War and Co-existence

Filomeno S. Sta. Ana III

Fighting a global war is often used to describe the fight against COVID-19.

One cannot tackle devoid of emotion the death and devastation caused by the pandemic.
The latest data (as of 21 June 2020): 463,000 have died out of 8.75 million confirmed
cases.

The U.S. alone has accounted for 121,000 deaths so far. This is equivalent to about a
fourth of global deaths. This number is more than double the American deaths in the
decade-long Vietnam War (1964-1975): 58,220. In fact, the Americans deaths from
COVID-19 have surpassed the total number of American fatalities from the wars in the
period after World War II. The Korean War, Vietnam War, War in Iraq, War in
Afghanistan plus the 9/11 terrorist attacks accounted for 104, 647 deaths all in all (source
of information: Nina Strochlic, “U.S. coronavirus deaths now surpass fatalities in the
Vietnam War,” National Geographic, 28 April 2020).

However, the number of confirmed COVID-19 deaths still undercounts the total fatalities
during the pandemic. We also have to consider the additional deaths that are indirectly
caused by COVID-19. Said differently, these non-COVID-19 fatalities occur because of
the pandemic conditions. The factors that explain the non-COVID-19 deaths during the
pandemic include the reluctance of sick people to seek hospitalization because of their
fear of getting infected, the incapacity of overwhelmed healthcare facilities to attend to
all critically ill people, and the inability of the weakened system to simultaneously
respond to different diseases.

The information on non-COVID19 fatalities during the pandemic can be drawn from the
metric called “excess mortality.” The World Health Organization defines it as “mortality
above what would be expected based on the non-crisis mortality rate” or “mortality that is
attributable to the crisis conditions” However, the data for excess mortality are scant.

The pandemic has likewise caused extreme economic hardship, resulting in incalculable
losses in terms of jobs, food security, and incomes. It is said that the economic crisis
brought about by COVID-19 is the worst since the Great Depression in the 1930s.

But if we use health as our primary indicator, the current global crisis is worse than the
Great Depression. One study for example shows that “many of the changes the deaths
from the different causes during the Great Depression were unrelated to economic
shocks.” More to the point, all-cause mortalities declined between 1929 and 1937. (See
David Stuckler, Christopher Meissner et al., “Banking crises and mortality during the
Great Depression: evidence from US urban populations, 1929-1937,” Journal of
Epidemiology & Community Health, 2012.) This could be explained by the New Deal,
which improved health outcomes.
Our consolation is that COVID-19 is, so far, not as extreme as the 1918-1919 influenza
pandemic that killed 50 million people worldwide. Without sounding deterministic, we
can exude confidence that we will beat COVID-19, thanks to the rapid advances in
science and technology in general and therapeutics in particular.

The optimistic scenario is that a vaccine can be introduced within two years. Even here,
we face challenges. Having a vaccine does not automatically mean that it will be made
available to everyone. And even given the access to the vaccine, the logistics and
resources to vaccinate everyone are formidable.

In this light, a petition letter, initiated by global leaders and influencers, is calling for a
“people’s vaccine” against COVID-19. Recognizing that making the vaccine available to
all is a political challenge, the signatories want COVID-19 licenses on knowledge, data,
and technologies be freely available to all countries and vaccines and treatments be
provided free of charge to all.

Even before reaching that point of rolling out the vaccine, we face immediate obstacles.
For countries that have initially flattened the pandemic curve (China, Singapore, Korea,
Japan, New Zealand, among others), fresh cases have emerged. For countries like the
Philippines that are struggling hard to tame the first wave, they have likewise been hit by
new outbreaks.

In the Philippines, the latest basic reproduction number is >1 (in the National Capital
Region, the number is 1.2; in Cebu, it is 2). Any reproduction number that is >1 means
that COVID-19 continues to spread, and a higher value (like in Cebu) suggests that
containment is more difficult.

To rely solely on a prolonged lockdown to contain the virus entails huge economic costs.
It likewise causes severe physical and mental stress to the populace. Hence, government
has to step up in implementing effective interventions like targeted testing, systematic
contact tracing, requiring people to wear masks, and having the sick go through self-
isolation. These are the standard weapons to fight COVID-19.

But having weapons does not make a solid strategy. Even if we are armed with these
weapons, the enemy that is the virus lives with us.

Here, we can reflect on the Japanese strategy of seeing the forest for the trees. A Japanese
doctor and professor of virology, Oshitani Hitsohi, explains this strategy in an interview
with the Japan Foreign Policy Forum (5 June 2020):

“The core of Japan’s strategy was not to overlook large sources of transmission. By
accurately identifying what we call ‘clusters,’ which are sources that have a potential to
become a major outbreak, we were able to take measures for the surroundings of the
clusters. By tolerating some degree of small transmissions, we avoided overexertion and
nipped [in] the bud…large transmissions. Behind this strategy is the fact that, for this
specific virus, most people do not infect others, so even if we tolerate some cases [to] go
undetected, as long as we can prevent clusters where one infects many, most chains of
transmissions will be dying out.”
Note i that the strategy allows some degree of toleration of transmission. The war that
Japan has conducted is not a war of attrition. It is not about “completely annihilating the
evil.”

It is a strategy that recognizes co-existence. And combined with the tools or weapons
that w at their disposal, they learn to adapt.