After the efforts of the IATF, the Department of Health and One Hospital Command to address the COVID-19 pandemic, the need to revitalize the country is in high bars. Though the said efforts have successfully increased and improved the current hospital capacity, the work does not end there. The country needs to emerge from the current recession to enable Filipinos regain their livelihood to support their families and communities. And everyone will agree that the economic enablement of Filipinos translates to their health and welfare.
However, building back the economy means increasing the public transport capacity which has been hitting only 20-30% of pre-pandemic capacity. This is due to the dilemma of contracting the virus from congested public transport spaces.
A group of expert panel of doctors with diverse backgrounds, including public health, epidemiology and infectious diseases, write a collective statement with the intention of seeing the country back on track as safely as possible. The group outlined and presented the 7 Commandments in public transport to some members of IATF last September 14 to help the country in reviving the economy while adhering to comprehensive public health standards.
The 7 Commandments
1. Wearing of proper face masks
2. Wearing of face shields
3. No talking and no eating
4. Adequate ventilation
5. Frequent and proper disinfection
6. No symptomatic passengers
7. Appropriate physical distancing
According to the group, these measures will be amongst the most comprehensive in the world, based on our consultation with international experts. These 7 Commandments need to be strictly enforced and independently monitored in their implementation. By imposing these strict measures, we believe we can gradually relax social distancing rules, in order to double or even triple our current public transport capacity, without compromising public health.
For example, a recent study from Duke University shows that surgical masks reduce droplet transmission by up to 99%, and that the simple act of not talking can reduce droplet counts by up to 4x. In addition, a meta-analysis published on June 22, 2020 in The Lancet, a leading international medical journal, shows that face masks and face shields can independently reduce the chance of viral transmission by up to 5-fold and 3-fold, respectively. In China, Japan, Korea, Singapore, Taiwan, Vietnam, and other countries, passengers wear face masks while sitting side-by-side in trains, while COVID cases remain manageable.
With regards to appropriate physical distancing, the World Health Organization recommends: “To the extent possible, keep a distance of at least 1 meter from other passengers when purchasing tickets, waiting to board public transport, and moving around public transport stations.”
While WHO recommends keeping a distance of 1 meter from other passengers to the extent possible, it allows for adjustments based on context. Given the group's other recommended health interventions, they proposed the gradual reduction of the physical distancing norm during transit to 0.5 meters or lower. Based on the review of the scientific literature and the policies and experiences of neighboring countries, the group of experts believe the evidence shows physical distancing can be maintained below 1 meter, so long as other health measures are also implemented.
According to the experts, there are many more layers to the proposal and the studies they are reviewing. Public policy has no quick-and-easy solutions, and addressing the transport crisis in this pandemic is no exception. Where possible, the experts would like to engage in further dialogue with the IATF, medical and transportation experts, and other stakeholders, about the proposal. Discussion to other groups' thoughts on health and other matters are also encouraged, including the overall increase of the supply of safe public transportation such as rail, buses, jeepneys, motorcycle taxis, and Transport Network Vehicle Services (TNVS), and the use of other options such as cycling, walking, and private shuttles. The full institutionalization of private sector expert consultation to further improve our overall management of the economy and public health is also highly encouraged.
The comparative toll on Filipinos from a further prolonged recession is much more devastating than the manageable risks entailed in our plan. The group believe that there is a way forward that carefully balances a careful reopening of public transport capacity, with public health, while allowing purposeful flexibility to re-adjust measures based on actual and evolving data from the ground.
The success of this plan is by no means guaranteed. It relies on the proper implementation and enforcement of these measures by the relevant agencies. Critically, it also requires the education of the public, who must take full responsibility for compliance with the 7 Commandments. This plan’s success also rests on continuous monitoring and data-driven evaluation by public health experts.
The hope is that by working together, we can implement these public health measures to revitalize our country safely and give Filipinos their lives back.
The 7 Commandments and recommendations sited in this article are outlined by Dr. Manuel M. Dayrit (Former DOH Secretary), Dr. Vicente Belizario, Jr. (Dean, College of Public Health, UP Manila), Dr. Teodoro Herbosa (Special Advisor, NTF against COVID-19, Former DOH Undersecretary, Dr. Michael Hernandez (Department Chair Environmental and Occupational Health, UP Manila), Dr. Manuel Francisco T. Roxas (Director,Philippine College of Surgeons Cancer Commission), Dr. Esperanza Cabral (Former DOH Secretary), Dr. Ma. Dominga Padilla (Founder and CEO of Eye Bank Foundation of the Philippines), Dr. Rontgene Solante (Infectious Disease Specialist)