COVID-19 Checklist : Are we headed from Pandemic to an Endemic state ?

August 13, 2022 People's Tonight 320 views

Dr. Tony LeachonMORE than two years into the global COVID-19 pandemic , the Philippines , though gaining momentum from February to May 2022 , has suddenly experienced a surge , that is taking longer than expected and is expected to extend up to December or the holiday season. That’s truly disheartening. We truly need to reflect and review our previous action plan to end this pandemic and shift right away to the endemic state. The people are waiting.

Is the COVID-19 pandemic a marathon or a sprint ? I know for our bored kids at home for the last two years and have put careers on hold, I would always tell them that “ dreams have no timelines.”

Deep inside , it’s not okay. It’s not fine. Most people have become anxious and depressed. They are worried about their health, loved ones and their future plans. They have dreams to chase and careers to pursue.

In reality, I’m a man with a sense of urgency. As an internist-cardiologist, I need to move quickly to save more lives. Thus, my attitude as a health advocate is to act quickly by giving suggestions to end this epidemic or pandemic and shift to endemic state. Let’s define certain terms.

What is an epidemic?

An epidemic disease is one “affecting many persons at the same time, and spreading from person to person in a locality where the disease is not permanently prevalent.” The World Health Organization (WHO) further specifies epidemic as occurring at the level of a region or community.

What is a pandemic?

Compared to an epidemic disease, a pandemic disease is an epidemic that has spread over a large area, that is, it’s “prevalent throughout an entire country, continent, or the whole world.”

In March 2020, the WHO officially declared the COVID-19 outbreak a pandemic due to the global spread and severity of the disease.

What does endemic mean?

Endemic is an adjective that means natural to, native to, confined to, or widespread within a place or population of people.

Endemic is perhaps most commonly used to describe a disease that is prevalent in or restricted to a particular location, region, or population. For example, malaria is said to be endemic to tropical regions, like the Philippines specifically , Palawan.

When I was summoned by the Office of the President to be a special adviser to the National Task Force against COVID-19 reporting to Sec. Carlito Galvez in March 2020, I was doing a Facebook live Vlog on a daily basis to come up with the COVID Command Center (CCC). Now it can be told. It was Senator Bong Go, Senate Chair, Committee on Health who advised the NTF to hire me as an adviser to help solve the crisis.

I have no special talents. I’m only passionately curious about societal change and health reforms. I’m an avid lover of checklist. In the book The Checklist Manifesto , Dr. Atul Gawande, a professor at Harvard Medical School and the Harvard School of Public Health and led the World Health Organization ‘s Safe Surgery Save Lives program, articulated convincingly the adoption of checklists in medicine. He narrated that in the 1970’s, Samuel Gorovitz and Alastair MacIntyre published a short essay on the nature of human fallibility. The two philosophers pointed out two basic reasons why we fail at what set out to do in the world. The first is ignorance — we may err because science has given us only a partial understanding of the world and how it works. The second type of failure is ineptitude — because this type , knowledge exists , yet we fail to apply it correctly.

Here’s a proposed checklist of recommendations for us to navigate the country to an endemic state.

Finding a Secretary of Health who can decide with integrity, competence , confidence, and sense of urgency;

Revitalizing the IATF: to be headed by NEDA with DOH , DILG, DICT , DOLE , the private sector ( medical experts and business community leads);

Redefining full vaccination as three doses (two primary + one booster);

Mobilizing all public and private stakeholders to plan a blueprint to fast-track shifting from pandemic to endemic;

Conducting an inventory of the vaccines on hand and partnering with the industry to analyze and come up with a marketing , logistics and distribution plan;

Reviewing of booster guidelines by aligning with the US CDC (Center for Disease Control and Prevention ) which has issued guidelines and maybe helpful for the nationwide rollout of the Boosters Filing a Certificate of Product Registration by the vaccine manufacturers at the FDA in the event that public health emergency status is lifted. This would ensure access, wide distribution and deployment of vaccines;

Creating a pandemic exit plan: Question: How to stop surge without affecting the economy (examples: lockdowns, stricter alert): A) Acute solutions: ventilation , wear masks, social distancing , testings, isolation, tracings — adherence to public health standards, purchase of anti-viral drugs e.g. Paxlovid, Molnupiravir B) Long haul solution: ramp up vaccination and boost up plus all of number one measures;

Monitoring of the action measures with definite timelines (visual map of the vaccination and booster program of the different regions for accountability); and

Establishing and institutionalizing a performance scorecard or metrics of success for all local government unit leaders

The lingering health crisis and resuming face-to-face classes. Since the January Omicron surge, the country has avoided a further surges in COVID-19 infections. Experts think that the disease has likely become endemic. However, removal of health protocols, including the basic masking policy, has been impeded by the low level of booster dose take-up, in large part due to local governments being preoccupied by the elections.

So far, the private sector is still not allowed on its own to procure the vaccines, which have only emergency use authorization, and the pharmaceutical companies themselves have no incentive to move away from the current system of wholesale public procurement. The failure to sustain vaccination momentum is hindering the education sector’s ability to return to in-person classes, with less than 15% of schools conducting face-to-face instruction.

We need to dance with the virus. We can’t live in fear forever. We need to adapt to the mutating virus given our low booster program and the compelling demand to fully open the economy.

Yesterday, the new CDC guidelines eliminated quarantines and put less emphasis on social distancing, routine surveillance testing and contact tracing. Obviously, we have to do more work to ensure that more people avail themselves of the protection that those measures have to offer and that more citizens can access those tools.

We should move quickly because the virus will be staying with us for a longer period of time. Subvariants are causing the surge with the waning immunity. We need a different set of eyes to attack the virus. Agile and strategic leadership is needed more than ever. Health should be the main focus to a successful economy.

We need a different approach. Let us embrace action and let us lessen the talks — that’s analysis paralysis , and we should take risks and not punish mistakes due to honest collaborative work. Missteps will happen, but our experience indicates that failing to act is much worse.

Whether we’re going to apply lessons from the pandemic remains to be seen, but doing so is key to ending that cycle, so outbreaks don’t become pandemics with countless consequences -lives lost, effects on health care, mental health, economy, education, relationships and careers.

Thus, we need a different strategy for overcoming failure, one that builds on science and experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such strategy — though it will seem ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies.

It is a checklist. By Dr. Tony Leachon