Sweat more to better fight COVID-19

(Published in ENRICH magazine 2021)

WITH COVID-19 on the way to becoming an endemic disease in the Philippines, and with the slow pace of local vaccinations, Filipinos will have to find more ways to protect themselves from this disease since herd immunity might be more than a decade away -- if worst comes to worst.

Ramping-up physical activities such as doing household chores and exercising offer an additional layer of protection against COVID-19. We should now consider becoming more physically active as part of our ingrained response to keeping safe from COVID-19, along with masking, frequent hand washing and social distancing.

Medical experts warn we should keep on practicing these three safety measures -- plus becoming more physically active -- and not rely on vaccinations alone to keep us safe from SARS-CoV-2, the constantly evolving virus that causes COVID-19.

SARS-CoV-2

Fight COVID-19 with exercise

It becomes necessary for unvaccinated Filipinos to add regular exercise to their daily "Mask. Hugas. Iwas." routine to help keep COVID-19 and its many mutations from infecting them. Exercise does help protect us from the worst of the disease.

Persons with histories of being consistently active are at reduced risk of suffering from severe COVID-19, according to a new study from Kaiser Permanente Southern California published in the British Journal of Sports Medicine this April. Based in California, Kaiser is the largest managed care consortium in the United States.

The Kaiser study involved some 50,000 people with COVID-19 and concluded that physical activity provides strong protection against the more tragic outcomes arising from a COVID-19 infection. It suggests that people who meet the target physical activity guidelines of the U.S. Department of Health and Human Services showed significantly lower incidences of hospitalization, admission to an ICU (intensive care unit) and death.

The study revealed that patients who were consistently inactive had 1.73 times greater odds of ICU admission than patients that were consistently active. The odds for death were 2.49 times greater for patients who were consistently inactive compared with patients who were consistently active.

Consistent inactivity poses the highest risk for death from COVID-19 apart from being over the age of 60 or having a history of organ transplant, said the study.

The study also found exercising from time to time lowered the odds for severe COVID-19 outcomes when compared to people who aren't active at all.

The U.S. health guidelines provide for at least 150 minutes per week of moderate to vigorous physical activity. A person needs to exercise some 22 minutes per day to meet this goal over one week.

The guidelines say working out for 22 minutes per day is more than enough to hit the 150-minute weekly target. One effective way to get to 22 minutes is to have an exercise session consisting of four rounds of five exercises lasting for one minute each.

Among the practical and sustainable strategies to exercise 22 active minutes a day include taking regular walks; doing short spurts of activity and working out smarter, not longer. You can also exercise a bit longer to obtain more protection.

 “Walk 30 minutes a day, five days a week at a moderate pace and that will give you a tremendous protective effect against COVID-19,” suggests Dr. Robert Sallis, a family and sports medicine physician at the Kaiser Permanente Fontana Medical Center. “I continue to believe that exercise is medicine that everyone should take — especially in this era of COVID-19.”

A word of caution, however. The elderly, people with co-morbidities such as heart disease, type 2 diabetes, cancer, arthritis and high blood pressure should consult with their doctors before embarking on a regular exercise program.

Elderly people walking

It's also wise to remember the health advantages that result from regular exercise. For one, exercise helps combat unhealthy conditions such as high blood pressure and diseases such as heart disease.

 It's long been proven that being active boosts high-density lipoprotein (HDL) cholesterol (or the "good" cholesterol) while decreasing unhealthy triglycerides that may lead to hardening of the arteries or thickening of the artery walls (arteriosclerosis). These conditions increase the risk of stroke, heart attack and heart disease.

Regular exercise and physical activity helps keep our blood flowing smoothly, which diminishes our risk of cardiovascular diseases. It also helps prevent or manage many health problems such as stroke, Type 2 diabetes, many types of cancer, arthritis, depression and anxiety. More important, exercise helps lower the risk of death from all causes.

Exercise is now more important than ever

Regular exercise and physical activity in the age of COVID-19 is now more important than ever due to the disappointing and confusing vaccination rollout situation facing Filipinos. The vaccination strategy implemented by the national government as of end-May has been a huge disappointment, especially in combating new variants, according to health experts and local officials.

Dr. Rontgene Solante, a member of the government’s vaccine expert panel, urged the administration to ramp-up the pace of nationwide vaccinations to protect more Filipinos against the B.1617 variant, or the "double mutant" from India, and other variants from abroad.

"The concern on this variant now is if this continues to circulate and our vaccination will not ramp up, there is a possibility that eventually, our vaccine will really not be able to be effective against this variant," said Solante, who is also chief of the Adult Infectious Diseases and Tropical Medicine unit at the San Lazaro Hospital.

Manila Mayor Francisco Moreno Domagoso described the laggard vaccine deployment nationwide as "super bagal" (super slow), and wondered aloud about the location of the vaccines.

"Hindi po mabagal. Super bagal," said Moreno in mid-May about the pace of vaccinations in Manila.

Moreno claimed millions of vaccines have arrived but remain stuck in warehouses. He said the city last received vaccines (8,400 CoronaVac doses) in April and hadn't received any until he made this comment. A few days after making this public complaint, however, Manila received more than 7,000 doses.

"If you believe that vaccination is the solution to restart the economy, and want people's lives to return to normal, the government shouldn't keep the vaccines stored in warehouses," he said.

His bewilderment came after the government previously announced the arrival on May 10 of the first vaccine shipment of 193,050 doses from Pfizer/BioNTech. Another 1.1 million doses are expected by June.

The first batch of the Pfizer/BioNTech mRNA vaccine sold under the brand name Comirnaty was donated by the COVAX facility. COVAX, or the "COVID-19 Vaccines Global Access," is a global initiative aimed at ensuring equitable access to COVID-19 vaccines. It was organized by GAVI, the Vaccine Alliance (formerly the Global Alliance for Vaccines and Immunization), the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO).

On the other hand, the government said the slow pace is due to vaccine shipments arriving in small quantities The Philippines' mass vaccination program began only in May.

"He (Moreno) said the pace of vaccinations is super slow and this is because we know that the vaccine arrived in tranches, and we cannot give everybody at the same time," said Dr. Myrna Cabotaje, Undersecretary of Health.

She said the National Capital Region is receiving anywhere from 50% to 70% of vaccine deliveries and remains the priority area for vaccinations because it leads the country in the number of COVID-19 cases.

In early March, the government secured 20 million doses of "mRNA-1273," the vaccine developed by Moderna, Inc. via an agreement with Moderna and the private sector. It then ordered five million more doses in late March. The first delivery (194,000 doses) of Moderna's two-dose vaccine is set to arrive on June 15.

On the other hand, 487,200 doses of "AZD1222," which is sold under the brand names Vaxzevria and Covishield and developed by AstraZeneca and Oxford University, arrived on March 4. A shipment of 38,400 doses arrived on March 7, bringing the total number of AZD1222 doses to 525,600. Two million more doses arrived on May 8. The AstraZeneca/BioNTech vaccines were donated by COVAX.

Then, there's the 25 million doses of China's CoronaVac, better known as the Sinovac COVID-19 vaccine, developed by Sinovac Biotech based in Beijing that began arriving starting March 29. CoronaVac was the first vaccine bought by the Philippines for its mass vaccination campaign.

The Food and Drug Administration (FDA) has issued emergency use authorizations (EUA) for seven vaccines: Pfizer–BioNTech, Oxford–AstraZeneca, Johnson & Johnson, CoronaVac, Sputnik V, Covaxin and Moderna, Inc.

As of May 11, some 2.5 million total vaccine doses were administered throughout the Philippines. Of this total, two million doses went to vaccinating individuals while 500,000 individuals received both the first and second doses.

The Philippines received 8.3 million doses, as of May 30. Of this total, 5.3 million were administered to Filipinos. As of May 31, some 3.65% of the population received the first of two vaccine doses, according to data from the investigative website, Rappler. Only 1.11% of the population received both doses.

And among the 10 countries comprising ASEAN (the Association of Southeast Asian Nations), the Philippines ranked second to last as of May 30 in terms of the share of the population that have received at least one vaccine dose.

Herd immunity in 14 years

Richard Gordon, chairman of the Philippine Red Cross, said the national government must increase the number of people being vaccinated daily by 240,000 to achieve herd immunity in 2021.

“At the rate that we are going, it will take 14 years (or by 2035) to attain herd immunity,” said Gordon.

"The problem is the vaccines are not coming fast and there should be accountability," he pointed out. "Who goofed? Why are we late? Why did Indonesia precede us in getting the vaccines? Why are we lagging? And why so much bureaucracy?”

For herd immunity to occur, some 70%, or more than 70 million of the Philippines' 108 million people, need to be vaccinated. For the administration to vaccinate 70% of Filipinos, an average of 350,000 to 500,000 inoculations per day is required, said former health secretary Manuel Dayrit. As of May 30, the seven-day average of vaccinated individuals stood at only 144,402.

Population protection, not herd immunity

On May 10, Carlito Galvez Jr., a retired Philippine Army general without any medical background but appointed the country's vaccine czar, said the government intends to inoculate between 25 million and 50 million Filipinos by September 21. He later did an about face, and announced the Philippines planned to attain herd immunity in November.

The pronouncements by Galvez, however, were later contradicted by the Department of Health and OCTA Research, which both agreed herd immunity within 2021 is impossible due to severe vaccine supply shortages and an inexplicable shortage of doctors and nurses to administer the jabs.

Instead of herd immunity, the DOH on May 26 said the government’s goal for the year is to reach what it calls "population protection,” which means vaccinating only 50% of the total population.

The phrase, population protection, is unique to the Philippines. Cabotaje explained population protection means reducing the number of deaths and hospitalized patients through vaccination. She said this term is the new buzzword the government will now use to describe its vaccination campaign.

"We prevent hospitalization. We prevent and minimize deaths by prioritizing. And the bigger the population that is vaccinated, we have population protection so hindi magkakahawaan (so there won't be infections),” she pointed out.

Cabotaje also explained the shift in the government’s vaccination program target was due to the presence of COVID-19 variants in the country.

“We are shifting to the term ‘population protection’ through mass immunization kasi po iyong ating herd immunity, marami pong mga kaakibat na mga criteria: We are considering the variant; We are considering the regular definition of the herd immunity na magkakaroon ka ng protection, ng full protection na tuluy-tuloy,” she said.