How Has the Philippines Managed to Contain the COVID-19 Outbreak?
As COVID-19 works its way around the globe, the Southeast Asian region has seemingly controlled its outbreak. Places like Singapore with highly advanced healthcare systems and contact tracing certainly have reputable data. But what about places like Indonesia, Malaysia, Thailand and the Philippines? Are we just missing cases?
It has been nearly three weeks and the Philippines has not reported a new case of COVID-19 since the initial three Chinese tourists*. (Update: Also Read "The Second Coming of COVID-19") We certainly aren’t immune to it because Filipinos in other countries have gotten the disease. Meanwhile, countries including the United States, South Korea and Italy are reporting community based-transmission and increasing numbers. It is easy to just say that because we are not testing as extensively as South Korea, we are probably not identifying a substantial number of COVID-19 cases in the community.
Here are some of the myths and facts on whether the Philippines has really done a decent job in containing a potential COVID-19 outbreak.
Myth No. 1: We can’t possibly do a good job controlling any kind of outbreak, because of incompetent healthcare workers and inadequate equipment.
"Sick Man of Asia" memes aside, the Philippines has performed well during past outbreaks. If we look at MERS and SARS, we have had very few cases due to a mixture of luck, good timing, and highly competent frontliners. The Department of Health uses WHO protocols and follows global reporting systems to ensure integrity of data.
Many physicians and healthcare workers are trained in the public health response. Some have studied abroad, while others have been trained locally by foreign and local experts. We use standard equipment recommended by WHO. While resources may be scarce, emergency funds are available and stockpiling of equipment is done as a precaution. Hospitals have been deputized and many have responded to the call by modifying their procedures to accommodate patients who may have COVID-19, mostly at their own cost. If you want proof, visit any level 2 or level 3 hospital and ask them about their preparations. DOH has deputized all hospitals to be ready for an epidemic, and many hospitals have frontliners equipped with the right tools to identify and treat potential cases.
Myth No. 2: We haven’t tested enough patients to properly assess the situation.
While it is true that South Korea has tested tens of thousands of cases, the reason for this is that they had a break in containment and clear community-based transmission. Unlike South Korea and Japan that only closed their borders to Hubei province in China, many countries in Southeast Asia, including the Philippines banned travel from the whole of China including Hong Kong and Macau.
While WHO has stated that travel bans aren’t all that effective in preventing transmission, they still decrease the stress on the public health system. Since the definition of a person under investigation (PUI) is someone with a history of travel in the last 14 days to outbreak areas AND symptoms (fever, cough, colds, sore throat etc.), closing borders drastically decreases the number of potential PUIs once a 14-day period has passed.
This is what happened in the Philippines. We admitted all PUIs and put them under isolation as part of containment, thus capturing the three confirmed cases of COVID-19 early and preventing spread in the community. That’s why we’ve test only 600 people. Singapore has tested about 1,300 and they are certainly very competent. Testing is needed if the situation calls for it. We follow WHO protocols, procedures, and principles of containment.
Myth No. 3. There is probably community transmission of COVID-19 and the DOH is not doing anything to look for it.
Aside from the quarantine and screening of travelers from areas of active transmission, the DOH has a something called SARI surveillance. This stands for Severe Acute Respiratory Infection surveillance. There are sentinel sites all over the country that specifically look for unusual clusters of severe pneumonia. From what we know of COVID-19, 80% of cases will be mild while 20% will end up in the hospital. So if a whole bunch of people with pneumonia end up hospitalized, then DOH will be alerted and will look into it.
We can’t assume that every cold and sniffle is potentially COVID-19 because people continue to get viral upper respiratory tract infections. Testing, while free to appropriate persons, actually costs the government about P5,000 per test. As the epidemic progresses and the likelihood of the entry of COVID-19 from places other than China increases, DOH can proactively investigate anyone with severe pneumonia if the probability is high enough. Until then, we use our testing judiciously and conserve our resources so that we are better prepared if this becomes a pandemic.
Fact No. 1: COVID-19 cases are spreading and will continue to spread. Chinese cases have peaked and some countries have demonstrated that containment is possible.
Chinese cases continue to drop and they are seeing fewer and fewer deaths. WHO has commended the containment efforts of several countries, including the Philippines. However we cannot keep travel restrictions indefinitely. As more countries declare outbreaks, we cannot lock everyone out. There is a high probability that it will come back. We should use this time to prepare. We should protect the most vulnerable members of our society, particularly the elderly and those with chronic illnesses.
Fact No. 2: Medications and vaccines are on the way.
There are several candidate drugs with good preliminary data, and drug trials to prove efficacy has started. There are several vaccine candidates, but this will take a little bit longer. Scientists are working with unprecedented speed and are harnessing the latest technologies. It is just a matter of time before major progress is made. In the meantime, meticulous care has shown that deaths from COVID-19 can be minimized.
It is disappointing that many Filipinos continue to distrust the effectiveness and thoroughness of the Philippine response. WHO has no problem believing our figures. If you care to go to the frontlines, you will see healthcare professionals ready to risk their lives to protect our country.
A recent case of COVID-19 that was diagnosed in Australia had a travel history from the Philippines, and many immediately assumed that the patient had picked it up here, without knowing her itinerary or examining the genetic sequence of the virus to trace where it had come from. DOH is investigating and if it is proven to be from here then they will act accordingly. These instances show that there is still a lot of work to be done in reassuring our people. It is understandable that in this climate of fear, there is a lot of distrust of authority. The government is working hard to ensure our safety. If you are not willing to trust our leaders, then trust the front liners who are also protecting their loved ones. We are all in this together. If we cooperate and support each other, then we will be okay.
*The Department of Health confirmed two new cases of COVID-19 in the Philippines, post-publication.