COVID-19 has precipitated a global pandemic infecting millions worldwide. In the Philippines, as it has in all other countries, the virus has caused economic and social upheavals and has fundamentally changed the life of every Filipino today.
This is the Philippine COVID-19 experience...thus far.
The Philippines: A COVID-19 Timeline
January 30—COVID-19 officially reaches Philippine shores. A 38-year old woman from Wuhan China tests positive for the virus. Meanwhile, in Geneva, the World Health Organization has declared COVID-19 as a public health emergency.
February 2—The Philippines records the first ever COVID-19 death outside China. He was a 44-year old traveler from the mainland.
February 26—The World Health Organization hailed the Philippines as having contained the virus after not reporting new cases for over two weeks.
March 6—After a month of posting no new cases, the DOH announces that two Filipinos have contracted the disease. Local transmission is now afoot in the populace.
March 11—COVID-19 claims its first Filipino life—the wife of a man who attended a senate hearing the week before. The same day, on the other side of the world, in Geneva, the World Health Organization now declares the COVID-19 as an international pandemic.
March 12—President Duterte announces that Metro Manila will be placed on lockdown.
March 15—The Metro Manila lockdown begins. Nobody is allowed to leave the house, except for those performing essential tasks and services.
March 17—In an effort to slow down the spread of the virus, at the stroke of midnight, the whole of Luzon is also put on lockdown. President Duterte declares a State of Calamity throughout the country for 6 months. The country records 187 cases of the virus, with 12 deaths.
March 25—The “Bayanihan To Heal As One Act” is signed, giving the president special powers to address the COVID-19 crisis.
April 6—President Duterte, through the IATF, announces a two-week extension of the Luzon lockdown.
April 24—President Duterte announces another two-week extension of the lockdown for high-risk areas. Low-risk territories will be placed under GCQ or General Community Quarantine.
May 12—Areas to be put under MECQ or Modified Enhanced Community Quarantine is announced. Under this regime, a limited resumption of transportation and re-opening of certain industries is allowed.
June 1—The lockdowns across the country are eased. Metro Manila is placed under General Community Quarantine. The effects of such moves remain to be seen.
As of the first of June, the coronavirus cases stand at 18,638.
What is COVID-19?
“COVID-19” is the name given by the World Health Organization for a virus believed to have originated from Wuhan China. The acronym stands for “Corona Virus Disease 2019.”
The coronavirus is a large family of viruses that include the common cold, the Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). Since the 1960s, hundreds of coronaviruses were discovered, which mostly circulate in animals like bats, birds, pigs, cats, and camels.
Every once in a while, these animal viruses jump over to the human population and cause disease. There are 7 known coronaviruses that affect humans. Of the seven, the 3 discovered in this century are considered the deadliest: SARS-CoV (2002), MERS-CoV (2012), and SARS-CoV2 (COVID-19).
Coronaviruses are so named because they have spikes on their surfaces that look like crowns or “corona.” These protein spikes are what binds to human cells, leading the way for infection.
How Is COVID-10 Spread?
The SARS virus of 2002 and the MERS of 2012 are deadlier than COVID-19. However, COVID-19 is more contagious than the other two.
Cities like Manila, Cebu, and Davao, and specific barangays where people are in close contact have seen spikes in infections. This is because the main mode of transmission is through respiratory droplets. This means that talking, coughing, and sneezing can release virus particles in the air.
Person-to-person transmission can easily take place through close contact with an infected person. As much as 3,000 droplets can be produced by a single cough, and these could be inhaled through the nose or the mouth.
The droplets could remain suspended in the air for a few minutes or land on surfaces. The transmission also occurs when hands that touched contaminated surfaces then interacts with the person’s mouth, nose, and eyes.
Thorough and frequent handwashing, disinfecting surfaces, social distancing, and the wearing of masks are simple ways to slow down the spread of COVID.
What are the symptoms of COVID-19?
According to our Department of Health, a great majority of COVID cases are “asymptomatic.” That is, they don’t show any physical ailments and don’t even know they are infected. This is consistent with what’s being seen in other countries and there are varying estimates as to the portion of the cases that are asymptomatic. The CDC says it is at 35%, a study from Wuhan pegs it at 42%, and still, another research report numbers as high as 81%.
For those who are going to eventually show symptoms, the incubation period is approximately 5 days and could include the following:
· fever
· chills
· body aches and pains
· fatigue
· sore throat
· dry cough
· headache
· diarrhea
· vomiting
· nausea
· loss of the sense of taste or smell
· rash
· discoloration on any part of the body
Serious symptoms that warrant immediate medical attention include:
· shortness of breath or difficulty breathing
· chest pains
The persons most at risk for the disease are the elderly members of the population as well as those with immunocompromised conditions like those taking immunosuppressive drugs for cancer or therapy, those suffering from weak immune systems such as patients with lupus, agammaglobulinemia, congenital IgA deficiency, and HIV/AIDS.
Besides age and the state of one’s immune system, comorbidities like high blood pressure, diabetes, kidney disease, hepatitis B infections, and a history of smoking can also result in poorer outcomes for the patients. This is especially alarming to countries like the Philippines which has a high rate of comorbidities. For example, 1 in 4 Filipinos are hypertensive, and 1 in 5 Filipinos are diabetic or pre-diabetic.
Hospitalizations due to COVID-19 will put tremendous stress on the country’s meager health resources, also negatively affecting non-COVID related patients. Worse, an early COVID study found out that the virus disproportionately affects poorer regions and impoverished communities in the country.
The more the world knows about how the virus works, the more the Philippine government is put on notice on how COVID can potentially damage the health of its vulnerable citizens.
It was once widely believed that COVID-19 only affects the lungs. As more data on the virus comes to light, it was discovered that the virus doesn’t just affect the respiratory system, but major organs like the heart, brain, kidneys, and intestines. It also ravages the blood vessels by causing clots in major arteries and veins.
Reports coming out of China and Italy show that 20% of COVID patients consequently have heart damage. After being infected with the disease, thirty percent of patients in China and New York are exhibiting signs of kidney damage.
Children are relatively safe from the disease. This conclusion has been borne out of studies from China, Italy, and Iceland.
As of late, however, a condition that resembles Kawasaki Disease and Toxic Shock Syndrome has been observed in children who later tested positive for the coronavirus.
The disease is believed to be related to COVID-19. According to the WHO, the symptoms of the disease, now called Multisystem Inflammatory Syndrome in Children (MISC) include:
· fever
· inflammation
· hypotension
· shock
Parents should also look for bloodshot eyes, high heart rate, skin rash, and prolonged abdominal pain.
Cases of MISC have been reported across Europe and North America.
Do I Have COVID-19?
Because the leading symptoms of COVID-19 resemble that of the common flu, the only way to diagnose if a person is infected is through testing.
Filipinos have often heard the mantra “Test! Test! Test!” as a way to combat the spread of the virus. It has started many a robust discussion in the media and online. So what is this COVID-19 test all about?
There are three different types of test that can be done in order to diagnose COVID-19:
Molecular Test (PCR)
This is the first type of test that has been developed and is the most reliable. You get your test results a few days after the samples are taken. In the Philippine setting, because of the different choke points in the process, results could come weeks after samples are taken.
This test looks for the actual genetic material of the virus. It is done through a nasal or throat swab at the back of the nose or throat in order to get a sample of the virus.
The quantity taken from the process is not sufficient for diagnosis. The testing lab needs to create millions of “copies” of the sample in order to get a sufficient amount of genetic material. The process used to amplify the sample, you may have heard, is the PCR or polymerase chain reaction.
Antibody Test
This test doesn’t look for the virus itself but for signs that the virus existed or exists. Our body’s immune system is highly specific and there are special antibodies for different viruses. This test tracks for a specific antibody as a way of indirectly identifying COVID-19.
Rapid antibody tests are often employed for mass testing. Blood via a pinprick is drawn from the patient, and in a few minutes or hours, you can get your test results. However, reports have surfaced about the apparent inaccuracies and inconsistencies of rapid testing, posting fake positives and fake negatives.
Because of this, the Philippine Society of Microbiology and Infectious Diseases (PSMID) has expressed their concerns about the rapid tests. As a gauge of an employee’s fitness to return to work, for example, it can be misleading, giving a false sense of supposed safety and protection.
Antigen Test
Like the PCR test, the specimen is also taken via swab to the back of the nose or throat. But instead of looking for genetic material, this test searches for proteins found on the surface of the virus.
Because proteins are easier to identify, this makes the whole process faster and cheaper. However, as a recently developed test, it is still not as accurate as the PCR tests, which are considered the gold standard for testing.
Testing is a testy subject in the Philippines, considering our limited resources. We have limited expertise, personnel, testing centers, reagents, and kits. There was even a time, early on, and this was reported in Bloomberg, that we had only 2,000 test kits for our population of 100 million. But we are playing catch up as more and more testing centers around the country are being activated.
How Do You Treat COVID-19?
As of this writing, there is no known medication or treatment for COVID-19.
Alleviative care is given to treat the symptoms instead of directly combating the virus.
Mild cases are advised to stay isolated, take plenty of liquids, and rest. Paracetamol is taken to help reduce fever.
Hospitalization is required for worse cases, where the patient can be closely monitored. Antibiotics are not given because these do not work with viruses.
As primarily a respiratory condition, extreme cases of COVID infection may require ventilators. These are mechanical devices that help a patient breathe by moving air in and out of the lungs. Ventilators are crucial because they are literally providing the breath of life to patients hit hard by the virus.
(As of April, the Philippines only has 1,263 ventilators across the country. The Department of Health is rushing to get more, but at best, that is only an addition of 1,500 ventilators for the whole population.)
In a span of three months, doctors have learned a great deal about COVID. One of the important discoveries is that convalescent plasma helps deal with the virus. Convalescent plasma is plasma taken from the blood of people who have already recovered from COVID. Since the donor’s blood contains the requisite antibodies against the virus, it can help other patients who are still battling the disease.
Convalescent plasma is a possible game-changer in the fight against COVID and senators Miguel Zubiri and Sonny Angara, after recovering from COVID, have donated blood to help others fend off the same.
That said, the search for drug treatment for the virus, is in full swing. The Philippines joined 35 other countries in the World Health Organization’s “The Solidarity Trial”. The program focuses on four specific drugs as possible treatment options for the virus. They are the following:
Remdesivir— an ebola treatment that yielded promising results against MERS and SARS. It is thought that Remdesivir might be a potentially effective treatment for COVID-19.
Lopinavir/Ritonavir— a known treatment for HIV.
Interferon beta-1a—a known treatment for multiple sclerosis.
Hydroxychloroquine—a treatment for lupus, malaria, and rheumatology conditions.
The Prospects For A Vaccine
The Philippines and the world are counting on a vaccine. Globally, there are over 100 researches and studies racing for an effective shot that will protect against COVID-19. (The Philippines itself is joining vaccine trials in Taiwan and China.)
There are as many timelines and predictions as there are researches. Some say that a vaccine will be out by the end of the year, others predict 2022. Still, others don’t believe we can have a vaccine for coronavirus, noting that the human race doesn’t have vaccines for many of the world’s pressing diseases like HIV and Hepatitis C.
In his testimony at the U.S. Senate, Dr. Anthony Fauci, the National Institute of Allergy and Infectious Diseases, thinks 18 months is possible. (That in itself is highly optimistic considering the usual timeline is around 5-15 years.)
When it comes to an effective and safe vaccine, there are no guarantees. COVID-19 is a novel disease and we are learning more about it every day.
It remains to be seen what would come out of this severely compressed vaccine development cycle. In the meantime, Filipinos are enjoined to keep safe and healthy by social distancing and regular handwashing.
This too...shall pass.