The uncertainties surrounding COVID-19
By Randy David
Philippine Daily Inquirer
October 18, 2020 at 5:25 am

Just when everyone thought Europe had defeated the coronavirus, today — nine months after it first arrived in the continent — it is making a comeback as a dreaded second wave. According to a CNN report, the World Health Organization has warned that Europe’s daily death toll from the disease could rise five times higher than its peak in April.

The same seems to be happening in the United States, where the observance of COVID-19 protocols has been complicated by the deep polarization in American politics. As in India and most of Latin America, the surge has been so relentless that it is almost pointless to tell when the first wave ends and the second or third begins.

In the meantime, progress on a safe and effective vaccine has been painfully slow, relative to expectations. The race to produce one ahead of all the others has spawned a “vaccine nationalism” that induces governments to overpromise, creating pressure on laboratories to shorten the period for crucial clinical trials. The good thing is that there is now also increasing public awareness of the need to do these trials right, and for a country’s regulatory bodies to complete the rigorous evaluation, before any vaccine is adopted for mass inoculation.

So focused have state authorities been on the urgency of finding a vaccine that the quest for a cure for COVID-19 itself has not received much attention. The thrust has been to manage the symptoms and lessen the deaths, using therapeutics originally designed for other illnesses.

None seemed more promising than the expensive drug Remdesivir, a broad-spectrum antiviral medication produced by Gilead Sciences. But, the other day, the WHO announced that the interim results from the trials it coordinated indicated that this drug appeared to have little or no effect on the mortality or treatment of COVID-19 patients. This is a setback that only heightens the sense that we still know very little about the course of this disease.

Compounding this uncertainty is the reality that even the epidemiology behind the disease has not yet been formulated with any precision. We still don’t know how and why people who test positive develop no symptoms yet can spread the virus. We don’t know why one member of a family can be a “super-spreader” and yet others in the same household remain uninfected. How exactly is this virus transmitted?

We know that the information concerning the coronavirus’ behavior is still in flux because the rules aimed at its containment also keep changing. There was a time when the wearing of face masks was prescribed only for those manifesting respiratory symptoms—so they don’t spread the virus. Today it is mandatory for everyone—so they don’t catch the virus. On top of that, a face shield is now advised for added protection when people are in a public space like a shopping mall or inside a store.

Amid this uncertainty, the government’s Inter-agency Task Force for the Management of Emerging Infectious Diseases last Friday announced the easing of restrictions in many areas of public life starting Oct. 21. The most important of these changes are: (1) the lifting of the ban on outbound “non-essential” travel of Filipinos to foreign destinations, which basically means permitting leisure trips; (2) the easing of local travel between provinces under general community quarantine and modified general community quarantine by persons other than those previously authorized; (3) the easing of the stay-at-home order so as to make it apply only to individuals below 15 and above 65, and those with health risks; (4) the easing of restrictions on the number of customers that may be allowed inside commercial establishments like shopping malls, restaurants, and salons; and (5) the shortening of curfew hours.

To a nation that has quietly suffered in the last seven months from what can only be described as “lockdown fever,” these tentative steps toward the eventual lifting of quarantine measures will be most welcomed. They will certainly inject some vigor into a flagging economy, and allow our daily wage earners to venture out a bit more freely in search of work.

But, while we are in the middle of a pandemic, there is no way we can ignore the substantial risks involved in any degree of reopening. It is true that the curve indicating new infections has been flat for some weeks now. But, the level at which it has stayed is between 2,500 and 3,000 per day. That is still high. Each one of those cases is a potential spreader if not promptly tested, properly isolated, and adequately contact-traced.

On CNN the other night, I could sense not a little weariness in the voice of the WHO regional director for Europe, which he tried to muffle with a large dose of hope. He said that Europeans need to brace themselves for what winter may bring, suggesting that countries might be better off with targeted quarantines than with general lockdowns. My hope, he said, is that this pandemic will go the way of all past ones: that it just loses steam and dwindles into a simple epidemic like the flu.

If and when it does, we are warned that it won’t be the last. There will be many more like it, possibly more virulent and lethal. Every pathogen will present its own unique challenges. But, while we may not be able to completely grasp the quirks of this particular virus before us, we will have learned a lot about how to better prepare ourselves for the next one. The SARS epidemic taught countries like China, Taiwan, South Korea, and Vietnam how to successfully manage COVID-19. The key is credible and competent leadership.

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