Expertise in the Time of COVID-19

Fellow ����ý columnist Diwa Guinigundo had recently written a column, but for another newspaper, titled “My perspective on some lockdown perspectives” (see Manila Bulletin, April 30). In this column, Diwa criticizes two World Bank papers that emphasize the economic costs arising from lockdowns.

On substance, the gist of Diwa’s argument is that the papers “ignore some realities in poor countries and disregard the nature of the disease itself.” Diwa also underscores the tradeoff that society makes, but that tradeoff, even if guided by technical cost-benefit analysis, is going to be constrained by society’s norms and values.

On style, I have noted how Diwa has crafted his criticisms in a sober, polite, and constructive way. In some instances (or in past columns), he would express his disagreements with others and point out their errors without mentioning their names.

The title of Diwa’s column in fact suggests a state of humility. He offers a perspective, but his perspective is but one of the many perspectives. And his column does not suggest either that his perspective is the definitive one.

This demeanor is very different from the young Diwa I knew. During his student activist days, including the period when he was the editor of the Philippine Collegian and later chair of the quasi Student Council, Diwa was combative and polemical. And up to the late 1990s, Diwa was engaged in intense and polemical debates with others (including my organization, Action for Economic Reforms) on monetary and exchange rate policies.

With Diwa’s column as springboard, it is worth returning to some of the contentious points found in the World Bank articles. The first research paper that Diwa cited is authored by Damien de Walque, Jed Friedman, Roberta Gatti, and Aaditya Mattoo. It is titled “How Two Tests Can Help Contain COVID-19 and Revive the Economy” (April 80). The paper makes a case for the “wide application” of two tests, namely the polymerase chain reaction (PCR) assay and the rapid antibody test.

The problem is that the paper does not make any critical qualifications about the limitations and risks of the antibody tests. The evidence around the world shows the unreliability of antibody testing. See for example The New York Times, “UK Paid $20 Million for New Coronavirus Tests. They Didn’t Work,” April 16. Or CNN’s “Prominent scientists have bad news for the White House about coronavirus antibody tests,” April 15.

CNN Philippines reported a story on May 1, in which the title says it all: “13 retuning OFWs in Cebu test positive for COVID-19 after testing negative from rapid test in Manila.” Earlier than the stories mentioned above, the Philippine Society for Microbiology (PSMID) published “Should IgM/lgG rapid test kit be used in the diagnosis of COVID-19?” (April 9). One key finding: “Existing guidelines do not recommend serologic antibody tests for the diagnosis of COVID-19 in currently symptomatic patients.”

The second paper that Diwa cites is authored by Norman Loayza and is titled “Smart containment and mitigation measures to confront the COVID-19 pandemic: Tailoring the pandemic response to the realities of developing countries,” April 7. Loayza’s message boils down to: “I have serious doubts about the efficacy of lockdowns.” He enumerates the reasons why lockdowns are ineffective.

Loayza dismisses lockdown as a strategy as a principle. It is a view that revives the neoliberal mindset that is obsessed with a few sacred tools but denies the possible effectiveness of other tools. In Loayza’s case, he makes a dichotomy between lockdown and “smart containment and mitigation measures” (e.g., personal and public hygiene; test, test, test; protection of the most vulnerable). They in fact can go together.

Diwa and I believe in something we learned from our activism: “concrete analysis of concrete conditions.” Lockdown might not be suitable in one country like Sweden (where citizens comply with rules without the need for compulsion and where half of the population live in a single-person household). But it can be a most appropriate strategy in other countries like the Philippines.

An evidence-based study written by Maria Elena B. Herrera, et al., titled “Evaluating Potential Consequences of Alternative Public Responses to the Covid-19 Epidemic in the Philippines” (April 8) states the following: If lockdown or enhanced community quarantine (ECQ) had never been implemented, “about 1.9 million individuals would have required hospitalization, with over 250,000 requiring critical care, and deaths would have exceeded 180,000” in the national capital region.

The pandemic has produced many overnight public health experts. The economists — like those mentioned in Diwa’s column — have become public health experts. The ophthalmologist, just because he is a doctor, thinks he has become a public health expert. The general, perhaps, because he has a degree in science (that is, military science) thinks he has become a scientist and thus has become qualified to be a public health expert.

And here’s the rub. Even a public health expert can err because of a wrong method (e.g., relying on a thin number or a based sample) or because of confirmation bias.

COVID-19 has many unknowns. No one is knowledgeable about the virus and the disease and how people will behave. No one has the answer. Everyone has to listen to one another. Listening nevertheless means giving premium to the facts and the evidence.

The evidence, contrary to what the World Bank writers, the ophthalmologist, and the ex-general claim, is that antibody testing is spotty and risky. Lessons from history (e.g., the Spanish flu of 1918) and current counterfactual evidence show that lockdown has prevented the occurrence of a much higher number of deaths.

But the conduct of science is also underpinned by a normative choice that society makes. For Diwa, it’s about perspectives (note that he acknowledges different perspectives) that “adhere to the fundamentals of protecting lives and public health.”

Filomeno S. Sta. Ana III coordinates the Action for Economic Reforms.