19. Therese dedicates this piece to all health care frontliners to let them know that they’re not alone in this battle.

This piece is part of a series by youth leaders from #WeTheFuturePH, a nonpartisan movement of Filipino youth standing up for rights, freedom, and democracy. 

This was written for all frontliners in health care, by a non-frontliner.  

This was also written for people whose social media posts are insults to the efforts and sacrifices of those working tirelessly to fight the menace that is COVID-19. 

To start things, I am a registered nurse by profession and used to work in a government hospital. As a former health care worker, I know too well what life is like inside – the long work hours, the stress, the life-and-death battles, the demands made by patients and watchers alike, the risks and dangers (inevitable exposure to a number of infectious diseases while on duty, for example), and the occasional feelings of disappointment and frustration every time someone decides it's okay to downgrade the health care profession and be bold about it. Even proud. (READ: Evicted, banned from eateries: Frontliners face discrimination in Iloilo City)

1. "It's just their job!" 

Reading this statement from posts by fellow Filipinos really strikes the heart. Health care is more than just a job, mind you. Aside from the necessary skills and knowledge, you need compassion, patience, and selflessness to be able to serve the sick, injured, and the dying. You must also be willing to sacrifice things like sleep and time for family. No other job in the world leaves you wanting to do more for those in your care, sometimes at the cost of your own peace of mind. 

Upon arriving home after a toxic shift – especially after a patient's death – we'd ask ourselves things like, "What went wrong? What else could have been done? Did I use the right management? How are his/her family members dealing with things now? Was I a bad doctor/nurse?"

We love caring for our patients so much that more often than not, we end up going above and beyond our duty, like looking for extra medications and supplies to give to financially challenged patients or lending a listening ear to the anxious and depressed. (READ: Germany to fly in Filipino nurses to care for their coronavirus patients – report)

2. "Why glorify them? They are NOT special!" 

Because of COVID-19, health care workers in the Philippines and all over the world are now in the spotlight. Before COVID-19, the health care profession was largely unappreciated. I actually feel happy that my fellow healthcare workers, especially my former workmates and supervisors, are now getting the attention and recognition they deserve. It's also heartwarming to know that for the past few days, individuals, groups, and government offices are showing support through donations like food and additional PPEs and services like free transportation and accommodation. 

For the record, health care workers never asked to be "glorified," but to be simply appreciated and respected like other professionals. Please remember that they are also human beings working to help other human beings. They get tired, stressed, and even put in harm's way while on the job. And not just that, they also go through the pain of being separated from their families to prevent their loved ones from being exposed to COVID-19.

We need them and at the same time, they also need us. Kindness is free and makes things a lot better. If you can't help by making donations, at least avoid spreading hate and negativity towards their work through unkind words.  

3. "They're only working for money!" 

Now this one got me fuming. Yes, like any other regular person with a job, a health care worker has a family to feed. But it's never just about the salary, which sadly, gets delayed for a lot of them every now and then. They don't just work to earn a living; they work for human lives. 

Know that no amount of money can ever replace the value of a single life. And while we're talking about a worldwide health threat like COVID-19, imagine the pain and pressure health care workers in largely affected countries like Italy and Iran are dealing with as we speak, with deaths here and there by the thousands. (READ: Long shifts, low pay are part of a PH nurse's reality)

4. "I don't give a f**k!"  

Guess what? COVID-19 doesn't give a f**k either. It's a danger to everyone everywhere, especially for those who don't care enough to follow simple precautions like staying home, practicing proper hygiene, and being honest enough about their symptoms.  

Just this weekend, a young nurse in Italy passed away as a result of being infected by COVID-19 while practicing her profession. A young Filipino doctor also passed away, all because of a patient who lied about his/her travel history. Before them, hundreds of healthcare workers have already lost their lives fighting COVID-19. All of them had families who depended on them. All of them had friends who adored them. All of them had workmates and colleagues who enjoyed their company, never to enjoy another day in their respective hospitals doing what they knew best – saving lives. 

You don't have to be in health care to be able to feel something about their deaths. You just need to be a decent human being and it actually won't cost you much. Exhibiting apathy by saying things like "I don't care!" or "IDGAF!" only shows that you are a sorry excuse for a human. A heartless and brainless alien from another galaxy perhaps?  

By disregarding (and even laughing at) the efforts of health care workers, you're actually killing their fallen comrades for the second time around. 

–– 

While not all of us can be frontliners, we can choose to fight COVID-19 and support those on the front lines by doing what we can. 

Whether you choose to donate food or PPEs, give a healthcare worker a ride home, give money for supplies, say prayers, write uplifting articles to spread awareness, or send healthcare workers letters of appreciation – it's all up to you. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic)

Always have this in mind:

Hate and negativity are weapons of the weak. 

Love and perseverance are weapons of the strong and selfless. 

Which weapons do you choose? – Rappler.com

Johanna Zehender is a registered nurse who writes to uplift nurses and fellow health care workers everywhere.

The coronavirus pandemic is exposing one of our greatest weaknesses as a society: the widening gap between the rich and the poor. With no end in sight at the moment, the impact of COVID-19 will be massive, devastating, and, in many areas of our lives, permanent.

This global pandemic worsens our already unequal and sexist economy. Just like in any crisis, it is always the poorest, marginalized, and most vulnerable people who suffer the most, especially women and girls.

It may appear that COVID-19 knows no race, gender, nor social or economic status – that one’s bank account and diplomas do not stop the rapid spread of the disease. However, our experience in the Philippines tells us a different story.

While it is true that anyone can be exposed, not everyone has the means to protect themselves, the opportunity to practice social distancing because of living and work arrangements, or the ability to cope financially and socially in the immediate and long-term. In some cases, ‘home’ is no longer a safe place for women who are quarantined with their abusers.

We must recognize the differentiated impacts of this pandemic and respond accordingly. 

According to the World Health Organization, 70% of the world’s health workers are women – they are now in the frontlines of the pandemic, challenged by the shortage of resources and protective equipment to keep them safe.

Unpaid care

In the Philippines, the livelihood of the women who comprise the majority of our informal sector, such as sidewalk vendors and home-based workers, have already been interrupted and negatively affected by the community quarantine restrictions.

On top of this, Oxfam’s recent findings on unpaid care and domestic work show that women in the Philippines are twice as much more likely to shoulder household tasks, such as childcare and cooking, which are compounded by expectations that they will now be the primary carers for the sick or for those under quarantine in the absence of enough hospital beds, test kits, access to critical medical services, and other social safety nets.

According to Oxfam’s latest inequality report, women around the world put in 12.5 billion hours of care work for free every day. Women’s unpaid care work alone is adding value to the economy by at least USD 10.8 trillion a year, a figure three times larger than the global tech industry.

In the Philippines, state think tank Philippine Institute for Development Studies estimates that women’s unpaid work is worth nearly PHP 2 trillion, roughly 20% of the country’s GDP. Yet, the unpaid care work that they do is radically undervalued and taken for granted by society.

Considering that the wheels of our economy and society keep turning at the expense of the largely undocumented and unaccounted unpaid care work of women and girls, then why do government approaches against COVID-19 fail to consider their needs?

Who is caring for our ‘invisible’ carers? These questions are even more critical now as we must all hold the line on existing commitments to women’s rights against a background of mounting economic disruptions, social injustice, regressive policies, and resource scarcity owing to the pandemic. 

We urgently need pro-poor and pro-women approaches to hurdle this health, poverty, and inequality crisis. We need more women from the marginalized and vulnerable sectors to participate in high-level decision making on local and national health preparedness and response.

We need the spaces for women’s rights and community-based organizations, self-help associations, cooperatives, and other civic groups to remain open and to persist, ensuring diversity in our voices. We need public health, social, and economic protection measures that understand and respond to the significant overlap between being a woman, being a carer, and being poor.

Flexible work arrangements

Governments and businesses can start caring for our carers by promoting flexible work arrangements and increasing access to paid leaves and social safety nets, including childcare support. Because COVID-19 is expected to increase the workloads of both paid and unpaid workers, our state duty-bearers must also invest in infrastructure and services that support the reduction of the unpaid care work of women, including water, energy, and health.

Women and men in the informal and agriculture sectors, as well as those trapped in ‘no work, no pay’ situations, will need support through emergency cash assistance that will tide them over and reinforce their dignity in these uncertain times. (Editor's note: Here's a donation link)

In the years to come, we will remember those who stood with the people during the crisis and those who simply looked after themselves. Our call is for governments and businesses to be on the right side of history.

Inaction robs women and girls of their time and opportunities, and puts at risk their safety and wellbeing. We either move forward with decisive and grounded solutions, or allow things to get worse with a business-as-usual approach. There is no middle ground because we are running out of time. – Rappler.com 

Vin Aranas is a communications lead at Oxfam. His work centers on responsible business practices, inclusive value chains, and women’s economic empowerment. Oxfam is an international confederation of 20 humanitarian and development organizations working in more than 90 countries.

Editor's note: A longer version of this article was first published on Medium on March 20, 2020. It is being reposted with the author's permission. Watch and read the transcript of his interview with Rappler's Maria Ressa. 

READ: Conclusion | [ANALYSIS] COVID-19: The hammer and the dance

Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.

Since my first article published on March 10, the conversation has changed and many countries have taken measures. Here are some of the most illustrative examples:

Measures in Spain and France

In one extreme, we have Spain and France. This is the timeline of measures for Spain:

On Thursday, March 12, the President dismissed suggestions that the Spanish authorities had been underestimating the health threat.

On Friday, they declared the State of Emergency.

On Saturday, measures were taken:

• People can’t leave home except for key reasons: groceries, work, pharmacy, hospital, bank or insurance company (extreme justification).
• Specific ban on taking kids out for a walk or seeing friends or family (except to take care of people who need help, but with hygiene and physical distance measures).
• All bars and restaurants closed. Only take-home acceptable.
• All entertainment closed: sports, movies, museums, municipal celebrations.
• Weddings can’t have guests. Funerals can’t have more than a handful of people.
• Mass transit remains open.

On Monday, land borders were shut.

Some people see this as a great list of measures. Others put their hands up in the air and cry of despair. This difference is what this article will try to reconcile.

France’s timeline of measures is similar, except they took more time to apply them, and they are more aggressive now. For example, rent, taxes and utilities are suspended for small businesses.

Measures in the US and UK

The US and UK, like countries such as Switzerland or Netherlands, have dragged their feet in implementing measures. Here’s the timeline for the US:

• Wednesday, March 11: travel ban.
• Friday: National Emergency declared. No social distancing measures.
• Monday: the government urges the public to avoid restaurants or bars and attend events with more than 10 people. No social distancing measure is actually enforceable. It’s just a suggestion.

Lots of states and cities are taking the initiative and mandating much stricter measures.

The UK has seen a similar set of measures: lots of recommendations, but very few mandates.

These two groups of countries illustrate the two extreme approaches to fight the coronavirus: mitigation and suppression. Let’s understand what they mean.

Before we do that, let’s see what doing nothing would entail for a country like the US.

Option 1: Do nothing

This fantastic epidemic calculator can help you understand what will happen under different scenarios. I’ve pasted below the graph the key factors that determine the behavior of the virus. Note that infected, in pink, peak in the tens of millions at a certain date. Most variables have been kept from the default. The only material changes are R from 2.2 to 2.4 (corresponds better to currently available information. See at the bottom of the epidemic calculator), fatality rate (4% due to healthcare system collapse. See details below or in the previous article), length of hospital stay (down from 20 to 10 days) and hospitalization rate (down from 20% to 14% based on severe and critical cases. Note the WHO calls out a 20% rate) based on our most recently available gathering of research. Note that these numbers don’t change results much. The only change that matters is the fatality rate.

If we do nothing: Everybody gets infected, the healthcare system gets overwhelmed, the mortality explodes, and ~10 million people die (blue bars). For the back-of-the-envelope numbers: if ~75% of Americans get infected and 4% die, that’s 10 million deaths, or around 25 times the number of US deaths in World War II.

You might wonder: “That sounds like a lot. I’ve heard much less than that!”

So what’s the catch? With all these numbers, it’s easy to get confused. But there’s only two numbers that matter: What share of people will catch the virus and fall sick, and what share of them will die. If only 25% are sick (because the others have the virus but don’t have symptoms so aren’t counted as cases), and the fatality rate is 0.6% instead of 4%, you end up with 500,000 deaths in the US. Still massive. But 20 times less than above.

The fatality rate is crucial, so let’s understand it better. What really causes the coronavirus deaths?

How should we think about the fatality rate?

This is the same graph as before, but now looking at hospitalized people instead of infected and dead:

The light blue area is the number of people who would need to go to the hospital, and the darker blue represents those who need to go to the intensive care unit (ICU). You can see that number would peak at above 3 million.

Now compare that to the number of ICU beds we have in the US (50,000 as of writing, we could double that repurposing other space). That’s the red dotted line.

No, that’s not an error.

That red dotted line is the capacity we have of ICU beds. Everyone above that line would be in critical condition but wouldn’t be able to access the care they need, and would likely die.

Instead of ICU beds you can also look at ventilators, but the result is broadly the same, since there are fewer than 100,000 ventilators in the US.

As of writing, at least one Seattle hospital is unable to intubate patients over 65 due to shortages of equipment and gives them a 90% chance of dying.

This is why people died in droves in Hubei and are now dying in droves in Italy and Iran. The Hubei fatality rate ended up better than it could have been because they built two hospitals nearly overnight. Italy and Iran can’t do the same: few, if any, other countries can. We’ll see what ends up happening there.

So why is the fatality rate close to 4%?

If 5% of your cases require intensive care and you can’t provide it, most of those people die. As simple as that.

Additionally, recent data suggests that US cases are more severe than in China. I wish that was it, but it isn’t. 

Collateral damage

These numbers only show people dying from coronavirus. But what happens if all your healthcare system is collapsed by coronavirus patients? Others also die from other ailments.

What happens if you have a heart attack but the ambulance takes 50 minutes to come instead of 8 (too many coronavirus cases) and once you arrive, there’s no ICU and no doctor available? You die.

There are 4 million admissions to the ICU in the US every year, and 500,000 (~13%) of them die. Without ICU beds, that share would likely go much closer to 80%. Even if only 50% died, in a year-long epidemic you go from 500,000 deaths a year to 2 million, so you’re adding 1.5 million deaths, just with collateral damage.

If the coronavirus is left to spread, the US healthcare system will collapse, and the deaths will be in the millions, maybe more than 10 million.

The same thinking is true for most countries. The number of ICU beds and ventilators and healthcare workers are usually similar to the US or lower in most countries. Unbridled coronavirus means healthcare system collapse, and that means mass death.

Option 2: Mitigation strategy

By now, I hope it’s pretty clear we should act. The two options that we have are mitigation and suppression.

Mitigation goes like this: “It’s impossible to prevent the coronavirus now, so let’s just have it run its course, while trying to reduce the peak of infections. Let’s just flatten the curve a little bit to make it more manageable for the healthcare system.”

This chart appears in a very important paper published by the Imperial College London. Apparently, it pushed the UK and US governments to change course.

It’s a very similar graph as the previous one. Not the same, but conceptually equivalent. Here, the “Do nothing” situation is the black curve. Each one of the other curves are what would happen if we implemented tougher and tougher social distancing measures. The blue one shows the toughest social distancing measures: isolating infected people, quarantining people who might be infected, and secluding old people. This blue line is broadly the current UK coronavirus strategy, although for now they’re just suggesting it, not mandating it.

Here, again, the red line is the capacity for ICUs, this time in the UK. Again, that line is very close to the bottom. All that area of the curve on top of that red line represents coronavirus patients who would mostly die because of the lack of ICU resources.

Not only that, but by flattening the curve, the ICUs will collapse for months, increasing collateral damage.

You should be shocked. When you hear, “We’re going to do some mitigation,” what you should really hear is, “We will knowingly overwhelm the healthcare system, driving the fatality rate up by a factor of 10 times at least.”

You would imagine this is bad enough. But we’re not done yet. Because one of the key assumptions of this strategy is what’s called “herd immunity."

Herd immunity and virus mutation

The idea is that all the people who are infected and then recover are now immune to the virus. This is at the core of this strategy: “Look, I know it’s going to be hard for some time, but once we’re done and a few million people die, the rest of us will be immune to it, so this virus will stop spreading and we’ll say goodbye to the coronavirus. Better do it at once and be done with it, because our alternative is to do social distancing for up to a year or risk having this peak happen later anyways.”

Except this assumes one thing: the virus doesn’t change too much. If it doesn’t change much, then lots of people do get immunity, and at some point the epidemic dies down.

How likely is this virus to mutate? It already has.

China has already seen two strains of the virus: the S and the L. The S was focused in Hubei and deadlier, but the L was the one that spread through the world.

Not only that, but this virus continues to mutate.

This graph represents the different mutations of the virus. You can see that the initial strains started in purple in China, but then they started mutating. The strains in Europe are mostly green and yellow families, while the US is seeing a different family in red. As more time passes, more of these strains will start appearing.

This should not be surprising: RNA-based viruses like the coronavirus or the flu tend to mutate around 100 times faster than DNA-based ones – although the coronavirus mutates more slowly than influenza viruses.

Not only that, but the best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.

That’s why you have to get a flu shot every year. Because there are so many flu strains, with new ones always evolving, the flu shot can never protect against all strains.

Put in another way: the mitigation strategy not only assumes millions of deaths for a country like the US or the UK. It also gambles on the fact that the virus won’t mutate too much – which we know it does. And it will give it the opportunity to mutate. So once we’re done with a few million deaths, we could be ready for a few million more — every year. This corona virus could become a recurring fact of life, like the flu, but many times deadlier.

The best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide.

So if neither doing nothing and mitigation will work, what’s the alternative? It’s called suppression.

Option 3: Suppression strategy

The mitigation strategy doesn’t try to contain the epidemic, just flatten the curve a bit. Meanwhile, the suppression strategy tries to apply heavy measures to quickly get the epidemic under control. Specifically:

• Go hard right now. Order heavy social distancing. Get this thing under control.
• Then, release the measures, so that people can gradually get back their freedoms and something approaching normal social and economic life can resume.

What does that look like?

All the model parameters are the same, except that there is an intervention around now to reduce the transmission rate to R=0.62, and because the healthcare system isn’t collapsed, the fatality rate goes down to 0.6%. I defined “around now” as having ~32,000 cases when implementing the measures (3x the official number as of today, 3/19). Note that this is not too sensitive to the R chosen. An R of 0.98 for example shows 15,000 deaths. Five times more than with an R of 0.62, but still tens of thousands of deaths and not millions. It’s also not too sensitive to the fatality rate: if it’s 0.7% instead of 0.6%, the death toll goes from 15,000 to 17,000. It’s the combination of a higher R, a higher fatality rate, and a delay in taking measures that explodes the number of fatalities. That’s why we need to take measures to reduce R today. For clarification, the famous R0 is R at the beginning (R at time 0). It’s the transmission rate when nobody is immune yet and there are no measures against it taken. R is the overall transmission rate.

Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.

Why? Because not only do we cut the exponential growth of cases. We also cut the fatality rate since the healthcare system is not completely overwhelmed. Here, I used a fatality rate of 0.9%, around what we’re seeing in South Korea today, which has been most effective at following a suppression strategy.

Said like this, it sounds like a no-brainer. Everybody should follow the suppression strategy.

So why do some governments hesitate?

They fear 3 things:

1. This first lockdown will last for months, which seems unacceptable for many people.
2. A months-long lockdown would destroy the economy.
3. It wouldn’t even solve the problem, because we would be just postponing the epidemic: later on, once we release the social distancing measures, people will still get infected in the millions and die.

Here is how the Imperial College team modeled suppressions. The green and yellow lines are different scenarios of suppression. You can see that doesn’t look good: We still get huge peaks, so why bother?

We’ll get to these questions in a moment, but there’s something more important before.

This is completely missing the point.

Presented like these, the two options of mitigation and suppression, side by side, don’t look very appealing. Either a lot of people die soon and we don’t hurt the economy today, or we hurt the economy today, just to postpone the deaths.

This ignores the value of time.

The value of time

In our previousposts, we explained the value of time in saving lives. Every day, every hour we waited to take measures, this exponential threat continued spreading. We saw how a single day could reduce the total cases by 40% and the death toll by even more.

But time is even more valuable than that.

We’re about to face the biggest wave of pressure on the healthcare system ever seen in history. We are completely unprepared, facing an enemy we don’t know. That is not a good position for war.

What if you were about to face your worst enemy, of which you knew very little, and you had two options: either you run towards it, or you escape to buy yourself a bit of time to prepare. Which one would you choose?

This is what we need to do today. The world has awakened. Every single day we delay the coronavirus, we can get better prepared. The next sections detail what that time would buy us:

Lower the number of cases

With effective suppression, the number of true cases would plummet overnight, as we saw in Hubei last week. 

As of today, there are zero daily new cases of coronavirus in the entire 60 million-big region of Hubei.

The diagnostics would keep going up for a couple of weeks, but then they would start going down. With fewer cases, the fatality rate starts dropping too. And the collateral damage is also reduced: fewer people would die from non-coronavirus-related causes because the healthcare system is simply overwhelmed.

Suppression would get us:

• Fewer total cases of coronavirus
• Immediate relief for the healthcare system and the humans who run it
• Reduction in fatality rate
• Reduction in collateral damage
• Ability for infected, isolated, and quarantined healthcare workers to get better and back to work. In Italy, healthcare workers represent 8% of all contagions.

Understand the true problem: Testing and tracing

Right now, the UK and the US have no idea about their true cases. We don’t know how many there are. We just know the official number is not right, and the true one is in the tens of thousands of cases. This has happened because we’re not testing, and we’re not tracing.

• With a few more weeks, we could get our testing situation in order, and start testing everybody. With that information, we would finally know the true extent of the problem, where we need to be more aggressive, and what communities are safe to be released from a lockdown.
• New testing methods could speed up testing and drive costs down substantially.
• We could also set up a tracing operation like the ones they have in China or other East Asia countries, where they can identify all the people that every sick person met, and can put them in quarantine. This would give us a ton of intelligence to release later on our social distancing measures: if we know where the virus is, we can target these places only. This is not rocket science: it’s the basics of how East Asia countries have been able to control this outbreak without the kind of draconian social distancing that is increasingly essential in other countries.

The measures from this section (testing and tracing) single-handedly curbed the growth of the coronavirus in South Korea and got the epidemic under control, without a strong imposition of social distancing measures.

Build up capacity

The US (and presumably the UK) are about to go to war without armor.

We have masks for just two weeks, few personal protective equipment (PPE), not enough ventilators, not enough ICU beds, not enough ECMOs (blood oxygenation machines)… This is why the fatality rate would be so high in a mitigation strategy.

But if we buy ourselves some time, we can turn this around:

• We have more time to buy all the equipment we will need for a future wave.
• We can quickly build up our production of masks, PPEs, ventilators, ECMOs, and any other critical device to reduce the fatality rate.

Put in another way: we don’t need years to get our armor, we need weeks. Let’s do everything we can to get our production humming now. Countries are mobilized. People are being inventive, such as using 3D printing for ventilator parts. We can do it. We just need more time. Would you wait a few weeks to get yourself some armor before facing a mortal enemy?

This is not the only capacity we need. We will need health workers as soon as possible. Where will we get them? We need to train people to assist nurses, and we need to get medical workers out of retirement. Many countries have already started, but this takes time. We can do this in a few weeks, but not if everything collapses.

Lower public contagiousness

The public is scared. The coronavirus is new. There’s so much we don’t know how to do yet! People haven’t learned to stop hand-shaking. They still hug. They don’t open doors with their elbow. They don’t wash their hands after touching a door knob. They don’t disinfect tables before sitting.

Once we have enough masks, we can use them outside of the healthcare system too. Right now, it’s better to keep masks for healthcare workers. But if they weren’t scarce, people should wear them in their daily lives, making it less likely that they infect other people when sick, and with proper training also reducing the likelihood that the wearers get infected. (In the meantime, wearing something is better than nothing.)

All of these are pretty cheap ways to reduce the transmission rate. The less this virus propagates, the fewer measures we’ll need in the future to contain it. But we need time to educate people on all these measures and equip them.

Understand the virus

We know very very little about the virus. But every week, hundreds of new papers are coming.

The world is finally united against a common enemy. Researchers around the globe are mobilizing to understand this virus better.

How does the virus spread?
How can contagion be slowed down?
What is the share of asymptomatic carriers?
Are they contagious? How much?
What are good treatments?
How long does it survive?
On what surfaces?
How do different social distancing measures impact the transmission rate?
What’s their cost?
What are tracing best practices?
How reliable are our tests?

Clear answers to these questions will help make our response as targeted as possible while minimizing collateral economic and social damage. And they will come in weeks, not years.

Find treatments

Not only that, but what if we found a treatment in the next few weeks? Any day we buy gets us closer to that. Right now, there are already several candidates, such as Favipiravir or Chloroquine. What if it turned out that in two months we discovered a treatment for the coronavirus? How stupid would we look if we already had millions of deaths following a mitigation strategy?

Understand the cost-benefits

All of the factors above can help us save millions of lives. That should be enough. Unfortunately, politicians can’t only think about the lives of the infected. They must think about all the population, and heavy social distancing measures have an impact on others.

Right now we have no idea how different social distancing measures reduce transmission. We also have no clue what their economic and social costs are.

Isn’t it a bit difficult to decide what measures we need for the long term if we don’t know their cost or benefit?

A few weeks would give us enough time to start studying them, understand them, prioritize them, and decide which ones to follow.

Fewer cases, more understanding of the problem, building up assets, understanding the virus, understanding the cost-benefit of different measures, educating the public… These are some core tools to fight the virus, and we just need a few weeks to develop many of them. Wouldn’t it be dumb to commit to a strategy that throws us instead, unprepared, into the jaws of our enemy? (To be concluded) – Rappler.com

READ: Conclusion | [ANALYSIS] COVID-19: The hammer and the dance

*Tomas Pueyo is a Silicon Valley entrepreneur and behavioral psychologist who specializes in exponential growth. He wrote the Medium post, "Coronavirus: Why You Must Act Now," which was read by tens of millions of people around the world.

READ Pueyo's previous work:

• [ANALYSIS] How many cases of COVID-19 will there be in your area?
• [ANALYSIS] COVID 19: The difference in death rates

Editor's note: A longer version of this article was first published on Medium on March 20, 2020. It is being reposted with the author's permission. Watch and read the transcript of his interview with Rappler's Maria Ressa. 

READ: Part 1 | [ANALYSIS] Strategies for fighting COVID-19

 

Now we know that the mitigation strategy is probably a terrible choice, and that the suppression strategy has a massive short-term advantage.

But people have rightful concerns about this strategy:

• How long will it actually last?
• How expensive will it be?
• Will there be a second peak as big as if we didn’t do anything?

Here, we’re going to look at what a true suppression strategy would look like. We can call it "the hammer and the dance."

The hammer

First, you act quickly and aggressively. For all the reasons we mentioned above, given the value of time, we want to quench this thing as soon as possible.

One of the most important questions is: how long will this last?

The fear that everybody has is that we will be locked inside our homes for months at a time, with the ensuing economic disaster and mental breakdowns. This idea was unfortunately entertained in the famous Imperial College paper:

Do you remember this chart? The light blue area that goes from end of March to end of August is the period that the paper recommends as the hammer, the initial suppression that includes heavy social distancing.

If you’re a politician and you see that one option is to kill hundreds of thousands or millions of people with a mitigation strategy and the other is to stop the economy for 5 months before going through the same peak of cases and deaths again, these don’t sound like compelling options.

But this doesn’t need to be so. This paper, driving policy today, has been brutally criticized for core flaws: they ignore contact tracing (at the core of policies in South Korea, China or Singapore, among others) or travel restrictions (critical in China), ignore the impact of big crowds...

The time needed for the hammer is weeks, not months.

This graph shows the new cases in the entire Hubei region (60 million people) every day since January 23. Within two weeks, the country was starting to get back to work. Within 5 weeks it was completely under control. And within seven weeks the new diagnostics was just a trickle. Let’s remember this was the worst region in China.

Remember again that these are the orange bars. The gray bars – the true cases – had plummeted much earlier.

The measures they took were pretty similar to the ones taken in Italy, Spain or France: isolations, quarantines, people had to stay at home unless there was an emergency or they had to buy food, contact tracing, testing, more hospital beds, travel bans… They were, however, more strict: for example, people were limited to one person per household allowed to leave home every 3 days to buy food. Also, their enforcement was severe. It is likely that this severity stopped the epidemic faster, but the current lockdowns in Europe are likely to have a similar result, even if not as fast.

Can we stay home for a few weeks to make sure millions don’t die? I think we can. It depends on what comes next, though.

The dance

If you hammer the coronavirus, within a few weeks you’ve controlled it and you’re in much better shape to address it. Now comes the longer-term effort to keep this virus contained until there’s a vaccine.

This is probably the single biggest, most important mistake people make when thinking about this stage: they think it will keep them home for months. This is not the case at all. In fact, it is likely that our lives will go back to close to normal. 

The dance in successful countries

How come South Korea, Singapore, Taiwan, and Japan have had cases for a long time – in the case of South Korea thousands of them – and yet they’re not locked down home? 

In this video, the South Korea foreign minister explains how her country did it. It was pretty simple: efficient testing, efficient tracing, travel bans, efficient isolating, and efficient quarantining.

This paper explains Singapore’s approach. Want to guess their measures? The same ones as in South Korea. In their case, they complemented them with economic help to those in quarantine and travel bans and delays.

Is it too late for other countries? No. By applying the hammer, you’re getting a new chance, a new shot at doing this right.

But what if all these measures aren’t enough?

The dance of R

I call the months-long period between the hammer and a vaccine "the dance" because it won’t be a period during which measures are always the same harsh ones. Some regions will see outbreaks again, others won’t for long periods of time. Depending on how cases evolve, we will need to tighten up social distancing measures or we will be able to release them. That is the dance of R: a dance of measures between getting our lives back on track and spreading the disease, one of economy vs. healthcare.

How does this dance work?

It all turns around the R. If you remember, it’s the transmission rate. Early on in a standard, unprepared country, it’s somewhere between 2 and 3: during the few weeks that somebody is infected, they infect between 2 and 3 other people on average.

If R is above 1, infections grow exponentially into an epidemic. If it’s below 1, they die down.

During the hammer, the goal is to get R as close to zero, as fast as possible, to quench the epidemic. In Wuhan, it is calculated that R was initially 3.9, and after the lockdown and centralized quarantine, it went down to 0.32.

But once you move into the dance, you don’t need to do that anymore. You just need your R to stay below 1. And you can do a lot of that just with a few simple measures.

 Detailed data, sources and assumptions here

This is an approximation of how different types of patients respond to the virus, as well as their contagiousness. Nobody knows the true shape of this curve, but we’ve gathered data from different papers to approximate how it looks like.

Every day after they contract the virus, people have some contagion potential. Together, all these days of contagion add up to 2.5 contagions on average.

It is believed that there are some contagions already happening during the “no symptoms” phase. After that, as symptoms grow, usually people go to the doctor, get diagnosed, and their contagiousness diminishes.

For example, early on you have the virus but no symptoms, so you behave as normal. When you speak with people, you spread the virus. When you touch your nose and then open the door knob, the next people to open the door and touch their nose get infected.

The more the virus is growing inside you, the more infectious you are. Then, once you start having symptoms, you might slowly stop going to work, stay in bed, wear a mask, or start going to the doctor. The bigger the symptoms, the more you distance yourself socially, reducing the spread of the virus.

Once you’re hospitalized, even if you are very contagious you don’t tend to spread the virus as much since you’re isolated.

This is where you can see the massive impact of policies like those of Singapore or South Korea:

• If people are massively tested, they can be identified even before they have symptoms. Quarantined, they can’t spread anything.
• If people are trained to identify their symptoms earlier, they reduce the number of days in blue, and hence their overall contagiousness.
• If people are isolated as soon as they have symptoms, the contagions from the orange phase disappear.
• If people are educated about personal distance, mask-wearing, washing hands, or disinfecting spaces, they spread less virus throughout the entire period.

Only when all these fail do we need heavier social distancing measures.

The ROI of social distancing

If with all these measures we’re still way above R=1, we need to reduce the average number of people that each person meets.

There are some very cheap ways to do that, like banning events with more than a certain number of people (eg. 50, 500), or asking people to work from home when they can.

Others are much, much more expensive, such as closing schools and universities, asking everybody to stay home, or closing bars and restaurants.

This chart is made up because it doesn’t exist today. Nobody has done enough research about this or put together all these measures in a way that can compare them.

It’s unfortunate, because it’s the single most important chart that politicians would need to make decisions. It illustrates what is really going through their minds.

During the hammer period, they want to go as low as possible while still remaining tolerable. In Hubei, they went all the way to 0.32. We might not need that: maybe just to 0.5 or 0.6.

But during the Dance of the R period, they want to hover as close to 1 as possible, while staying below it over the long term.

What this means is that, whether leaders realize it or not, what they’re doing is:

• List all the measures they can take to reduce R
• Get a sense of the benefit of applying them: the reduction in R
• Get a sense of their cost: the economic and social cost.
• Stack-rank the initiatives based on their cost-benefit
• Pick the ones that give the biggest R reduction up until 1, for the lowest cost
  
  

 This is for illustrative purposes only. All data is made up. However, as far as we were able to tell, this data doesn’t exist today. It needs to.

Initially, their confidence in these numbers will be low. But that‘s still how they are thinking – and should be thinking about it.

What they need to do is formalize the process: understand that this is a numbers game in which we need to learn as fast as possible where we are on R, the impact of every measure on reducing R, and their social and economic costs.

Only then will they be able to make a rational decision on what measures they should take.

Conclusion: Buy us time

The coronavirus is still spreading nearly everywhere. 152 countries have cases. We are against the clock. But we don’t need to be: there’s a clear way we can be thinking about this.

Some countries, especially those that haven’t been hit heavily yet by the coronavirus, might be wondering: is this going to happen to me? The answer is: it probably already has. You just haven’t noticed. When it really hits, your healthcare system will be in even worse shape than in wealthy countries where the healthcare systems are strong. Better safe than sorry, you should consider taking action now.

For the countries where the coronavirus is already here, the options are clear.

On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.

On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.

Governments around the world today, including some such as the US, the UK, Switzerland, or Netherlands have so far, as of writing, chosen the mitigation path.

That means they’re giving up without a fight. They see other countries having successfully fought this, but they say: “We can’t do that!”

What if Churchill had said the same thing? “Nazis are already everywhere in Europe. We can’t fight them. Let’s just give up.” This is what many governments around the world are doing today. They’re not giving you a chance to fight this. You have to demand it. – Rappler.com

*Tomas Pueyo is a Silicon Valley entrepreneur and behavioral psychologist who specializes in exponential growth. He wrote the Medium post, "Coronavirus: Why You Must Act Now," which was read by tens of millions of people around the world. 

READ Pueyo's previous work:

• [ANALYSIS] How many cases of COVID-19 will there be in your area?
• [ANALYSIS] COVID 19: The difference in death rates
• [ANALYSIS] Strategies for fighting COVID-19

I am a physician, an adult cardiology fellow. I am also a frontliner. 

Regardless of how many times I wash my hands or wear a surgical mask or an N95 mask, I am at a high risk for any kind of infection. Frontliners are not at a lesser risk of infection just because of strict self-protection protocols.

It was around March 9 when I was unconsciously exposed to a Patient Under Investigation (PUI)-turned-COVID positive case in the hospital — all during my tour of duty. Despite my protective gear and meticulous handwashing, I slowly contracted symptoms, such as low-grade fever, chills, and muscle pains. I could’ve stopped working, but I had to continue on and fulfil my duty to the patients we had to save.

Two days later, during my 36-hour tour of duty, the symptoms started to hit me hard: high-grade fever, chills, and worsening joint pains. I sought consult at our emergency room, and I was then declared as a PUI. (READ: Braving a pandemic: Frontliners battle fear to confront the novel coronavirus)

Patient under investigation 

My first COVID swab was traumatic. They stuck the swab through my nose to get a sample – an experience that I didn’t want to repeat again, though I had it for 4 more times after that. Worse, I had to wait not just 24 to 48 hours, but rather, 6 days before my first test came out. It was negative. 

I was sent home that day to start my home quarantine. I stayed at my aunt’s condominium unit away from my family, whom I haven’t seen for days and counting since my ordeal started. My greatest worry then was my parents, who are in their senior years and have their own share of co-morbidities, possibly contracting the virus from me and my younger brother, who is also a doctor. It was a worrisome idea that I had to bear for days on end. (READ: LIST: How to help healthcare workers, frontliners during coronavirus pandemic) 

During my self-quarantine, I felt so alone: I had to fix my own room and prepare my own meals despite the high fever and chills. I had to take my paracetamol pills to tone down a fever that never seemed to disappear. I even had to do tepid sponge baths on myself despite my worsening weakness. It was hard, but I had to survive on my own.

Five days after the index event — going on the third day of self-quarantine — my friend and former chief resident, an Infectious Disease fellow, strongly advised me to get admitted because of my worsening symptoms. I was hesitant at first, but because my fever was spiking to as high as 40 degrees Celsius and my body was not having any of it anymore, I had myself admitted at our hospital. But first, I had another COVID swab taken while waiting for 10 hours outside the sweltering heat of the ER, packed with PUIs and unsuspecting COVID-positive cases. 

Seeing the ER staff working hard round-the-clock made me realize the risks these heroes: doctors, nurses, and ancillary staff, take just to save one soul at a time, even at the expense of their own safety. 

People were ranting about poor service. But what good do their rants about waiting for 10 hours make when the staff are so overworked to the point that they even tend to forget to care for themselves? (READ: Undermanned, overworked: A doctor's view from the frontlines of the coronavirus outbreak)

I was then admitted at a regular room-turned-isolation room — a heroic and gallant effort on the part of the hospital to accommodate such patients despite going beyond their capacity to admit more. That room would then bear witness to the sufferings I was about to endure during my stay.

Positive case

I never felt so hopeless and weak on my first week: persistent fever and chills, loss of appetite to the point I was seeing my jawline after the first hospital week, and worsening muscle aches. The worst was when, at one time, I was coughing non-stop, suffocating and gasping for air due to the lack of oxygen inside my infected lungs, that the nurse hurriedly hooked me to the oxygen tank via a nasal cannula just to help me breathe. I was already submissive to the fact that I was about to get intubated and possibly sent to the Intensive Care Unit, but God had another day ready for me.

It was during that harrowing moment when I then learned of my fate: I was COVID-19 Positive. 

I became PH 253.

When I was told of my diagnosis, my first reaction was just any sick doctor’s reaction to his or her own illness: “Okay.”

Back then, I was already in the doldrums of my sickness: antibiotics were not working well on me. My sputum culture turned out consistent with hospital-acquired pneumonia. My chest X-ray showed progression of pneumonia infiltrates, and round-the-clock, high-dose intravenous paracetamol was not doing wonders.

Prayers and well-wishes from my family, fellow doctors, staff, med school, residency and fellowship friends and even from my nephew’s pre-school teacher, were enough then just to keep me alive during those worsening times. 

Things started to turn for the better when my antibiotics were shifted to Ertapenem, a high-level antibiotic, and two “miracle” pills for COVID-19: Hydroxychloroquine and Azithromycin. As these medications were started, my fever then started to abate, up to the point that my hospital bed was drenched in sweat after the second dose of Ertapenem. 

Waiting for full recovery

I was starting to breathe better to the point that I did not need oxygen support anymore. I started feeling lighter and better to the point that I could already open the air-conditioning unit and absorb all the chill inside the room. A chest x-ray then showed that my pneumonia was starting to clear out and improve.

It was a miracle that I didn’t expect. To think I had already submitted to the sad truth that I may not make it through. 

Five days after I started feeling well, my attending doctor had me endure two repeat COVID swabs — tests to prove that my sickness was nearing its end. The pain that I had to endure just to have swabs stick inside my throat and nose were nothing now compared to the trauma I felt when I thought I was about to die.

Looking back, I realized that COVID-19 spares no age group, and that it can devour even the strongest of immune systems. My experience with that harbinger of death taught me to trust the process through the unsung heroes of this fight – our frontliner doctors, nurses, and staff, – to believe in the power of medicine and science, to have a great support system to hold on to, and most especially, to pray to God, and have faith to trust in miracles.

To date, I am still waiting for the results of these COVID swabs while on my second week of confinement. 

Once these results come back negative, it won’t take long before I am sent back to the throes of war — an invisible war against an invisible foe, to become a frontliner yet again, ever ready to save people one soul at a time. – Rappler.com

Dr. Jose Antonio Bautista, or Bodjie to his family and friends, is an Adult Cardiology Fellow at the Heart Institute of St. Luke’s Medical Center - Global City, Taguig. He enjoys seeing and treating patients during busy days, reading textbooks and journals, and presenting in conferences and conventions. He watches movies and anime, dabs into tech, games, and food, and spends quality time with his family during his spare time.

In the tidal wave of ideas bursting onto the coronavirus scene, certain issues stand out: increasing infection rates; the lack of test kits; terrifying mortality statistics' doctors, nurses, and medical personnel without protective gear; overcrowded hospitals; physical distancing; and governance.

What about the millions of urban poor living in the densely packed neighborhoods of Metro Manila? How are they affected? Can anyone explain to a family of 10 living in a 20 sqm shack how to distance themselves one meter apart?  How are the 16,000 households in Baseco, Manila facing looming virus outbreaks while simultaneously suffering the impact of sudden income and job losses? Informal settlements are a COVID-19 disaster waiting to happen. (READ: Thousands of Metro Manila’s poorest left out as deadly coronavirus spreads)

Since the current lockdown prevents academic researchers from making field visits, Mary Racelis (MR) on Saturday, March 21 called Jeorgie Tenolete (JT), President of Kabalikat, a People’s Organization, on his cellphone asking him how Baseco was doing in the wake of COVID-19. The following account is JT’s assessment as told to and written by MR.         

A community leader tells it like it is

“You know, we’re used to disasters and disaster preparation here. We’ve coped with everything from floods, fires, earthquakes, even volcanos – but this coronavirus is something else!  We’ve never experienced anything like it!”

JT is mainly referring to the staggering challenge of mobilizing a huge community of urban poor households to combat the looming health and economic disasters facing them. 

As of March 21 only one person has been confirmed positive in Baseco, an OFW who recently flew in from the Middle East and is now under hospital care. Two others have self-quarantined because they recently arrived from countries with high infection rates – a resident Korean couple and a Filipino worker returning from Europe. Another 8 persons with colds and fever are currently being monitored by health workers every 3 hours and receiving paracetamol. If they still have a fever by the third visit, they will be transferred by DSWD staff to a hospital via the ambulance parked at Baseco’s entrance. No one has died.

To a question about the surprisingly low number of infections, JT chuckles, “People have grown up here facing so many illnesses that they have probably developed immunity, even against corona!”

More soberly he acknowledges that the lack of testing may explain the small numbers. Now that the health personnel have PPEs (personal protection equipment) and thermal guns donated by VP Leni’s office and a city councilor, they are in a better position to detect colds, coughs, labored breathing, and fever. Community health workers lead the surveillance teams with one standing at the entrance applying a thermal gun to those coming into the barangay. Others walk house to house with the block coordinators tracking down people with symptoms and starting monitoring procedures.    

The multi-sectoral Coronavirus Interagency Committee organized by the barangay captain meets regularly to assess the situation and decide on needed action. Since Kabalikat is a member, JT gets access to up-to-date information and enables his members to participate in the planning and decisions reached for Baseco. Donations from partner fundraisers, Urban Poor Associates, Kaya Natin Movement, and the Peace and Equity Foundation reach Kabalikat through the nearest local bank branch, enabling it to purchase supplies locally. The City of Manila and the Department of Labor and Employment (DOLE) assist through the barangay captain. 

Life goes on during a lockdown. Residents adjust to the 3-hour windows allowed for visits to the market or pharmacy. Limited funds and refrigeration require daily food purchases. As for social distancing, although the barangay captain constantly warns his constituents against clustering, they appear to take this as a joke. The barangay captain retaliates with repeated tongue-lashings, upon which they disperse only to recongregate once he has left the scene. Most, residents though, abide by the government orders. 

The COVID-19 threat remains amorphous. Far more alarming and immediate is the problem of feeding one’s family. Post-lockdown losses of incomes and jobs have hit the community hard. Affected are thousands of families with little or no savings: small-scale vendors in Divisoria; bus, jeepney and tricycle drivers; cargadores at the pier; workers dismissed by their shuttered companies; those still employed but unable to get to work because their companies are too far away with no transport available. (READ: Give cash to urban poor during coronavirus lockdown – experts)

People complain: while the still invisible epidemic merits serious attention, so do the masses of people who are visibly hungry now. How are they supposed to manage? What if the food packet distributions last only one week? What is the government doing about the situation? Distribution delays add further anger and resentment. All this could have been avoided, insist many, had the government given cities and barangays more time to prepare. (READ: Fighting coronavirus requires efforts to help the poor – PCIJ report)

What message would I send the President and government if given the chance?  Let me offer some comments circulating in Baseco: 

When the authorities realized they had to call for a lockdown of the city, they should have immediately assembled key officials, business people, and civil society representatives, including POs at local levels, to plan the future scenarios. That would have meant infinitely better preparation. How? Through onsite pre-positioning of sufficient food stocks, water, medicine, health equipment, fuel, and other priority items including cash. Communities could have been mobilized to cooperate in that effort – from planning through implementation and evaluation. 

Instead, what happened? The government gave people no advance warning. By ordering an immediate lockdown, they ignored the chance to do serious stakeholder planning and community mobilization.  Now, people are really suffering, not only in Baseco but in other urban poor barangays also.

Again, our leaders must confront the health threat, but also take seriously the economic crisis they have created. Otherwise, COVID-19 will bring us increased hunger, sickness, lowered body resistance, and death. Government needs to act – and fast!

The researcher’s end-note (MR): 

The COVID-19 incidence appears still low in Baseco, perhaps because health threats surface slowly but more likely because genuine testing is absent. Despite delays in information and material assistance from the national government, many community groups have voluntarily come forward to address anticipated COVID-19 threats under the overall leadership of the barangay captain. All in all, the barangay is managing well in this initial phase of the crisis. Yet, vigilance is imperative to prepare for the pandemic’s predictable next phases.

Critical issues emphasize putting in place long-term support to chronically vulnerable groups. Also needed are dramatic measures to assist those families recently affected by income and job losses. Perceptions of an ill-prepared government with a top-down style and limited faith in its citizens’ capacities undermine hope. When future statistics are recited, urban poor Filipinos suspect they will make up the highest percentages of reported deaths. Baseco therefore speaks for many of its counterpart Metro Manila communities when it demands urgent attention to the disastrous economic downturn that is accompanying COVID-19. Is anyone listening? – Rappler.com

Jeorgie Tenolete is the president of Kabalikat sa Kaunlaran sa Baseco, Manila, which partners with NGO Urban Poor Associates (UPA)

Mary Racelis is a social anthropologist at the Ateneo de Manila University and a trustee on the UPA Board.

The public outcry against the original drafts of the emergency power bills led to a better version of the law, thanks to the intervention of the progressive bloc in the House of Representatives and the amendments made by the Senate.

The Bayanihan law, as passed, is no longer the vague bill that granted broad and unfettered powers to the President that was drafted with a prolonged lockdown in mind. The original bill especially of the House was favored by the country’s security control apparatus led by the police-military establishments and appealed to the hammer-minded President. That is why it was focused on security concerns.

But the Bayanihan law as passed goes beyond security measures and is multi-pronged in strategy: health, economic, and security directions with the budget needed to achieve them.

The actual powers granted to the President under the Bayanihan Law can be divided into the following:

Health strategy
The Bayanihan Law is heavy on health strategy. The health strategy appears to focus on a shift to massive testing (with contact tracing and isolation) as opposed to prolonged lockdown as the solution to fight the pandemic:

• Streamlining of accreditation of test kits
• Prompt testing of persons under investigation (PUI) and persons under monitoring (PUM)
• Compulsory and immediate isolation and treatment of patients
• PhilHealth coverage for all COVID-19 treatments
• Ensuring that donation of health products is not delayed
• Priority procurement, allocation and distribution of medical goods such as test kits, PPEs, medical devices (i.e. mechanical ventilators), and medicines (i.e., vaccines)
• Allocation of these medical goods to COVID-19 referral hospitals
• Engage volunteer health workers who shall get compensation plus hazard pay
• Special Risk Allowance for all public health workers on in addition to the hazard pay
• Cash compensation of P100,000 to public and private health workers who may contract severe COVID-19 infection on duty, and P1 million to public and private health workers who may die fighting the COVID-19 epidemic.
• Limited take-over with proper compensation of the following, if they unjustifiably refuse or are incapable of operating during the COVID-19 crisis: private hospitals; establishments for the purpose of housing health workers; transportation of frontliners. 

Economic strategy
The law also recognizes that an economic solution is needed to complement the health strategy. This includes:

• Emergency subsidy of P5,000 to P8,000 to 18 million low income households all over the country
• Enforce anti-hoarding and profiteering measures for food, clothing, medical supplies etc
• Availability of credit and lower interest rates for production
• Incentives to manufacturers/importers of healthcare supplies
• Ensure supply chain of food and medicine
• Residential rent freeze for 30 days without penalties, interests, and other fees
• Authorize alternative work arrangements for both government and private sector
• Lift the 30% limit on the Quick Response Fund

Security
The security strategy is not the focus of the law but appears to be complementary to the health and economic strategies. It includes:

• Ensure compliance of local government units (LGUs) while still respecting their autonomy
• Regulate transportation and traffic

Budget
To enable the multi-pronged strategies, the law sources the funds to achieve the strategies:

• Additional budget from the Executive branch for the Department of Health (DOH); UP PGH; calamity fund; Department of Labor and Employement (DOLE) for the displaced workers; Department of Trade and Industry (DTI) for its Livelihood Seeding Program; Department of Agriculture for its Rice Farmers Financial Assistance; Department of Education for the School Based Feeding Program; Department of Social Welfare and Development for Assistance to Individuals in Crisis Situations; LGUs for their Quick Response Funds.
• Use of Special Purpose Funds for COVID-19 response
• Report to Congress the amounts, realignment of funds every Monday of the week.

If this is the law that addresses COVID-19, why is the national implementing authority all military officers? (READ: What we know so far: PH National Action Plan on coronavirus)

Where is the DOH and DOST for health? The DTI, DOLE, and the National Economic and Development Authority for economic strategy? The Department of Budget and Management for budget?

Why is the implementing agency monopolized by the government's security apparatus when the law directs a multi-pronged strategy, with security just complementary to health and economic strategies?– Rappler.com 

Susan Villanueva is a practising lawyer and professor at the UP College of Law. She first posted this piece on Facebook.