- The COVID-19 pandemic gives a new meaning to resilience thinking, with countries all over the world scrambling to find the best balance between eliminating the virus and minimizing social and economic damage.
- Dr. Ronald Law, Chief of the Preparedness Division of the Department of Health-Health Emergency Management Bureau, shares his insights on the role of science and research to combat COVID-19 and the knowledge gaps that need to be addressed to implement timely public health interventions to control transmission and prevent resurgence of cases.
- This post is a commentary contribution and does not necessarily reflect the views of the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD).
If our well-being or survival in this pandemic were to depend on how much or little we know about the science of COVID-19, then we need to sound the alarm now for rapid, quality and equitable research on COVID-19.
While we’re lost in the business (and busyness) of response, it is imperative for us to find our way to addressing knowledge gaps that when answered can shine a good light on what directions we need to take and how to go about the journey. We can’t forever grope in the dark--it’s a sure recipe for a disaster within a disaster. Science and resilience thinking should be that light with research paving the way.
Aside from political will, public health expertise, government resources, social capital and other “effective” interventions in the pandemic playbook being written across the globe, the role of research should be front and center especially now more than ever.
Almost 8 months from waking into this surreal if not harrowing world that is filled with uncertainties, the only thing certain about COVID-19 is that it is too complex that we have more questions than answers that science can find.
While all of humanity’s labors and hopes are pinned on the medical aspect of research—the discovery of a vaccine or a group of drugs to protect against the virus or quell the negative health effects of the disease, several public health aspects that pertain to transmission, prevention, control and risk management remain to be poorly elucidated.
Let us count the ways and measure how wide the knowledge gaps are.
There is evidence that COVID-19 is a zoonotic disease--can be passed from animals to humans but up to now, the animal reservoir or habitat where the virus thrives and other animal hosts in the chain of infection are not yet well-defined. Bats, rodents, cats, dogs, the list goes on.
It is established that the elderly population (above 60 years old) and those with underlying medical conditions are the high risk groups for infection. However, the specific conditions--diseases, health status, predisposing factors and indicators for severe disease are not yet as clear. It is perplexing to note why some young people can develop severe infections even without comorbid conditions.
It is known that transmission can happen 1-3 days before the onset of symptoms but there is still no data to describe the magnitude and extent of asymptomatic and pre-symptomatic transmission let alone the infectious dose of the virus.
Globally, only 1-3% of cases is attributed to the 0 to 19-year age group. Children show lower risk of infections and when they do, the usual symptoms may not be observed. But just how susceptible and infectious they are compared to adults are still burning questions.
It is widely held that timely public health interventions are essential to control transmission and we know that countries which have employed a mix of public health and social measures have already been successful to a certain extent; but despite all the elaborate models that data scientists can churn out, what specific combination of interventions is needed to prevent resurgence of cases? What is the impact of individual and combined public health and social measures on COVID-19 and non-COVID-19 issues alike? These are not yet found in the vast literature.
We’ve seen that transmission is common in closed settings (hospitals, prisons, public transport) and super-spreading events are responsible for the exponential rise of cases. But key questions are: What are the characteristics of these settings? What are the main transmission routes? What are risk factors of people in these settings?
In terms of infection prevention and control, we know that droplet spread is the main route of transmission and that masks of different kinds afford some protection from the virus. Recently, evidence on airborne transmission is already coming to fore. But up to now, effectiveness, adverse events, and sustainability of use of masks, respirators and face shields still have to be investigated. Likewise, in environmental health, we are still grappling with the ideas of spread of the virus in water and fecal matter, role of fomites (inanimate objects like doorknobs, mobile phones, elevator button) in spreading the disease and effective technologies for decontamination.
Lastly, we know that the pandemic disproportionately affects the population. When it comes to strengthening response and addressing social justice, these questions linger: How uneven are the impacts to different social groups in specific settings and contexts? What is the importance of adaptation and the role of communities in response and mitigation? We still need to crunch some data to back up these relevant arguments so governments are properly guided on prioritization of target groups, resource allocation and resilience planning in the new normal.
While (im)patiently waiting for the outcomes of massive global trials for vaccines and treatment, these public health research questions that span epidemiology, health policy, environmental health and social sciences are more than enough to preoccupy the best minds of our scientific and medical communities the world over and in the Philippines.
More than enumerating these as part of a robust research agenda, the Philippine research community should commit to implement relevant research that will support our collective pandemic response. This is the most “science-based” strategy as we can ever get. Also, the government is called to the challenge of mustering its energy and marshalling its resources to convene experts from different fields, disciplines and institutions, to build on their rich trove of expertise, resources and networks, to work on this ambitious but future-defining agenda.
Lastly, we need to adopt a research mindset that frames the success stories of other countries from a global perspective and perceives our own good practices on the ground as practical evidence that can make a big difference in our response. We can learn or unlearn a thing or two on this. And no one can argue with us on that.
Aside from his position in the DOH, the author is a professor of public health at the University of the Philippines-College of Public Health, UERM Memorial Medical Center Graduate School, Ateneo School of Medicine and Public Health and the University of Washington in the U.S.
He is a recent US-ASEAN Fulbright scholar focused on health security, emergencies and disasters. He is also part of the technical working group working on the health resilience thread of the National Unified Health Research Agenda (NUHRA) and a member of the DOST-PCHRD Disaster Risk Reduction - Climate Change Adaptation (DRR-CCA) Program Technical Advisory Group.
- Written by Ronald Law