Distance Formula

2020 hallmarks the year Filipinos faced two wars at the same time: The COVID-19 pandemic and an inefficient government response. This pincer attack pushed healthcare workers and frontliners over the edge while forcing researchers to search for what would be the miracle cure. Even then, only a select few have gained international traction. Bliss it is to think that an end is near for this pandemic but it must be recognized that in a battle with the microscopic, scientific, and rational decision-making is what saves us.

Going the distance: Then-Anti-terror bill protesters go the social distance to push for calls against the said bill last June 4, 2020. Photo taken from Rappler; shot by Anjo Lapresca.

In terms of treating COVID-19, the World Health Organization (WHO) on March 18, 2020 announced the start of “Solidarity,” an international clinical trial to help find the most effective treatment regimens for COVID-19 by assessing the efficacy of existing antiviral and anti-inflammatory agents. According to WHO, these trials will help cut the time it takes to develop clinical trials by 80%. The participation of over 100 countries, including the Philippines, will only hasten results from these trials.

Instead of concocting treatments from scratch, public health experts and researchers looked into the effects of pre-existing drugs, as well as unapproved drugs that performed well against the viruses that cause Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS) in animal models. Of these trial drugs, Chloroquine, Lopinavir-Ritonavir, and Remdesivir (READ: WHO launches global megatrial of the four most promising coronavirus treatments) have caught global attention.

Chloroquine and one of its less aggressive derivatives, Hydroxychloroquine, have been staples of malaria treatment since World War II. While the drugs certainly have antiviral properties, much of how they interact with viruses is unknown as published in a critical analysis paper published in PLOS Medicine. The drugs interfere with nearly all processes of cellular infection and replication. With the medication’s uncertainty, it makes it difficult for scientists to identify whether these drugs are actually effective or just causing more damage overall.

Although there are in vitro inhibitory effects against SARS-CoV-2, the virus that causes COVID-19, it is only exhibited in very high concentrations. And even then, antiviral properties are “partial at best.” In this event, the body suffers from the repercussions of being exposed to such high doses. Researchers indicate that such levels raise concerns over cardiovascular toxicity and may cause complications in the heart like arrhythmia or irregular heart rhythm. Ultimately, WHO decided on June 17, 2020 to discontinue solidarity trials involving Chloroquine and Hydroxychloroquine as data showed that these drugs do not decrease the mortality among hospitalized COVID-19 patients when compared with individuals given standard care.

Next on the list is Lopinavir-Ritonavir. This treatment scheme is actually a combination of two drugs, Lopinavir and Ritonavir, that are used to treat the Human Immunodeficiency Virus (HIV). Lopinavir works to inhibit the protease for different viruses. These proteases are essential in the replication mechanisms of the viruses. Lopinavir can be thought of as brakes that prevent the collision between virus and protease. But since Lopinavir easily dissolves in the body, Ritonavir is coupled with it to make it last longer. Analogously, Ritonavir can be thought of as brake fluid, prolonging the effects of Lopinavir.

To the world’s interest, researchers have observed that this drug combo shows inhibitory effects on the proteases of other coronaviruses like SARS and MERS in animal models. This sounds reassuring for the most part, but after clinical trials in different hospitals, the duo exhibited little to no significant difference in combating SARS-CoV-2 when compared to standard care. It is also worth noting that physicians advise caution on the use of Lopinavir-Ritonavir in patients with cardiovascular diseases and pancreatitis. Some of the biggest risks, according to a paper published on SpringerLink, is abnormal heart rhythm and subsequent increased risk of sudden cardiac death. This means that dangerous exposure to the drug duo increases the time it takes the heart to “recharge” between beats, which later leads to complications and even death. Meanwhile, according to a paper published by the Centre for Evidence-based Medicine of the University of Oxford, common side effects of this treatment scheme include gastrointestinal disturbances like diarrhea. Since the risks outweigh the benefits, WHO decided to cancel trials on this treatment along Chloroquine.

While the previous two treatments ended up being scrapped, Remdesivir, a drug originally developed for Ebola, sets itself apart by reducing the recovery time of adult COVID-19 patients to 11 days. A report published in the New England Journal of Medicine explains the case of Remdesivir when compared to the 15 days it takes to recover for patients who only received placebos as treatment. These effects may be explained by Remdesivir’s antiviral properties by mimicking a component of viral RNA that a virus needs to replicate itself. While a virus like SARS-CoV-2 binds itself to these ‘fake building blocks’, Remdesivir works to stop its spread in the body.

Despite being the best option to treat COVID-19 so far, there is still a lot unknown on how much and what time the drug should be optimally administered. Remdesivir’s clinical trials that were based on Wuhan did not enroll enough patients to be statistically powerful; concerns for its generalizability is still uncertain for other parts in the world. This is without even addressing problems for accessibility and distribution to both urban and rural hospitals.

With the country’s rising prevalent COVID-19 cases, 5,000 members of the Concerned Doctors and Citizens of the Philippines (CDCph) led by former health secretary Jaime Galvez-Tan called on President Duterte to adopt a national protocol of lifting imposed lockdowns in replacement of preventive health measures and early treatments, even referring hydroxychloroquine as a reliable drug to COVID-19 infection. The program promises that the government will no longer have to choose between saving the economy or the lives of Filipinos (READ: Doctors’ group seeks end to all lockdowns)

Despite having the world's longest lockdown coupled with militaristic approaches and still having a hefty amount of cases, lifting community quarantines would be futile without mass testing and aggressive contact tracing in place. Early treatment requires earlier detection and with the lack of identification and isolation mechanisms present in the Philippines, the program may incur more cases rather than suppress the virus’s spread. Even if the program would be implemented, hydroxychloroquine has raised concerns regarding causing heart abnormalities, so prescribing the drug as a viable treatment would mean exposing Filipinos, whose leading cause of death is cardiovascular diseases, to greater risks of heart complication that may only do harm in the long run.

Saving Filipino lives should be the priority of the government above all, and it has been clear that for the past six months that their priorities are misplaced. The government should focus on flattening the curve by implementing mass testing and contact tracing while investing in strengthening its social safety nets. With the poor bearing with starvation and workers dealing with unemployment while politicians exploiting the current pandemic and governmental bodies allocating its budget elsewhere, transparency and systemic change should be sorted out by placing competitive and knowledgeable experts in-charge while weeding out incompetent and corrupt officials.

In addition to demanding accountability, better treatment of our healthcare workers should be called for. The government’s move to bar Filipino nurses from leaving the country is counterproductive of their goal to increase the workforce in the medical field. The entry-level salary for nurses in the country is at a staggering low of almost 10,000 Php per month. Compare this to countries like the United States where nurses earn over 200,000 Php in the same amount of time. For any worker to stay in their country, national governments must ensure that work environments provide opportunities for holistic and financial growth.

It must be made clear that the end is nowhere near. Accepting this harsh reality is the first step to fully grasp our responsibilities as members of the community. Filipinos should realize that pinning all hopes on trial drugs promotes a false sense of security. While preliminary clinical results are promising, these do not translate to an immediate cure. Research is grounded on reliable and valid statistics, So while data is scarce and researchers are under pressure, it is a must to continue to treat the pandemic with the highest extent of caution through careful public health measures and still observing social distancing.

As we move forward and understand the situation we are in, we gain distance relative to the first step. Distance, being a physical quantity, is something we can resign to when we are connected by a bond that transcends physicality, much like how we Filipinos remain united despite the waters that divide us. When we look back, we see our triumphs against systems that tested our bonds. We see the same struggles reflected in our future in this pandemic. And though the end is far, we must continue to call for a government that will walk with us despite the distance. In the fight against microscopic foes and macroscopic social inequalities, let us join our heads instead of our hands as we conquer these wars from both sides.