Much of the past two weeks in the Philippines mirrors what happened in the United States, down to the timeline. There were a handful of infected imported cases detected in late January before travel restrictions were imposed. Three COVID-19 imported cases were detected in late January (two of which died), followed by a month of no new cases discovered. Red flags went up on March 6-7th when Taiwan caught an imported case from the Philippines, followed by two domestic cases discovered without any travel history or known contact.
Over the next week officials and the public slowly caught up to the stark reality of what this meant: there was a previously undetected and currently uncontained community outbreak in the Philippines. Like the US, it was undetected because of a shortage of test kits. Until about two weeks ago, the Philippines DOH had to send kits out-of-country for testing. Now the University of the Philippines is producing its own PCR tests that could be sequenced at highly-secured bio-labs on campus. There were about 2000 tests available last week.
The outbreak was and is uncontained because it was undetected. About 17% of tests are coming back positive right now. 142 people had tested positive and 12 have now died from COVID-19 by March 17th, representative of both exponential growth and a high case/fatality ratio of 8.2%. Following Department of Health epidemic protocols, President Duterte issued a Red Alert 2 lockdown three days ago. These ‘community quarantines’ will be discussed below.
The simple fact is that nobody knows how widespread this outbreak is in the Philippines. It is vitally important for the rest of the world to help Philippine testing capacity so that we can know whether, or by how much, higher temperatures and humidity can slow the COVID-19 outbreak. The most recent, and only, epidemiological model for the Philippines published so far paints a bleak picture:
- There are likely 3600 cases in the Philippines right now, implying that <4% of cases have been identified.
- The doubling time is 4 days.
- The epidemic will peak in mid-June at approximately 250k infections
- Applying the Imperial College COVID-19 assumptions
- ~22k will die (.9% CFR)
- ~49k will be severe cases requiring hospitalization with oxygenization
These numbers exceed the thresholds we advise in Policy Recommendations for some form of lockdown. It should have happened earlier, in fact. Even though the only confirmed community outbreak cases are in the Metro Manila area, the lockdown was expanded to include the entirety of Luzon Island yesterday. What outsiders simply call ‘Manila’ is officially the National Capital Region (NCR), a metropolis of sixteen distinct city-level political entities. The ‘community quarantine’ is meant to keep outbreaks from spreading between districts at all levels. Armed blockades are being set up at administrative borders that millions of people cross daily.
It would seem DOH has already determined COVID-19 has spread throughout Luzon. Their priority now is to prevent exporting cases domestically to the provinces where the quality of emergency healthcare deteriorates rapidly the further from Tier 1 cities one gets. We will try to compile a more complete statistical picture in coming days, but the open source material we have found shows:
- Only 4 out of 17 regions complied with the local DOH standard local hospital bed ratio and only the National Capital Region complies with the World Health Organization’s guideline requirements [source]
- One oxygen ventilator per ten ICU hospital bed [source]
An uncontained COVID-19 outbreak outside of Cebu and NCR, undetected until hospitals become overwhelmed, would be disastrous. Following Iran, where the reported numbers are untrustworthy, the Philippines is now the second developing country with limited state capacity to experience a COVID-19 outbreak. Testing is in extremely short supply in the provinces. So is the medical equipment needed to treat patients with severe symptoms.
- Cancel all domestic flights and outbound international travel
- Quarantine all international arrivals, regardless of nationality, for 14 days.
- Quarantine every household with a confirmed or suspected COVID-19 infection.
- Pre-emptively isolate and quarantine people over the age of 60.
- ‘Community Quarantine’ every Philippine city until the situation is either better understood or under control.
- Appeal to the international community for aid and technical support, especially ASEAN countries like Singapore and traditional development partners like Korea, Japan, and the United States.
- Specifically, the Philippines needs tens of thousands of serological tests that don’t need to be returned to labs and provide results quickly.
- Heavily monitor food security metrics.
- Unconditional cash transfers to sustain food security for the poorest, enact eviction bans, and supply no interest loans to businesses.