Exactly a month ago, former Economic Planning Secretary Ernesto Pernia (then the concurrent chair of the Commission on Population and Development or POPCOM, where I work as Executive Director) sent me a text:
“A worry to consider re Community Quarantine (even unexpanded) is the likely wide-scale negative externality. Imagine ordinary workers and others living especially in low-income houses/quarters congested as they already are during non-work hours (social distancing a luxury) with scarce water supply and food, let alone pastime activity/entertainment. Contagion is inevitable but without testing available and health workers/inspectors to detect symptoms, there’ll be so many latent COVID-19 positives to infect several others in the quarantined community.”
After I replied about non-pharmaceutical interventions (NPIs) like social or physical distancing needing to be complemented by other NPIs in epidemiology at community level like contact tracing, Secretary Ernie concluded:
That, coming from my boss, was my cue: We need to develop other weapons in the Philippines’ COVID-19 fight.
POPCOM started analyzing the 2010 Census of Population and Housing produced by the Philippine Statistics Authority for clues; the census is the only time the government actually goes into every household and sees the way its citizens live.
Then I came across a post from Sonny Africa of IBON which pointed out that three out of 10 houses in Metro Manila are inadequate for social distancing. This led us to narrow the analysis to the living space Filipinos have and whether physical distancing is possible.
When one thinks about living space, one can think about Hong Kong where the average living space is down to 4.3 square meters, about the size of a table tennis table. Some countries have mandated six square meters as the minimum to achieve physical distancing.
In our National Capital Region (NCR), 3.785 million Filipinos (27.2% of NCR’s population of 13.867 million) live in 812,584 housing units under 20 square meters, which leaves only 4.25 square meters per person. When we drill down to single-detached houses of less than 20 square meters, the poorest in Metro Manila (2.066 million, or 14.9% of NCR’s population) have living spaces down to four square meters per person. “Infeasible” is the term Secretary Pernia would use.
If we look further into these cramped houses, one can see that a significant number of senior citizens (84,726) are residents, thus these seniors are at greater risk of acquiring COVID-19. Yet another 51,365 senior citizens live alone in this type of housing, apart from any family member. As such, they are isolated and may be unable to move around in an enhanced community quarantine setting.
POPCOM analysis shows that communities are vulnerable in the following ways:
Large numbers of housing and population in a limited land area. (For example, Barangay Pinagbuhatan in Pasig has a land area of 1.52 square kilometers with 125,597 people.)
Large numbers of small houses under 20 square meters with a household size of four or more. (Pinagbuhatan has 3,590 of these housing units with 15,680 residents.)
Senior citizens living in small houses. (Pinagbuhatan has 416 seniors residing in this kind of housing.)
Seniors living alone in small housing. (236 seniors in Pinagbuhatan live alone in small houses.)
With the approval of the Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID), POPCOM will monitor all of the 42,044 barangays nationwide on their vulnerabilities based on living spaces and the number of senior citizens living in COVID-19-susceptible conditions.
While we learn more every day about COVID-19 and know where it is spreading, we are always one step behind, because it takes two weeks to manifest itself in terms of confirmed cases and one to two days for the test results to come out. If we know where we are vulnerable, we can best defend ourselves and pursue the virus in the communities where it thrives, which is among vulnerable Filipinos living in cramped spaces.
Local chief executives (city and municipal mayors) can use this vulnerability analysis to prioritize barangays for contact tracing using their health and population staff members whenever confirmed cases are discovered. Newly confirmed or even suspect cases can trigger targeted testing of close contacts, suspects, and probable cases, as well as senior citizens/persons with co-morbidities in their vicinity.
While testing for COVID-19 is a much talked about topic, no one really talks about the number of tests we really need to make since we can probably do only 10,000 a day at best. Without really significant testing capacity (which for our population should be around 100,000 per day, or three million a month) at the peak, we need to optimize other non-pharmaceutical interventions, aside from physical distancing.
The Demographic Vulnerability Tool needs to be used, most specially in local government units (LGUs) with few or no cases, as the tool is best used for defense and early response. Without testing, suspects must be identified soon and isolated.
How can this be done? The four agencies (POPCOM, the Department of Health, the Department of the Interior and Local Government and the National Economic and Development Authority) are proposing the mobilization of health and population workers as Local Epidemiology and Contact Tracing Teams (LECTT) by each municipal or city mayor. Nothing would satisfy Former Secretary Pernia more than seeing his recommendation bear fruit. The infeasible can yet be made more effective if we use our vulnerability to our advantage.
Juan Antonio Perez III is a doctor of medicine, and a partner of Action for Economic Reforms. He is a civil servant at POPCOM and a public health worker with experience in local health systems and health information systems.