“Never was so much owed by so many to so few,” was a line used by Winston Churchill to describe the heroism of the pilots of the Battle of Britain who sacrificed life and limb to defend freedom from the Nazis.
The same sentence is more than apt to describe the efforts of our medical front liners during this pandemic. In the face of an unknown killer that was slaughtering indiscriminately, healthcare workers did not cower. They fought tooth and nail to save patients from the jaws of death, at great risk to their own lives. Many of our comrades fell to the same plague. Many who recovered went right back to taking care of COVID-19 patients. Many are still dealing with the long-term effects of severe COVID-19.
It takes years of study to become a nurse or a doctor. Aside from the academic work, hundreds of hours are spent in the hospital wards patiently honing life-saving clinical skills. Interacting with patients, talking to them, empathizing with their pain, diagnosing their disease, treating them with the right medications, and comforting them when they are dying is not just a job. It is a vocation to take care of God’s children. To risk dying from an infectious disease after having gone through all this work is not just admirable, it is valiant.
The most crucial subspecialists during this pandemic are the infectious diseases physicians and the pulmonologists. This does not take away from the importance of the other specialties. Indeed, many internists, subspecialists, family medicine practitioners, emergency room physicians, anesthesiologists, and surgeons were in harm’s way. Even at the height of the pandemic, gastroenterologists were doing endoscopies on COVID-19 positive patients, cardiologists did emergency angioplasties, nephrologists continued running hemodialysis units. Interns, residents, fellows, and other trainees were the truest of frontline troops, donning hellishly uncomfortable PPE for hours on end directly caring for patients. Many got sick and died. Among these, infectious diseases physicians and the pulmonologist were the ones tasked with figuring out how best to take care of COVID-19 patients in the face of so much uncertainty.
Infectious diseases physicians
Historically, the subspecialty of Infectious Diseases has not been a popular one. Infectious diseases in developed countries like the US is not a field that many choose after completing their internal medicine, pediatric, or family medicine training. Non-communicable diseases are the highest burden conditions in these countries, and subspecialties like cardiology and gastroenterology remain the most lucrative and desirable. In the Philippines, most physicians constantly deal with infectious diseases, such as dengue and tuberculosis, and so many feel that further training in infectious diseases is not all that important.
With the rise of antibiotic-resistant bacteria and increasing cases of HIV, infectious diseases as a field has gradually grown in recognition and popularity. With the unfortunate global impact of the COVID-19 pandemic, everyone has now realized how important the field of infectious diseases is to our collective survival. The subspecialty does not only deal with the clinical aspects of infectious diseases, but, more important during pandemics, the public health impact of interventions that can control spread and save millions of lives.
There are only several hundred infectious diseases specialists in the country. The Philippine Society for Microbiology and Infectious Diseases (PSMID) is the professional society of pediatric and adult infectious diseases practitioners. Its members have been at the forefront of the COVID-19 response. The dynamic evidence-based guidelines for taking care of severe and critically ill COVID-19 patients are constantly updated with the latest studies.
Infectious Disease physicians and pulmonologists are at the core of any team taking care of the sickest COVID-19 patients. In the Philippines, this partnership, along with other specialties and other healthcare workers, has resulted in some of the lowest death rates for COVID-19 per million cases globally.
The Technical Advisory Group (TAG) of the Department of Health, of which I am a part, has been advising the scientific policies of the government. TAG members must also handle multiple roles. I serve as a molecular epidemiologist tasked with understanding the different COVID-19 variants. Dr. Marissa Alejandria, an adult infectious diseases subspecialist and epidemiologist, additionally serves as the current president of PSMID. Dr. Anna Ong-Lim is a pediatric infectious diseases subspecialist. She has handled many information dissemination activities in media and academic settings.
Leading the infection control committees of almost every tertiary hospital in the different provinces is an infectious diseases subspecialist who formulates isolation and quarantine protocols and coordinates vaccination efforts. Regional IATFs are also advised by these doctors. Finally, infectious diseases subspecialists are at the forefront of direct patient care, deciding on timely and state-of-the-art interventions for the sickest of COVID-19 patients and ensuring that everything is done to try to save lives.
Just as critical to the pandemic response are the pulmonologists. COVID-19 is a respiratory illness, and whether a patient lives or dies is dependent on getting enough oxygen to the lungs and to the vital organs. Most pulmonologists are also critical care specialists, and they manage the ventilators and all other forms of oxygen delivery to patients. Pulmonologists are also among the most exposed to COVID-19, with many of them contracting the illness because of direct patient contact. While infectious disease doctors focus on antivirals, pulmonologists use medications that modulate the inflammatory response of the body to the virus. It is the uncontrolled inflammation of the lungs that typically causes so much damage to the body. Pulmonologists have learned quickly to use judicious oxygen therapy, corticosteroid, and immunomodulators to calm down the body’s maladaptive response to the SARS-CoV-2 virus, resulting in major improvements in survival. They also address the many complications of COVID-19, such as the risk of blood clots.
Infectious Disease physicians and pulmonologists are at the core of any team taking care of the sickest COVID-19 patients. In the Philippines, this partnership, along with other specialties and other healthcare workers, has resulted in some of the lowest death rates for COVID-19 per million cases globally. Case fatality rates are significantly below the worldwide average, and Filipino healthcare workers are largely responsible for this.
Unfortunately, we have lost some dear colleagues and mentors along the way. Dr. Salvacion Gatchalian, a pediatric infectious diseases physician and president of the Philippine Pediatric Society, was the first among our colleagues to fall to COVID-19. Dr. Ricardo Salonga, a pioneer of adult pulmonary medicine and an esteemed professor to many of us at the UP College of Medicine, succumbed to complications after successfully fighting off his COVID-19 infection.
As many of us contemplate a post-COVID-19 world, we remember those who have given the ultimate sacrifice and honor their deeds in our hearts. To quote a line from Saving Private Ryan, those of us left behind need to “Earn this.” The sacrifice of so many fine men and women should be matched with a firm dedication to be a better people, and to live our lives as selflessly as these heroic frontliners have done.