Published November 16, 2020, 11:22 AM

by Dr. Edsel Salvana

This November, we pay homage to those we’ve lost

Dr. Edsel Maurice T. Salvana

As we marked All Souls, we paused to remember the people who had perished in this pandemic. About 1.2 million people have died worldwide from Covid-19, and the death toll continues to rise. These are not mere numbers. Every single one of those deaths is someone’s father, son, mother, daughter, sibling, or friend. Those are 1.2 million bereaved families mourning the loss of a loved one.

Here at home, we have lost more than 7,000 Filipinos to the virus. While our case fatality rate remains low at about two percent, every single person who dies is an irreplaceable loss. Many of those who have perished are frontline healthcare workers who braved exposure to the virus while taking care of their fellow Filipinos. Many more healthcare workers have fallen sick and may have lasting damage to their bodies.

Why is Covid-19 so deadly? And how does it kill people? What have we learned so far, and are we getting better at saving people?

Covid-19 and the virus that causes it, SARS-CoV-2, are new to the human population. There is no immunity to it, and there is no road map to how the body reacts to it. As a respiratory virus, its main target organ is the lungs. It can cause a severe pneumonia, to the point that there is not enough oxygen getting to the vital organs. This is by far the most likely cause of death—multiple organ failure from acute respiratory distress syndrome, or ARDS.

LIGHT OF PHILIPPINE PEDIATRICS Dr. Salvacion “Sally” Gatchalian was the Philippines Pediatric Society president and the assistant director of the Research Institute for Tropical Medicine (Photo from Philippine Pediatric Society)

Covid-19 also seems to affect other organs and systems of the body. It can cause havoc on the clotting system, and this is why some patients come in with strokes or heart attacks—the blood vessels to the brain and heart can suddenly be blocked by clots that form as part of the body’s reaction to the virus. Some people’s immune systems go into overdrive, and can severely damage the

body aside from attacking the virus. Many Covid-19 survivors suffer lasting heart and lung damage from which it can take many years to recover.

Covid-19 kills more old people than young people. Covid-19 in children looks more like the common cold, and very few develop severe illness or die. For middle aged people, it can look like a bad case of the flu. For those above 60 years of age, however, it behaves like SARS, and can kill more than 10 percent of elderly patients who come down with it. People with chronic illnesses such as heart problems or lung disease are also more likely to die.

GREAT PILLAR OF PHILIPPINE CARDIOLOGY Dr. Raul Diaz Jara, served as the president of the Philippine Heart Association and is a known cardiologist and internist (Photo from Philippine Heart Association)

About 10 to 30 percent of persons infected with SARS-CoV-2 never get physically sick. Among those who do develop symptoms, 80 to 90 percent will have mild disease, which consists of cough, colds, and sometimes fever. Another 10 to 20 percent will develop moderate illness that manifests as a pneumonia, but without the need for oxygen. Severe Covid-19 occurs in five to 10 percent of patients and this includes all the previous manifestations plus the need for oxygen support to maintain adequate oxygenation of the blood. About one to five percent develop critical disease, which includes ARDS and will need intensive care unit admission and some will require mechanical ventilation.

It is the severe and critical patients who are most likely to die, and they are the reason the healthcare system needs to be protected from overwhelming surges. With proper care, only about five to 10 percent of the critical patients will die. Without proper hospital care, all critical patients and maybe half of severe patients may succumb to Covid-19.

BRILLIANT PULMONOLOGIST Dr. Ricardo Salonga was a well-known pulmonologist, a patient and persevering educator, and a staunch advocate of community medicine

Almost all of us have been personally affected by this pandemic through the death of a loved one, a friend, or a mentor. The medical community has lost many doctors, nurses, and other healthcare workers. The losses to society from the deaths extend beyond the economic.

Among the first to fall was Dr. Salvacion Gatchalian.

Ma’am Sally, as she was fondly called, was a pediatric infectious diseases doctor. She was also the president of the Philippine Society for Pediatrics at the time of her death. She was one of the staunchest advocates for vaccines in the world. Imagine the academic hurdles she had to overcome, for training to be in her subspecialty takes more than 10 years after graduation from college. Imagine her thousands of patients who lost their beloved pediatrician. The Philippine Pediatric Society, an organization of nearly 6,000 members, lost her guidance and leadership at a crucial time. As perhaps the time for a Covid vaccine release nears, imagine how immeasurable the value of her experience and knowledge would have been.

Dr. Raul Jara was a cardiologist at the Philippine General Hospital. A teacher to medical students and mentor to cardiology fellows, he died just as promising new drugs for treating Covid were emerging. The loss of one who could bridge the gap between classical cardiology and the new world of echocardiography and high-tech instrumentation cannot be quantified.

Some did not die directly from Covid, but Covid hastened their deaths. Dr. Ricardo Salonga, a pioneering pulmonologist, recovered from Covid but later succumbed to other medical issues. Though his insights in the care of patients with lung disease have helped many, the irony of the toll a lung disease took on him is not lost on his colleagues.

The world has lost other people whose contributions to society are both tangible and intangible. Teachers, nurses, scientists, employees who make companies great, moms and dads who care for small children, so many were lost.

This pandemic has changed our world forever and has taken away so much. We each need to do our part to ensure that we continue to curtail our death toll. As we eagerly await a safe and effective vaccine, we should also remember those who have not been lucky enough to survive. When this is all over, we should take the time to celebrate the lives taken from us. This pandemic has not given us the luxury of properly grieving our profound losses. When that time comes, we can cry our unshed tears and begin healing our broken hearts.