April 15, 2021 — With the Philippines’ response to COVID-19 viewed as inadequate and amid a new surge in cases, the 23rd Anniversary Forum of the UP Manila National Institutes of Health held on March 2 presented a different view of the crisis. The theme focused on the far-reaching, wider context of outliving the pandemic and going beyond resiliency for a roadmap that recognizes the interrelationships of human health, animal health, and environment.
Dr. Michael Tan, National Academy of Science and Technology (NAST) Academician and former UP Diliman chancellor, articulated this theme in his keynote speech entitled “COVID-19: Circularity and a Better Normal.”
Recounting the origin of the virus that started in wildlife before jumping to humans, he stated that the changes in the human relationships with animals and the environment and our intrusion into natural habitats and environmental degradation have created the situation we are in.
COVID-19 not being the last pandemic we will experience, he said it is not enough to speak of resilience as it often becomes an excuse and justification for inaction. Despite more popular terms such as “new normal” and “reset,” he used “circularity” and “better normal” which are more reflective of what is happening now and what will happen in the future as we strive to outlive the pandemic.
He defined better normal as dealing with the long-term effects of COVID-19, preparing for future public health emergencies, and being able to mitigate the impact of disasters, public health or otherwise. It means avoiding mistakes of the past and addressing the comorbidities, not just medical but also psychosocial or the things that make us more vulnerable which also makes COVID-19 very destructive.
“Our lack of preparedness for COVID-19 does not augur well for future public health emergencies as well as other natural disasters. What if the “Big One” that we are anticipating turns out to be not an earthquake but a pandemic more serious than COVID-19,” he posited.
Towards the better normal, Dr. Tan suggested a change from the current linear paradigm sometimes referred to as “take, make, and dispose” (to extract something from nature, make something out of it, then dispose of it), that assumes infinity of resources to the circularity approach.
Circularity recognizes that resources are finite and that models for development must look for ways of closing the loop. “Whenever we produce something, we have to look at the entire life cycle as a circle so that we have to consider planning and redesign, reuse, readaptation, reimagination, and disposal, if necessary; but not before they have been reused,” he stated.
Five health-related domains
Under the first domain, Clinical Practice, he stressed the need to create a national database that looks at asymptomatic, mild, moderate, and severe COVID and at long COVID. This should include affected organ systems and pathophysiology, therapeutic itineraries, including complementary and alternative modes similar to the exhaustive studies of other countries.
The database will entail clinical data and information on signs and symptoms. Dr. Tan argued that for a typhoon-prone country like the Philippines, COVID should draw on metaphors of cytokine storms to help people understand it more. Advisories are also needed on medicines, supplements, and practices being used.
There is almost no information on long COVID with employers and even health personnel. There are other serious multisystem injuries and their implications for health financing, workplace policies, and schools should be studied.
For the second domain, Epidemiology, Dr. Tan asked who are being infected, where and in what circumstances? The virus hits urban poor barangays much harder. Contract tracing is being done but he wondered if data gathered are being fed into a database.
With world data clear that nearly all infections occur indoors, it is vital to know what are these indoors in the Philippines, whether homes, restaurants, or public vehicles. He urged a political economy emphasis looking at socio economic status, gender, ethnicity, and other social determinants of disease that have not been looked into.
Under the third domain, Mental Health, he argued that social isolation and sequestration have aggravated existing mental health problems and caused new ones. Rules are too rigid and unchanging and the long-term effects on mental health will be severe for young people and the elderly with greater vulnerability as well for domestic violence for women and children and for COVID’s neurological aspects.
Dr. Tan pushed for a review of lockdown policies especially as they impact on mental health in its widest sense, including the cognitive integrity of children and elderly. For children, he talked about intergenerational circularity he referred to as a vicious cycle. He suggested simple solutions allowing breaks for sunlight, fresh air, exercise, and cognitive stimulation.
For the fourth domain, Food and Nutrition, he mentioned that the problems on food supply surfaced from day one of the lockdown, especially for the elderly, disabled, and the sick. The initial shortages have resulted in people eating comfort food which were often junk food. He revealed that hunger has doubled from 8.8% in January 2020 to 18% in March, tripled to 30.7% in July and went down a bit in November.
He cited the NAST webinars on planetary health diets emphasizing circularity by tapping local farmers. Legislation is needed to encourage urban gardening and sanction subdivisions that prohibit planting of fruits and vegetables. He hoped the plantdemic phenomenon can avert the often unhealthy food ayudas.
With Vaccination as the fifth domain, Dr. Tan said so much hope is put on vaccines but there is widespread vaccine hesitancy related to the growing denial of COVID, mistrust due to previous vaccine scares, and the Dengvaxia issue. A Nov 2020 Pulse Asia survey revealed only 32% of Filipinos are willing to be vaccinated.
A major challenge, he stated, is the need for IEC materials to address vaccine hesitancy and explain what efficacy means. Failure to lure more people to be immunized will affect the entire barangay. It is important to let people know that even after getting the shot, they will not achieve immunity at once and such things need to be communicated well.
At the core of these domains is Governance. Dr. Tan acknowledged that circularity and a better normal runs best on trust and faith. “Many problems arose out of neglect of the basics in public health so that people don’t trust government and health professionals as they used to.”
With a need for and expectations of far-reaching changes beyond the pandemic, he expressed hope that “with trust and faith, we will be able to move to a better normal.”
Cynthia M. Villamor
Published in UP Manila Healthscape Special COVID-19 Issue No. 26
