The CoviD-19 saga: Philippines Coronavirus Response

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According to Our World in Data, a University of Oxford data hub that researches and collects data around the world, the Philippines has the third most number of cases in Southeast Asia, 15th in Asia, and 39th in the world

As of 6 June, 2020, there have been 21,340 confirmed cases of the disease in the country.

Out of these cases, 4,441 recoveries and 994 deaths were recorded – these numbers equate to a 4.66% fatality rate. In Southeast Asia, the closest numbers we have are with Indonesia and Malaysia.

While Singapore has the most number of cases, it has only 24 deaths with 24,209 recoveries.

Malaysia has clocked in 8,303 cases 117 deaths and 6,635 recoveries, making its numbers quite good overall. Indonesia on the other hand, arguably could be considered the highest fatality rate in in the region (5.8%) with 1,801 deaths out of 30,514 cases.

Undeniably Indonesia also has the worst testing rate, with 394,068 tests against its 273 million population so far, or around 1,442 tests per million.

In contrast Philippines actually fares better with 408,945 tests from more than 376,341 unique individuals for a population 110 million.

Overall, however, the rest of South East Asia fares better, making Indonesia and the Philippines the two worst hit countries in the region.

Support from the World Health Organization (The First 100 days)

A 9 May WHO report details the joint projects of WHO and Department of Health in the Philippines.

In the report was how the WHO helped the Philippines establish its testing laboratories, how it assisted the Epidemiology Bureau’s developing COVID KAYA, a case and contact tracing reporting system for epidemiology and surveillance officers, health care providers and laboratory-based users, expanding the capacity of the previous CoviD-19 information system.

It strengthened infection prevention and control with modules and seminars and trainings for frontliners – which have since been rolled out more widely by partners USAID-MTaPS and UNICEF to cover over 5,500 health workers to date. Trainings were also included for non-pharmaceutical interventions and mental health measures in public health.

The Philippines is also part of WHO’s Solidarity trials to find effective CoviD-19 Treatment.

WHO also supported and amplified DOH messaging by releasing various communication materials on the risk of CoviD-19 and how people can protect themselves through social media and traditional media. Partners such as UNICEF and OCHA helped in reaching vulnerable groups, getting their feedback and understanding their information needs.

Technical support was provided to aid in the logistics in the recalibration of PPE requirements by using WHO projection tools, provided cost estimates, and advised on streamlining the distribution flow of PPEs and other essential supplies.

WHO conducted scoping missions in 10 out of 16 regions outside the National Capital Region to assess the needs and capacity of Health Development Centers in responding to CoviD-19.

WHO staff have also been deployed in specific high-risk subnational areas in the country to provide technical support for the response. At the same time, contact tracing in subnational areas is also being strengthened with WHO, DOH Epidemiology Bureau, and UP College of Nursing developing a training programme and learning resource materials on contact tracing to build the capacity of epidemiology and surveillance officers and local contact tracing teams.

Prison authorities were tapped to work with Public Health officials in mitigating prison based health – WHO also supported the strengthening of community-based interventions and social support and addressing the needs of specific populations such as people with pre-existing mental and substance use disorders.

Philippines: What went wrong?

It’s safe to say that we have a better response than what we had yesterday, or the week before, or the month before. With the support of Global Health authorities such as the WHO, it’s surprising that our numbers are fairly poor compared to our Asian neighbors.

The root of the problem were factors arguably tied to our national government’s response and implementations of the policies, may it be in time or how strict they were followed. While Singapore, Taiwan, Vietnam, and Hong Kong took the early initiative on travel restrictions and emergency measures, the Philippines was noticeably late.

The travel ban that was implemented was initially only for Wuhan in January 1, then China a few days after. The delay is attributed to the Philippines-China relationship. Rapid decreases in healthcare supplies came after with the decline in masks – with the government clarifying that it wouldn’t be distributing masks as supplies have run thin but a few days earlier, the government were touting Philippine generosity in aiding China with a donation of masks worth $1.4 million that were shipped to Wuhan.

The late travel bans and dwindling supplies was when public ire on the Philippine government’s CoviD-19 response started – but it didn’t stop there.

A State of Public Health emergency was declared days before the Philippines had its 100th confirmed case. Then after, the government opened a war chest totaling P26 billion more or less, but only 11.4% was going to healthcare and almost half of it going into tourism. As of June, according to data by the Bureau of the Treasury Philippine debt is now P8.6 trillion due to loans from world banks for the CoviD-19 response which alarmed the public.

WHO has urged the mass production and use of test kits as a basic necessity, and although the government made quite an improvement with its testing capabilities it was not without controversies.

Alleged VIP testing of public officials drew public ire yet again even when the DOH initially stated that mass testing is not a priority due to scarce test kits and a strict algorithm or guideline is to be followed for the testing. Numerous people considered actual patients by the said algorithm were dying before they could even get test results. Philippine Senator Koko Pimentel III, who was among those tested, violated quarantine protocols to visit his pregnant wife in the hospital, putting all the medical staff at risk – with the incident warranting no probe or sanctions.

Various quarantine violations plagued the country not only from ordinary citizens, but law makers and law enforcers, one of the latest of which was Manila’s chief of Police Debold Sinas hosting a birthday party for more than 50 people – again no sanctions. In the last week of March, to alleviate the effects of the lockdowns, the government announced a larger economic relief package of nearly P200 billion primarily for low-income families, dubbed the Social Amelioration Program (SAP).

Since then there are reports of constant complaints of SAP funds and goods not reaching its intended beneficiaries – a significant story on 1 April happened when more than 100 people from Sitio San Roque gathered on a nearby highway to voice their discontent and demand food and aid, and of whom 21 were arrested for quarantine violations. Public unrest became commonplace, drawing in stories such as those of a mentally ill Army veteran shot dead for being outside, a fish vendor severely beaten for not wearing a face mask and on 1 May, ninety-two individuals across five cities were imprisoned while either engaging in feeding programs or joining online protests.

Manila’s lockdown is considered one of the world’s strictest with 11 weeks, or 80 days – longer than the 76-day lockdown of Wuhan, the Chinese city that was the early epicenter of CoviD-19, yet the effects of a longer lockdown didn’t quite hit the necessary mark.

There are spurious talks of people not receiving their cash aid, or local government not hitting targets for distribution.

Compounding this belief was the fact that in May, a man in Cebu died of heat stroke while waiting in line for cash aid.

What could have been done

The notion that the Philippines could have won in the pandemic earlier draws a bitterness from the public whose cries for early border closure and mass testing fell deaf in government’s ears. Easing lockdown restrictions by May 2020 because we have beaten the virus would have been a cause of envy from our neighbors.

The following is no longer an objective review but a retrospective critique on Philippine governance that more or less lead to the lackluster coronavirus response.

Pre-pandemic Philippines already had existing controversies that had repercussions when the pandemic came. Contractualization in the working class offered less benefits and savings for them in a lockdown. There are various incidents of farmers being shot and subdivisions or event centers replacing agricultural lands – being an agricultural nation, the Philippines could have been set out to combat food shortages yet in recent years we import rice from other countries (like Vietnam).

This contributed to food shortages and an imbalance of food distribution when the country is left on its own. The Philippines’ budgets are skewed away from science, health and calamity preparation even when we are a tropical country prone to infectious diseases or storms. The responses post calamities (or post-war) are riddled with issues such as delay. The country’s health sector is starved even if it has the best Nursing and Medical schools in the region because the country’s healthcare professionals are working in other countries due to low domestic income. The doctor to patient ratio is not ideal and it does not help that the country currently has the highest positive cases of healthcare workers in Southeast Asia.

The WHO’s guidelines for coronavirus response included proper dissemination of information, and yet the Philippines is plagued with controversies in its media. It is classified as the most dangerous for journalists in Asia and it is also infamous for media shut downs.

Lastly an early closure became hampered by the government’s relationship with the Chinese state. These general pre-pandemic issues had contributed much to its losses.

What could we still do?

A boost in the healthcare system and lockdown easing that is complemented by enhanced by test, trace, and treat capabilities. According to a paper by Ronald Mendoza, Ateneo De Manila University – Ateneo School of Government, policymakers could pursue integrative health crisis planning and investments in both institutions- and skills- development to strengthen resilience against future health shocks. Perhaps most importantly, reforms and investments could help enhance affordable healthcare, minimizing out of pocket expenses notably for poor and low-income citizens and more effectively managing costs through inclusive social insurance and efficient public-private balance in healthcare provision.

Issues that plagued the healthcare system include insufficient and non-inclusive healthcare and social protection, combined with a growing level of inequality that, in part, reflected itself in densely populated urban slums that are vulnerable to contagion, as well as easily impacted by quarantines and lockdowns.

The Philippines can look no further for successful countries to replicate but its own neighbors. Vietnam is considered one of the world’s best in responding to the pandemic.

President Rodrigo Duterte is welcomed by Vietnamese Prime Minister Nguyen Xuan Phuc during a courtesy call on September 29. | "Rodrigo Duterte with Nguyễn Xuân Phúc" by Wikimedia Commons is in the Public Domain
President Rodrigo Duterte is welcomed by Vietnamese Prime Minister Nguyen Xuan Phuc during a courtesy call on September 29. | “Rodrigo Duterte with Nguyễn Xuân Phúc” by Wikimedia Commons is in the Public Domain

WHO epidemiologist Aileen plant describes it as a “real, old-fashioned infectious disease containment.”

Vietnam’s methods are cost efficient, relying more on strict prevention methods, contact tracing and isolation. The use of social media and technology, government propaganda vice Premier Vu Duc Dam “War Rhetoric” against the disease garnered public cooperation.

Vietnam is arguably inferior to Philippines in terms of economy and technology yet they managed to control the virus better than us and most of its Southeast Asian neighbors.

Vietnam’s success despite being relatively “poorer” meant we have everything in our plate to succeed. Hope is not at all lost for Philippines as well as for other countries fairing “poorly” in this pandemic. A change in policies also means good adaptation and mistakes are meant to be corrected.

But it must be done immediately as another day in an overrun country is potentially another life lost.

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