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Last line of defense


Almost three months into the new administration and the President is still to appoint a permanent Health Secretary. Meantime, the battle against COVID-19 continues, the state of public health emergency remains, and the threat of the local spread of monkeypox and the possible resurgence of polio persist. Dengue continues to remain a major issue as well.

I am sure the Department of Health (DoH) bureaucracy can function effectively even with just an Acting Secretary. However, Health should be the priority at this point. And the appointment of a permanent secretary, I believe, will help the DoH function more effectively. In crisis situations, leadership is very important.

Meantime, the Palace issues an order making the use of masks “voluntary” in open public spaces. At the same time, it thumbs down the DoH proposal to redefine “fully vaccinated” from COVID-19 to mean having received two main doses and at least one booster shot. As of Sept. 10, the country reported 26,074 active COVID-19 infections.

Also, the positivity rate in Metro Manila was reported to have increased to 13.3% on Sept. 9 from the previous week’s 12.1%. Metro Manila’s reproduction number was also reported to have increased to 1.11 from 0.93, indicating that infections are going up. Growth rate was 6% on Sept. 3 to 10, up from -17% the week before. But despite these numbers, masking was made voluntary in open spaces.

I am concerned about the timing of the “unmasking” order, considering where we are at present in dealing with COVID-19. Moreover, I cannot perceive any public good to be promoted or achieved by allowing people to unmask in open public spaces. If at all, unmasking raises the risk of transmission. At the same time, the order is open to various misinterpretations that can have a negative impact on public health.

Also, in line with COVID management, local government units have issued local ordinances or local laws regarding masking, and penalizing those who refuse or fail to wear masks in public. In this line, local governments will also need to amend local ordinances before the mask mandate can be removed.

Several days ago, Malacañang issued an executive order making the use of face masks voluntary in open spaces and noncrowded outdoor areas with good ventilation. In this line, the Philippine Star reported, the DoH was directed to update the guidelines on minimum public health standards (MPHS). Although the DoH reportedly prefers to keep the mask mandate even outdoors.

The difficulty with the Palace order is that it supposedly limits unmasking outdoors to “low-risk individuals and in low-risk settings,” with the DoH saying that “masking will be optional [only] for those who are not vulnerable.” However, in terms of implementation, for those tasked with enforcing the order, how then will they make the distinction?

My other concern with the presidential order is that it can lead to debates and arguments among citizens who have differing or opposing interpretations of the “unmasking” rule. BusinessWorld reported, for instance, that some legal experts believe the rule applies only to public spaces and does not cover privately owned spaces, even if these are patronized by the public.

“The order is limited to public places and noncrowded areas owned and operated by the government,” BusinessWorld quoted former congressman Terry Ridon as writing in a Facebook Messenger chat. “Owners and operators of private spaces are free to choose whether to adopt the same policy or maintain a mask mandate within their premises.” He also said “the government will have to respect private prerogatives within their own premises.”

In a separate Messenger chat, lawyer Michael Henry Ll. Yusingco was quoted as writing that the “executive order on mask-wearing by itself is not enough… it could only be enforced as a guideline within the Executive branch.” While lawyer Theodore O. Te, a former Supreme Court spokesman, tweeted, “Unfortunately, open, noncrowded and good ventilation are all open to personal interpretation and opinion.”

Lawyer Antonio Gabriel M. La Viña, meanwhile, wrote in a Messenger chat that “the policy is clear but is intended really to be flexible… This makes sense and allows local governments, offices, and establishments to use common sense in applying the policy.”

I prefer that the mask mandate remain for now, even outdoors. People should still be encouraged to keep their masks on, even outdoors, except when drinking or eating. Masking, even outdoors, should remain as part of minimum public health standards until some metrics are met with respect to the drop in the number of COVID cases as well as transmission and reproduction rates.

As Joey Francis Hernandez, treasurer of the Philippine Society of Public Health Physicians, noted in a Messenger chat, by allowing people to unmask in public places, “it would also be more difficult to control the spread of the coronavirus, considering that even if physically distanced, coughing and sneezing can transmit droplets potentially infected with SARS-CoV-2.”

The crux of the matter is that the executive order does not distinguish between people who are sick and contagious but do not know it (early stage or asymptomatic), and those who are healthy. Neither can anyone effectively distinguish the vaccinated from the unvaccinated just by looking at them, and the healthy from the immunocompromised. The “unmasking” order’s only parameters are that the space must be open, not crowded, outdoor, and with good ventilation.

Consider the case of an asymptomatic but contagious individual, unaware of his condition as he is seemingly healthy, choosing to unmask in a public park that is open, not crowded, outdoor, and with good ventilation. He sits about two meters away from another person who is unvaccinated or is only partially unvaccinated.

By allowing both to unmask at the same time, at the same place, over a prolonged period, two meters apart from each other, no rules are violated, and minimum public health standards are still met. Until the asymptomatic individual suddenly coughs or sneezes perhaps because of pollen or dust or some irritation. Then a potential problem arises. Multiply this scenario even by just a handful and the risk of COVID transmission escalates exponentially. Only because both have chosen to unmask.

We have gone a long way from April 2020. Lockdowns are now a thing of the past. Schools have reopened for face-to-face classes, and there are very few restrictions in place now with respect to the mobility of people. Many offices have issued return-to-work orders. People have started going out, or are travelling, and spending more time outside of their homes. In short, we now have a semblance of normal times.

Masks, whether indoor or outdoor, are our last line of defense and should be the last to go. Do we really need to unmask now, while we remain vulnerable to COVID? What public value or public good does “unmasking” in public, even outdoors, promote or achieve at this point?

Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council


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