THE Philippines’ Department of Health (DOH) reported recently the first cases of the COVID-19 Omicron subvariant XBB and the XBC variant on Tuesday, October 18. At least 81 cases of XBB were detected in two regions in the country, while 193 XBC cases were detected in 11 regions.

The Omicron XBB subvariant was first detected in India in August 2022. To date, XBB has been detected in at least 24 countries and four continents. This subvariant of the more transmissible Omicron variant, is a recombinant of BA .2.10.1 and BA 2.75 sub-lineages and has been reportedly behind the increase in the majority of cases in Singapore in recent weeks.The XBB has been touted to have a higher immune evasion against transmission compared to BA. 5.

While the XBB appears to evade vaccine immunity and is even more transmissible than the BA.5 subvariant, Singapore health authorities said there was no evidence that the variant has caused more severe illness in patients who have been infected so far. Most infections reported mild symptoms similar to previous Omicron infections.

The XBC variant is a recombinant of the Omicron BA.2 and Delta variant.

The UK Health Security Agency (UKHSA) has classified it as “ variant under monitoring “ but the WHO and European CDC have yet to determine the risks this variant poses. Further studies are needed to characterize XBC in terms of transmissibility, effect on disease severity, and ability to escape immune response.

How would the government respond then to this sudden arrival of subvariants in the midst of current thrusts of our national leaders to conduct face to face classes on November 2 and open fully the economy through aggressively pursuing tourism programs ?

Know-how and sophisticated economic recovery plans have increased remarkably but we continue to struggle to deliver on our targets due to COVID subvariants.

Are we going to ignore these subvariants and the attendant risks to the school children and to our people?

A checklist is therefore needed due to two important things according to Harvard professor Dr. Atul Gawande :

Ignorance = thus knowledge is key

Ineptitude = knowledge is present but we fail to apply correctly.

Consistent with these concepts , I would like to propose a 10-point checklist to address XBB and XBC subvariants and I strongly recommend the following measures :

1. Monitor cases in different regions and observe clinical presentation

2. Suspend optional face masks in outdoors indefinitely since virus is airborne

3. Reassess face to face classes to protect school kids since they are the last ones to be vaccinated ; propose blended (online and F2F). Check positivity rate in the LGU.

4. Strengthen MPHS (wear face masks, ventilation physical distancing and hand washing ) – massive public health education

5. Boost up aggressively.

6. Plan to procure bivalent or the second generation vaccines. Up To Date vaccination is important to prevent surges.

7. Prepare for potential surges during the UNDAS and Xmas season.

8. Coalition of stakeholders e.g. government agencies, business sector, medical community, logistics , Mercury, Watsons and other pharmacies

9. No lockdowns. Continue with our work.

10. Checklist , scorecard and monitoring metrics of success.

I know we have put it in the hands of our leaders the disposition to implement measures to open up the economy but public safety is paramount. We don’t want our country to fail. We need to help our leaders. Avoidable failures are common and persistent , not to mention demoralizing and frustrating across many fields – from medicine to finance, business to government. Thus we need diverse opinions and a different strategy for overcoming failures , one that builds on experience and takes advantage of the knowledge and expertise health advocates have but somehow also makes up for our inevitable human inadequacies during crisis situations.

By the way , we hope and pray that PBBM will name a permanent DOH Secretary of Health.

President Ferdinand “Bongbong” Marcos Jr. said he will appoint a permanent secretary of the Department of Health (DOH) as soon as the Philippines moves out of the COVID-19 emergency and all businesses have opened up. By far the biggest mistake people make when trying to change organizations is to plunge ahead without establishing a high enough sense of urgency. This error in medical practice is fatal because we are dealing with human lives and because transformations always fail to achieve their objectives when complacency levels are too high. Too much past success, a lack of visible crises , low performance standards, insufficient feedback from external constituencies and more all up to : “ Yes , we have our problems , they aren’t that terrible and I’m doing my job just fine , “ or “ Sure we have big problems , and they are all over there. No worries.”

Albert Einstein once said, “The leader is one who, out of the clutter, brings simplicity … out of discord, harmony … and out of difficulty, opportunity.” We should look at different perspectives to make the system work. The job of our PBBM as a leader is to make sure everybody in the administration has great opportunities, and that they feel they’re having a meaningful impact to our society.

The Secretary of Health ( SOH ) is needed now to provide direction and confidence to the Filipino people. The next SOH can provide strategic goals with timelines and set the organizational structure to function efficiently. OIC Sec. Vergeire is a good candidate for the position so she will be inspired to work.

Delegation with authority is key. By Dr. Tony Leachon

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Anthony C. Leachon, M. D.

Independent Health Reform Advocate

Past President ,
Philippine College of Physicians

Chair , Kilusang Kontra Covid
( KILKOVID )