‘Excess deaths’ after COVID

The Philippine experience of the COVID-19 pandemic has become a rich source of learning for the Department of Health (DOH) in responding to global public health crises. Being one of the government’s anti-COVID vaccine experts during the pandemic, incumbent Health Secretary Dr. Teodoro Herbosa vows to build upon these lessons learned on emerging out of the pandemic. So before any brewing outbreak could develop into a full-blown epidemic, Herbosa stepped in immediately to nip in the bud the rising cases of similar highly infectious diseases of pertussis and measles.

The DOH Secretary reassured the public during our Kapihan sa Manila Bay news forum last Wednesday the outbreaks of pertussis and measles are both still in the stage of clustering, or observed rising in “pockets” around the country. Since these are also very transmissible diseases carried by airborne viruses, Herbosa prioritizes preventive measures through more vaccination rather than therapeutic to address these latest threats to our country’s public health system.

So far, Herbosa rued 49 young children were reported to have died due to pertussis because they were not vaccinated. The DOH has already recorded nearly a thousand cases in the first quarter of this year. The figure is way above the 28 pertussis cases recorded in the same period last year.

But one death is still one death too many.

As of last monitoring of the DOH Epidemiology Bureau, he cited, the areas of CALABARZON accounted for 187 pertussis cases, or 22 percent of the total cases, compared to only three pertussis cases last year. The National Capital Region (NCR) came in second with 158 and third is Central Luzon with 132.

Of the total at the NCR, Pasig and Quezon City posted the most number of pertussis cases. Herbosa credited, however, Quezon City Mayor Joy Belmonte for quickly taking action to stop the citywide spread of pertussis. Initially, Mayor Belmonte declared last March 21 a citywide outbreak of pertussis. Mayor Belmonte subsequently announced the emergency procurement of P13 million worth of 6-in-1 vaccines and antibiotics. The DOH Secretary could only wish other local government chief executives would follow the lead of Mayor Belmonte of being pro-active in addressing the public health concerns of their constituents.

Currently, Herbosa disclosed, the DOH is re-distributing vaccines to areas with outbreaks of pertussis while additional vaccines to augment the diminishing supply of the DPT (diphtheria, pertussis and typhoid) vaccine have yet to arrive. Although the DOH estimates the DPT vaccine stock to run out by May due to the sporadic outbreaks of pertussis, Herbosa counts upon the assurance of the Serum Institute of India to deliver 4 million doses of DPT by July this year.

In the measles cases, Herbosa disclosed, the highest incidences are reported in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). In fact, the DOH Secretary flew last week all the way to Cotabato and met with their officials led by BARMM Chief Minister Al Haj Murad Ebrahim to check on the implementation of the measles outbreak response immunization.

According to Herbosa, the measles outbreak in BARMM provinces started in September last year but transmissions continued due to “failed outbreak response.” The DOH chief traced this largely to the “perennial problem of vaccination hesitancy,” especially on the part of the parents. Todate, he cited, 500,000 children out of the 1.3 million target population in BARMM have gotten their anti-measles vaccine.

“That has been the uphill battle. While measles is a vaccine-preventable disease like pertussis, but many parents don’t believe in vaccines,” Herbosa rued. During his dialogue with BARMM officials, all agreed that the only way to prevent a full-blown epidemic is that no one is left behind and unvaccinated.

“Parang giyera, pag may naiwan sa measles vaccines, lahat matatamaan,” Herbosa paraphrased Murad’s retort to him. (It is indeed like a battle when someone is left behind, everyone gets hit, too.) Murad once headed the separatist rebel group that is now bound in a formal peace pact with the government.

The immunization was temporarily suspended in observance of Eid’l Fitr last April 10 but would resume this week now that the Muslim feast is over.

Herbosa conceded the low immunization rate in the Philippines led to the resurgence of pertussis and measles. These infectious diseases have practically “disappeared” already because of the required vaccination to newborn babies. In fact, he noted, many young doctors have not encountered until now pertussis, or whooping cough, or “tusperina” in Tagalog.

On a lighter vein, Herbosa noted half-amused the differing ways newscasters pronounce pertussis: “It is per-TA-ssis, when an American says it. But us Filipinos, we say per-TU-ssis.”

Herbosa could only blame the advent of anti-vaxxers who vigorously fought the mandatory COVID-19 vaccines during the pandemic for the decline in immunization rate as well as the psychosocial effect of the pandemic.

“Because while we were having a pandemic, certain people did not want to go to hospital fearing to get COVID. We doctors even advised those with immune-compromised conditions not to go to hospital if not necessary,” Herbosa recalled.

“That created excess deaths,” he rued.

As defined by the Philippine Statistics Authority (PSA), Herbosa cited, “excess deaths” refer to deaths more than the normal number of deaths per year. An epidemiology term, “excess deaths” happen only during pandemic and disaster times, he pointed out.

The Philippines had the longest lockdown of our country’s borders that started on March 15, 2020 in a bid to stop the spread of COVID-19 infection. The World Health Organization, he cited, recognized the Philippines as “among the better countries” with high anti-COVID vaccination rate of 78 million out of 110 million population and 61,000 confirmed COVID-related deaths.

“That’s the downside of any disaster. Maswerte ka, buhay ka pa,” the DOH chief quipped, quoting one infamous comment made during the “Haiyan” disaster in Leyte.“ After COVID, there is a rise in regular number of deaths,” the DOH admitted.

“All those (other diseases) we neglected in the past three years are my problems now that I am the Health Secretary,” Herbosa sighed.

The Health Secretary is not complaining though.