Gratitude and a look back at the pandemic response
Published Jan 3, 2023 12:05 am
CLINICAL MATTERS
DR. EDSEL SALVANA
As we ring in the New Year with few remaining pandemic restrictions, it is easy to forget the hardships we all endured in the last two and a half years. Airports and bus terminals were full to bursting this holiday season, and many people were able to physically be together for Christmas after two long years apart. Amid all the joy and celebration, it is important to recognize the hard work that was put in to get us here and to remember those who lost their lives without seeing the end of the pandemic.
The Philippines’ pandemic response was put in place as early as January 2020 when reports of a new coronavirus then known as nCoV (novel coronavirus) came out of China. True enough, the first three cases of Covid-19 were from Chinese tourists. The Department of Health and the private sector hospitals went into overdrive in a desperate attempt to contain the SARS-CoV-2 virus. I still remember how emergency rooms were radically transformed, with biohazard containment areas and facilities for safe treatment of potentially infectious patients. The healthcare staff were given a crash course in the proper use of PPE, with intricate protocols for donning and doffing the various layers of protection. Any person with a history of travel from China along with a flu-like illness was treated as a potential Covid-19 infection and was immediately isolated. We even had a term for these patients - PUI or Person Under Investigation, while waiting for the test result. Close contacts of the person were known as PUMs, or Persons Under Monitoring.
I recall my first PUI in February 2020, a seafarer we admitted who was repatriated from China with a sore throat. We had such a hard time convincing his wife that if she went into his room, she could not go out until the patient’s test result came back negative. Unfortunately, this process took about one week at that time. The infection control setup during those days was still finding its legs, and we had to correct many breaks in protocol as doctors, nurses, and maintenance staff struggled with the new rules. Fortunately, the test came back negative and it turned out to be a good learning experience, which helped us improve our containment policies. Looking back at whole genome data from that time period, the Philippines was able to contain the initial onslaught of Covid-19 with those first three cases since no direct descendants from those initial imported infections (one lineage A and two lineage B) were detected in the community. Those early heroic efforts delayed community transmission of Covid-19 in the Philippines by at least a month.
When community transmission was declared in March 2020 after the entry of lineage B.6, I ended up taking care of two of the first Filipino deaths from Covid-19. The tests came back positive after both patients had died. A large number of people had to be quarantined, myself included. This was because these patients had not been properly isolated initially since they did not have a travel history and we only tested them after they failed to improve with usual treatment per the protocol since there were strict parameters to qualify for an RT-PCR. The story of how we ended up shutting down Metro Manila and how it saved over 200,000 lives has been told in a previous column (https://mb.com.ph/2022/04/26/how-my-ted-training-helped-me-save-filipinos-from-covid/). Many healthcare workers still remember how scary those times were, as patient after patient turned positive and so many of us were quarantined as the virus spread. Some even paid the ultimate price for their heroism, succumbing to severe pneumonia from Covid-19. One of those early deaths was Dr. Salvacion “Sally” Gatchalian, a pediatric infectious diseases doctor and a dear colleague, mentor, and friend. As some of our own comrades got infected, it hit very close to home and morale was at an all-time low.
Against all odds, the combined efforts of the government and the private sector succeeded in flattening the curve in the first year of the pandemic. Without the initial lockdowns and cooperation of everyone, an additional 350,000 Filipinos would have died from Covid-19. Private citizens sent food and PPE to emergency rooms to support exhausted healthcare workers. Our own laboratory at the NIH, which was one of the first deputized RT-PCR testing facilities, received donations of equipment and consumables from various private enterprises. Our staff never lacked for food or drink as people shared what they had in a truly whole-of-nation approach.
The second year of the pandemic saw a gradual relaxation of restrictions and the start of an unprecedented vaccination campaign. I was one of the first Filipinos to receive the Covid-19 vaccine and I was so relieved when I got it since I knew that Covid-19 had become much less deadly for me. There was a lot of controversy when the first vaccines that became available were Chinese vaccines since China was the first country willing to commit a shipment in March 2020. There was some very misleading propaganda that these vaccines were not useful at all, which ran counter to scientific data. Fortunately, many people opted to receive the Chinese vaccines anyway when they saw that healthcare workers like myself were more than happy to receive them. The early vaccination campaign saved thousands of lives, most of whom were frontline healthcare workers who might have died if they had waited for the mRNA vaccines to arrive. Unfortunately, many people did die from vaccine hesitancy because of the misinformation spread against Chinese vaccines.
It was also the year of the onslaught of the variants of concern Alpha, Beta, and Delta. Delta in particular upended expectations as many people were already talking about the end of the pandemic as the vaccination program progressed. Beta seemed to have immune evasive properties that significantly lessened the efficacy of the vaccines against infection. Fortunately, vaccines remained effective in preventing severe disease. The Delta wave saw the highest number of deaths as this variant was much more deadly and was much more transmissible. Hospitals were overflowing with patients. A preemptive lockdown tempered what could have been a much bigger disaster after mathematical modeling by the FASSSTER group convinced the IATF-MEID to follow the experts’ recommendations. I also had the dubious distinction of taking care of the first four cases of Delta in the Philippines in May 2021. These four were seafarers who were repatriated after becoming ill at sea but were promptly isolated upon arrival. One of them progressed very fast and died. We suspected he had Delta. The other three recovered, thanks to effective antivirals like remdesivir and much more refined therapeutic strategies. Isolation protocols worked very well since there were no onward transmissions from these patients and community transmission of Delta did not occur until two months later in July.
The Omicron wave in January 2022 saw the beginning of the end of the pandemic. Despite a record number of cases, the deaths did not reach the level of Delta, and hospitals were not as overwhelmed. There was clear decoupling of deaths from the number of cases as a result of widespread vaccination. Boosting early also helped, with healthcare workers and the elderly prioritized for the inoculations. After that, it was smooth sailing and the transition from the Duterte to the Marcos government no longer saw any huge spikes in Covid-19 cases. Even with the removal of mask mandates, the immunity wall is holding and hospital healthcare utilization is below 20 percent, paving the way for a good Christmas.
Looking back, it is hard to imagine what we have been through. Many people seem to have already moved on. Those of us who were on the front lines, however, still bear the scars of countless battles of life and death. We should never take for granted the extreme hardship that many had to endure to get us to the point where our lives are nearly back to normal. Things could easily have been much, much worse. Thankfully, the government listened to sound scientific advice and the people followed. The response was far from perfect, but it got the job done. We are 155th in the world in terms of cases per million and 130th in deaths per million despite our limited resources and high population density. Our mobility now exceeds pre-pandemic levels and our economy is on its way to recovery. Ninety-nine percent of the eligible population has been vaccinated, and bivalent boosters are on the way.
Against all odds, the Filipino people prevailed against Covid-19. And for that, we should all be truly grateful.
DR. EDSEL SALVANA
As we ring in the New Year with few remaining pandemic restrictions, it is easy to forget the hardships we all endured in the last two and a half years. Airports and bus terminals were full to bursting this holiday season, and many people were able to physically be together for Christmas after two long years apart. Amid all the joy and celebration, it is important to recognize the hard work that was put in to get us here and to remember those who lost their lives without seeing the end of the pandemic.
The Philippines’ pandemic response was put in place as early as January 2020 when reports of a new coronavirus then known as nCoV (novel coronavirus) came out of China. True enough, the first three cases of Covid-19 were from Chinese tourists. The Department of Health and the private sector hospitals went into overdrive in a desperate attempt to contain the SARS-CoV-2 virus. I still remember how emergency rooms were radically transformed, with biohazard containment areas and facilities for safe treatment of potentially infectious patients. The healthcare staff were given a crash course in the proper use of PPE, with intricate protocols for donning and doffing the various layers of protection. Any person with a history of travel from China along with a flu-like illness was treated as a potential Covid-19 infection and was immediately isolated. We even had a term for these patients - PUI or Person Under Investigation, while waiting for the test result. Close contacts of the person were known as PUMs, or Persons Under Monitoring.
I recall my first PUI in February 2020, a seafarer we admitted who was repatriated from China with a sore throat. We had such a hard time convincing his wife that if she went into his room, she could not go out until the patient’s test result came back negative. Unfortunately, this process took about one week at that time. The infection control setup during those days was still finding its legs, and we had to correct many breaks in protocol as doctors, nurses, and maintenance staff struggled with the new rules. Fortunately, the test came back negative and it turned out to be a good learning experience, which helped us improve our containment policies. Looking back at whole genome data from that time period, the Philippines was able to contain the initial onslaught of Covid-19 with those first three cases since no direct descendants from those initial imported infections (one lineage A and two lineage B) were detected in the community. Those early heroic efforts delayed community transmission of Covid-19 in the Philippines by at least a month.
When community transmission was declared in March 2020 after the entry of lineage B.6, I ended up taking care of two of the first Filipino deaths from Covid-19. The tests came back positive after both patients had died. A large number of people had to be quarantined, myself included. This was because these patients had not been properly isolated initially since they did not have a travel history and we only tested them after they failed to improve with usual treatment per the protocol since there were strict parameters to qualify for an RT-PCR. The story of how we ended up shutting down Metro Manila and how it saved over 200,000 lives has been told in a previous column (https://mb.com.ph/2022/04/26/how-my-ted-training-helped-me-save-filipinos-from-covid/). Many healthcare workers still remember how scary those times were, as patient after patient turned positive and so many of us were quarantined as the virus spread. Some even paid the ultimate price for their heroism, succumbing to severe pneumonia from Covid-19. One of those early deaths was Dr. Salvacion “Sally” Gatchalian, a pediatric infectious diseases doctor and a dear colleague, mentor, and friend. As some of our own comrades got infected, it hit very close to home and morale was at an all-time low.
Against all odds, the combined efforts of the government and the private sector succeeded in flattening the curve in the first year of the pandemic. Without the initial lockdowns and cooperation of everyone, an additional 350,000 Filipinos would have died from Covid-19. Private citizens sent food and PPE to emergency rooms to support exhausted healthcare workers. Our own laboratory at the NIH, which was one of the first deputized RT-PCR testing facilities, received donations of equipment and consumables from various private enterprises. Our staff never lacked for food or drink as people shared what they had in a truly whole-of-nation approach.
The second year of the pandemic saw a gradual relaxation of restrictions and the start of an unprecedented vaccination campaign. I was one of the first Filipinos to receive the Covid-19 vaccine and I was so relieved when I got it since I knew that Covid-19 had become much less deadly for me. There was a lot of controversy when the first vaccines that became available were Chinese vaccines since China was the first country willing to commit a shipment in March 2020. There was some very misleading propaganda that these vaccines were not useful at all, which ran counter to scientific data. Fortunately, many people opted to receive the Chinese vaccines anyway when they saw that healthcare workers like myself were more than happy to receive them. The early vaccination campaign saved thousands of lives, most of whom were frontline healthcare workers who might have died if they had waited for the mRNA vaccines to arrive. Unfortunately, many people did die from vaccine hesitancy because of the misinformation spread against Chinese vaccines.
It was also the year of the onslaught of the variants of concern Alpha, Beta, and Delta. Delta in particular upended expectations as many people were already talking about the end of the pandemic as the vaccination program progressed. Beta seemed to have immune evasive properties that significantly lessened the efficacy of the vaccines against infection. Fortunately, vaccines remained effective in preventing severe disease. The Delta wave saw the highest number of deaths as this variant was much more deadly and was much more transmissible. Hospitals were overflowing with patients. A preemptive lockdown tempered what could have been a much bigger disaster after mathematical modeling by the FASSSTER group convinced the IATF-MEID to follow the experts’ recommendations. I also had the dubious distinction of taking care of the first four cases of Delta in the Philippines in May 2021. These four were seafarers who were repatriated after becoming ill at sea but were promptly isolated upon arrival. One of them progressed very fast and died. We suspected he had Delta. The other three recovered, thanks to effective antivirals like remdesivir and much more refined therapeutic strategies. Isolation protocols worked very well since there were no onward transmissions from these patients and community transmission of Delta did not occur until two months later in July.
The Omicron wave in January 2022 saw the beginning of the end of the pandemic. Despite a record number of cases, the deaths did not reach the level of Delta, and hospitals were not as overwhelmed. There was clear decoupling of deaths from the number of cases as a result of widespread vaccination. Boosting early also helped, with healthcare workers and the elderly prioritized for the inoculations. After that, it was smooth sailing and the transition from the Duterte to the Marcos government no longer saw any huge spikes in Covid-19 cases. Even with the removal of mask mandates, the immunity wall is holding and hospital healthcare utilization is below 20 percent, paving the way for a good Christmas.
Looking back, it is hard to imagine what we have been through. Many people seem to have already moved on. Those of us who were on the front lines, however, still bear the scars of countless battles of life and death. We should never take for granted the extreme hardship that many had to endure to get us to the point where our lives are nearly back to normal. Things could easily have been much, much worse. Thankfully, the government listened to sound scientific advice and the people followed. The response was far from perfect, but it got the job done. We are 155th in the world in terms of cases per million and 130th in deaths per million despite our limited resources and high population density. Our mobility now exceeds pre-pandemic levels and our economy is on its way to recovery. Ninety-nine percent of the eligible population has been vaccinated, and bivalent boosters are on the way.
Against all odds, the Filipino people prevailed against Covid-19. And for that, we should all be truly grateful.