Philippines, the country with one of the World’s longest lockdown: A status update
Philippines, the country with one of the World’s longest lockdown: A status update
Cris Niño Bon B. Marasigan and Gladys Maria V. Pangga
College of Veterinary Medicine, University of Philippines, Los Baños,
Date written: 27 September 2021
Status: A year and a half have passed since the country was placed under different community quarantine schemes, yet the increasing rate of COVID-19 infection cases is yet to improve. According to the Department of Health (DOH) of the Philippines, the confirmed COVID-19 cases in the country have already amounted to 2, 304, 192; of which 90.7% are total recoveries, 7.7% active cases, and 1.56% mortalities, as of this writing.
With the surge of the delta variant of SARS-CoV-2, currently the dominant COVID-19 variant in the country, the daily reported cases of the infection usually go beyond 20,000 on the average (Rappler, 2021). In fact, the latest tally of new confirmed cases today has already reached 21, 261 which still conforms to the average daily reported cases in the country. Meanwhile, the total number of individuals who recovered and died from the disease was reported to be 13,644 and 277, respectively (DOH, 2021).
Current problems. The Philippine health system is currently on a verge of collapse. Due to the high record of COVID burden, the utilization rates of hospital rooms and beds for COVID-19 patients have been consequently increasing in the whole country. It is estimated that around one third of hospitals in the Philippines are close to full capacity (DOH, 2021). Specifically, out of 1,292 recorded facilities, 422 are classified as having “critical” occupancy rate (wherein >85% beds are being utilized by COVID patients), with occupancy rates of ICU, isolation, and ward beds reaching up to ~70% (DOH, 2021). Several hospitals such as those in Manila and Bacolod have stopped admitting COVID-19 cases, stating that health workers cannot handle the workload, which is further burdened by the increasing incidence of cases among medical personnel as well (Rappler, 2021, ABS-CBN News, 2021).
Low supplies and shortages on equipment and drugs are also on the rise in the country. Currently, mechanical ventilators have been approximated to have less than 50% availability (DOH, 2021), whilst supply of oxygen tanks are now running low (GMA News, 2021). Supplies of tocilizumab, an off-label anti-inflammatory drug allowed for COVID patients requiring high doses of oxygen and with elevated markers of inflammation, has been estimated to last only until December 2021. Due to this, DOH is looking for other “re-purposed drugs” such as Baricitinib that is already being used in some hospitals (The Philippine Star, 2021). Similarly, although its use is conditionally recommended by the World Health Organization, shortage and overpricing of Remdesivir are being reported in hospitals such as in Cagayan de Oro (Rappler, 2021).
Other alternative treatment for COVID-19 in consideration are virgin coconut oil (VCO), the Chinese drug lianhua qingwen (LQ), convalescent plasma (CP), the anti-gout drug colchicine, and ivermectin (Rappler, 2021). At present, clinical trials for VCO, colchicine and ivermectin as adjunct therapy is still ongoing (DOST, 2021) whereas LQ is a registered prescription drug in the country however not as a COVID-19 medication (PNA, 2021). CP is approved for compassionate use and considered a treatment protocol in some hospitals with its effectiveness not yet verified (DOH, 2020). Despite the strong advice of the Philippine Medical Association against its use, at least 6 hospitals have secured compassionate special permit for COVID patient use (GMA News, 2021; CNN, 2021). According to the Inquirer (2021), trial on ivermectin use will start on September and is expected to run for 8 months. As for the issue that the Filipino tradition tuob (steam inhalation) as a cure of COVID, the DOH has warned the public against its use as there is no scientific evidence for its effectiveness (Inquirer, 2020).
Furthermore, one of the biggest challenges that the Philippines is facing is the government’s poor leadership regarding issues about the healthcare sector, and its rather reactive approach to the health crisis. Since the start of the pandemic, many health workers have already raised their concerns regarding the policies formulated by the agency, particularly of the abrupt re-opening of establishments without any pro-active contingency plans to minimize the rate of infection. However, the government still pushed through with their plans in trying to boost the economy, including easing our country’s borders (Lau, 2021). This year alone, the country had to be placed under community quarantine in multiple occasions due to the exponential growth in confirmed cases (Rappler, 2021; Tantuco, 2021; US Embassy in the Philippines, 2021).
While it is understandable to re-open the establishments for economic purposes, the implemented protocols, including previously the mandatory use of face-shield; a type of face protection that even the Center of Disease Control (CDC) do not recommend (CDC, 2021), did not only cause confusion among the public but also allowed discriminatory tendencies towards the unvaccinated by calling them names like ‘walking COVID-19 spreaders’ (Devio and Magnahoy, 2021; Hallare, 2021; Teodoro, 2021). This is also despite the scientific evidence that indicates that there is no significant improvement against aerosol transmission when face shields are used in combination with masks (Verma et al., 2020; Salimnia et al., 2021). It is even surmised that face shields can be contaminated by virus airborne particles, and thus, may increase the transmission risk of SARS-CoV-2 (CNN, 2021).
Also due to the high increase in hospitalizations, health care workers are reported to be extremely tired and demoralized. Many overworked nurses have staged protests and are threatening to file mass resignations amidst the health crisis if the benefits and compensations promised by the government are not given this September (Baron, 2021; CNN, 2021; Velasco, 2021). Indeed, the current programs and policies still need further revisions in consultation with unbiased health experts.
Measures. Since the onset of pandemic, there have been modifications in safety protocols and policies concerning re-opening of establishments. Among them are: a) mandatory use of face-shields; b) al fresco (‘outside’) dining; c) 50% allowable capacity for transportation; and, d) age-related restrictions. And while these policies can really minimize the rate of transmission, we still cannot deny the fact that without any pro-active movements (i.e. routine mass testing, equal distribution of vaccines, etc.), these measures will remain subpar. In a related article written by Mendoza et al. (2021), it was mentioned that false confidence in receiving negative result from a single test may have contributed to the spread of the infection; citing complacency after a negative result adds as a big factor.
Already hailed as having one of the longest and strictest lockdowns globally (Hapal 2021), different regions in the Philippines are still in lockdown. As a proposed solution to this, the government has recently established a new health scheme termed as a “granular lockdown” defined as “micro-level quarantine for areas identified as critical zones by the local government unit which may be declared regardless of alert levels” or in short “localized lockdowns” (IATF, 2021). With this strategy, municipal and city mayors have now the authority to impose lockdowns at the barangay level according to new alert level system guidelines. This is currently being piloted in the National Capital Region (PNA, 2021).
In terms of financial help, many residents and labor groups still find the aid insufficient (Cantos, 2021). It is noteworthy that only residents coming from areas under the enhanced community quarantine were qualified to receive the financial aid (maximum amount of around 100 USD per household; good for 14 days) - with the high inflation rate, this amount will not even last a week in a family of 5. Moreover, not everyone within the “bubble” (from ECQ areas) had received assistance as we, personally, did not receive any assistance from the local government units. With these policies, many are forced to work and do labor with fears of contracting the disease.
As of this writing, the number of slots for government-funded swab testing is still very limited. Since private establishments and offices are now requiring negative RT-PCR results before employees are even allowed to resume work, people have resorted to fund their own testing which creates an additional financial burden.
Education. The Philippines has been claimed to be the “only country in SouthEast Asia” that had not reopened amid the pandemic (Inquirer, 2021). For the school year 2021-2022 in the Philippines, the Department of Education (DepEd) has still prohibited face-to-face classes (DepEd, 2021). Developed as a response to the pandemic, the basic education-learning continuity plan (BE-LCP) is the major approach provided by DepEd for remote learning of students. With the aim of providing quality education in the new normal setting, the BE-LCP involves the distribution of self-learning modules across the country, which is integrated with alternative learning modalities such as modular, television-based, radio-based instruction, blended and online (DepEd, 2020). Other programs to be launched by the DepEd includes the alternative learning system (ALS), Brigada Eskwela, Oplan Balik Eskwela, Public Education Network, and Computerization Program (DepEd, 2021).
Notwithstanding, the country is described to be still lagging. Communication issues (internet and gadget availability), difficulty in student supervision (by parents and teachers), disengagement of students due to financial reasons, lack of a learning conducive environment and technological capacities, mental health issues, are some of the common hurdles by Filipino students, especially those from rural areas (Inquirer, 2021). The common strategies of Filipino students to these challenges include resource management and utilization, help-seeking, technical aptitude enhancement, time management, and learning environment control (Barrot et al., 2021).
Vaccination program. Vaccine rollout in the Philippines is still at the initial phase. The first batch of vaccines against COVID-19 (CoronaVac, (Sinovac), China) had arrived in the country starting March 2021, with an initial number of doses reported to reach 600,000 (VOA News, 2021); this was followed by millions of vaccine donations from AstraZeneca-Oxford University (AZN), Pfizer-BioNTech, Johnson & Johnson/Janssen (J&J), and Moderna manufacturers. As of September 13, 2021, Sinovac is the country’s largest vaccine stockpile with more than 33 M doses, which is then followed AZN (9.4M), Pfizer (5.8M), Moderna (4.3M), J&J (3.2M), Sinopharm (1.1M), and lastly Sputnik V (Gamaleya) with 380,000 doses (Rappler, 2021).
Following the arrival of vaccines, the supervising agency had proposed a priority listing as follows: Priority Eligible A (Workers in frontline health services, all senior citizens, persons with co-morbidities, frontline personnel in essential sectors such as uniformed personnel and indigent population); Priority Eligible B (teachers, Social workers, government workers, etc.); and Priority C (Rest of the Filipino population not included in previous groups) (DOH, 2021). Although the supplies are still limited, registered residents are encouraged to get the free COVID-19 shots when they can. Originally, the government aimed to vaccinate 70% of the country’s population before the end of 2021. However, due to consequences of the delta variant, it has been raised up to 90% coverage, which now includes vaccine administration of individuals below 18 years old (Rappler, 2021). To date, more than 17 million people have already been fully vaccinated against COVID-19 (22% of the original target population), while 22 million have gotten their initial dose (ABS-CBN News, 2021).
With six months passed since the vaccination rollout, concerns on the “waning” efficacy of vaccines (especially of Sinovac) and the use of boosters are increasingly reported (Business World, 2021; CNN, 2021). However, the Philippine administration has still no definitive decision or recommendation for this (PNA, 2021).
Romanticizing resiliency. “Filipino resiliency” has been a known trademark for Filipinos. Resiliency is described as the ability to quickly recover from challenges and to be able to manage hardships in life. However, this term has also been exploited and overused by politicians so that their mismanagement would be masked. People have gotten used to the idea that we should remain steadfast and resilient in spite of crises because “we are Filipinos and nothing can bring us down”. Clearly, this romanticizes resilience which puts the burden to bear sufferings on individuals rather than on people in power (Molina, 2021).
Apart from the negative implications on social and economic state, this pandemic has significantly impacted our mental and physical health for obvious reasons. By looking at the lens of a privileged, one could say that this situation has positively brought their family together and tighter; or that, the situation has provided them new ideas to venture and expand their individualities. But this is in no way a reflection of how the majority of our people felt, that is, a significant decline in their quality of life (Marquez, 2020). One cannot simply imagine the burden of being unemployed in a country with high inflation rate (PSA, 2021), while constantly getting anxious of getting infected with COVID-19 disease. Really, there is not enough words to describe how our lives have changed over the years; mostly adaptive and not for our growth and development. If there is one ‘positive’ thing that this pandemic situation has brought to light, it would have to be the “anomalous spending” of government funds intended for (but not limited to) health (CNN, 2021d; Porcala, 2021).
ABS-CBN News. 2021. 17 million now fully vaccinated vs COVID-19 in Philippines. Retrieved from https://news.abs-cbn.com/news/09/14/21/17-million-now-fully-vaccinated-vs-covid-19-in-ph
ABS-CBN News. 2021. Ospital ng Sampaloc to stop admitting COVID-19 patients. Retrieved from: https://news.abs-cbn.com/news/08/30/21/ospital-ng-sampaloc-to-stop-admitting-covid-19-patients
Baron G. 2021. 10 volunteer doctors in PGH resign — spox. Retrieved from https://mb.com.ph/2021/09/09/10-volunteer-doctors-in-pgh-resign-spox/
Barrot, J.S., Llenares, I.I. & del Rosario, L.S. Students’ online learning challenges during the pandemic and how they cope with them: The case of the Philippines. Educ Inf Technol (2021). https://doi.org/10.1007/s10639-021-10589-x
BusinessWorld, 2021. Study shows antibodies from Sinovac’s COVID-19 shot fade after 6 months, booster helps. Retrieved from: https://www.bworldonline.com/study-shows-antibodies-from-sinovacs-covid-19-shot-fade-after-6-months-booster-helps/
Cantos J. 2021. ‘Health, labor groups nakulangan sa ayuda’. Retrieved from https://www.philstar.com/pilipino-star-ngayon/bansa/2021/09/04/2124707/health-labor-groups-nakulangan-sa-ayuda
CDC. 2021. COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
CNN. 2021. PGH grapples with manpower shortage after 10 volunteer doctors resign. Retrieved from https://cnnphilippines.com/news/2021/9/9/PGH-volunteer-doctors-resign.html
CNN. 2021. Face shields can absorb COVID-19 airborne particles, simulation shows. Retrieved from: https://cnnphilippines.com/news/2021/9/7/face-shield-simulation.html
CNN. 2021. Results still inconclusive on ivermectin use on COVID-19 patients — doctors' groups . https://cnnphilippines.com/news/2021/5/2/ivermectin-philippine-medical-association.html
CNN. 2021d. PhilHealth insists ₱15B funds not missing, 98% already 'liquidated'. Retrieved from: https://www.cnnphilippines.com/news/2021/4/3/philhealth-15-billion-funds-98--liquidated.html
CNN. 2021. Sinovac vaccine's efficacy vs Delta 'wanes' after 6 months — expert. Retrieved from: Retrieved from https://cnnphilippines.com/news/2021/8/30/sinovac-delta-wanes-six-months.html
Devio L and Maghanoy CC. 2021. Unvaccinated could face discrimination, govt warned. Retrieved from https://www.manilatimes.net/2021/07/31/news/national/unvaccinated-could-face-discrimination-govt-warned/1809132
Department of Health. 2021. DOH Bulletin #551. Retrieved from https://doh.gov.ph/covid19casebulletin551
DepEd. 2020. Modular learning preferred by CL learners; DepEd prepares Self-Learning Modules for education’s new normal. Retrieved from: https://region3.deped.gov.ph/modular-learning-preferred-by-cl-learners-deped-prepares-self-learning-modules-for-educations-new-normal/
DepEd. 2021. DepEd issues guidelines for SY 2021-2022; face-to-face classes still prohibited. Retrieved from: https://www.deped.gov.ph/2021/08/09/deped-issues-guidelines-for-sy-2021-2022-face-to-face-classes-still-prohibited/
DOH. 2021. Covid19 tracker. Retrieved from: https://doh.gov.ph/covid19tracker
DOH. 2021. Department Memo No. 2020- 0381: Interim Guidelines on the COVID-19 Disease Severity Classification and Management. Retrieved from: https://doh.gov.ph/sites/default/files/health-update/dm2020-0381.pdf
DOST. 2021. Virgin coconut oil as adjunctive therapy for COVID-19. Retrieved from: https://www.dost.gov.ph/knowledge-resources/news/72-2021-news/2411-virgin-coconut-oil-as-adjunctive-therapy-for-covid-19.html
GMA News. 2021. Due to low supply of tanks, only oxygen refills available in Bambang in Manila. Retrieved from: https://www.gmanetwork.com/news/news/metro/802209/due-to-low-supply-only-oxygen-refills-available-in-bambang-in-manila/story/
GMA News 2021. 6 hospitals received compassionate permit for ivermectin use vs. COVID-19 —FDA . https://www.gmanetwork.com/news/news/nation/786286/6-hospitals-received-compassionate-permit-for-ivermectin-use-vs-covid-19-fda/story/
Hallare K. 2021. ‘Enhanced Confusion Quarantine’: Jonvic Remulla confused over gov’t’s ‘ever-changing’ ECQ rules. Retrieved from https://newsinfo.inquirer.net/1412970/enhanced-confusion-quarantine-cavite-governor-confused-over-national-governments-ever-changing-ecq-guidelines
Hapal, K. (2021). The Philippines’ COVID-19 Response. Journal of Current Southeast Asian Affairs, 40(2), 224–244. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1868103421994261
Inquirer (2020). DOH: No scientific evidence ‘tuob’ can kill virus causing COVID-19. Retrieved from: https://newsinfo.inquirer.net/1297449/doh-no-scientific-evidence-tuob-can-kill-virus-causing-covid-19
Inquirer (2021) PH’s clinical trial for ivermectin as COVID-19 treatment to start on Sept. 15. Retrieved from: https://newsinfo.inquirer.net/1482050/phs-clinical-trial-for-ivermectin-as-covid-19-treatment-to-start-on-sept-15
Inquirer (2021) PH lags behind in acting on remote learning problems amid pandemic. Retrieved from: https://newsinfo.inquirer.net/1418185/ph-lags-behind-in-acting-on-remote-learning-problems-amid-pandemic
IATF. 2021. Guidelines on the plot implementation of alert levels system for COVI9-19 response in the national capital region. Retrieved from: https://www.officialgazette.gov.ph/downloads/2021/09sep/20210913-Certified-Guidelines-for-Pilot-Areas.pdf
Lau E. 2021. Philippines to lift travel ban on passengers from the UAE and nine other countries. Retrieved from https://www.thenationalnews.com/travel/covid-19-travel/2021/09/04/philippines-to-lift-travel-ban-on-passengers-from-the-uae-and-nine-other-countries/
Marquez C. 2020. Inquirer, SWS: 62% Filipinos say quality of life worsened in the past 12 months. Retrieved from: https://newsinfo.inquirer.net/1374508/sws-62-filipinos-say-quality-of-life-worsened-in-the-past-12-months
Mendoza AM, dela Cruz MM, Gozum IA and Galang JF. 2021. The need for mass testing and the proper post-COVID-19 test behavior in the Philippines. Journal of Public Health 43(2): e348–e349 https://doi.org/10.1093/pubmed/fdab065
Molina C. 2021. Berkeley MDP: Why Filipinos resent resilience. Retrieved from: https://mdp.berkeley.edu/why-filipinos-resent-resilience/
PNA, 2021. IATF releases ratified guidelines on granular lockdowns. Retrieved from: https://www.pna.gov.ph/articles/1153434
PNA, 2021. Booster shots still a no for now; DOH allocates funds for 2022. Retrieved from: https://www.pna.gov.ph/articles/1151830
PNA. 2021. ‘Lianhua Qingwen’ registered but not as Covid medication. Retrieved from: https://www.pna.gov.ph/articles/1135819
Porcala, D. 2021. PhilStar: P9 billion fund anomaly in special risk allowances bared. Retrieved from: https://www.philstar.com/headlines/2021/08/11/2119075/p9-billion-fund-anomaly-special-risk-allowances-bared
PSA, 2021. Summary Inflation Report Consumer Price Index (2012=100): August 2021. Retrieved from: https://psa.gov.ph/statistics/survey/price/summary-inflation-report-consumer-price-index-2012100-august-2021
Rappler. 2021. Are we missing out on alternative treatments for COVID-19? Retrieved from: https://www.rappler.com/newsbreak/in-depth/are-we-missing-out-on-alternative-treatments-for-covid-19
Rappler. 2021. In photos: Metro Manila under ECQ v3.0. Retrieved from https://www.rappler.com/nation/photos-metro-manila-ecq-august-6-2021
Rappler 2021. Health system ‘crashing’, says head of largest Bacolod COVID-19 facility. Retrieved from: https://www.rappler.com/nation/health-hospital-system-crashing-says-head-largest-bacolod-covid-19-facility
Rappler 2021. Delta now dominant COVID-19 variant in the Philippines – WHO Retrieved from: https://www.rappler.com/nation/who-says-delta-now-dominant-covid-19-variant-philippines-august-31-2021
Rappler 2021. Cagayan de Oro's rising COVID-19 cases lead to remdesivir shortage, overpricing. Retrieved from: https://www.rappler.com/nation/cagayan-de-oro-rising-covid-19-cases-remdesivir-shortage-overpricing
Rappler 2021. Philippines raises COVID-19 vaccination target to 90% of population. Retrieved from: https://www.rappler.com/nation/philippines-raises-covid-19-vaccination-target-percentage-population
Rappler 2021. TRACKER: The Philippines’ COVID-19 vaccine distribution. Retrieved from: https://www.rappler.com/newsbreak/data-documents/tracker-covid-19-vaccines-distribution-philippines
Reuters (2021) Hundreds of Philippine hospitals near full capacity as virus cases surge. Retrieved from: https://www.reuters.com/world/asia-pacific/hundreds-philippine-hospitals-near-full-capacity-virus-cases-surge-2021-08-09/.
Salimnia, H., Meyer, M. P., Mitchell, R., Fairfax, M. R., Gundel, A., Guru, N., & Chopra, T. (2021). A laboratory model demonstrating the protective effects of surgical masks, face shields, and a combination of both in a speaking simulation. American journal of infection control, 49(4), 409–415. https://doi.org/10.1016/j.ajic.2021.01.012
Tantuco V. 2021. Laguna to stay under ECQ until August 20. Retrieved from https://www.rappler.com/nation/laguna-under-ecq-until-august-20-2021
Teodoro LV. 2021. Disorder and confusion. Retrieved from https://www.bworldonline.com/disorder-and-confusion/
The Philippine Star. 2021. Alternatives to scarce COVID-19 treatment drug sought. Retrieved from: https://www.philstar.com/headlines/2021/09/05/2124941/alternatives-scarce-covid-19-treatment-drug-sought.
US Embassy in the Philippines. 2021. Health Alert: ECQ extended for NCR and neighboring areas (April 4, 2021). Retrieved from https://ph.usembassy.gov/health-alert-ecq-extended-for-ncr-and-neighboring-areas-april-4-2021/
Velasco R. 2021. Mass resignation looms as hospital capacity still at ‘high risk’. Retrieved from https://interaksyon.philstar.com/politics-issues/2021/08/17/198274/mass-resignation-looms-as-hospital-capacity-at-still-high-risk/
Verma, S., Dhanak, M., & Frankenfield, J. (2020). Visualizing droplet dispersal for face shields and masks with exhalation valves. Physics of Fluids, 32(9), 091701. https://doi.org/10.1063/5.0022968
VOA News. 2021. Philippines finally receives first batch of COVID-19 vaccine. Retrieved from https://www.voanews.com/a/covid-19-pandemic_philippines-finally-receives-first-batch-covid-19-vaccine/6202689.html