CLINICAL MATTERS

Even as the Covid-19 pandemic seems like a distant memory, those of us who see patients daily in the hospital are constantly reminded of how things can change in an instant. A few days ago, a patient with cancer was admitted to our hospital complaining of shortness of breath. I took one look at the X-ray and immediately ordered a Covid-19 test. It came back positive, and despite starting steroids and anti-viral medication, the patient still ended up in the intensive care unit. I do not know if he will survive since he still requires a lot of oxygen.

As a frontliner, I vividly remember the pandemic Christmases of 2020 and 2021 and how scared we were of what might happen if people started gathering in large numbers and infecting one another. In the early days of the pandemic, before the vaccines arrived, I had to take care of good friends, physician colleagues, and professors with Covid-19, some of whom did not make it. One professor sheltered in his home and took all precautions but unfortunately let his guard down when his relatives visited. He and his wife ended up in the hospital with Covid-19. His wife survived but he could not be taken off oxygen and he eventually died.

Last December 2020, many restrictions were still in place. Some people were allowed outside their homes but were required to wear a mask at all times. Institutions were still under strict capacity controls and seniors and children were not allowed to leave their homes. The silver lining was that Pfizer reported that it had produced an effective vaccine, and it was just a matter of time before it would be rolled out worldwide. As the hospitals continued to be inundated with COVID-19 patients and people continued to die from the SARS-CoV-2 virus, there was hope that the nightmare would end sooner rather than later. Against all odds, there was no holiday surge in cases and we all felt hopeful that 2021 was going to be when the tide would turn.

True enough, Covid-19 vaccines finally arrived in the Philippines in February of 2020. Chinese vaccines, specifically Sinovac, were the first to arrive since most Western vaccines were snapped up by rich countries. I was the second person to receive the vaccine after Dr. Gerardo Legaspi, the director of the Philippine General Hospital, and I felt very emotional on that day. When I received my second dose a few weeks later and became fully vaccinated, a lot of my own fear of dying from Covid-19 was lifted and I was a lot less scared of taking care of Covid-19 patients. Due to deliberate misinformation by the US’ clandestine operations, some vaccine hesitancy against Chinese vaccines emerged and some people opted to wait for the Western vaccines such as Pfizer. Unfortunately, some of these patients, especially the elderly and immunocompromised ones, ended up with severe Covid-19 before they could be vaccinated and many of them died. Retrospective studies showed that all vaccines, regardless of brand, had a high degree of protection against developing severe Covid-19 and death.

Shortly after the euphoria brought about by vaccination, the first variants of concern started arriving. The Alpha and Beta variants pushed our cases up to unprecedented levels. Later that year, Delta finally made it to our shores even as we were ramping up nationwide vaccination. The greatest number of deaths during the pandemic occurred from August to September 2021, and hospitals were inundated anew. A preemptive lockdown was put in place as modeling by government scientists showed that without a lockdown, an unacceptable number of people were going to die from the Delta wave. Vaccination was accelerated, even as the first boosters were being given. The first signs that vaccines were making a significant impact emerged in Metro Manila, where, compared to all the other provinces that were still ramping up vaccination, the number of deaths started to decouple from the number of cases.

When December 2021 came along, new Covid-19 cases had gone down substantially but there was still a lot of trauma from the Delta wave. There were fewer restrictions compared to December 2020 since many people had been vaccinated, but we still held our breath as more people were allowed to gather for what turned out to be a good Christmas. Unfortunately, this was short-lived because Omicron entered the Philippines in January 2022 and caused the largest number of Covid-19 cases ever recorded. Remarkably, despite Omicron causing double the number of Covid-19 cases compared to Delta, the number of deaths was less than half of that from Delta. This, to me, was the beginning of the end of the pandemic. Vaccines had decreased the deadliness of SARS-CoV-2 to a level where it was becoming safe to open up fully, and we worked with the government to rationally relax the pandemic restrictions. Despite the entry of more Omicron variants, hospital and ICU Covid-19 cases continued to drop and occupancy rates remained low. By December 2022, we were well on our way back to normalcy.

Most people are no longer wearing their masks this holiday season. It is easier to breathe, and it is nice to see people’s faces. I don’t think I would recognize half the residents and fellows I trained during the pandemic without their masks. My 12-year-old daughter, who was by far the longest holdout among us inconstantly wearing a mask when going outside, finally stopped wearing one last month. I still wear my mask in the hospital especially when I do rounds or when I go to see patients in the emergency room. Masks work not just against Covid-19 but also for many of the seasonal respiratory viruses including influenza and RSV. I get that many people are reluctant to remember the years we lost during the pandemic, but the lessons we learned will help us avoid future lockdowns as long as we do not forget them. I get reminded whenever I see a new Covid-19 patient, but most people aren’t really interested in revisiting those difficult times. If there is one silver lining from those dark days, it is that for that one moment in time, Filipinos were united in the fight against a common enemy. By working together, we did better than most countries, even the rich ones. And for that, we should be truly grateful.