AT this point, with September over, the Duterte administration has still not issued a full comment on the Lancet Covid-19 Commission statement published on September 14, which ranked the Philippines 66th out of 91 countries surveyed on the effectivity of their response to the coronavirus disease 2019 (Covid-19) pandemic.
It also has said nothing about the “medical populism” paper published in the Global Public Health journal in August, which tagged President Rodrigo Duterte as a populist with respect to the pandemic alongside President Donald Trump of the United States and President Jair Bolsonaro of Brazil.
Strangely, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID), which has charge of everything here concerning the handling of the pandemic, has kept silent.
I presume that by now the generals and bureaucrats at the IATF-EID have gotten their respective staffs to procure for them copies of the two publications, so they can study them:
1. The Lancet Covid-19 Commission statement for the 75th anniversary of the United Nations; and
2. The Global Public Health journal paper on “Medical populism and the Covid-19 pandemic” by Dr. Gideon Lasco that was published in August.
The two papers are illuminating in their respective ways. The big question is what the IATF-EID will do with them, if they ever get around to reading them.
Lancet Covid-19 Commission statement
I present below a brief summary of the Lancet statement, and have included a note on the medical populism paper.
“The Lancet Coovid-19 Commission was launched on July 9, 2020, to assist governments, civil society and UN institutions in responding effectively to the Covid-19 pandemic. The commission aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions; overcoming humanitarian emergencies, including poverty, hunger and mental distress, caused by the pandemic; restructuring public and private finances in the wake of the pandemic; and rebuilding the world economy in an inclusive, resilient, and sustainable way.
Urgency of suppressing pandemic
“The Covid-19 epidemic can and should be suppressed through non-pharmaceutical interventions, including effective community health services, that cut transmission of the virus, to be followed by the introduction of effective and safe vaccines as rapidly as science permits. Countries should not rely on herd immunity by natural infection to suppress the epidemic. The disease and death that would accompany natural infection rates to reach herd immunity, typically estimated as 40 to 60 percent of the population infected, would be unacceptably high. Uncertainty also remains about the duration of acquired immunity from past infections.
“To implement non-pharmaceutical interventions, we urge countries to scale up with all urgency their public health workforces, including epidemiologists, public health technicians, nurses, testers, contact tracers, and community health workers. Community health workers can contribute to controlling community spread and protecting vulnerable people in the community, particularly through testing, education on prevention and treatment, and education on the mental health effects of social isolation.
“The vexing question of whether to close schools is perhaps the single most challenging non-pharmaceutical intervention. Schools can safely reopen when community transmission is low and school facilities and staff have been appropriately prepared. When it is not safe to open schools, countries and localities should aim to implement online education accessible to all students.”
Dynamics of Covid-19 in 91 countries
The Lancet commission compared the dynamics of Covid-19 for the month of August 2020 across 91 countries with sufficient data. It reports four measurements of the pandemic. The first measurement is incidence: the number of newly confirmed cases per million population per day, averaged over the 31 days of August. The second is the mortality rate, measured as the deaths per million per day, averaged over the same period. The third indicator is the number of Covid-19 tests done in August relative to the number of new cases in August, which functions as a proxy measure for the scale of testing.
The fourth measurement is the average effective reproduction rate, which is the effective reproduction number averaged over the month, indicating whether the epidemic was rising or falling.
The countries were classified according to the number of new cases per day per million population, because this is the most straightforward measure of rate of transmission of the virus. A country is classified as being in suppression if there are five or fewer new cases per million population per day (in August), provided that the rate of testing is ample, which the commission defined as at least 20 tests per new case. A country is classified as having low transmission if there are 10 or fewer new cases per million population per day but the country is not in suppression. A countryis classified as having moderate transmission with 10 to 50 new cases per million per day. High transmission is 50 to 100 new cases per million per day, and very high transmission is 100 or more new cases per million population per day.
Nineteen places achieved suppression in August: Taiwan, Thailand, Vietnam, Laos, Cambodia, China, Myanmar, Malaysia, New Zealand, Uganda, Togo, Pakistan, Latvia, Luxembourg, Uruguay, Republic of Korea, Finland, Cuba and Rwanda. Ten of the 19 are in the Asia-Pacific region, the highest performing region globally.
The difference across countries in the rate of transmission of the virus is stark and remarkable, ranging from less than one new case per million population per day to several hundred new cases per million population per day. This enormous range underscores that countries with high or very high rates of transmission are failing to undertake sufficient NPIs to control the pandemic.
The great divide in the outcomes of the epidemic has been the relative success of the Asia-Pacific region compared with Western Europe and the Americas, with most of the rest of the world somewhere in between.
The Lancet Covid-19 Commission will monitor the global progress in suppressing the pandemic and making an inclusive and sustainable recovery with a new set of metrics that it will regularly publish.
The next scheduled statement of the commission will be in early 2021.
One reason for failure to suppress the epidemic is thought to be a style of political leadership that has been called ‘medical populism.’ Gideon Lasco in his paper titled “Medical populism and the Covid-19 pandemic,” published in the Global PublicHealth journal has described political leaders as “simplifying the pandemic by downplaying its impacts or touting easy solutions or treatments, spectacularizing their responses to crisis, forging divisions between the ‘people’ and dangerous ‘others,’ and making medical knowledge claims to support the above.”
Lasco makes three cases in point: the US President Trump, President Duterte and Brazilian President Jair Bolsonaro.
“We call on governments to prioritize advice from the professional public health community, working in cooperation with international agencies and learning from the best practices of other nations. Leaders should desist from expressing personal viewpoints that are at odds with science,” the paper said.