The Delta variant is the most closely watched coronavirus mutation yet, and with good reason: it’s twice as transmissible as the original virus, with one positive person potentially capable of causing infection in another nine to 13 persons.
Community transmission largely attributed to the Delta variant is causing an increase of reported cases on daily basis including unfortunately hundreds of reported daily deaths. Even countries that previously contained COVID-19 transmission are seeing a rapid rise in cases partly driven by this more transmissible variant. What can the Philippines do to strengthen its response?
To minimize the impact of the Delta variant, the World Health Organization (WHO) encourages the government, local government units (LGUs), employers, and all Filipinos to act proactively and together to break the chains of transmission and prevent its further spread in households, communities, and workplaces. We need to work together to successfully address this evolving challenge.
“The coronavirus has mutated to spread quickly to more people. We also must adapt our own mindsets and behaviours – to adapt quickly to this new reality so we can minimize the impact of the evolving pandemic both as individuals and as a community,” said Dr Rabindra Abeyasinghe, WHO Representative to the Philippines.
Pandemic fatigue behind poor adherence to minimum public health standards
Nearly 20 months into the global health crisis, pandemic fatigue is contributing to and creating risks as the mental distress of losing jobs, keeping families safe, or the sweeping uncertainty of the future takes a toll on many Filipinos.
“People are taking risks to earn a living despite the threats of Delta and other variants or even simply getting together with their loved ones,” said Dr Abeyasinghe. “These are understandable, but in the face of a more transmissible variant, we need to be extra vigilant and adopt ways to be safe in these settings. The minimum public health standards when complied with due diligence are still very effective in preventing transmission and interrupting chains of transmission.”
Aside from wearing masks and physically distancing, WHO emphasizes the need for avoiding closed and crowded settings and ensuring good ventilation. Opening windows at home or in workplaces prevents people from inhaling air carrying very small droplets or aerosol particles that contain infectious coronavirus.
Physical distancing could be more challenging in public spaces like public transport, indoor dining spaces, some workplaces, wet markets and groceries. “We encourage safety or enforcement officers to be on alert and remind people to keep their distance from others,” said Dr Abeyasinghe. “It is not just about telling them what to do, however, but also pointing out why they still need to do it – to keep themselves and others safe.” These behaviours and practices are equally important for the non-vaccinated and the vaccinated. This is because we are seeing breakthrough infections that are usually less severe even among the vaccinated.
Less social mixing, fewer risks
Although it’s not universally clear that the Delta variant itself causes more severe cases, such reports have come from several countries. The higher transmissibility of the Delta variant leads to a larger pool of people getting infected. Unfortunately, this also includes increased numbers among children and unvaccinated elderly persons. The larger number of people infected results in higher numbers of persons developing severe disease and seeking hospital critical care, potentially overwhelming the healthcare systems in many affected countries, especially in countries with low vaccination coverage among elderly and comorbid populations.
“Compared to the SARS-CoV-2 wild type, the highly transmissible Delta variant which causes higher viral loads in the respiratory tract spreads faster and infects more people, potentially affecting every individual in a household if one person gets infected.
In the Philippines, the early lockdown in the country’s capital and areas with increasing COVID-19 cases have decreased the movement of people and somewhat delayed the surge of cases. However the decrease in mobility in the most recent Enhanced Community Quarantine (ECQ) was noticeably higher compared with previous lockdowns.
As the National Capital Region continues in MECQ. we need to all limit our movement to essential errands and turn to online tools for work and social engagements as much as possible.
Vaccination protects the community
Social mixing also poses greater risks to vulnerable people who are unvaccinated. The increase of cases seen by WHO in countries around the world is largely among unvaccinated.
Senior citizens and people with underlying conditions will be gravely affected if the Delta variant spreads far and wide in the country. “Before Delta cause surges everywhere in the Philippines, those at high risk of severe disease and death due to COVID-19, the elderly (A2) and comorbid populations (A3) must be fully vaccinated as soon as possible,” said Dr Abeyasinghe.
“It is not enough to meet population protection in a few areas. Inoculating people in the A2 and A3 priority groups all over the country can create the most impact in decongesting hospitals and saving lives.”
WHO also welcomes the idea of NCR cities “vaccinating as one,” allowing residents of one local government unit (LGU) to get their jabs in another. “We support this localized dose sharing for the elderly and people with comorbidities. It is a resourceful and timely suggestion and addresses the urgency of our situation with the Delta variant.”
Vaccines not only protect elderly and persons with comorbidities, they help reduce severe infections in families preventing the need for out of pocket expenditure, they also protect the hospitals from being overwhelmed contributing to economic recovery of the country. Recent data shows that all vaccines are highly effective in preventing severe disease and death. Vaccines are not 100% effective in preventing infections with the new variants, but fully vaccinated people experience breakthrough infections that are often mild. Additionally, vaccinated people shed the virus for a shorter duration of time potentially reducing the risk of others being infected.
Save beds for severe cases to save lives
WHO has been supporting the expansion of the health care system through the setting up of step-down facilities and expansion of ICU capacities. As the number of cases increases and the health care capacities come under pressure it’s important to better manage the existing capacities through referral and back referrals. Infected persons with no or minimal risk can be managed at home or in isolation facilities, reserving hospital space for high risk and severely ill patients.
Temporary treatment and monitoring facilities (TTMFs) are an important part of the COVID-19 response as they help prevent infection at home and congestion of hospitals. They could be facilities to isolate mild and asymptomatic COVID-19 patients, or step-down facilities for recovering patients.
“The Philippines can learn from countries that stringently implement suggested triage algorithms and save hospital beds for severe cases,” said Dr Abeyasinghe. “We encourage home-based care for those who meet the following criteria: Patients at low risk, those who have a separate isolation room with toilet and good ventilation and can have their daily needs delivered at home.”
If home isolation is not possible, access to TTMFs must be facilitated by LGUs to lessen transmission in the household. Based on PhilHealth’s home isolation guide, health care providers and patients must have daily check-ins for at least 10 days to ensure monitoring of symptoms and immediate action if inpatient care is needed.
Investing in and ensuring telemedicine services are in place facilitates better adherence to infection and prevention control (IPC) measures at all stages of care, and protects care givers from unnecessary exposure.