ANALYSIS: Quarantine extension will only work with social distancing

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COVID-19 can infect over 90 million individuals in the Philippines alone if social distancing will not be properly practiced. Photo by JL JAVIER

Editor’s note: Jose Galang is a senior copy editor at CNN Philippines. He is a veteran business/economics/political economy journalist and has previously headed newsroom operations at The Manila Chronicle, Business Day, and Business World, among others. He has also written for the Far Eastern Economic Review, Financial Times, and a London-based online science and development journal.

Manila (CNN Philippines Life) — Instead of letting the Luzon-wide enhanced community quarantine expire next week as originally scheduled, the government has chosen to bite the bullet and extend it by two weeks until the end of April.

The extension will prevent people from again converging in large numbers in shopping malls, offices, schools, and various public places. There is a good chance now that social distancing, a crucial part of the quarantine strategy aimed at preventing COVID-19 infections from growing further on a massive scale, will not simply evaporate in the summer heat while medical experts continue to focus on ways to tame the spread of the still mysterious coronavirus.

The quarantine, now on its fourth week, is showing us that if people just observe simple social distancing, the number of new infections and deaths from the vicious coronavirus could be held down significantly. An untimely lifting of controls of people movement could reverse that and spark a new wave of people getting sick, experts in killer epidemics argue.

One recently published study estimated that in the Philippines, the number of COVID-19 cases can potentially reach well over 90 million — making practically the country’s entire population sick — if no mitigation measures and related safeguards are put in place. Intensive social distancing occupies a high ranking among those recommended measures.

But the number of infections could be reduced dramatically with strict quarantine and social distancing, particularly among senior citizens. As is now widely recognized, the great majority of people who catch the virus will recover after getting timely treatment. Many will die, however.

These are among the projections made by a group of experts and researchers on infectious diseases at the Imperial College London, a public research university specializing in science, technology, and medicine, as stated in a research report released last March.

The numbers they came up with are staggering, even hard to believe. The estimates are calculated from available data from government and international institutions like the World Health Organization and the World Bank. Actual patterns seen in COVID-19’s spread in China and elsewhere, along with known behaviors of past viruses, were also factored into the calculations.

If nations fail to implement mitigation measures, the Imperial College London study says, the coronavirus could spread wildly and infect up to around seven billion people worldwide. The worldwide death toll could reach 40 million this year.

But the projected death toll could be cut in half, saving 20 million lives, with the help of “mitigation strategies focusing on shielding the elderly (with a 60 percent reduction in social contacts) and slowing but not interrupting transmission,” according to the study.

If the Philippines now terminates quarantine measures and related restrictions, most analysts believe there would likely be a return to sharp increases in new infections. The country cannot afford that. Photo by JL JAVIER

In the Philippines, the study estimates, there could be up to 93.6 million cases of infections without any mitigation measures. If the government implements restrictions like lockdowns and isolation of patients, and if people seriously observe social distancing and good personal hygiene, the number of infections is projected to be around 62.3 million.

That grim scenario may have been averted now, with the implementation of rigid controls on people interactions and with the continuing acquisition of critical goods like face masks and alcohol.

Even with restrictions, the Imperial College London study says, there could still be around 1.4 million cases that will require hospital treatment, with over 220,000 of them needing critical care. The estimated death toll, on the other hand, could reach 250,000 under an unmitigated environment, but that number could be slashed to around 167,000 with relevant restrictions and social distancing.

The report concludes that “the only approaches that can avert health system failure in the coming months are likely to be intensive social distancing measures… preferably combined with high levels of testing.”

It is heartening to note that Philippine authorities are implementing a host of measures that mirror the experts’ recommendations. But still, a few local politicians have until lately disregarded the imperative of keeping distance from others or refraining from attending or hosting parties and other gatherings that can become centers of virus transmission.

Furthermore, despite the enhanced community quarantine now in force, there are still many going out and loitering in public places. Understandably, many of them go out in search of livelihood and of supplies for their daily sustenance, and officials have not been quick in providing assistance.

The Imperial College London research is one of the early studies that focus on the rampaging COVID-19 pandemic. An earlier modeling conducted by Harvard University professor Marc Lipsitch projected that between 20 percent and 60 percent of the world population will inevitably get sick of COVID-19.

Lipsitch, head of the Harvard Center for Communicable Disease Dynamics, said among other recommendations that the sooner social distancing measures are taken, the better to contain the coronavirus’s spread.

The epidemiologist, in a press conference streamed from Harvard on March 23, also predicted that eventually COVID-19 will become a seasonal ailment like the flu.

All these statements could be taken to imply that without intensive social distancing, the local epidemic could overwhelm the healthcare system. In Metro Manila, there are now clear signs that the strain on hospitals and healthcare workers is becoming increasingly heavy.

How the virus spreads

Understanding how the coronavirus is contracted and passed on to others will encourage people to heed experts’ calls for such measures as social distancing and staying at home for the duration of the pandemic.

Many scientific reports say that, on top of the droplets that come from COVID-19-sick people when they cough or sneeze, there is one characteristic of the coronavirus that makes its spread rapid.

Medical experts say that once the virus enters a person’s body, it quickly starts to reproduce in that person’s cells. The virus attacks one cell in the human body and quickly moves on to other cells and further out of the body into the environment around the infected person. The process is called viral shedding.

A study published on March 8 says that viral shedding can happen even among people who show no symptoms of COVID-19 — they don’t experience fever, cold or other ailments usually related to the infection.

The study, conducted by a German team, and reported last week in the science journal Nature, confirms previous suspicions that some people infected with the virus can be highly contagious when they have mild or no symptoms.

Further research is being done on viral shedding, but it is already being cited as a possible cause of transmissions that are not always detected by health personnel. Researchers are still studying how fast the viral shedding is from asymptomatic people and how contagious those individuals remain over time.

A report in the journal Lancet says that based on actual cases in Wuhan, the city in China where the pandemic first erupted, viral shedding can last for a median period of 20 days, with some cases even registering 37 days. That means an infected person, without knowing it, could potentially be capable of making others sick for over a month.

Every COVID-19-sick person can be capable of transmitting the virus to around three others. One public health expert in Wuhan has been recently quoted as saying that at least 59 percent of those infected during the start of the outbreak there remained active and continued to interact with others.

More recent observations, including those in the World Health Organization, indicate that the coronavirus could even be airborne. The head of WHO’s emerging diseases and zoonosis unit told a virtual media briefing last March 16 that coronavirus particles “can stay in the air a little bit longer.”

Extending the implementation of lockdowns — including asking people to maintain social distancing and healthful habits — appears to be the only viable option now to avoid a disaster of epic proportions. Photo by JL JAVIER

Months of suppression

Warning that delays in setting up strategies to contain transmission will lead to “worse outcomes and fewer lives saved,” the Imperial College London study also says suppression strategies will need to be maintained “until vaccines or effective treatments become available to avoid the risk of later epidemics.”

The study identified the household as “a key context” for COVID-19 transmission. “The average size of households that have a resident over the age of 65 years is substantially higher in countries with lower income compared with middle- and high-income countries,” it says.

In the Philippines, based on government statistics, around two-thirds of the nearly 23 million households account for the nearly 8 million elderly population aged 60 years and above. That indicates the large-scale challenge for the country in containing COVID-19 transmission.

The World Health Organization continues to urge people to clean their hands frequently with soap and water or with an alcohol-based hand-rub. Also on the WHO menu of protective measures is social distancing.

If the Philippines now terminates quarantine measures and related restrictions, most analysts believe there would likely be a return to sharp increases in new infections. The country cannot afford that.

A more recent study conducted by another set of researchers at the Imperial College London concludes that in Europe, strategies such as isolation of patients and social distancing among healthy individuals could have prevented around 59,000 deaths amid an estimated number of infections of up to 43 million people in March.

Extending the implementation of lockdowns — including asking people to maintain social distancing and healthful habits — appears to be the only viable option now to avoid a disaster of epic proportions.