To Focus on the Vulnerables, Not in the Number of Infected Persons
On May 21 this year I wrote an article in my blog titled “Reopening: From flattening the curve to control COVID-19”. There, I mentioned that I am not an expert in public health, but I am a citizen concerned with the well-being of my fellow human beings, and who aims at finding a rational solution to the pandemic caused by Covid-19, without resorting to a total and prolonged confinement of the population.
In the early stages of contagion in Panama, during the second week of March, the government established a total quarantine, following a similar behavior of other countries, and as a natural reaction against a deceitful virus, which takes several days to develop in the human body.
At that moment, there was already knowledge everywhere in the world that Covid-19 was a viral respiratory illness, which became a new member of the already known coronavirus family. In regard to its background, we can mention SARS-CoV-I detected in Hong Kong in 2003 and its other cousin, MERS-CoV found in Saudi Arabia in 2012. Being a viral respiratory illnesses, its transmission goes easily from person to person through droplets when coughing or talking in close proximity with other people, the same way as happens with the common cold or flu.
Likewise, statistics has shown that the Covid- takes longer time to incubate in the human body compared with other respiratory illnesses, which makes an easy and quick transmission among people. However, according to the World Health Organization and governments around the world, 80 percent of the population experience light or no symptoms, 15 percent are gravely affected needing respiration aid, and 5 percent become critically ill, requiring ventilation and with low probabilities of surviving.
Another important characteristic of Covid-19 is its aggressiveness when infecting people with preexisting conditions, either elderly people or not so old persons. As a result, elderly people who are vulnerable due to underlying conditions or aging or other persons with preexisting conditions such as obesity, diabetes, heart disease, hypertension, cancer, immunodeficiency, among others, have a high probability of dying if infected with Covid-19. These are the patients who mostly fill the Intensive Care Units of hospitals everywhere in the world, generating fears in health authorities in view of overwhelming number infected people, and thus, the inability of the health system to provide enough beds and equipment to treat this avalanche of vulnerable people.
When the pandemic reached Panama, health authorities declared the state of emergency on March 13 and later commanded a total quarantine, setting up a state of general confinement with the purpose of protecting the health of people and hoping to contain the contagion in the country. However, today 12 of July, almost four months since quarantine measures were implemented, the level of contagion has increased progressively since the end of May, reaching highest levels in July.
This situation has pushed the government to reassess its strategy, reformulating the course of action, based on the facts we all know. In this regard, I would like to make some suggestions, which I believe could help not only to contain the spread of the virus, but also start the punctual reopening of the economy with specific dates.
First, I would suggest placing all people with light Covid-19 symptoms in hotels, not in their residences. By sending them home, it increases the level of contagion as it is difficult to control the behavior of people in the family environment. We are a culture influenced by the heat of the tropic, making us restless, and especially when people know that they will be lightly affected by the virus. Besides, Covid-19 has revealed the great level of socio-economic inequality that permeates in our society, as well as the poor level of education reflected in the behavior of certain citizens who do not follow the health guidelines nor the quarantine. In addition, placing people in hotels would boost the income of one sector that has been hardly hit by the pandemic.
Second, I would recommend a national media campaign requesting people with underlying conditions to avoid leaving their houses until government measures reach an important level of control of Covid-19. The media campaign must create awareness among the population, so that all citizens at the workplaces, schools, stadium, gyms, cinemas, theaters and any other social space use masks and keep social distance in front or near vulnerable people.
Third, I would recommend including private clinics in the national effort to treat infected people, supporting the national health system, besides hiring more health workers and setting up addition medical facilities in convention centers. From the beginning, several countries set up medical facilities in tents and other installations to cope with the avalanche of people that would overload the health system.
Fourth, being Covid-19 a respiratory illness, the national media campaign should send a punctual message to the population, requesting everyone to seek early medical attention when feeling the lightest symptoms, such as fatigue, sore throat, light cough or fever, especially now that Panama is going through rainy season and common cold start to appear everywhere.
Fifth, I would suggest focusing on carrying out Polymerase Chain Reaction (PCR) in the areas of high level of infections (Chorrera, Arraijan, and San Miguelito) and any other places with new outbreaks, tracing infections and putting fires aside here and there. At this moment, I believe that Panama Center, East and West must have high level of infections (due to those infected who went sent home and other irresponsible people who do not follow the indications of health authorities).
Sixth, it would be advisable to carry out mapping with antibody tests (Rapid Diagnostics Test-RDT approved by the Federal Drug Administration of US), which should be applied in all provincial capitals to detect asymptomatic people and find out levels of immunity among the population. These tests must have specificity and sensitivity levels above 90 percent to achieve the highest possible levels of accuracy, avoiding false positives and negatives. This type of tests would serve
as complement for the PCR tests, contributing to monitor the trajectory of the virus in the country.
When the country starts the reopening of the economic activities, the government should allow companies and institutions to carry out antibody tests (RDT) to their staff. I understand that the Panama Canal will soon implement these tests among his employees.
I think the above suggestions will allow the government a reopening of economic activities in the short period of time, and the focus should no longer be the daily counting of infected people, but how much reduction there has been in the number of people who were place in the Intensive Care Unit or hospital rooms, besides avoiding more fatalities.
In sum, if the government focuses its efforts on the protection of vulnerable people, it will no longer need to worry about daily infected people. Already citizens know what to expect. And it will depend on each one to protect their love ones with underlying conditions, as I have been doing with some of my relatives with preexisting conditions.
If confinement measures did not produce good results in more than three months, insisting in this policy will cause the economic bankruptcy of the country with the ensuing wave of violence and political instability no one desires.
Authorities and health experts have done a great job in their efforts to protect the health of the population, however, the present situation demands the socio-economic protection of the nation, and to this end, we need leadership. As the US political analyst Zakaria Fareed mentioned, war is a very delicate matter to be left only to the generals.
We need the President to direct the country into a new dynamic to combat the pandemic, reopening economic activities, either by region or sectors, while coexisting and coping with Covid-19.
Many countries have already reactivated their economies while outbreaks continue to emerge in different places, as it is the case in Japan where I reside; Yet, it is the time to go back to work, coexisting with coronavirus and prioritizing the protection of vulnerable people.
Dr. Ritter Diaz
Independent Business and Government Consultant
Former Ambassador of Panama to Japan